Family Nurse Practitioner Q&A Flashcards Assessment test with 100% correct answers 2025

Which of the following is used to screen for color blindness in a 7-year-old boy?

A. Snellen chart

B. Ishihara chart

C. Cover/uncover test

D. Red Reflex

B. Ishihara chart

The ishihara chart (or ishihara color test) is used to evaluate color blindness and can be used in patients ranging from school-aged children to adults. It displays colored numbers with different colored dots on the background. A pediatric color vision test for preschool children (3-6 years of age) uses shapes instead of numbers.

A 70-year-old male patient complains of a bright-red-colored spot that has been present in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new-onset cough from a recent viral upper respiratory infection. The only medicine he is taking is Bayer aspirin 1 tablet a day. Which of the following actions is appropriate follow-up for this 70-year-old patient?

A. Refer the patient to an optometrist

B. Refer the patient to an ophthalmologist

C. Advise the patient that the condition is benign and will resolve spontaneously

D. prescribe an ophthalmic antibiotic solution

C. Advise the patient that the condition is benign and will resolve spontaneously. Subconjunctival hemorrhages do not require any treatment. The blood in the eye will be absorbed within 10 to 14 days.

Which of the following is an accurate description of eliciting Murphy's sign?

A. On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle.

B. Bend the patient's hips and knees at 90 degrees, then passively rotate the hip externally, and internally.

C. Ask the patient to squat, then place the stethoscope on the apical area.

D. Press into the abdomen deeply, then release it suddenly.

A. On deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle.

Murphy's sign is tested during an abdominal examination for biliary disorders. As the patient breathes in, the abdominal contents are pushed downward as the diaphragm moves down and the lungs expand. As the patient stops/hold the breath, the gallbladder comes in contact with the examiner's fingers and may elicit pain. To be considered positive, the same maneuver must not elicit pain when performed on the left side. A negative Murphy's test in the elderly is not useful for ruling out cholecystitis if history and other tests suggest the diagnosis.

A middle-aged woman who works in the housekeeping department of a hospital presents to the employee health clinic with a complaint of a needlestick too her left thumb. The needle was in one of the garbage bags from the emergency department. The patient had a little bleeding that stopped spontaneously. Which of the following is the next step?

A. Order an enzyme-linked immunosorbent assay (ELISA) test, as soon as possible.

B. Recommend a tetanus booster in 1 week.

C. Offer the patient hepatitis B immunoglobulin.

D. Order a chest x-ray

A. order an enzyme-linked immunosorbent assay (ELISA) test as soon as possible

Employee health clinic protocols for needlesticks recommend ordering an ELISA test as soon as possible to establish baseline blood work for the employee.

A 22-year-old sexually active woman is complaining of amenorrhea and new-onset bloody vaginal spotting. On examination, her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse practitioner order initially?

A. Flat plate of the abdomen

B. Complete blood count (CBC) with with cell differential.

C. Urine pregnancy test.

D. pelvic ultrasound.

C. Urine Pregnancy Test

The patient's history of amenorrhea and new onset of bloody vaginal spotting combined with positive physical findings of left adnexal tenderness and cervical motion tenderness are highly suggestive of an ectopic pregnancy rather than pelvic inflammatory disease (PID). Refer this patient to the emergency department if ectopic pregnancy is suspected. The presence of amenorrhea should be treated as a pregnancy until proven otherwise.

You can determine a pulse deficit by counting the:

A. Apical and radial pulses at the same time, then finding the difference between the two

B. Apical pulse first, then the radial pulse, and subtracting to find the difference between the two.

C. Apical pulse and the femoral pulse at the same time and finding the difference between the two.

D. Radial pulse first, then counting the femoral pulse and subtracting to find the difference between the two.

A. Apical and radial pulses at the same time, then finding the difference between the two.

The pulse deficit is the difference between the apical pulse and the radial pulse. These should be taken at the same time, which will require that two people take the pulse: one with a stethoscope and one at the wrist. Count for 1 full minute. Then subtract the radial from the apical.

A 30-year-old chef complains of pruritic hives over her chest and arms, but denies difficulty swallowing or breathing. She reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate?

A. Obtain a complete and thorough history

B. Recommend an oral antihistamine such as diphenhydramine 25 mg po QID

C. Give an injection of epinephrine 1:1000 intramuscularly STAT.

D. Call 911

A. Obtain a complete and through history

Before prescribing medications, a through history must be obtained to determine possible causes of hives. The patient denied difficulty with swallowing and breathing, so there was no medical emergency that would require calling 911.

When the nurse practitioner is evaluating a patient for intermittent claudication, he or she would first:

A. Order a venogram

B. order TED anti-embolism stockings

C. Check the ankle and brachial blood pressures before and after exercise

D. check the pedal and posterior tibial pulses.

C. Check the ankle and brachial blood pressures before and after exercise.

Initial evaluation for intermittent claudication would include checking the ankle and brachial blood pressures before and after exercise.

A nurse practitioner is doing a funduscopic exam on a 35-year-old woman during a routine physical exam. He notices that she has sharp disc margins and a yellowish-orange color in the macular area. The ratio of veins to arteries is 3:2. What is the next most appropriate action?

A. Advise the patient that she had a normal exam.

B. Advise the patient that she had an abnormal exam.

C. Refer the patient to the emergency room.

D. Refer the patient to an opthalmologist.

A. Advise the patient that she had a normal exam

The optic disc of a normal examination has sharp margins, a yellowish-orange to a creamy pink color, and round or oval shape. To test, have the patient look at a distant fixed point and direct the light of the ophthalmoscope at the fundus. The ophthalmoscope (set at +8 to +10) should be close to your eyes; your head and scope move together. Check for the red reflux, then adjust the diopter setting; approach more closely to inspect the optic disc, veins, arteries, and the macula. The veins are darker in color and larger than the arterioles (3:2 ratio).

What is the clinical significance of this finding in a 35-year-old patient?

A. The patient has a higher risk of blindness.

B. The patient should be evaluated for hyperlipidemia.

C. The patient should be evaluated by an ophthalmologist.

D. The patient should be evaluated for acute glaucoma.

B. The patient should be evaluated for hyperlipidemia.

Arcus senilis is caused by lipid deposits deep in the edge of the cornea and is quite commonly present in the elderly. However, it can also appear earlier in life as a result of hypercholesterolemia.

All of the following are associated with emphysema except:

A. A barrel-shaped chest

B. Pursed-lip breathing

C. A chest radiograph result with infiltrates and flattening of the costobertebral angle

D. Dyspnea when at rest.

C. A chest radiograph result with infiltrates and flattening of the costovertebral angle.

Emphysema is characterized by having a barrel-shaped chest, pursed-lip breathing, and dyspnea when at rest. Infiltrates on an x-ray indicated bacterial infection, such as pneumonia.

A 56-year-old mechanic is brought to your office complaining of heavy pressure in the substernal area of his chest that is radiating to his jaw. The pain began while he was lifting up a tire. He now appears pale and is diaphoretic. His blood pressure is 199/60 mmHg, and his pulse is 50 beats/minute. What is the most appropriate action?

A. Perform a 12-lead EKG

B. Call 9-1-1

C. Administer a morphine injection for pain

D. Observe the patient in the office

B. Call 9-1-1

Heavy chest pressure in the substernal area radiating to the jaw, diaphoresis, low blood pressure, and bradycardia are signs of cardiac arrest. This patient is exhibiting classic symptoms of a myocardial infarction and needs immediate treatment. Call 9-1-1 immediately and transfer the patient to the emergency room.

A 20-year-old Asian man reports pain in his right knee after twisting it while playing soccer. The injured knee locks up when he attempts to straighten his leg. Which of the following actions is the best course for this patient?

A. Refer him to an orthopedic specialist

B. Refer him to a chiropractor

C. Advise him that the clicking noise will resolve within 2 to 4 weeks

D. Advise him to use an elastic bandage wrap during the first 2 weeks for knee support and to see you again for reevaluation.

A. Refer him to an orthopedic specialist.

Referral to orthopedics is advised for evaluation of the need for treatment and surgery (arthroscopic repair). If the tear is minor and the pain and other symptoms resolve quickly, muscle-strengthening exercises may be all that is needed to recover fully. In this case, a patient is usually referred to physical therapy. A large meniscus tear that causes symptoms or mechanical problems with the function of the knee joint may require arthroscopic surgery for repair.

Which of the following situations is considered emergent?

A. A laceration on the lower leg of a patient who has been taking aspirin (Bayer) 81 mg every other day.

B. Rapid breathing and tachycardia in a patient with a fever.

C. An elderly man with abdominal pain whose vital signs appear stable.

D. A 37-year-old male biker with a concussion due to a fall who is slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs.

D. A 37-year-old male biker with a concussion due to a fall who is slightly agitated and does not appear to understand instructions given by the medical assistant checking his vital signs.

The biker who has the concussion is the emergent situation due to his agitation and his inability to follow directions, which could mean he has some type of brain trauma. A concussion is a traumatic brain injury (TBI) that may result in a bad headache, altered levels of alertness, or unconsciousness. The following are emergency symptoms for which immediate medical care should be sought: changes in alertness and consciousness, seizures, muscle weakness on one or both sides, persistent confusion, repeated vomiting, unequal pupils, unusual eye movements, problems with walking, or coma. The patient on aspirin who has a laceration can be treated with pressure to stop the bleeding until help arrives. The elderly man with abdominal pain has apparently normal vital signs. Tachycardia is common in patients with fever.

Which type of breath sounds are best heard over the base of the lungs?

A. Fine breath sounds

B. Vesicular breath sounds

C. Bronchial sounds

D. Tracheal breath sounds

B. Vesicular breath sounds.

Vesicular breath sounds are heard best over the base of the lungs. Vesicular sounds are soft and/or blowing, heard throughout inspiration, and fade away with expiration. Bronchial sounds are heard over the bronchi, the largest tubes in the anterior chest. Sounds are loud and high pitched. Tracheal breath sounds are heard over the trachea. These sound harsh and similar to air being blown through a pipe. Vesicular breath sounds are heard best over the base of the lungs. Vesicular sounds are soft and/or blowing, heard throughout inspiration and fade away with expiration. Bronchial sounds are heard over the bronchi, the largest tubes in the anterior chest. Sounds are loud and high pitched. Tracheal breath sounds are heard over the trachea. These sound harsh and similar to air being blown through a pipe.

Which of the following is considered an objective finding in patients who have a case of suppurative otitis media?

A. Erythema of the tympanic membrane

B. Decreased mobility of the tympanic membrane as measured by tympanogram.

C. Displacement of the light reflex.

D. Bulging of the tympanic membrane.

B. Decreased mobility of the tympanic membrane as measured by tympanogram.

Acute suppurative otitis media is an acute infection affecting the mucosal lining of the middle ear and the mastoid air system. Suppurative stage: The tympanic membrane bulges and ruptures spontaneously through a small perforation in the pars tensa. Ear discharge is usually present. Diagnosis is usually made simply by looking at the eardrum through an otoscope. The eardrum will appear red and swollen, and may appear either abnormally drawn inward or bulging outward. Using the tympanogram with the otoscope allows a puff of air to be blown lightly into the ear. Normally, this should cause movement of the eardrum. In an infection, or when there is fluid behind the eardrum, this movement may be decreased or absent.

All of the following are considered benign physiological variants except:

A. Internal tibial torsion

B. Supernumerary nipples

C. Split uvula

D. Cheilosis

D. Cheilosis

Cheilosis or angular cheilosis (perleche) is an acute or chronic inflammation of the labial mucosa and adjacent skin due to excessive moisture and/or salivation. The corners of the mouth are macerated with fissures and painful reddened skin. Risk factors are dentures, poor oral hygiene, drooling, dry mouth (sicca symptoms), oral fungal infection, immunodeficiency, and vitamin deficiency.

A patient who recently returned from a vacation in Latin America complains of a severe headache and stiff neck that a were accompanied by a high fever for the past 12 hours. While examining the patient, the nurse practitioner flexes both the patient's hips and legs and then tells the patient to straighten them against resistance. The name of this test is:

A. Kernig's maneuver

B. Brudzinski's maneuver

C. Murphy's sign

D. Homan's sign

A. Kernig's maneuver

Kernig's maneuver is performed by having the patient flex both hips and legs and then straighten the legs against resistance, testing for meningeal and spinal inflammation. Flexion of hip and knees is a positive sign for meningitis. Brudzinski's maneuver is performed by placing the patient's hands behind his or her head, and gently tucking chin to chest. Murphy's sign is elicited by having the patient inspire with the tips of the examiner's fingers placed on the right upper quadrant, at the liver border, under the ribs. Pain on inspiration is suggestive of cholecystitis. Homan's sign is flexion of the foot, causing pain in the posterior calf area, suggestive of a deep vein thrombosis.

A mother brings in her 6-year-old daughter to see the nurse practitioner (NP). She complains that the school nurse found a few nits in her daughter's hair. The mother states that the school has a "no nits" policy regarding head lice and her daughter cannot go back to school until all the nits have been removed. The child was treated with permethrin shampoo (Nix) twice about 3 months ago. During the physical exam, the NP sees a few nits that are about 2 inches away from the scalp. The child denies itchiness on her scalp. Which of the following is the best action for the NP to follow?

A. Prescribe lindane (Kwell) for the child because she may have head lice that are resistant to permethrin.

B. Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair

C. Advise the mother to retreat the child with permethrin cream instead of shampoo

D. Reassure the mother that the nits will probably drop off after a few weeks.

B. Advise the mother to use a nit comb after spraying the child's hair with white distilled vinegar, wait for 15 minutes, and then rinse the hair

According to the Centers for Disease Control and Prevention (CDC), nits that are more than 1/4 inch from the scalp are usually not viable. The child also does not have an itchy scalp. One method of removal is to soak the patient's head with distilled vinegar (and then rinse after), which will break down the protein of the nit casings, making it easy to comb them out of the hair.

The cremasteric reflex is elicited by:

A. Asking the patient to open his or her mouth and touching the back of the pharynx with a tongue blade.

B. Hitting the biceps tendon briskly with a reflex hammer and watching the lower arm for movement.

C. Hitting the patellar tendon briskly with a reflex hammer and watching the lower leg for movement.

D. Stroking the inner thigh of a male patient and watching the testicle on the ipsilateral side rise up toward the body.

D. Stroking the inner thigh of a male patient and watching the testicle on the ipsilateral side rise up toward the body.

The cremasteric reflex is elicited by stroking the inner thigh (proximal to distal) with a blunt instrument such as a handle of the reflex hammer. The testicle and scrotum should rise on the stroked (ipsilateral) side.

A 12-year-old girl is complaining of a 2-week history of facial pressure that worsens when she bends over. She complains of tooth pain in her upper molars on the right side of her face. On physical exam, her lung and heart sounds are normal. Which of the following is the most likely diagnosis?

A. An acute dental abscess

B. Chronic sinusitis

C. Acute sinusitis

D. Severe allergic rhinitis

C. Acute sinusitis.

Signs and symptoms of acute sinusitis include headaches, facial pain that worsens with bending over, eye/ear pressure and pain, aching in upper jaw/teeth, reduced smell and taste, cough (especially at night due to the nasal drainage), sore throat, bad breath, and fatigue.

You are checking a 75-year-old woman's breast during an annual gynecological exam. The left nipple and areola are scaly and reddened. The patient denies pain or pruritus. She has noticed this scaliness on her left nipple for the past 8 months. Her dermatologist gave her a potent topical steroid, which she used twice a day for 1 month. The patient never went back for the follow-up. She still has the rash and wants an evaluation. Which of the following is the best invention for this patient?

A. Prescribe another potent topical steroid and tell the patient to use it twice a day for 4 weeks.

B. Order a mammogram and refer the patient to a breast surgeon.

C. Advise the patient to stop using soap on her breasts when she bathes and avoid drying up the skin on her areolae and nipples.

D. Order a sonogram of the breast and fine-needle biopsy of the breast.

B. Order a mammogram and refer the patient to a breast surgeon

A scaly, reddened rash on the breast that does not resolve after a few weeks of medical treatment may indicate breast cancer. She should have a mammogram performed and see a breast surgeon for evaluation and treatment. Paget's disease of the breast is a rare type of cancer involving the skin of the nipple and, usually, the areola. It may be misdiagnosed at first because its early symptoms are similar to those caused by some benign skin conditions. Most patients with Paget's disease of the breast also have one or more tumors inside the same breast, either ductal carcinoma in situ or invasive breast cancer.

During a breast exam of a 30-year-old nulliparous woman, the nurse practitioner palpates several rubbery mobile areas of breast tissue. They are slightly tender to palpation. Both breasts have symmetrical findings. There are no skin changes or any nipple discharge. The patient is expecting her menstrual period in 5 days. Which of the following would you recommend?

A. Referral to a gynecologist for further evaluation.

B. Advise the patient to return in 1 week after her period so her breasts can be checked.

C. Advise the patient to return in 6 months to have her breasts rechecked.

D. Schedule the patient for a mammogram.

B. Advise the patient to return 1 week after her period so her breasts can be rechecked.

Symptoms of fibrocystic breast disease include cyclic tenderness with prominent breast tissue that is present in both breasts. The symptoms are worse about 1 week before menses. A few days after menses starts, the bloating and breast tenderness resolve. Symptoms are caused by elevated hormone levels (progesterone). Fibrocystic disease is differentiated from breast cancer by the lack of a dominant mass or other symptoms such as peau d'orange, dimpling, retraction, or eczema-like rash on the nipples and areola.

Which of the following is useful in primary care when evaluating a patient for possible acute sinusitis or hydrocele?

A. Checking for the cermasteric reflex

B. Transillumination

C. Ultrasound

D. CT scan

B. Transillumination.

Transillumination is a technique used with a light source, such as an otoscope, to visualize fluid below the skin surface, which will appear as a "glow." Ultrasound and CT scan are not readily available in the primary care setting; the patient must be sent to radiography for these tests to be preformed.

The following statements are true about Wilms' tumor except:

A. The most frequent clinical sign is a palpable abdominal mass

B. It is a congenital tumor of the kidney

C. Microscopic or gross hematuria is sometimes present

D. The tumor commonly crosses the midline of the abdomen when it is discovered.

D. The tumor commonly crosses the midline of the abdomen when it is discovered. A Wilms' tumor is a congenital tumor of the kidney that should never be palpated, once diagnosed, to avoid the spread of the tumor cells. Microscopic or gross hematuria may be present.

A female patient complains of dizziness when she moves her head. You suspect benign paroxysmal positional vertigo. The diagnosis is supported by the presence of:

A. Tinnitus

B. Horizontal nystagmus with rapid head movements

C. New-onset hearing loss

D. Duration longer than 2 years.

B. Horizontal nystagmus with rapid head movement. Symptoms of benign paroxysmal positional vertigo include horizontal nystagmus with rapid head movement. Performing the Dix-Hallpike maneuver and/or the roll test will cause the symptoms of vertigo to appear.

All of the following are physiological changes that occur in the body as we age except:

A. the half-life of some drugs is prolonged

B. There is an increase in cholesterol production by the liver

C. There is a mild increase in renal function

D. There is a slight decrease in the activity of the immune system

C. There is a mild increase in renal function

Physiological changes that occur in the elderly include decrease in renal function, increased half-life of some medications, increase in cholesterol production by the liver, and slight decrease in the immune system.

Which of the following physical exam findings is most specific for systemic lupus erythematous (SLE)?

A. Swollen and painful joint involvement

B. Fatigue and myalgia

C. Stiffness and swelling of multiple joints

D. Malar rash

D. Malar rash

A malar rash is the butterfly-shaped rash on the middle of the face that is caused by a type of photosensitivity reaction. It is associated with systemic lupus erythematosus (SLE). The other answer options are also found with diseases such as rheumatoid arthritis, polymyalgia rheumatica, and others.

The bell of the stethoscope is best used for auscultation of which of the following?

A. S3 and S4 and low-pitched tones

B. S3 and S4 only

C. S1 and S2 and high-pitched tones

D. S1 and S2 only

A. S3 and S4 and low-pitched tones

The bell is most useful for picking up low-pitched sounds; for example, S3, S4, and mitral stenosis. The diaphragm is most useful for picking up high-pitched sounds; for example, S1, S2, aortic or mitral regurgitation, and pericardial friction rubs.

The sentinel nodes (Virchow's nodes) are found at the:

A. Right axillary area

B. Left supraclavicular area

C. Posterior cervical chain

D. Submandibular chain

B. Left supraclavicular area

The sentinel nodes are found at the supraclavicular area of the chest. They are the first lymph nodes that a cancer lesion will drain into. Therefore, when cancer is diagnosed, these nodes are biopsied to see whether the cancer has spread into the lymph system.

A White 15-year-old male is brought by his father for a physical exam. The father is concerned that his son is "too short" for his age. The father reports that when he was the same age, he was much taller. His son wants to try out for the football team, but the father is concerned because his son might be "too short" to join. Which of the following physical exam findings is worrisome?

A. Small, smooth testicles with no pubic or facial hair

B. Smooth testicles with rugated scrotum that is a darker color than the patient's normal skin color

C. Smooth testicles with coarse and curly pubic hair

D. Straight pubic and axillary hair with a long thin penis

A. Small, smooth testicles with no pubic or facial hair.

Small, smooth testicles with no pubic or facial hair (Tanner stage I) is a worrisome finding at the age of 14 years because it signifies that the boy is not in the pubertal stage yet. The average age of onset of puberty among boys is 12 years (range, 10-14 years). The maximum growth spurt in boys occurs about 2 years after the onset of puberty. Boys start about 1 year later than girls and continue to grow until their early 20s (college).

During the physical exam of a 60-year-old adult, the nurse practitioner performs an abdominal exam. The nurse practitioner is checking the left upper quadrant of the abdomen. During percussion, an area of dullness is noted beneath the lower left ribcage. Which of the following is a true statement regarding the spleen?

A. The spleen is not palpable in the majority of healthy adults.

B. The spleen is 8 to 10 cm in the left midaxillary line at its longest axis.

C. The spleen is 2 to 6 cm between the 9th and 11th ribs on the left midaxillary line.

D. The splenic size varies depending on the patient's gender

A. The spleen is not palpable in the majority of healthy adults.

The spleen is located in the left upper quadrant of the abdomen under the diaphragm and is protected by the lower ribcage. In the majority of adults, it is not palpable. The spleen's longest axis is 11 to 20 cm. Any spleen larger than 20 cm is enlarged. The best test for evaluating splenic (or hepatic) size is the abdominal ultrasound. Disorders that can cause splenomegaly include mononucleosis, sickle cell disease, congestive heart failure, bone marrow cancers )myeloma, leukemia), and several other diseases.

A 60-year-old female truck driver presents to the outpatient urgent care clinic of a hospital complaining of the worsening of her lower-back pain the past few days. Pain is accompanied by numbness in the perineal area. She describes the pain started on the mid-buttock of the left leg and recently started to go down the lateral aspect of the leg toward the top of the foot. During the physical exam, the ankle jerk and the knee jerk reflex are 1+ on the affected leg and 2+ on the other leg. The pedal, posterior tibialis, and popliteal pulses are the same on both legs. Which of the following tests should the nurse practitioner consider for the patient.

A. Order an MRI scan of the lumbosacral spine as soon as possible.

B. Write a prescription for ibuprofen 800 mg PO QID with a muscle relaxant and advise the patient to follow up with her primary care provider within 3 days.

C. Refer the patient to an orthopedic surgeon

D. Ordering an imaging study of the spine is premature because the majority of low back pain cases resolve within 10 to 12 weeks.

A. Order an MRI scan of the spine as soon as possible.

The patient has new-onset numbness of the perineal area (saddle anesthesia), the sciatica is worsening, and the deep tendon reflexes of the lower extremity are decreased on the afflicted side. Rule out cauda equine syndrome and order and MRI (preferred test). The MRI can detect nerve root compression, herniated disk, cancer, and spinal stenosis (narrowing of the spinal canal). In addition, the patient needs to follow up with a neurologist as soon as possible.

What is the best description of Cullen's sign?

A. The onset of hyperactive bowel sound before the onset of ileus

B. A reddish-purple discoloration that is located on the flank area.

C. A bluish discoloration or bruising that is located on the umbilial area.

D. The acute onset of subcutaneous bleeding seen during acute pancreatitis.

C. A bluish discoloration or bruising that is located on the umbilical area.

Cullen's sign is the acute onset of bluish discoloration that is located on the umbilical/periumbilical area, caused by bruising underneath the skin. A bluish discoloration located on the flank area is called the Grey-Turner's sign. It is a sign of a severe case of pancreatitis.

A 45-year-old man fell asleep while smoking in his bedroom and started a fire. According to the patient, he refused to go to the emergency department because he had only minor burns. About 12 hours later, he presents to a walk-in urgent care center complaining of a new cough that is productive of saliva with clear mucus containing small carbonaceous black particles. his brows appear singed. Which of the following is the priority when evaluating this patient?

A Perform a medical history, including prescription, over-the-counter, and herbal medications.

B. Assess the patient for respiratory distress.

C. Evaluate the patient for asthma and atopy

D. Use the rule of nines to evaluate the total body surface area (TBSA)

B. Assess the patient for respiratory distress

Assess the patient for respiratory distress as soon as possible. Follow the "ABCs" and assess the patient for any life-threatening symptoms. Smoke inhalation lung injury is the main cause of death in thermal burn victims.

A 55-year-old woman brings her mother, who is 82 years of age, to the emergency department of a local hospital. She reports she found her mother on the floor when she checked on her that morning. Her mother was awake and oriented, but needed help getting up. Her mother states that she thinks she passed out. She is being evaluated by a physician who orders an EKG and x-rays of both hips. Regarding laboratory testing, which of the following tests is important to perform initially?

A. Urinalysis

B. Serum electrolytes

C. Blood glucose

D. Hemoglobin and hematocrit

C. Blood glucose

Checking the blood glucose is indicated for patients with syncopal and near-syncopal episodes. The nurse practitioner should also perform a thorough history of the incident. Possible causes of syncope are cardiac arrhythmia, vasovagal, hypoglycemia, orthostatic hypotension, seizure, accidental fall, and others.

One of the developmental milestones for this age group is the ability to draw a stick-figure "person" with six separate body parts. What is the age group that this finding is associated with.

A. 3-year-olds

B. 4-year-olds

C. 5-year-olds

D. 6-year-olds

C. 5-year-olds

By 5 years of age, a child can draw a stick person with six body parts, can copy a triangle, can print some letters and numbers, and can count to 10 or more.

An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the rapid onset of severe low-back pain accompanied by abdominal pain that is gradually worsening. The patient appears pale and complains that he does not feel well. During the abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus as she palpates this area with her hand. Which of the following conditions is mostly likely?

A. Abdominal aortic aneurysm

B. Cauda equina syndrome

C. Acute diverticulitis

D. Adenocarcinoma of the colon

A. Abdominal aortic aneurysm

Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray or abdominal ultrasound. Although small aneurysms are usually not detectable during abdominal exams, the larger aneurysms may be palpable during an abdominal exam, but abdominal obesity will obscure the findings. The symptoms in this case point toward a rapidly dissecting aneurysm. The best action is to call 911 STAT.

A 75-year-old woman presents complaining of a soft lump on her abdomen that is located on the periumbilical area. She tells the nurse practitioner that she does not know how long she has had the lump or whether it has changed in size or shape. She denies abdominal pain, problems with defecation, loss of appetite, weight loss, trauma. When performing an abdominal exam, what is the best method to differentiate an abdominal wall mass from an intra-abdominal mass?

A. Palpate the abdominal wall while the patient is relaxed

B. Instruct the patient to lift her head off the table while tensing her abdominal muscles to visualize any masses and then palpate the abdominal wall

C. Instruct the patient to lie still for a few seconds while you palpate the abdominal wall.

D. Palpate the abdomen deeply, then release the palpating hand quickly.

B. Instruct the patient to lift her head off the table while tensing her abdominal muscles to visualize any masses and then palpate the abdominal wall.

An abdominal wall mass will become more prominent when the abdominal wall muscles are tense. If it is an intra-abdominal mass, it will be pressed down by the muscles and will become less obvious or disappear. Some of the most common abdominal wall masses are hernias (epigastric, umbilical, incisional). This patient has a periumbilical hernia (soft lump on her abdomen that is located on the periumbilical area that is painless).

A sexually active 16-year-old girl is brought by her mother for a physical exam. During the exam, the nurse practitioner notes some bruises on both breasts.All of the following are important areas to evaluate in this patient during this visit except:

A. Depression

B. Tanner stage

C. Sexual history

D. Sexually transmitted diseases (STDs)

B. Tanner stage

The stem of the question is asking for the important areas to evaluate in this patient "during this visit." This is a priority-type question. The priorities to evaluate in this patient are depression, sexually transmitted disease (STD) testing, and sexual history. The Tanner staging does not have to be done "during this visit."

A positive psoas and obturator sign is highly suggestive of which of the following conditions?

A. Ectopic pregnancy

B. Acute appendicitis

C. Peritontitis

D. Abdominal aortic aneurysm

B. Acute appendicitis

Both the psoas and obturator signs are associated with acute appendicitis. When the appendix becomes inflamed or ruptured, the blood and pus irritate the psoas and/or obturator muscles, which are both located in the retroperitoneal area. Both muscles are hip flexors and assist with hip movement.

All of the following clinical findings are major or minor criteria for pelvic inflammatory disease (PID). Which of the following is classified as a minor criterion that is not required for diagnosis of PID?

A. Cervical motion tenderness

B. Adnexal tenderness

C. Uterine tenderness

D. Oral temperature >101F (>38C)

D. Oral temperature >101F (>38C)

Pelvic inflammatory disease (PID) is a clinical diagnosis. The presence of at least one of the major criteria (cervical motion tenderness, adnexal tenderness, uterine tenderness) when combined with the history if highly suggestive of PID. Minor criteria are not necessary, but they help to support the diagnosis of PID (oral temperature >101F [>38C]), mucopurulent cervical or vaginal discharge, elevated sedimentation rate, elevated C-reactive protein, large amount of WBCs on saline microscopy of the vaginal fluid, or laboratory documentation of cervical infection with Neisseria gonorrhoeae or Chlamydia trachomatis

Which of the following is considered an abnormal finding?

A. A "clunk" sound heard while performing the Ortolani maneuver

B. A 6-month-old infant who starts to babble

C. A 10-year-old boy with aching pain on the front of the thighs that starts in late afternoon or at night

D. A 12-month-old who is "cruising"

A. A "clunk" sound heard while performing the Ortolani maneuver

The "clunk" sound during the Ortolani maneuver is a positive finding and signifies a possible hip abnormality (hip dysplasia) in infants. Refer the infant to a pediatric orthopedist. Infants start to babble at 6 months. At 12 months, babies lear to "cruise" or to hold onto furniture while walking. Some boys and girls may have "growing pains" on both legs (or both thighs, calves, or behind the knees), which are usually felt in the late afternoon, evening, and/or at night. These symptoms should not interfere with the child's ability to play and affect children from age 3 to 12 years. Stretching exercises of the thighs and hamstrings, massaging the area, and warm packs are helpful. If pain affects only one leg or hip, it is abnormal (rule out bone cancer, sarcoma, leukemia, hip abnormalities). In such cases, refer the patient to a pediatric orthopedist.

A 36-year-old woman is seen by the nurse practitioner for a Pap smear and gynecological exam. The patient is of Ashkenazi Jewish ethnicity. Her mother died of breast cancer at age 50 years. Her 57-year-old sister has recently been diagnosed with breast cancer. The breast exam is negative for a dominant mass and the axillae doe not contain any masses. All of the following are appropriate measures for this patient except:

A. Mammogram and MRI of the breast

B. Referral to a breast specialist

C. Check serum carcinoembryonic atigen (CEA) and cancer antigen (CA) 125 levels.

D. Genetic counseling and BRCA testing.

C. Check serum carcinoembryonic antigen (CEA) and cancer antigen (CA) 125 levels

The patient is a woman who is of Ashkenazi Jewish background with a positive family history of breast cancer (mother, sister). She is at very high risk for BRCA1 or BRCA2 mutations (hereditary breast cancer). The U.S. Preventive Services Task Force (2013) recommends that primary care providers screen women for a family history of breast, ovarian, tubal, or peritoneal cancer. Women with positive screening results should receive genetic screening, and, if indicated after counseling, BRCA testing. These high-risk women are screened with a mammogram and breast MRI and are best managed by breast cancer specialists.

A preschool girl who is homeschooled is brought by her mother to the walk-in clinic because of acute onset of fever, runny nose, cough, sore throat, and red eyes with a morbilliform rash. The mother reports that her daughter has never been immunized. The family recently returned from a vacation. Which of the following conditions is most likely?

A. Rubella

B. Varicella

C. Fifth Disease

D. Rubeola

D. Rubeola

Rubeola, also known as measles, is caused by the rubeola virus. It is very contagious and is transmitted via droplets like the common cold. Koplik's spots (tiny white spots in buccal mucosa) are present during the prodromal period. The blotchy pink rash is also known as a morbilliform rash. Treatment is symptomatic and most people recover in 2 to 3 weeks. Measles outbreaks caused by poor MMR (measles, mumps, rubella) vaccination rates have been reported in some areas of the United States. Do not confuse rubeola with rubella (German Measles).