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A patient currently undergoing concurrent chemotherapy/radiation treatment for glottic squamous cell carcinoma is admitted to the rehab unit you oversee for management of intractable nausea, vomiting, and dehydration. Admission CBC showed WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8. Which of the following conditions is this patient at risk for?

A. Macrocytic anemia due to B12 deficiency

B. Iron deficiency anemia due to chronic blood loss

C. Microcytic anemia due to chronic kidney disease

D. Aplastic anemia due to bone marrow suppression

D

Your patient presents to the urgent care clinic with a swollen exudative pharynx, profound fatigue, and a very tender left upper quadrant abdomen. What is the most likely diagnosis?

A. Strep pharyngitis

B. Tonsillitis

C. Epstein Barr virus (EBV)

D. Pancreatitis

C

Which of the following best characterizes presbycusis in the older adult?

A. Bilateral low-frequency sensorineural hearing loss

B. Bilateral high-frequency sensorineural hearing loss

C. Unilateral high-frequency sensorineural hearing loss

D. Unilateral low-frequency sensorineural hearing loss

B

A 35-year-old woman presents with allergic rhinitis, experiencing significant nasal congestion, sneezing, and itchy eyes. She has tried over-the-counter antihistamines with limited relief. What is the most appropriate next step in management?

A. Oral decongestants

B. Nasal saline irrigation

C. Intranasal corticosteroids

D. Referral to an allergist for immunotherapy

C

A patient currently undergoing concurrent chemotherapy/radiation treatment for glottic squamous cell carcinoma is admitted to the rehab unit you oversee for management of intractable nausea, vomiting, and dehydration. Admission CBC showed WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8. Which of the following conditions is this patient at risk for?

A. Iron deficiency anemia due to chronic blood loss

B. Microcytic anemia due to chronic kidney disease

C. Macrocytic anemia due to B12 deficiency

D. Aplastic anemia due to bone marrow suppression

D

A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers. He has a history of rectal adenocarcinoma and completed concurrent chemotherapy/radiation earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC 0.8, and peripheral smear shows dysplasia. What additional work-up would you anticipate for this patient?

A. Colonoscopy and fecal occult blood test

B. Bone marrow biopsy and flow cytometry

C. No additional work-up is required, these are expected sequela of his oncologic treatment

D. Repeat CBC/CMP/peripheral smear in eight weeks

B

Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or poorly responsive:

A. Pancytopenia

B. Aplastic anemia

C. Macrocytic anemia

D. Myelodysplastic syndrome

D

Treatment for symptomatic aplastic anemia includes all the following except:

A. Bone marrow transplant

B. PRBC/Platelet/WBC transfusions

C. Prophylactic antibiotics

D. Removal of bone marrow stimulants

D

A patient diagnosed with iron deficiency anemia requires iron supplementation. Which of the following treatments would likely be ineffective?

A. Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago

B. Iron sucrose 200 mg IV infusion weekly x 8 weeks in a 26 y.o. F at 34 weeks of pregnancy

C. Ferrous sulfate 325 mg PO TID for a 25 y.o. F with menorrhagia

D. Ferrous sulfate 325 mg PO BID for a 63 y.o. M with ulcerative colitis

A

Which of the following is not a common mechanism of neutrophil expenditure and resultant neutropenia?

A. Decreased neutrophil production in the bone marrow

B. Redistribution of neutrophils to the spleen or vascular endothelium

C. Loss of circulating neutrophils in acute blood loss

D. Immune destruction

C

Which of the following blood lead levels (BLL) would likely require chelation therapy?

A. < 80 mcg/dL

B. 35 mcg/dL

C. >100 mcg/dL

D. 75 mcg/dL

C

A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for:

A. cauda equina syndrome.

B. renal dystrophy.

C. Paget's disease.

D. multiple myeloma.

D

Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following?

A. Thrombocytopenia

B. Aplastic anemia

C. Myelodysplastic syndrome

D. Disseminated intravascular coagulation

D

A patient on warfarin (Coumadin) therapy for recurrent deep vein thrombosis (DVT) is about to have lumbar spinal fusion surgery. The patient's warfarin is put on hold starting 5 days prior to the surgery and subcutaneous enoxaparin (Lovenox) has been ordered for DVT prophylaxis until the resumption of the warfarin. The nurse practitioner knows that the patient's postoperative warfarin dose should be restarted based on the:

A. Value of her morning Prothrombin time

B. baseline PT and INR values

C. target INR of 2.5

D. Loading dose of 20 mg, plus the previous warfarin dose

B

Your patient presented yesterday to urgent care with symptoms of lower extremity weakness and then went home for observation with family. They have returned to urgent care, and it now appears to be affecting the patient’s abdomen in just the past few hours. What is your priority intervention?

A. Order physical therapy evaluation and treatment

B. Immediate transportation to the hospital and monitor for airway involvement

C. Apply oxygen via nasal cannula

D. Assess muscular strength in bilateral lower extremities

B

Which of the following is a common symptom of Systemic Lupus Erythematosus (SLE)?

A. Joint pain and swelling

B. Frequent urination and thirst

C. Sudden weight gain and high blood pressure

D. Persistent cough and shortness of breath

A

Patients with Stevens-Johnson syndrome should be managed by which of the following mechanisms?

A. With negative pressure isolation due to contagious nature of SJS

B. Similarly to burn patients due to loss of fluid volume

C. Similarly to heart surgery patients due to risk of hypervolemia

D. With off floor privileges to encourage mobility and retaining muscle mass

B

Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV?

A. NRTIs

B. Protease antagonists

C. NNRTIs

D. Protease inhibitors

B

A patient who has active herpes zoster is at risk of shedding which contagious virus?

A. Varicella zoster

B. Herpes simplex virus -2

C. Herpes simplex virus -1

D. Shingles

A

Your patient presents with painless lymph node swelling, weight loss, night sweats, and asks what is wrong with him. Which of the following represents a most appropriate intervention to confirm a diagnosis of lymphoma?

A. Order a core needle biopsy

B. Order a CBC and TSH

C. Examine the patient

D. Consult pulmonology

A

The patient with anaphylaxis is experiencing which type of hypersensitivity response?

A. Type I

B. Type III

C. Type II

D. Type IV

A

Your patient has been diagnosed with HIV and wants to know the goal of treatment with “all these medications”. Which of the following represents the most reasonable goal in the treatment of HIV?

A. Ability to reduce to one medication as therapy rather than multiple agents

B. Reducing the CD4 count to an undetectable level

C. Reducing viral load to an undetectable level

D. Complete healing with no need for further medications

C

Your patient arrives the urgent care complaining of a swollen throat and vocal changes. Which of the following statements made by the patient brings an index of suspicion of angioedema?

A. I have been taking my lisinopril for the past week as prescribed

B. I do not take any ibuprofen since it gives me an upset stomach

C. I have never had this happen before

D. This seems to be getting better already getting out of the cold

A

Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis?

A. Prednisone burst, then taper to a lower daily maintenance dose

B. Methotrexate daily

C. Oxycontin PRN for mild pain

D. Adalimumab daily

C

A 43-year-old male patient weighing 100kg was burned over 20 percent of their body with partial thickness burns after escaping a house fire. Using the Parkland formula, what is the most appropriate amount of IV fluid resuscitation to provide the patient in the first 8 hours?

A. 8 Liters

B. 2 Liters

C. 3 Liters

D. 4 Liters

D

What is the etiology of verruca?

A. Human Papilloma Virus infection in the skin

B. Chronic UV-B exposure to the skin

C. Chronic UV-A exposure to the skin

D. Group B Strep infection in the skin

A

Which of the following medications is prescribed for the treatment of pinworm?

A. Metronidazole (Flagyl)

B. Corticosteroids

C. Lindane (Kwell)

D. Albendazole(Albenza)

D

A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions on the face, ears, and hands presents with a firm erythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is:

A. Seborrheic keratosis

B. Melanoma

C. Squamous cell carcinoma

D. Sebaceous hyperplasia

C

A Caucasian male patient with fair skin and green eyes is at a particularly high risk for which of the following serious skin conditions?

A. Wrinkles

B. Sunburn

C. Keratoacanthoma

D. Skin cancer

D

An adult female with a diagnosis of eczema was given a prescription of hydrocortisone valerate 0.2% (Westcort) ointment last week for increased itching. The patient returns today reporting no improvement and more itching. The nurse practitioner’s examination finds many vesicles and papules on hands, chest, and buttocks. The nurse practitioner also finds a linear burrow between the fingers and prescribes:

A. a higher potency topical steroid.

B. imiquimod 5% (Aldara) cream.

C. ketoconazole (Nizoral) topical.

D. permethrin 5% (Elimite) cream.

D

What is the following is not an effective strategy of treatment for verruca?

A. Punch biopsy

B. Cryotherapy

C. Shave biopsy

D. Curettage

C

What is the most likely diagnosis for an elderly patient with GI cancer who presents with skin pallor, conjunctival pallor, palpitations, and weakness?

A. Iron deficiency anemia

B. Peptic ulcer disease

C. Autoimmune hemolytic anemia

D. Gastroesophageal reflux disease

A

The 61-year-old female patient with lichen sclerosis has been prescribed clobetasol propionate 0.05% ointment. Which of the following statements made by the patient demonstrates good understand of her new prescription?

A. I like this drug since I can take this for months and stop it abruptly without any side effects

B. I will not use this anywhere other than where it is prescribed since it has a high risk of damaging my skin

C. If I don’t see results from this, I can switch to a higher potency steroid than an ointment.

D. I can add additional medications at the same site if they are put on top of the steroid

B

Herpes zoster can be difficult to diagnose in the prodromal stage, but can later be identified by the presence of characteristic:

A. Unilateral vesicular lesions

B. Bilateral dermatomal lesions

C. Herpetic whitlows of the fingers

D. "herald spots" at the site of infection

A

The most specific test for gout is:

A. Synovial fluid with monosodium urate crystals

B. Hyperuricemia greater than 7mg/dL

C. Serum purine level

D. Normalized uric acid level after a trial of allopurinol (Zyloprim)

A

Which of the following are not items assessed for compartment syndrome?

A. Guarding

B. Pain

C. Sensation

D. Skin color

A

Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis?

A. Indomethacin (Indocin)

B. Allopurinol (Zyloprim)

C. Misoprostol (Arthotec)

D. Salicylic acid (aspirin)

B

Which of the following treatments is most successful for patients with chronic fatigue syndrome?

A. Graded exercise program

B. Antiviral therapy

C. High carbohydrate diet

D. CNS stimulants

A

Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis?

A. Allopurinol (Zyloprim)

B. Salicylic acid (aspirin)

C. Indomethacin (Indocin)

D. Misoprostol (Arthotec)

A

Which of the following behaviors is likely to elicit rhabdomyolysis?

A. Participating in a full ironman triathlon

B. Working out for 30 minutes with plyometric exercises

C. Starting on a low-intensity statin for lipid reduction

D. Swimming for 10 minutes in a lap pool

A

Patients who have been in a multi-car pileup should be evaluated for which of the following elements of the secondary survey?

A. Evidence of adequate circulation

B. Work and depth of breathing

C. Deformities

D. Airway patency

C

A 25-year-old athlete presents with shoulder pain and difficulty with overhead activities. Physical examination suggests impingement syndrome. What is the most appropriate initial treatment?

A. Physical therapy focusing on rotator cuff strengthening

B. Surgical intervention

C. Nonsteroidal anti-inflammatory drugs (NSAIDs) and physical activity modification

D. Corticosteroid injection

A

An 84-year-old patient present with complaints of diffuse bilateral lower back pain which is made worse by standing. On exam the patient maintains a posture of forward flexing at the waist. The most likely diagnosis is?

A. Lumbar strain

B. Lumbar disk herniation

C. Spinal stenosis

D. Nerve root impingement

C

A geriatric patient with a history of gout presents with an acute attack. He had stopped taking allopurinol (Zyloprim) for a few months but resumed taking it a few days ago when the pain returned. He says that the pain is getting worse. The nurse practitioner should:

A. Start another hypouricemic agent such as probenecid and titrate allopurinol to a lower dose

B. Continue allopurinol and order a serum uric acid test to confirm gout as the diagnosis

C. Start the patient on a short-term steroid

D. Continue allopurinol and encourage dietary changes to avoid foods high in purines

C

Which of the following bacteria are commonly associated with pyelonephritis?

A. Klebsiella

B. Streptococcus

C. Staphylococcus

D. Enterococcus

A

Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses?

A. urge-type incontinence

B. overflow incontinence

C. functional incontinence

D. stress incontinence

A

A 45-year-old man with a history of benign prostatic hyperplasia (BPH) presents with worsening urinary symptoms, including nocturia and weak stream. What is the most appropriate initial pharmacological treatment?

A. Antibiotics

B. Alpha-blockers

C. 5-alpha-reductase inhibitors

D. Anticholinergics

B

A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is:

A. Sexually transmitted infection

B. Urinary tract infection

C. Benign prostatic hypertrophy

D. Bladder carcinoma

D

A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynecology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable cystoscopy. Which of the following is an appropriate plan of care?

A. Referral to psychiatry

B. Nitrofurantoin (Macrodantin) 100 mg oral once daily

C. Amitriptyline (Elavil) 25 mg oral once daily

D. Propranolol (Inderal) 10 mg oral once daily

C

Which of the following states represents an example of postrenal failure?

A. Blood clot obstructing a foley catheter after a transurethral prostatectomy

B. Hypotension after overdosing on lisinopril

C. Contrast induced nephropathy after an angiogram

D. Overuse of furosemide

A

An older adult patient with chronic renal disease has been experiencing a steady decrease in glomular filtration rate over the past 3 months. Which type(s) of antihypertensive medication would be most appropriate for the patient at this time?

A. Beta-blocker, thiazide diuretic

B. Aldosterone antagonist

C. Angiotensin-converting enzyme (ACE) inhibitor, thiazide diuretic

D. Angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker

D

Patients presenting to the emergency department with hematuria and RBC casts in their urine should be considered for which diagnosis?

A. Acute tubular necrosis

B. Glomerulonephritis

C. Nephrotic syndrome

D. Pyelonephritis

B

A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no allergies. What is the most appropriate first-line antibiotic treatment?

A. Nitrofurantoin

B. Amoxicillin

C. Trimethoprim-sulfamethoxazole

Ciprofloxacin

A

Which of the following suggest a diagnosis of glomerulonephritis?

A. WBC casts in urine

B. Absence of albuminuria

C. CD4 count of 50 with hematuria

D. Elevated WBCs on urinalysis

C

In treating a pregnant female with migraine headaches, which of the following drugs would be contraindicated?

A. Sumatriptan succinate (Imitrex)

B. Frovatriptan (Frova)

C. Amitriptyline (Elavil)

D. Ergotamine tartrate (Migergot)

D

Your patient has been noticing progressively worsening muscular weakness over the past 15 months to the point he is not able to stand and is effectively wheelchair bound. Which of the following diagnoses can reasonably be excluded?

A. Myasthenia Gravis

B. Anterior cord syndrome

C. Descending Guillain-Barre

D. Multiple Sclerosis

C

A 70-year-old man presents with acute onset of right-sided weakness and difficulty speaking. His symptoms started 2 hours ago. What is the most appropriate initial intervention?

A. Administer intravenous tPA

B. Start anticoagulation therapy

C. Perform a CT scan of the head

D. Administer aspirin

C

An adult female presents to the clinic with complaints of dizziness, weakness, fatigue, weight loss, and increased tanning of scars, areolas, and hand creases. The patient's husband states that she seems depressed and is eating a lot of salt. To determine the suspected cause of the patient's symptoms, the nurse practitioner would order a:

A. Random glucose test

B. Liver function test

C. Complete blood count (CBC)

D. Morning cortisol level

D

An adolescent male college freshman presents to the student health office with concerns about succeeding in school. He is in his second semester and is on academic probation because of poor grades. He states that he has always struggled in school but managed to graduate from high school with a 3.5 grade point average because his parents monitored and controlled his studying...

A. explaining that his high school grades prove that he does not have a learning disorder, he just needs to work harder

B. acknowledging that he might have an attention disorder or learning disability, and then refer him for an evaluation

C. calling his parents after he leaves the office to report his school problems and recommending tutoring services

D. informing him that he might have an attention disorder or learning disability, but is too old for any diagnosis or treatment

B

A woman with vascular dementia presents with agitation. Your first action should be to do which of the following:

A. prescribe an anxiolytic

B. mini mental exam

C. prescribe an antipsychotic

D. assess for infection

D

A patient who presents to your clinic with an acute change in facial symmetry, inability to speak clearly and unilateral muscular weakness should be transported for evaluation immediately as treatment for embolic stroke with tPA within which timeframe?

A. Less than 24 hrs.

B. Less than 8 hrs.

C. Less than 4.5 hrs.

D. Less than 6 hrs.

C

An adult patient presents with a history of headaches. Which new symptom should immediately cause the patient to be referred for further evaluation and possible neuroimaging?

A. Frontal headache upon awakening

B. Aura of visual flashing lights

C. Unilateral motor weakness

D. Unilateral pulsating head pain

C

Medication overuse (analgesia rebound) headaches occur:

A. In approximately half of all patients with chronic daily headaches.

B. infrequently in patients who use analgesics regularly.

C. occasionally during switching from one type of analgesic to another.

D. in the majority of patients using analgesics.

A

Patients who take chronic anti-seizure medication should be notified of which risk of abrupt change or discontinuation of these medications?

A. Increased seizure threshold

B. Discontinuation syndrome

C. Decreased seizure threshold

D. Flu-like symptoms

C

A healthy unvaccinated child is exposed to Hepatitis A. The best option for therapy is:

A. hepatitis B vaccine

B. zidovudine

C. immune globulin

D. Inactive hepatitis A vaccine

C

A 5-year-old boy is brought to the clinic with a rash that started on his face and spread to the trunk. The rash is described as "slapped cheek" appearance. What is the most likely diagnosis?

A. Roseola

B. Fifth disease

C. Rubella

D. Measles

B

By what age should a child typically be able to walk independently?

A. 15 months

B. 16 months

C. 18 months

D. 12 months

A

A nurse practitioner is evaluating an infant for possible colic. Which of the following could indicate the need for a more extensive evaluation?

A. Moist mucus membranes and flat fontanels

B. 3-oz (85 g) weight gain over the past 2 weeks

C. Stool negative for occult blood

D. Onset at 4 weeks of age

B

A 5-year-old girl presents with fever, rash, hacking cough, and swollen, tender lymph nodes. The rash started on her face and has spread to the rest of her body. What is the most likely diagnosis?

A. Fifth disease

B. Chickenpox

C. Measles

D. Scarlet fever

C

A neonate has purulent discharge of the eyes and erythema. History includes a vaginal birth at term delivered at home. What is the most likely cause of the presenting signs and symptoms?

A. Chlamydia trachomatis infection

B. Viral conjunctivitis

C. E-coli infection

D. Subconjunctival hemorrhage

A

At what age should a child typically begin to show interest in playing with other children and engaging in cooperative play?

A. 5 years

B. 2 years

C. 3 years

D. 4 years

C

A 7-year-old child presents with group A streptococcal infection confirmed by throat culture. Past history includes treatment for positive streptococcal infection with erythromycin (EryPed oral suspension) 3 weeks ago. What is the most appropriate next intervention?

A. Obtain culture for all household members.

B. Treat with azithromycin (Zithromax) for 10 days.

C. Treat with amoxicillin for 10 days.

D. Intramuscular Penicillin.

C

A late adolescent is brought to the nurse practitioner’s office by her mother, who is concerned about her daughter’s recent weight loss and the potential of purging herself after meals. The daughter denies any self-induced vomiting, starvation or excessive activity. History reveals that the daughter was consistently in the 50th percentile for weight but is now in the 10th percentile. She does state that she jogs 5 miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment?

A. Electrolytes, FSH, stool for occult blood

B. Creatine phosphokinase, follicle-stimulating hormone (FSH)

C. Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis

D. Electrolytes, fasting blood sugar

C

A 5-year-old boy presents with a sore throat, fever, and a sandpaper-like rash. What is the most likely diagnosis?

A. Measles

B. Fifth disease

C. Kawasaki disease

D. Scarlet fever

D

A 25-year-old woman presents with a 2-year history of fluctuating mood states, including periods of mild depression and hypomania. These symptoms have not been severe enough to meet the criteria for major depressive or manic episodes. What is the most likely diagnosis?

A. Cyclothymic disorder

B. Bipolar II disorder

C. Dysthymia

D. Bipolar I disorder

A

A 30-year-old woman presents with a 6-month history of persistent sadness, loss of interest in activities she once enjoyed, fatigue, and difficulty concentrating. She also reports changes in appetite and sleep patterns. What is the most likely diagnosis?

A. Major depressive disorder

B. Bipolar disorder

C. Generalized anxiety disorder

D. Dysthymia

A

Which of the following is a common physical sign of bulimia nervosa?

A. Calluses or scars on the knuckles

B. Persistent fever

C. Enlargement of the thyroid gland

D. Rapid fluctuation in weight gain or loss

A

first line treatment for generalized anxiety disorder:

A. Wellbutrin

B. Zoloft

C. Remeron

D. Buspar

B

Patients who overdose on amitriptyline should be treated with which of the following agents?

A. Glucagon IV

B. Sodium bicarbonate IV

C. Calcium chloride IV

D. Phenylephrine PO

B

Treatment for extrapyramidal symptoms should include which of the following?

A. Discontinuing use of diphenhydramine

B. Increasing the dose of the typical antipsychotic

C. Discontinuing use of Cogentin

D. Switching to an atypical antipsychotic from a typical antipsychotic

D

The 32-year-old female patient newly diagnosed with depression is likely to be started on which of the following agents with the fewest risks of extrapyramidal symptoms?

A. Atypical antipsychotics

B. Monoamine oxidase inhibitors

C. Selective serotonin reuptake inhibitors

D. Tricyclic antidepressants

C

Which of the following need to be assessed when determining if a patient is a risk of self-harm or harm to others?

A. Physical examination

B. Means to commit the harm to self or others

C. Social history

D. Medical history

B

Which of the following represent precipitating factors for excited delirium?

A. Lopressor use

B. LSD use

C. Cigar smoking

D. Amitriptyline use

B

A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate?

A. Double dosing for 2 days

B. Providing reassurance

C. Modifying use

D. Changing to Ortho-Novum 1/35

B

A male presents with a painless penile lesion which has been present for 4 weeks. There is no urethral discharge. He is sexually active with multiple partners and does not use a condom. The initial diagnosis is:

A. Primary syphilis

B. Herpes simplex type 2

C. Lichen planus

D. Chancroid

A

In treating a pregnant female with migraine headaches, which of the following drugs would be contraindicated?

A. Amitriptyline (Elavil)

B. Frovatriptan (Frova)

C. Sumatriptan succinate (Imitrex)

D. Ergotamine tartrate (Migergot)

D

A patient is 28 weeks pregnant and presents with a single episode of vaginal bleeding. Prenatal progress is normal, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate to determine a diagnosis?

A. non-stress test

B. Nitrazine test

C. Ultrasound

D. Bimanual cervical examination

C

Which of the following tests is the most effective in differentiating between solid and cystic breast lesions?

A. Screening mammography

B. Fine needle aspiration

C. Ultrasonography

D. Xeromammographic

C

A pap smear report for a 24-year-old indicates atypical squamous cells of undetermined significance (ASCUS). The patient's previous Pap smears were normal. The nurse practitioner should next:

A. Have the patient return for a Pap smear in 1 year

B. Repeat the Pap smear in 1 month

C. Refer for colposcopy

D. Request HPV testing

D

A 28-year-old woman in her first trimester of pregnancy presents with nausea and vomiting. What is the most appropriate initial management?

A. Advise bed rest

B. Recommend small, frequent meals

C. Prescribe metoclopramide

D. Prescribe ondansetron

D

A 28-year-old patient presents with profuse yellow vaginal discharge, odor, and local irritation. She reports completing a 7-day course of oral metronidazole (Flagyl), 500 mg b.i.d. 4 weeks ago. She has had multiple recurrences over the last 18 months. Microscopic examination reveals presence of clue cells. Which of the following is the most appropriate treatment intervention?

A. Oral metronidazole (Flagyl), 500 mg b.i.d., plus metronidazole vaginal gel (MetroGel), for 5 days

B. Treat both patient and partner(s) with oral metronidazole (Flagyl), 500 mg b.i.d., for 7 days

C. Treat patient with metronidazole vaginal gel (MetroGel) b.i.d. and partner(s) with tetracycline, 250 mg q.i.d., for 7 days

D. Metronidazole vaginal gel (MetroGel) twice weekly for 4 to 6 months

B

Your 25-year-old female patient presents with symptoms of hypotension, tachycardia, fever, diarrhea, lower abdominal pain, and erythematous palms. Based on these symptoms, what element should be included in the physical examination?

A. Pulmonary exam

B. Rectal exam

C. Pelvic exam

D. Musculoskeletal exam

C

Risk factors for genital herpes include:

A. genetic transmission.

B. multiple sexual partners and frequent use of public spas.

C. infection with other sexually transmitted diseases before the age of 12.

D. multiple sexual partners and years of sexual activity.

D

Which of the following is a typical symptom of asthma in adults?

A. Weight loss

B. Frequent sinus infections

C. Persistent cough, especially at night

D. High blood pressure

C

he optimal treatment for latent tuberculosis is:

A. Isoniazid (Nydrazid) for 9 months.

B. ethambutol for 6 months.

C. rifampin (Rifadin) for 5 months.

D. pyrazinamide for 6 months.

A

A 60-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with an acute exacerbation, including increased sputum production and dyspnea. He has no known drug allergies. What is the most appropriate initial antibiotic treatment?

A. Azithromycin

B. Amoxicillin-clavulanate

C. Levofloxacin

D. Doxycycline

B

What does force vital capacity (FVC) represent in pulmonary function testing?

A. The maximum volume of air that can be inhaled after a normal exhalation.

B. Maximum volume of air that can be forcefully exhaled after maximum inspiration.

C. Total volume of air exhaled during the first second of forced expiration.

D. Volume of air remaining in the lungs after forced exhalation

B

Recommendation for advanced COPD treatment:

A. daily antibiotics

B. short acting beta agonist

C. oral bronchodilator

D. long-acting beta agonist

D

A 55-year-old man with a history of smoking presents with a persistent cough and hemoptysis. A chest X-ray reveals a solitary lung nodule. What is the most appropriate next step?

A. CT scan of the chest

B. Bronchoscopy

C. PET scan

D. Sputum culture

A

The nurse practitioner caring for the hospitalized 14-year-old patient with multiple days of high concentration oxygen should evaluate the patient for which of the following exams?

A. Vagus nerve exam

B. 2D Echocardiography

C. Facial nerve exam

D. Visual acuity test

D