3P 157 Questions from pdf-

When performing a visual acuity test the nurse practitioner notes 20/30 in the left eye and 20/40 in the right eye using the Snellen eye chart. This means:

a) have the patient returning in two weeks for a follow up vision screen

b) dilated the eye and retest

c) refer the patient to an ophthalmologist

d) document this as a normal finding

○ Correct Multiple Choice Answer: c refer the patient to an ophthalmologist

○ Summary: Snellen chart results of 20/30 and 20/40 indicate reduced visual acuity, meaning the patient sees at 20 feet what a person with normal vision sees at 30 or 40 feet, respectively. These are not considered normal findings and warrant referral to an ophthalmologist for comprehensive evaluation and management.

The American psychiatric association's diagnostic and statistical manual of mental disorder defines Munchausen Syndrome By Proxy

a) a self-inflicted injury to gain attention

b) a caregiver making up or causing an illness or injury in a person under his or her care

c) an abusive behavior that does not involve the caregiver

d) a situation in which the abuser is often inattentive and uncaring toward the victim

○ Correct Multiple Choice Answer: b

a caregiver making up or causing an illness or injury in a person under his or her care

Summary: Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caregiver of a child, most often the mother, makes up fake symptoms or causes real symptoms to make it look like the child is sick.

Symptoms of depression are a side effect of which neurotransmitter medication?

a) dopamine

b) gabapentin

c) mil

d) cortisol

○ Correct Multiple Choice Answer: a

○ Summary: depression is often linked to imbalances in serotonin and norepinephrine. The question phrasing is somewhat ambiguous, but among the given options, dopamine is the neurotransmitter whose dysregulation directly contributes to depressive symptoms.

Which lesion is dark raised and asymmetric with irregular border?

a) Nevus

b) Actinic keratosis

c) Keratoacanthoma

d) Melanoma

○ Correct Multiple Choice Answer: d

Melanoma

Summary: The description directly matches the ABCDE criteria used to identify melanoma: Asymmetry, Border irregularity, Color variation (often dark or multiple colors), Diameter (typically >6mm), and Evolving (changes in size, shape, or color)

A 32 years old woman presents with dull puffiness of the eyes pronounced not pitting periorbital edema this finding is suggestive of this condition?

a) Nephrotic syndrome

b) Myxedema

c) Cushing syndrome

d) Sinusitis

○ Correct Multiple Choice Answer: b

Myxedema

Summary: Myxedema,is a deposition of mucopolysaccarides in the dermis. Is commonly found if patients have advanced hypothyroidism. The classic skin changes are: swelling of face, lips, eyelids, and tongue or swelling and thickening of skin anywhere on the body, especially the lower legs. Myxeduma is the hallmark of Grave's disease an autoimmune form of hyperthyroidism. Myxedema can also occur in Hashimoto's thyroiditis a form of hypothyroidism.

A 42 years old woman with a past medical history of migraine headaches is requesting prophylactic medication treatment. Which medication should the Nurse practitioner prescribe?

a) Sumatriptan (Imitrex)

b) Amitriptyline (Elavil)

c) Verapamil (verelan)

d) Metoprolol (Lopressor)

○ Correct Multiple Choice Answer: b

Amitriptyline (Elavil)

Summary: Amitriptyline, a tricyclic antidepressant and is used off-label for the prophylactic (preventive) treatment of migraine headaches. Sumatriptan is an abortive migraine medication used during an acute migraine attack, not for prevention

A pediatric patient has areas of scaling on the scalp with round patches of alopecia. This clinical finding is consistent with:

a) Tinea capitis

b) Seborrheic dermatitis

c) Trichotillomania

d) Alopecia areata

○ Correct Multiple Choice Answer: a.

Tinea capitis

Summary: Tinea capitis is a fungal infection of the scalp that commonly presents in children with scaly, erythematous (red) patches and associated hair loss (alopecia).

What is the appropriate prophylactic medication for an 18 years old woman with a past medical history of migraine headaches?

a) Sumatriptan (Imitrex)

b) Propranolol (Inderal)

c) Ibuprofen (motrin)

d) Dihydroergotamine (DHE)

○ Correct Multiple Choice Answer: b

Propranolol (Inderal)

Summary: Propranolol, a beta-blocker, is a well-recognized and effective medication commonly prescribed for the prophylactic treatment of migraine headaches. Sumatriptan and Dihydroergotamine are used for acute migraine attacks, not prevention

Why would a combined hormonal contraceptive be contraindicated in a 36 year old patient with a past medical history of type 2 diabetes, obesity, chronic smoking and sedentary life

a) She is obese

b) She has type 2 diabetes mellitus

c) Her age and tobacco use

d) She leads a sedentary lifestyle

○ Correct Multiple Choice Answer: c

Her age and tobacco use

Summary: Combined hormonal contraceptives are contraindicated in women over 35 who smoke due to a significantly elevated risk of serious cardiovascular events, including stroke and myocardial infarction.

Rh negative women should receive Rho (D) immunoglobulin at what gestational time?

a) 6 weeks

b) 12 weeks

c) 28 weeks

d) 35 weeks

○ Correct Multiple Choice Answer: c

28 weeks

other info: What happens if the client is RH negative and has a negative antibody screen?She will need repeat antibody screens and should receive Rho(D) immune globulin (RhoGAM) at 28 weeks gestation

What medication should be avoided when prescribe prophylactic therapy for headache

a) Verapamil

b) Propranolol

c) Venlataxine (Effexor)

d) Nimodipine

○ Correct Multiple Choice Answer: c

Venlataxine (Effexor)

○ Summary: While some SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) like venlafaxine can be used for migraine prophylaxis, they are generally associated with a higher burden of side effects. Patients should have drug free period for 3-4 weeks every 6 mos.

When interpreting a complete blood count (CBC) lab report which of the following results describes the size of the RBCs?

a) Hemoglobin

b) Mean corpuscular volume (MCV)

c) Red cell distribution width (RDw)

d) Hematocrit

○ Correct Multiple Choice Answer: b

Mean corpuscular volume (MCV)

○ Summary: The Mean Corpuscular (cell) Volume (MCV) is a measurement of the size of red blood cells (RBCs).. Small-sized RBCs result in a lower MCV, while larger RBCs result in a higher MCV

What is the mechanism of action of prostaglandin E1 (PG1) in a patient with transposition of the great arteries

a) To maintain equal pressure in the ventricles

b) To maintain patency of the great arteries (specifically, the ductus arteriosus)

c) To produce vasodilation on

d) To prevent cyanotic episodes by trapping blood in the lower

○ Correct Multiple Choice Answer: b

To produce vasodilation on

Summary: In infants with transposition of the great arteries, prostaglandin E1 (PGE1) is administered to keep the ductus arteriosus patent. This allows for mixing of oxygenated and deoxygenated blood, which is crucial for survival until surgical correction can be performed

Which of the following complaints best describes lower extremity calf pain associated with peripheral artery disease

a) A sharp stabbing pains

b) A dull pain or cramp

c) An electric shock

d) A pulsating pain

○ Correct Multiple Choice Answer: b

A dull pain or cramp

○ Summary: peripheral artery disease (PAD) signs and symptoms include: painful cramping in one or both of your hips, thighs or calf muscles after certain activities such a walking or climbing stairs (claudification), let numbness or weakness, coldness in your lower leg or foot, especially when compared to the other side.

Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47- year-old premenopausal woman?

a) Hirsutism

b) Gynecomastia

c) Oligomenorrhead

d) Acne

○ Correct Multiple Choice Answer: b

Gynecomastia

Summary: hyperprolactinemia causes typical symptoms in premenopausal women, and in men but not in postmenopausal women. hyperprolactinemia in Premenopausal women causes hypogonadism, with symptoms that include infertility, oligomenorrhea, or amenorrhea and less often galactorrhea. Gynecomastia is the enlargement of male breast tissue.

When treating a patient with asthma who is experiencing acute wheezing which medication should be given to relieve the symptom?

a) Short acting bronchodilator

b) Long acting bronchodilator

c) Inhaled corticosteroid

d) Combination of methylxanthine and long acting bronchodilator

○ Correct Multiple Choice Answer: a

Short acting bronchodilator

○ Summary: Short-acting beta-agonists (SABAs), such as albuterol, are the first-line and most effective medications for the rapid relief of acute asthma symptoms like wheezing, as they quickly relax the smooth muscles around the airways and restore normal airflow. Agonists/stimulators of adrenergic receptors in SNS(sympathomietics); albuterol (ventolin), levalburterol (xopenex), pirbuterol(maxair), terbutaline(brethine), metaporterenol(Alupent)

Which immunization reduces a patient's risk for infection with the virus that causes painful localized blistering rash?

a) Smallpox vaccine

b) Varicella vaccine (chicken Pox)

c) Shingles (herpes zoster) vaccine

d) Meningococcal vaccine

○ Correct Multiple Choice Answer: c

Shingles (herpes zoster) vaccine

○ Summary: The shingles (herpes zoster) vaccine protects against the reactivation of the varicella-zoster virus, which causes shingles, a characteristic painful, localized blistering rash. In people who have had chickenpox, the virus never fully cleared from the body; instead it remains dormant in the nerve tissues

Headache warning signs that need prompt investigation include all of the following EXCEPT:

a) new onset after age 50

b) aggravated or relieved by change of position

c) precipitated by Valsalva maneuver

d) Headache relieved with mild infrequent use of analgesics

○ Correct Multiple Choice Answer: d

Headache relieved with mild infrequent use of analgesics

Summary: Headaches that are easily and infrequently relieved by typical over-the-counter analgesics are generally considered benign. The other options are "red flag" symptoms that suggest a more serious underlying condition and warrant prompt investigation

The client with iron deficiency anemia should be advised to take the iron supplement

a) With milk to avoid stomach upset

b) With milk of magnesia at bedtime to avoid constipation

c) On an empty stomach between meals

d) For 30 days to 5 weeks

○ Correct Multiple Choice Answer: c

On an empty stomach between meals

○ Summary: Iron is best absorbed in an acidic environment, and its absorption can be hindered by food or certain medications (like antacids or dairy products). Therefore, taking iron supplements on an empty stomach, between meals, generally maximizes absorption.

Which one of the following statements is true of Munchausen syndrome by proxy?

a) The injury is self-inflicted as the patient is seeking attention from others

b) Under the supervision of adults other than the abuser, the patient does not exhibit symptoms

c) The caregiver is usually not involved in the abusive behavior

d) The abuser is often inattentive and uncaring towards the victim

○ Correct Multiple Choice Answer: b

Under the supervision of adults other than the abuser, the patient does not exhibit symptoms

○ Summary: A defining characteristic of Munchausen Syndrome by Proxy is that the symptoms often disappear or improve when the child/victim is removed from the care of the perpetrator, as the symptoms are intentionally created by the abuser. Munchausen syndrome by proxy is a mental illness and is also a form of child abuse.

Which of the following is the most common presenting sign of substance abuse in adolescents?

a) Poor school performance

b) change in sleep habits

c) increased blood pressure

d) changes in behavior

○ Correct Multiple Choice Answer: d

changes in behavior

○ Summary: While poor school performance and changes in sleep habits can be signs, broader behavioral changes (e.g., mood swings, new peer groups, increased secrecy, withdrawal from family, defiance, poor judgment) are often the earliest and most common indicators of substance abuse in adolescents, as they encompass a wider range of observable alterations.

A woman is 11 weeks pregnant and has a maternity history of one full term vaginal delivery, a set of premature triplets delivered vaginally, and a first trimester abortion. Using her TPAL system to document her maternal status

a) Gravida 4 para 1114

b) Gravida 4, para 1314

c) Gravida 3, para 1114

d) Gravida 3, para 1112

○ Correct Multiple Choice Answer: b

Gravida 4, para 1314

○ Summary: Gravida refers to the total number of pregnancies (including the current one). TPAL stands for Term births, Preterm births, Abortions (or miscarriages), and Living children.

■ Gravida: Current pregnancy (1) + full-term delivery (1) + triplets (1) + abortion (1) = 4

■ Term: 1 (one full-term vaginal delivery)

■ Preterm: 3 (a set of premature triplets)

■ Abortion: 1 (a first-trimester abortion)

■ Living: 4 (assuming the full-term child and all triplets are living) GTPAL

The nurse practitioner palpates an enlarged right epitrochlear lymph node in a 30 years old patient. The Nurse Practitioner should asses the patents

a) Throat, face, and right ear

b) Neck and supraclavicular region

c) Right forearm and hand

d) Right groin and abdomen

○ Correct Multiple Choice Answer: c

Right forearm and hand

Summary: The epitrochlear lymph nodes are located on the medial aspect of the arm, above the elbow. They drain the ulnar side of the forearm and hand. Therefore, enlargement indicates a potential issue in these distal areas. Lower arm and hand for erythema and swelling.

Anticholinergics are indicated for the treatment of

a) Asymptomatic bacteriuria

b) Renal insufficiency

c) Urge incontinence

d) Overflow incontinence

○ Correct Multiple Choice Answer: c

Urge incontinence

○ Summary: Anticholinergics are drugs that block the action of acetylcholine, which helps to relax the bladder detrusor muscle and suppress involuntary bladder contractions, thereby reducing the symptoms of urge incontinence (overactive bladder). Anticholinergics can treat a variety of conditions, including urinary incontinence, overactive bladder, COPD. They also help block involuntary muscle movements associated with certain diseases such as Parkinson's disease.

A patient presents with signs of chest pain, the nurse practitioner observes jugular venous distention. Their finding is consistent with

a) Hypertension

b) Heart failure

c) Asthma

d) Pneumonia

○ Correct Multiple Choice Answer: b

Heart failure

○ Summary: Heart failure causes decreased cardiac output when the heart fails as a pump and the circulations becomes backed up and congested. Signs and symptoms: dyspneas, orthpnea, paroxymal nocturnal dyspnea, decreased blood pressure, dependent, pitting edema; anxiety; confusion; Jugular vein distention; fatigue. The S3 may be the earliest sign of heart failure.

On examination of the neck, a dome shaped lesion in the dermis forming a benign closed firm sac attached to the epidermis is noted on the right lateral side of the neck. The type of lesion is known as

a) Keloid

b) Tophi

c) A cutaneous cyst

d) Chondrodermatitis

○ Correct Multiple Choice Answer: c

A cutaneous cyst

○ Summary: The description of a dome-shaped, firm, benign sac in the dermis that is often attached to the epidermis, possibly with a visible punctum (dark dot/blackhead), is characteristic of a cutaneous cyst, such as an epidermoid (common on face/neck) or pilar(trichilemmal) cyst(common on the scalp.

Symptoms of heartburn and regurgitation are associated with:

a) Hiatal hernia

b) Gastroesophageal reflux

c) Peptic ulcer disease

d) Esophageal cancer

○ Correct Multiple Choice Answer: b

Gastroesophageal reflux

Summary: Heartburn (a burning sensation behind the sternum) and regurgitation (the backward flow of stomach acid or undigested food into the esophagus or mouth) especially when lying down or bending over are the cardinal symptoms of gastroesophageal reflux disease (GERD)

A 70 years old man walks 20 minutes most days of the week. He has begun to complain of pain of his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 20 minutes walks without stopping to rest. What choice best describes the pain associated with peripheral artery disease?

a) A sharp, stabbing pain

b) A dull pain and cramp

c) An electric shock

d) A pulsating pain

○ Correct Multiple Choice Answer: b

A dull pain and cramp

○ Summary: This scenario describes intermittent claudication, the hallmark symptom of peripheral artery disease (PAD). It is characterized by a reproducible dull ache, cramp, or fatigue in the leg muscles (most commonly the calf) that is brought on by exertion and relieved by rest. Other signs and symptoms may include leg numbness or weakness, coldness in leg or foot when compared to the other side, sores on the toes, feet or legs that won't heal, a change in the color, hair losd or slower hair growth, shiny skin. no pulse or a weak pulse in legs or feet.

papilledema is a cause for concern because it is suggestive of

a) Optic atrophy

b) Microaneurysms

c) Increased intracranial pressure

d) Retinal hemorrhage

○ Correct Multiple Choice Answer: c

increased intracranial pressure

○ Summary: Papilledema is the swelling of the optic disc (the area where the optic nerve enters the eyeball) caused by increased intracranial pressure (ICP), which pushes the brain and optic nerve forward.

A 38-year-old patient with a history of abdominal pain presents to the nurse practitioner. Findings reveal superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. Hemorrhagic pancreatic is suspected because of which finding?

a) A positive Gray Turner's sign

b) A positive Cullen's sign

c) Kaposi's sarcoma

d) Petechiae

○ Correct Multiple Choice Answer: b

A positive Cullen's sign

Summary: Cullen's sign refers to the superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus, which is a sign of retroperitoneal hemorrhage, often seen in severe acute pancreatitis with hemorrhagic necrosis.

A 57 years old post-menopausal female presents with a complaint of vaginal burning, pruritus and painful intercourse. On examination, the nurse practitioner would be most concern with the findings

a) A thin, pale, dry vaginal mucosa

b) Absence of rugae

c) A friable cervix

d) Raised yellowish cervical lesion

○ Correct Multiple Choice Answer: a

A thin, pale, dry vaginal mucosa

Summary: The symptoms (vaginal burning, pruritus, dyspareunia or painful intercourse) in a post-menopausal woman are classic for atrophic vaginitis, which is caused by estrogen deficiency. On examination, this presents as thin, pale, and dry vaginal mucosa due to reduced blood flow and lubrication.

Friable refers to tissue that is easily irritated, which makes it more prone to inflammation, bleedng, or tearing. Vaginal rugae disappear in those with an estrogen deficiency and those who are older. Nabothian cysts (also called epithelial cyst) are common and benign and considered normal feature of adult cervix. They may be translucent, opaque, whitish to yellow.

What intervention does the American College of Rheumatology recommend as first line therapy for Osteoarthritis, rheumatoid arthritis or something else

a) Diagnostic workup to rule out rheumatic arthritis

b) NSAID use at lowest effective dosec

c) Acetaminophen use up to 4 grams/day

d) Exercise and weight loss

○ Correct Multiple Choice Answer: d

Exercise and weight loss

○ Summary: For osteoarthritis, especially of weight-bearing joints like the knee and hip, non-pharmacological interventions such as regular exercise (to improve strength and flexibility) and weight loss (to reduce joint stress) are strongly recommended as first-line therapies. For every 10 lbs of weight lost over 10 years reduces the chance of developing knee OA by up to 50%.

Which of the following drugs is not contraindicated for concurrent use with warfarin (Coumadin)?

a) Amoxicillin (Amoxil)

b) Trimethroprim/sulfamethaxazole (Bactrim)

c) Ciprofloxacin (Cipro)

d) Clarithromycin (Biaxin)

○ Correct Multiple Choice Answer: a

Amoxicillin (Amoxil)

○ Summary: Among the listed antibiotics, amoxicillin has a minimal or no significant interaction with warfarin, unlike trimethoprim/sulfamethoxazole (Bactrim), ciprofloxacin (Cipro), and clarithromycin (Biaxin), which are known to potentiate warfarin's anticoagulant effect and are often contraindicated or require close monitoring.

The lymphatic ducts drain into the (APEA)

a) arterial system

b) venous system

c) vertebral bodies of the spine

d) shoulder

○ Correct Multiple Choice Answer: b

venous system

○ Summary: The major lymphatic ducts, such as the thoracic duct and the right lymphatic duct, collect lymph from various parts of the body and ultimately empty their contents into the subclavian veins, which are part of the systemic venous circulation.

Which of the following is the most appropriate treatment for trichomoniasis in a non- pregnant woman?

a) Metronidazole (flagyl)

b) Doxycycline (Vibramycin)

c) Clindamycin (Cleocin)

d) Clotrimazole (lotrimin)

○ Correct Multiple Choice Answer: a

Metronidazole (flagyl)

Summary: Metronidazole is the drug of choice and most effective treatment for trichomoniasis, a sexually transmitted infection caused by the parasite Trichomonas vaginalis

Osteosarcoma in a pediatric patient is most often diagnosed when there is:

a) Pain in the affected bone

b) Pathologic fracturec

) Repeat fracture

d) Apophyseal avulsion

○ Correct Multiple Choice Answer: a

Pain in the affected bone

○ Summary: Persistent or worsening bone pain, especially at night or with activity, is the most common presenting symptom that leads to the diagnosis of osteosarcoma, the most prevalent primary bone cancer in children and adolescents. It arises most often in the wide ends of long bones, such as the femur and tibia in the leg and the humerus in the uper arm

In a patient who has a history of migraine headaches, which characteristics is most common?

a) Focal deficits

b) Family history

c) Weakness

d) Initial onset after age 35

○ Correct Multiple Choice Answer: b

Family history

Summary: Migraine headaches have a strong genetic predisposition, and a positive family history of migraines is a very common characteristic among individuals who experience them.

1. Symptoms associated with small bowel obstruction usually include:

a) Nausea and diarrhea

b) Vomiting and pain

c) Hematemesis and bloody stool

d) Indigestion and anorexia

○ Correct Multiple Choice Answer: b

Vomiting and pain

○ Summary: Small bowel obstruction is classically characterized by abdominal pain, nausea, and significant vomiting from vagal nerve stimulation, often followed by abdominal distention from accumulation of chyne or ascites.

Unilateral rhinitis could be caused by all of the following except

a) A foreign body in the nasal canal

b) A nasal polypc

c) Drug induced rhinitis

d) A deviated sputum

○ Correct Multiple Choice Answer: c

Drug induced rhinitis

○ Summary: Unilateral rhinitis suggests a localized issue affecting one nostril, such as a foreign body, a nasal polyp, or anatomical abnormalities like a deviated septum. Drug-induced rhinitis, however, typically affects both nasal passages (bilateral) as a systemic or generalized response.

A 7 years old child has been diagnosed with acute sinusitis. The drug class that should be avoided is:

a) Antihistamines

b) Expectorants

c) Decongestants

d) Nasal steroids

○ Correct Multiple Choice Answer: a

Antihistamines

○ Summary: Antihistamines are generally avoided in the treatment of acute sinusitis (unless allergic rhinitis is a significant contributing factor) because they can dry and thicken nasal secretions, potentially hindering sinus drainage and worsening congestion.

A patient present with an elongated head with bony prominence of the forehead, nose and lower jaw. These facial features could be suggestive of:

a) Nephrotic syndrome

b) Acromegaly

c) Cushing's syndrome

d) Parkinson's disease

○ Correct Multiple Choice Answer: b

Acromegaly

○ Summary: Acromegaly, caused by excessive growth hormone production, leads to characteristic coarse facial features including an elongated head, bony prominent forehead, enlarged nose, and prognathism (protrusion of the lower jaw) due to abnormal bone and soft tissue growth.

Why would a child diagnosed with beta thalassemia and hemosiderosis receive deferoxamine (desferal)?

a) To prevent blood transfusion reactions

b) To simulate red blood cell production

c) To improve the oxygen carrying capacity of RBCs

d) To eliminate excessive iron and prevent organ damage

○ Correct Multiple Choice Answer: d

o eliminate excessive iron and prevent organ damage

○ Summary: Deferoxamine is an iron-chelating agent. In patients with beta-thalassemia who receive frequent blood transfusions, it is used to bind and remove excess iron from the body, thereby preventing iron overload (hemosiderosis) and subsequent organ damage. Given SQ by pump overnight to prevent free iron released with RBC destruction from building up in tissues and causing damage.

A patient has newly diagnosed hypothyroidism. What are the patients TSH level expected to be?

a) Higher than normal

b) Lower than normal

c) Within normal range

d) TSH is not used to diagnose hypothyroidism

○ Correct Multiple Choice Answer: a

Higher than normal

○ Summary: In primary hypothyroidism, the thyroid gland produces insufficient thyroid hormones. In response, the pituitary gland increases its production of Thyroid Stimulating Hormone (TSH) in an attempt to stimulate the thyroid, resulting in a TSH level that is typically higher than the normal range.

Dose of thyroid medications may need adjustment.

Which of the following symptoms would be a clinical manifestation noted during the secondary stage of syphilis?

a) Absence of symptoms

b) Single painless lesion, chancre on the genital area

c) Rash marked by red or reddish-brown, penny-sized lesions over the palms and soles

d) Poor muscle coordination

○ Correct Multiple Choice Answer: c

Rash marked by red or reddish-brown, penny-sized lesions over the palms and soles

○ Summary: A classic and highly characteristic manifestation of secondary syphilis is a widespread mucocutaneous rash, which frequently involves the palms of the hands and soles of the feet, presenting as red or reddish-brown, often non-itchy, maculopapular lesions. Other symptoms of secondary syphilis include sore throat, fever, swollen lymph glands, headaches, fatigue, muscle aches, wart-like patches around skin folds or genitals.

During the breast examination of a peri-menopausal woman, the NP detects a spontaneous bloody discharge from the right nipple. This indicates further evaluation.

a) fibroadenoma

b) polycystic breast disease

c) an intraductal papilloma

d) pituitary prolactinoma

an intraductal papilloma

○ Summary:

intraductal papillomas are usually solitary and <1cm. Located in large lactiferous sinuses or ducts and have a tendency to bleed. polycystic breast disease presents with generalized breast pain and tenderness. Green or dark brown non bloody discharge that tends to leak without pressure or squeezing.

An 84-year-old male with prostatic hypertrophy is at increased risk of

:a) Constipation

b) Fecal incontinence

c) Urinary tract infections

d) Prostate cancer

Urinary tract infections

○ Summary: BPH increases the risk of: Acute urinary retention, UTI and Sepsis.

47. A characteristic lesion observed in a male with primary syphilis is a:

a) Group of small scattered vesicles

b) Chancre

c) Papule of many shapes

D) Non-tender penile indurated nodule

Chancre

Summary: Primary syphilis typically presents as a solitary, painless chancre, whereas secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum.

48. During an acute attack of gout, the nurse practitioner knows NOT to prescribe

a) Colchicine (Colcrys)

b) Allopurinol (zyloprim)

c)Steroids

d) NSAIDS

Colchicine (Colcrys)

Summary: Colchicine has two distinct applications in gout. First, it can be used to treat an acute gouty attack. Second, it can help prevent attacks in chronic gout

49. What two vitamins and minerals should be included in oral multivitamins in women

a)Folic Acid and Vitamin C

b)Iron and Vitamin B12

c) Vitamin D and Iron

d) Folic Acid and Iron

Folic Acid and Iron

50. In a patient with bacterial meningitis, the most common reason for finding of headaches:

a) Meningeal erythema

b) Increased intracranial pressure

c) Meningeal irritation

d) Swelling of the spinal cord

Increased intracranial pressure

51. Janeway lesions, petechiae and Oster nodes are associated with:

a) Gonococcemia

b) Infective endocarditis

c) Hyperthyroidism

d) Peripheral vascular disease

Infective endocarditis

52. A patient present with decreased hearing related to antibiotic use. Which class of antibiotics is this

a) Aminoglycosides

b) Beta-lactams

c) Cephalosporins

d) Macrolides?

Aminoglycosides

Summary: Aminoglycosides antibiotics, vancomycin and aspirin are some medication that can cause hearing loss

53. Which antihypertensive would be appropriate to prescribe for a hypertlensive patient ( BP 150/195) that is in her third trimester

a) Candesartan

b) Lisinopril

c) Methyldopa

d) Furosemide?

Methyldopa

Summaey: Oral methyldopa has been assigned to pregnancy category B. Methyldopa is a drug of first choice for control of mild to

moderate hypertension in pregnancy and is the most widely prescribed antihypertensive

54. A 40-year-old admits to multiple sex partners presents with several lesions over his body. Finding reveals hemorrhagic vesiculopustular lesions over the hands and feet. These lesions are most likely associated with:

a) Gonococeemia

b)Infective endocarditis

c) Hyperthyroidism

d) Peripheral vascular disease

Gonococeemia

55. Which agent is NOT useful in prophylactic treatment of migraine headaches

a) Sumatriptan (Imitres)

b) Amitriptyline (elavil)

c) Verapamil (verelant)

d) Metropolol (lopresor)

Sumatriptan (Imitres)

Explanation: Sumatriptan is used to treat migraines (not to prevent them). It helps to relieve headache, pain, and other migraine symptoms (including nausca, vomiting, sensitivity to light & sound).

56. The right lymph duct drains lymphatic fluid from all the

following expect the (APEA)

a) Right side of the heard

b) Right upper thorax

c) Right arm

d) Right leg

Right leg

57. Acute lymphocytic leukemia is usually diagnosed by:

a) A completed blood count

b) Magnetic resonance imaging

c)A nuclear bone scans

d) A bone marrow examination

bone marrow examination

58. The medication that blocks the

transportation of glucose across the intestines into the blood stream to target prandial blood glucose is:

a) Metformin (Glucophage XR)

b) Acarbose (Precose)

c) Rosiglitazone (Avandia)

d) Glipizide (Glucotrol XL)

Acarbose (Precose)

Acarbose inhibits enzymes (glycoside hydrolases) needed to digest carbohydrates, specifically, alpha-glucosidase enzymes in the brush border of the small intestines, and pancreatic alpha- amylase.

59. Prostate pain is usually located

in the:

a) Supra pubic area

b) Back

c) Perineum

d) In the glans penis

Answer says perineum

But notes say Prostate pain is usually located in the lower abdomen, back, or groin

60. A nurse practitioner examines the skin of an elderly patient which finding below is NOT benign lesion associated with the aging process a) Xerosis

b) Cherry angiomas and senile purpura

c) Senile keratosis and senile lentigines

d) Dermatophytosis

Dermatophytosis

Explanation:

Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, ichy, scaly, circular rash

61. A 65-year-old male presents with findings of symmetric thorax with moderate kyphosis and anterior diameter. Chest expansion is decreased and the diaphragm descending 2 cm bilaterally. These findings relate to:

a) Pneumothorax

b) Plural effusion

c) A fractured rib

d) Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease

62. Phenazopyridine (Pyridium) is recommended for very short term use in patients with urinary tract infections (UTIs) because:

a) Possible resistance

b) Occurrenee of hemolytic anemia c) Gastritis

d) Cost

Occurrence of hemolytic anemia

Explanation: usual side effects are Headache, rash, pruritus and occasional gastrointestinal disturbance. An anaphylactoid-like reaction has also been described. Occurrence of hemolytic anemia, Methemog lobinemia, renal and hepatic toxicity have been reported, usually at overdosage levels

63. Estrogen-progestin contraceptives should be avoided in women with:

a) Tension headaches

b) Migraines with aura

c) Unilateral headaches

d) Cluster headaches

Migraines with aura

Explanation:

Combination contraceptives is a good choice for patients of childbearing age, younger than 35 with NO aura migraine

Chollier video part 1

64. The addition of benzoyl peroxide to erythromycin for the topical treatment of acne:

a) Improves the efficacy of erythromycin

b) Decrease the risk of desquamation

c) Decreases the risk of resistance to erythromycin

d) Increases the time patient can be exposed to sunlight

Improves the efficacy of erythromycin

65. An elderly male with benign prostate hyperplasia (BPH)should be advised to avoid antihistamines. What is the reason for this

a) Urinary incontinence

b) Constipation

c) Orthostatic hypotension

d) Urinary retention

Urinary retention

66. Examination of the hair reveals a fine silky appearance. This finding may be seen in patients that have:

a) Hypothyroidism

b) Hyperthyroidism

c) Type 2 diabetes

d) Celiac disease

Hyperthyroidism

67. A patient develops a cough secondary to an angiotensin-converting-enzyme (ACE). The most appropriate statement related to ACE-I cough is that the cough typically:

a) Resolves within a week after stopping the ACE inhibitor

b) Resolves with splitting the daily dose to twice daily dosing

c) Occurs with an angiotensin- II receptor blocker (ARB)

d) Affects men more than women

Resolves within a week after stopping the ACE inhibitor

Explanation:

A dry hacking cough usually begins 1-2 weeks of starting ACE, but may occur up to 6 months later. Typically resolves 1-4 days of discontinuation of therapy, but may linger up to 4 weeks

68. A patient with a diagnosis of giardiasis is being treated with metronidazole (flagy|). What information would be important to obtain before prescribing this medication

a) If the patient allergic to sulfa

b) If the patient has peptic ulcer disease

c) If the patient is at least 18 year of age

d) If the patient drinks alcohol

If the patient drinks alcohol

69. A 20 years old male living in the college dorm, complains of a dry cough for the past month. Assessment finding associated with an atypical, community acquired pneumonia would include:

a) A low-grade fever, malaise, and clear lung fields on auscultation

b) A low-grade fever, malaise, and crackles audible throughout the lung fields

c) Temperature of 101 F, sore throat, and diminished breath sounds on auscultation

d) Temperature of 102° F, dyspnea, and diminished lung sounds on auscultation

A low-grade fever, malaise, and clear lung fields on auscultation

70. The most appropriate medication indicated for reversing the anticoagulated effects of dabigatran etexilate (Pradaxa)

a) Idarucizumab (Praxbind)

b) Vitamin K

c) Protamine sulfate

d) Fondaparinux (Arixtra)

Idarucizumab (Praxbind)

71. A common pathological finding in patient with asthma

a) Necrosis of small airway

b) Absence of goblet cells

c) Absence of ciliary regeneration

d) Hypertrophy of smooth muscle

Hypertrophy of smooth muscle

72. Which cranial nerves are responsible for eye movement

a) CN II, IlI, IV

b) CN IlI, IV, VI

c) CN II, IV, VI

d) CN I, IV, VII

CN IlI, IV, VI

oculomotor (III) nerve, trochlear (IV) nerve and the abducen (VI) nerve.

73. The typical presentation of severe acute aortic regurgitation (AR) includes sudden severe shortness of breath, rapidly developing heart failure, and:

a) Dry cough

b) Chest pain

c) Decreased blood pressure

d) Systolic murmur?

Decreased blood pressure

74. Disorders in the kidneys and the ureters may cause pain in all of the following areas except the:

a) Abdomen

b) Flank

c) Back

d) Suprapubic

Suprapubic

Renal and urethral pain is usually located in the flank area, abdomen or groin.

75. When palpating the prostate gland during the rectal exam, the prostate feels tender, swollen, boggy and warm. This finding is consistent with:

a) A normal prostate gland

b) Acute bacterial prostatitis

c) Benign prostatic hyperplasia

d) Carcinoma of the prostate

Acute bacterial prostatitis

Explanation:

A boggy prostate describes a gland that is edematous and tender such as in patients with bacterial prostatitis.

76. This contagious disease causes fever, headache, stiff neck,

Photophobia, nausea, vomiting, and altered mental status. What immunization prevents this

a) Meningococcal vaccine

b) Pneumococcal vaccine

d) Varicella vaccine

e) Measles, Mumps, and Rubella (MMR) vaccine

Meningococcal vaccine

77. Headache warning signs that need prompt investigation include all of the following:

a) New onset after 50

b) Aggravated or relieved by change of position

c) Precipitated by Valsalva

maneuvers.

d) Headaches relieved with mild recurrent use of analgesics

ABC not d

78. Serotonin Syndrome is a potentially life-threatening condition associated with:

a) Depression

b) Anxiety

c) Increased levels of serotonin

d) Chlylothorax?

Increased levels of serotonin

79. Which one of the following statements about treating scabies

with lindane (Kewell) is correct

[Know that Nix is the treatment.]

a) Lindane is safe to use in pregnant women, babies, children, and the elderly

b) Lindane lotion and/or shampoo in not considered first-line therapy

c) Repeated applications of lindane can be used if there has been a twelve-hour interval

d) Lindane can be used in patient with a history of seizures? .

Lindane lotion and/or shampoo is not considered first-line therapy

Explanation

Lindane is used to treat lice and scabies, but it may cause serious

side effects. Safer medications are available to treat these conditions. You should only use lindane if there is some reason you cannot use the other medications

80. Symptoms consistent with later stage human deficiency disease (HIV) typically include all of the following except,

a) Night sweats

b) Lymphadenopathy for more than 3 months

c) Persistent vomiting

d) Persistent, unexplained fatigue

Persistent vomiting is not a late stage hiv symptom

This is the late stage of HIV infection: symptoms include: Rapid weight loss, Recurring fever or profuse night sweats, Extreme and unexplained tiredness, Prolonged swelling of the lymph glands in the armpits, groin, or neck, Diarrhea that lasts for more than a week, Sores of the mouth, anus, or genitals, Pneumonia, Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids, Memory loss, depression, and other neurologic disorders

81. The earliest clinical manifestation of diabetic nephropathy is:

a) An elevation in blood urea nitrogen (BUN)

b) An elevation in blood urca nitrogen (BUN) and creatinine (CR)

c) A decreased glomerular filtration rate

d) Microalbuminuria

Microalbuminuria

82. When fluid accumulates between the visceral and parietal pleural spaces, the term used is:

a) Pericardial effusion

b) Pleural effusion

c) Pleural emphysema

Pleural effusion

83. Children born with Down syndrome often have other anomalies. They especially require evaluation of what body system

a) Orthopedic

b) Gastrointestinal

c) Cardiac

d) Endocrine?

Cardiac

84. What finding is typical in a patient with a meniscal tear (APEA)

a) Positive McMurray's test

b) Positive anterior drawer line

c) Audible click at the joint test

d) Fixed patellar subluxation?

Positive McMurray's test

85. The nurse practitioner diagnoses a female patient with trichomoniasis. A common chief complaint of a patient with trichomoniasis is:

a) Painless, ulcerated vulvar lesion with vaginal discharged

b) Fever, papules, and vaginal discharged with burning

c) Vaginal discharge

d) Dyspareunia and upper abdominal pain

Vaginal discharge

86. When deciding on an initial treatment option for an acute flare of atopic dermatitis, unresponsive to emollient therapy, the next best choice for treatment is:

a) Oral corticosteroids (prednisone) b) Betamethasone dipropionate 0.05% (betanate)

c) Desonide 0.5%

d) Pimecrolimus 1% cream (Elidel)

Desonide 0.5%

87. When examining the breast, the "tail of Spence* would be located

a) In the upper inner quadrant

b) In the lower inner quadrant

c) In the lower outer quadrant

d) Laterally across the anterior axillary fold

Laterally across the anterior axillary fold

88. Headaches with symptoms of nausea and vomiting may be associated with all of the following, EXCEPT

a) Migraine headache

b) Brain tumors

c) Subarachnoid hemorrhage

d) Tension headache

Tension headache

89. Which of the following finding could indicate a need for further evaluation of the cardiac patient

a) Hematocrit 42%

b) Potassium 4.2 mg/dl

c) Sodium 140 mEq/dl

d) Low density lipoprotein of 190 mg/dI

Low density lipoprotein of 190 mg/dI

90. Alpha-adrenergic blocker increases urine outflow in males by:

a) Improving detrusor muscle stability

b) Shrinking the prostate gland

c) Relaxing prostate smooth muscle d) dilating the urethral vasculature

Relaxing prostate smooth muscle

91. The scoliosis patient who would cause the greatest concern for the nurse practitioner is a:

a) 13 y/o female with a 10" curve

b) 17 y/o female with a 10' curve

c) 12 y/o female with a 5 curve

d) 18 ylo female with a 5" curve

13 y/o female with a 10" curve

92. Which finding below would be unusual in a patient with diabetic retinopathy

a) Papilledema

b) Dot and blot hemorrhages

c) Microaneurysms

d) Cotton wool spots

Papilledema

93. Where should the uterine fundus be palpable at 12 weeks

a) At the level of the umbilicus

b) At the leveI of the symphysis pubis

c) Midway between the symphysis and umbilicus

d) Below the symphysis pubis

at the leveI of the symphysis pubis

94. Ophthalmoscopic examination of a 40 years old carpenter reveals a triangular thickening of the bulbar conjunctiva across the outer surface of the cornea. This condition is termed:

a) Corneal arcus

b) Corneal scar

c) Pterygium

d) Cataract

A pterygium is a growth of the

conjunctiva (triangular thickening) that overs the cornea.

95. A patient calls the nurse practitioner, and states that he missed his morning daily dose of warfarin 5 mg yesterday and today. The nurse practitioner instructs the patient to:

a) Wait until tomorrow and resume daily dosing of warfarin 5 mg.

b) Take warfarin 10 mg now

c) Take warfarin 5 mg now, warfarin 5 mg at 5 pm today and resume the daily warfarin 5 mg dose in the morning as schedule

d) Take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as scheduled

Take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as scheduled.

96. What common clinical finding is present in a patient who has croup

a) Barking cough

b) Sudden onset of symptoms

c) Nighttime symptoms

d) Shortness of breath?

Barking cough

97. A type of breast cancer that begins with erythema and swelling of the breast and progresses rapidly is termed:

a) Paget's disease

b) Invasive ductal carcinoma

c) Inflammatory breast cancer

d) Invasive lobular carcinoma

Inflammatory breast cancer

98. Salmeterol (serevent) in combination with an inhaled steroid is prescribed for a patient with moderate persistent asthma. What is the most important teaching point about salmeterol

a) It is not effective during an acute asthma attack

b) It may take 2 to 3 weeks to begin working

c) The drug works within 10 minutes

d) The drug may be used by patients 6 years older?

It is not effective during an acute asthma attack

99. A 50 years old male has a non-tender, enlarged scrotum. The nurse practitioner suspects which of the following conditions:

a) Orchitis

b) Epididymitis

c) Hydrocele

d) Prostatitis

Hydrocele is produced by fluid in the sae which normally surrounds the testicle. It often presents as painless swelling in the scrotum

100. Risk factors associated with breast cancer include all of the following except:

a) Personal family history of breast cancer

b) Use of hormone replacement therapy

c) Post-menopausal obesity

d) Low socioeconomic status

Low socioeconomic status