Description

1. Question: Your patient presents with pale, waxy legs, weak peripheral pulses, and states he is having difficulty walking great distances due to the pain in his calves. The most appropriate non-invasive test to evaluate his leg vascular flow quality is which of the following exams?
2. Question: Your 53 year-old female patient is experiencing shortness of breath and has a diagnosis of pulmonary arterial hypertension. Which ventricle is directly experiencing increased afterload from this disease state?
3. Question: A patient arrives to the urgent care clinic after several days of crushing chest pain rated 10 out of 10 on a zero to 10 scale with associated left arm numbness and shortness of breath. The pain has lessened over the last 24 hrs to a 4 out of 10. Given the extended duration from onset to presentation, what finding would be expected on the EKG?
4. Question: An otherwise healthy African American adult male has been diagnosed with hypertension. He has been restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is still elevated. Which is the BEST medication to prescribe him?
5. Question: A nurse practitioner places a 76-year-old patient on nifedipine (Procardia) 10 mg t.i.d. for angina. The patient is unable to remember to take the medication at the scheduled times. The practitioner should:
6. Question: The most important diagnostic factor in evaluating angina pectoris is the patient’s:
7. Question: Your patient is complaining of paroxysmal atrial fibrillation. Which medical procedure is commonly used to treat this condition?
8. Question: Ophthalmic examination of a patient with a 10-year history of poorly controlled hypertension, despite three-drug-therapy, would most likely reveal:
9. Question: An older adult with diabetes mellitus presents with leg cramps. She states that the cramps were worst when walking to the supermarket. If she stops to rest, the pain subsides. The nurse practitioner knows that this patient needs a workup for:
10. Question: The inability to fully relax the myocardium during relaxation is a trademark of which of the following diagnoses?
11. Question: A 18-year-old woman presents with increased thirst, frequent urination, and unexplained weight loss. Her fasting plasma glucose level is 200 mg/dL. What is the most likely diagnosis?
12. Question: A 48-year-old female presents with a history of hypothyroidism controlled with levothyroxine (Synthroid). She reports that she has been taking excessive amounts of the drug over the past year, to control her weight. This behavior can cause or aggravate which of the following conditions?
13. Question: A patient presents for recheck of their thyroid-stimulating hormone (TSH). The patient was started on levothyroxine (Synthroid) 50 mcg 8 weeks ago. Today the TSH is 10.5 μU/mL [normal = 0.4-2.5 μU/mL]. Based on this lab work, which is the most appropriate action?
14. Question: Which of the following is the most common cause of Cushing’s Syndrome?
15. Question: Pheochromocytoma is best diagnosed by which of the following tests:
16. Question: A 33-year-old woman presents with intermittent palpitations, anxiety, and heat intolerance. Her thyroid function tests reveal low TSH and high free T4. What is the most likely diagnosis?
17. Question: All the following are factors associated with a development of type II diabetes EXCEPT:
18. Question: An adult female presents with a chief complaint of fatigue and weight gain. She states that she doesn’t feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings would support this diagnosis?
19. Question: After confirming your patient is hypercortisolemic, a critical part of the diagnostic work up is to do which next?
20. Question: A patient with diabetes mellitus who is taking insulin presents for a follow up. The patient’s blood glucose log reveals wide variations in readings, as well as numerous episodes of hyperglycemia and hypoglycemia. Which is the nurse practitioner’s best therapeutic intervention?
21. Question: An elderly patient is being admitted to the skilled nursing facility and is being screened for the risk of falling. Which of the following information would trigger a complete falls assessment?
22. Question: How should a nurse practitioner evaluate if palliative care is effective?
23. Question: Which is best performed to assess the risk for fall in an 88-year old adult?
24. Question: Which of the following gastrointestinal changes is associated with normal aging?
25. Question: A 90-year-old female is brought to the clinic by her neighbor. She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner’s pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next?
26. Question: A 42-year-old female presents with large watery frequent stools. She also reports abdominal pain and cramping, bloating and gas. What is the primary management for this patient?
27. Question: An older adult has a follow-up fasting lipid panel 6 months after making therapeutic lifestyle changes. LDL=205mg/dL (Normal=<100mg/dL), HDL=44mg/dL, and triglycerides=180mg/dL (Normal-<150mg/dL). The patient is placed on statin therapy. Two months later, the patient presents for follow-up and complains of body aches. In addition to creatine phosphokinase (CPK), which of the following tests should the nurse practitioner order?
28. Question: The best medication for a patient who presents with irritable bowel syndrome with cramping is:
29. Question: A patient states that his girlfriend was recently diagnosed with hepatitis, and he tests positive for hepatitis C. He expresses fear of the diagnosis because his father died after a liver transplantation. Which existing information in the patient’s history is the most significant factor in the progression of liver failure?
30. Question: A 38-year-old male presents to the ER with complaints of abdominal pain, intermittent diarrhea, and has a positive occult blood. A stool culture is done which does not show any organism growth. His CRP and fecal calprotectin are elevated, and a colonoscopy is performed with biopsy which shows changes consistent with Crohn’s disease, which are mild. What of the following represent the first line of treatment for this illness?
31. Question: A 63-year-old male presents with a suspected lower GI bleed. He reports passing frank small amounts of blood several times today. He denies use of NSAID’s or blood thinners. What questions would be important to ask to further differentiate your diagnosis?
32. Question: An adult female with rheumatoid arthritis presents to the office for a follow up. She is currently taking methotrexate and over the counter Ibuprofen. Today she complains of severe stomach pain and intense abdominal cramping. After the nurse practitioner makes appropriate adjustments to the patient’s medication regimen, the patient still complains of abdominal discomfort and reports dark stools. The practitioner suspects:
33. Question: An adult female presents with profus, watery diarrhea and loss of appetite for the past 5 days with 4-5 stools per day. Stool cultures are positive for C Diff. Patient cannot afford Vancomycin. The most appropriate antibiotic is:
34. Question: A 29-year-old male presents with severe abdominal pain, he has a history of alcohol abuse, and recurrent pancreatitis. Patient’s Lipase is elevated, and he has nausea and vomiting as well. Abdominal CT shows inflammatory changes around the pancreas. What is the most important intervention to consider in the acute phase?
35. Question: The most common side effect of the oral ribavirin used in the treatment of hepatitis C is:
36. Question: Which of the following is not a domain of Social Determinants of Health as identified in Healthy People 2030?
37. Question: Which act formed in 1996 was created to protect patient health information from being disclosed without the patient’s consent or knowledge?
38. Question: A patient states they do not want to have any further medical care and wishes to leave against medical advice. Unknown to you, the healthcare tech then held their arm down to get an IV catheter placed against their will. The healthcare tech is at risk of being charged with which of the following:
39. Question: Your irate patient on involuntary hold due to risk of harm to themself or others says they are going to “kill you when you leave work after they get discharged”. This statement is an example of which of the following?
40. Question: An 87-year-old female has a history of ovarian cancer. She recently completed the tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she plans to stop chemotherapy; she has lived a good life and is ready to die. She is alert and very active, and lives with her son. The family is determined that the patient will complete the chemotherapy. The nurse practitioner’s most appropriate action is to:
41. Question: A 51-year-old male patient presents to the urgent care with a unilateral injected cornea and nausea. He reports visual acuity changes and light sensitivity. Which of the following is not included in your differential?
42. Question: An adult patient diagnosed with retropharyngeal abscess should be treated with which of the following antibiotics?
43. Question: 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?
44. Question: The patient with epiglottitis presents to your care with worsening shortness of breath and stridor. Which intervention should you prepare for next?
45. Question: Your patient has a Le Fort III fracture and is admitted for close monitoring. Which of the following represent a potential complication of this type of fracture?
46. Question: The patient has been diagnosed with hyphema after a car accident and airbag deployment. Treatment commonly includes which of the following medications?
47. Question: A young adult presents with a sore throat, nasal congestion, postnasal drip, no temperature elevation, and no lower respiratory involvement. The most appropriate initial intervention is to:
48. Question: Your 25-year-old male patient presents to the primary care office with a complaint of sore throat, difficulty swallowing, and flu-like symptoms. Which of the following potentially life-threatening illnesses should you rule out in your evaluation?
49. Question: An adult patient presents with acute onset of right eye pain, redness and decreased vision. Suspecting open-angle glaucoma, the nurse practitioner should:
50. Question: An elderly patient has throbbing pain in the left eye, blurred vision, marked photophobia, and redness around the iris. What is the nurse practitioner’s initial diagnosis?
51. Question: Which of the following is appropriate long-term treatment for B12 deficiency in a patient with a history of gastric bypass?
52. Question: Which of the following is not a common mechanism of neutrophil expenditure and resultant neutropenia?
53. Question: A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for:
54. Question: 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:
55. Question: Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following?
56. Question: A 14-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and:
57. Question: Treatment for symptomatic aplastic anemia includes all the following except:
58. Question: he best laboratory test to distinguish iron deficiency anemia from other anemias is:
59. Question: A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for management of pain due to pelvic fracture after motor vehicle collision. Admission labs show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection. What is the most appropriate level of intervention for this patient?
60. Question: Which of the following blood lead levels (BLL) would likely require chelation therapy?
61. Question: Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV?
62. Question: Which of the following symptoms best describes a classic case of systemic lupus erythematosus?
63. Question: 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?
64. Question: Patients with a diagnosis of myasthenia gravis are more likely to have the presence of which tissue in greater quantities?
65. Question: A 35-year-old woman presents with fatigue, joint pain, and a butterfly-shaped rash on her face. What is the most appropriate initial management in primary care?
66. Question: Your patient has been started on sulfamethoxazole for a urinary tract infection and two days later states she feels painful blistering on her skin. Which of the following life-threatening disease states are you most concerned about?
67. Question: 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?
68. Question: A patient who has active herpes zoster is at risk of shedding which contagious virus?
69. Question: Your patient presents with 2-month progressive weakness in legs, loss of coordination, and loss of bladder tone. Which of the following diseases should be investigated?
70. Question: The patient with anaphylaxis is experiencing which type of hypersensitivity response?
71. Question: The treatment of Shigeliosis is:
72. Question: Herpes zoster can be difficult to diagnose in the prodromal stage, but can later be identified by the presence of characteristic:
73. Question: An adult daycare worker presents with severe itching on the arms and around the arms and wrists. The patient’s skin is mildly excoriated from scratching. Microscopic examination of a skin reveals scabies. The treatment of choice for the patient would be?
74. Question: A 30-year-old woman presents with a history of recurrent herpes simplex virus (HSV) infections on her lips. She wants to know how to manage future outbreaks. What is the most appropriate initial management for recurrent HSV?
75. Question: A 21-year-old athlete presents with painful, erythematous, non-pustular firm cysts on both forearms, which are not the result of an injury. The patient is afebrile. Medication includes cephalexin (Keflex), 500 mg q.i.d. Two days later, the patient returns with fluctuant, pustular, larger lesions that are more painful. The nurse practitioner should perform wound:
76. Question: Using the rule of palms, a patient with burn surface equivalent to 20 of the patient’s palms would be how many percent body surface area?
77. Question: 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?
78. Question: The patient with a sebaceous cyst on the arm that is now draining is noted to have unilateral cellulitic streaking ascending proximally from the abscess site. Which of the following represents the most appropriate treatment in this scenario?
79. Question: An adult photography developer presents with two small vesicles on his right middle finger, proximal to the nail bed. He says he wears gloves when he works with photography chemicals. He admits to chewing his fingers, and notes that this is his fourth episode. Previous cultures have been negative. The MOST likely diagnosis is:
80. Question: A 27-year-old male patient, who works as a janitor, presents with a 6-month history of an intermittent rash on his hands. History reveals itching and occasional burning. Examination reveals irregularly-distributed scaly maculopapular erythematous patches extending from the dorsum of the hand several inches up the forearms, and dry palms with no nail involvement. The most likely diagnosis is:
81. Question: Which of the following distinguishes plantar fasciitis from other common foot problems?
82. Question: Your patient with a recent fall from the edge of the bathtub who developed a hip fracture should be worked up with which of the following exams?
83. Question: Your urgent care patient has been found down at home lying for 2 days straight in their urine and feces after a rave with ecstasy and binge drinking. What condition is this patient at risk for developing?
84. Question: 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?
85. Question: A 50-year-old man with a history of osteoarthritis presents with knee pain that is interfering with his daily activities. What is the most appropriate initial non-pharmacological management?
86. Question: For primary prevention of osteoporosis in females, the US Preventative Task Force recommends bone density screening:
87. Question: An adolescent athlete presents with shoulder pain and inability to raise the arm above the shoulder. The most likely diagnosis is:
88. Question: A 75-year-old presents with depression. The patient also has osteoarthritis of both knees that interferes with mobility. Which antidepressant may also benefit osteoarthritis?
89. Question: The patient undergoing a cardiac arrest after a recent fracture should be considered for which of the following potential causes of pulseless electrical activity?
90. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
91. Question: Which nationality is four times as likely as Caucasians to be diagnosed with kidney disease?
92. Question: Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis?
93. Question: An 80-year-old man with a history of chronic kidney disease (CKD) presents with increased fatigue, pruritus, and swelling in his lower extremities. Which of the following lab tests would be most important to assess the progression of his CKD?
94. Question: Patients presenting to urgent care with hematuria and RBC casts in their urine should be considered for which diagnosis?
95. Question: Which portion of the renin-angiotensin-aldosterone mechanism is inhibited by lisinopril?
96. Question: Which of the following bacteria are commonly associated with pyelonephritis?
97. Question: Which of the following states represents an example of postrenal failure?
98. Question: What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with more than 20% resistance?
99. Question: 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?
100. Question: Your patient presents to the Urgent Care with periorbital and peripheral edema and has evidence of macroalbuminuria. Which state is described by this clinical presentation?
101. Question: An adolescent male college freshman presents to the student health office with concerns about not 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. He wonders if he has a learning disability or other disorder. The nurse practitioner should respond by:
102. Question: Which of the following is a common initial symptom of Alzheimer’s disease?
103. Question: A patient is newly diagnosed with multiple sclerosis. Treatment includes prednisone with physical therapy. The nurse practitioner advises the patient to begin disease-modifying therapy:
104. Question: An elderly female is being treated with gabapentin (Neurontin) for neuropathic pain. Six months ago, she was started on a dose of 600 mg at HS. She states that she feels much better now, but that she becomes very dizzy when she gets up. Which of the following would be the best approach now?
105. Question: A geriatric male with trigeminal neuralgia who has a history of hypertension and depression is currently taking amlodipine besylate (Norvasc), 5 mg daily and sertraline (Zoloft), 25 mg daily. He is allergic to penicillin and imipramine (Tofranil). The patient has been treated unsuccessfully with gabapentin (Neurotin). The drug of choice for this patient would be:
106. Question: An elderly woman has vascular dementia. In the past week she’s become agitated, is making less sense when she talks, and is sleeping more. Vital signs are: BP=110/76, P=86 regular, R=12/min, T=97.9 degrees F (36.6 degrees C). What should the nurse practitioner do?
107. Question: 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:
108. Question: A 37-year-old woman with a history of chronic migraines presents with unilateral headache, photophobia, and nausea. She mentions that her headaches have been progressively worsening. What is the most appropriate next step in evaluation?
109. Question: 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?
110. Question: An adult patient reports increasingly frequent migraines, especially upon rising in the morning. The headaches have been successfully managed in the past with acetaminophen (Tylenol) and sumatriptan (Imitrex) p.r.n., and a neurological etiology has been ruled out. Of the following drugs, which would be recommended for prophylactic migraine management in this case?
111. Question: A mother presents her 12-month-old child with concern because the child does not yet say “mama” or “dada.” The mother reports that in the first months of life, the child enjoyed being talked to. The past medical history is negative for ear infections. The nurse practitioner should:
112. Question: A 13-year-old patient returns to the office complaining of intermittent headache for the past couple of weeks. Which would be the most concerning symptom?
113. Question: A 7-year-old boy presents with recurrent abdominal pain, diarrhea, and weight loss. What is the most appropriate initial test?
114. Question: A 15-year-old adolescent athlete complains of chest pain and fainting during intense exercise. On examination, a systolic ejection murmur is heard that increases with standing. What is the most likely diagnosis?
115. Question: A healthy unvaccinated child is exposed to Hepatitis A. The best option for therapy is:
116. Question: A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal area. Which diagnostic procedure would confirm a diagnosis of pinworm infestation?
117. Question: 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?
118. Question: 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?
119. Question: A late adolescent female is requesting information on HPV vaccine. Which of the following statements indicates need to further education?
120. Question: A nurse practitioner is assessing a 3-day-old newborn. The parents yesterday expressed concerns over breastfeeding. The newborn was assessed as jaundiced with an elevated bilirubin level at 15.0 mg/dL. The parents were instructed to increase breastfeeding and to return to the clinic today. Today’s assessment shows the newborn continues with jaundice and the bilirubin level is now 19.4 mg/dL. The nurse practitioner should:
121. Question: Which of the following symptoms are not found in anti-depressant discontinuation syndrome?
122. Question: Which of the following represent precipitating factors for excited delirium?
123. Question: The nurse practitioner prescribes amitriptyline (Elavil) for a patient with neuropathic pain secondary to diabetes mellitus. On follow-up, the patient presents with urine retention and dry mouth. The practitioner should:
124. Question: Which of the following drug classes is associated with anticholinergic side effects?
125. Question: Which is the most common reason for hallucinating?
126. Question: The patient with a history of child abuse is seeing you for a panic attack and symptoms of vision loss. Such physical manifestations of neurologic issues with no acute findings to substantiate their physical findings are likely reflective of which diagnosis?
127. Question: The use of which class of anti-anxiety medication should be limited to short duration of lowest dose possible?
128. Question: Your patient presents to urgent care with a non-life threatening, self-inflicted laceration to their radial artery. After providing medical care to stabilize their wound, which of the following priorities should the nurse practitioner prioritize first?
129. Question: During an exam, your patient is experiencing visual hallucinations. The patient should be responded to in which of the following ways?
130. Question: Which of the following represent extrapyramidal symptoms?
131. Question: An older adult female reports nasal congestion, clear nasal secretions, and a post-nasal drip since going through menopause. After a thorough examination reveals no significant abnormalities, the nurse practitioner diagnoses the patient with:
132. Question: A young adult female presents to the clinic with complaints of vaginal itching and lower abdominal pain with nausea. Which of the following situations would this patient have the highest risk of developing pelvic inflammatory disease?
133. Question: A nurse practitioner examines a female patient with suspected trichomoniasis, which is a disease cause by:
134. Question: Unilateral spontaneous serous or serosanguineous discharge from a single duct of a breast is most often caused by:
135. Question: 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?
136. Question: The NP should educate mothers that the most effective form of birth control while breastfeeding is:
137. Question: Which of the following women is MOST at risk for developing breast cancer?
138. Question: All of the following are usually associated with an abruptio placentae EXCEPT:
139. Question: An adult female 12 weeks gestation G1P0 presents to the OB clinic with lower quadrant abdominal pain, and cramping, spotting, and low back pain. Vital signs are: BP = 80/50 mm Hg, P = 130, R = 30/min, and she is afebrile. What is the most likely diagnosis?
140. Question: The preferred treatment for early syphilis is:
141. Question: In addition to a drug like oral inhaled fluticasone, which of the following drug classes would be most likely added in daily management of advanced chronic obstructive pulmonary disease (COPD)?
142. Question: Which of the following scenarios suggest a high risk of metabolic acidosis?
143. Question: An adult female with moderately severe asthma is being treated with metered-dose inhalers, including a steroid and a beta-2 agonist. The patient states that she has stopped using the inhalers because they no longer work. Further questioning reveals that she has been trying to use the steroid inhaler for acute exacerbations. The nurse practitioner should instruct the patient to:
144. Question: An adult patient who has persistent asthma currently uses an inhaled corticosteroid as maintenance treatment. The nurse practitioner knows that the patient understands how to use the medication when the patient states:
145. Question: Which of the following agents is a common cause of bacterial pneumonia?
146. Question: Anticholinergic agents such as ipratropium (Atrovent) and tiotropium (Spiriva) are used in COPD primarily to:
147. Question: The spirometry finding of an FEV1 of 0.50 in a 60-year-old patient with a cough is diagnostic of:
148. Question: A patient with acute hyperventilation is at risk for which of the following acid base derangements?
149. Question: Which of the following agents would NOT be useful in reducing pulmonary edema in a patient with cardiogenic shock?
150. Question: Your patient who has undergone right upper lobectomy for stage II adenocarcinoma does not have any nodes positive for metastasis on pathology. Which of the following stages is ruled out by the absence of positive lymph nodes?