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1. Question: Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which of the following?
2. Question: A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and shortness of breath. His ECG shows ST-segment elevation. What is the initial management response?
3. Question: An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and pallor. What is the most likely diagnosis?
4. Question: An older adult female presents for her annual examination. According to AHA guidelines, which physical activity goal is expected for this patient?
5. Question: Recommendation for lipid check in adolescent with type 1 DM?
6. Question: An adult patient has an INR of 1.4 while on warfarin. Which dietary item would likely decrease the effects of warfarin?
7. Question: A patient presents with atrial fibrillation and a heart rate of 122 bpm. What is the next appropriate order?
8. Question: A patient with HFrEF is discharged after an acute MI and stent placement. What is the priority heart failure management after discharge?
9. Question: An older adult with diabetes presents with leg cramps that worsen with walking and improve with rest. What condition requires workup?
10. Question: A 65-year-old smoker with hypertension and high LDL presents for follow-up. What medication should be started?
11. Question: Which individual is at highest risk for developing type II diabetes?
12. Question: What screening test should be regularly performed to monitor early diabetic nephropathy?
13. Question: All of the following are risk factors for type II diabetes EXCEPT which?
14. Question: What is the appropriate starting dose of levothyroxine for an elderly patient with low BMI?
15. Question: Patients on levothyroxine should be monitored for signs of which complication?
16. Question: All of the following are consistent with hyperosmolar hyperglycemic state EXCEPT which?
17. Question: A patient with low TSH, elevated free T4, and positive TSI antibodies should be counseled regarding which diagnosis?
18. Question: A sedentary adult with BMI 31 presents for an initial visit. Which diabetes screening test should be ordered?
19. Question: A patient with fatigue, hair loss, cold intolerance, high TSH, and low free T4 requires what treatment?
20. Question: A woman with irregular menses, hirsutism, obesity, and elevated testosterone has which initial treatment?
21. Question: A 90-year-old woman with signs of neglect and bruising is suspected of abuse. What is the nurse practitioner legally obligated to do?
22. Question: Management of COPD in the elderly is best guided by which factor?
23. Question: A patient with gradual cognitive decline following prior CVA most likely has which diagnosis?
24. Question: Which test is best to assess fall risk in an elderly patient?
25. Question: A frail elderly patient presents with constipation. What age-related physiologic change is the most likely cause?
26. Question: A patient with continuous colonic inflammation and bloody stools most likely has which diagnosis?
27. Question: What physical exam finding is the most specific indicator of ascites?
28. Question: An adolescent with asthma has persistent nocturnal cough despite therapy. What is the most likely cause?
29. Question: Which tumor marker is important in suspected colon cancer?
30. Question: A geriatric patient with anemia and positive guaiac stool requires which diagnostic test?
31. Question: What is the initial treatment for new-onset GERD in an older adult?
32. Question: Which biopsy finding confirms Barrett’s esophagus?
33. Question: Oral clindamycin is contraindicated in which condition?
34. Question: What must be considered before performing colonoscopy in a patient with suspected lower GI bleed?
35. Question: A patient with refractory GERD symptoms requires which diagnostic test?
36. Question: In a mass anthrax exposure, what is the drug of choice for prophylaxis?
37. Question: Under the Affordable Care Act, what is the primary access point encouraged for continuity of care?
38. Question: In end-of-life care with futile prognosis, which consult would NOT be appropriate?
39. Question: Which scenario is an example of implied consent?
40. Question: In evidence-based screening, what does test sensitivity measure?
41. Question: Which symptom is NOT associated with Ménière’s disease?
42. Question: A Le Fort III fracture is associated with which complication?
43. Question: Sudden flashing lights followed by partial vision loss suggests which diagnosis?
44. Question: A patient with sore throat, congestion, and no fever requires which initial intervention?
45. Question: Postmenopausal woman with chronic clear rhinorrhea and no abnormalities has which diagnosis?
46. Question: An elderly patient with eye pain, photophobia, and redness around the iris likely has what condition?
47. Question: Fever, periorbital swelling, and proptosis require what action?
48. Question: What is the first-line antibiotic for acute bacterial sinusitis?
49. Question: Acute eye pain with halos, cloudy cornea, and fixed pupil requires what immediate action?
50. Question: Which potentially life-threatening condition must be ruled out in a patient with sore throat and dysphagia?
51. Question: A battery factory worker with abdominal pain and fatigue requires which lab test?
52. Question: What is the appropriate long-term treatment for B12 deficiency after gastric bypass?
53. Question: Untreated myelodysplastic syndrome increases the risk of developing which malignancy?
54. Question: What is the initial management of acute sickle cell pain crisis?
55. Question: Overactivation of coagulation and fibrinolysis causing thrombosis and bleeding describes which condition?
56. Question: An asymptomatic patient with mild neutropenia requires what level of intervention?
57. Question: Which thrombocytopenic condition does NOT require immediate action?
58. Question: An elderly patient with anemia, bone pain, osteoporosis, and elevated ESR should be evaluated for what?
59. Question: In which patient is PRBC transfusion recommended?
60. Question: A child with sickle cell disease requires ongoing monitoring of which parameter?
61. Question: Which immunoglobulin provides long-term passive immunity from mother to fetus?
62. Question: What is first-line treatment for mild systemic lupus erythematosus?
63. Question: Anaphylaxis represents which type of hypersensitivity reaction?
64. Question: What diagnostic intervention confirms suspected lymphoma?
65. Question: Which medication benefits patients with primary progressive multiple sclerosis?
66. Question: Methotrexate therapy is most consistent with which diagnosis?
67. Question: Progressive leg weakness, coordination loss, and bladder dysfunction suggest which disease?
68. Question: Which medication class is NOT part of standard HIV therapy?
69. Question: Painful blistering after sulfamethoxazole use raises concern for which condition?
70. Question: Patients with bradykinin-mediated angioedema should avoid which medication?
71. Question: A janitor with chronic hand rash likely has which diagnosis?
72. Question: What is the etiology of actinic keratosis?
73. Question: Plaque-like skin lesions on extensor surfaces treated with DMARDs indicate which condition?
74. Question: All of the following contribute to acne EXCEPT which?
75. Question: Using the rule of palms, burns covering 20 palms equal what percentage of total body surface area?
76. Question: Your patient has been noticing cracking and peeling on their hands and having some vesicular rash component. Which of the following is NOT likely the diagnosis?
77. Question: What is the most common form of skin cancer?
78. Question: Your patient is being educated about the management of a new diagnosis of melanoma. Which technique is most likely used in removal of the melanoma?
79. Question: A 61-year-old female with lichen sclerosis has been prescribed clobetasol propionate 0.05% ointment. Which patient statement demonstrates correct understanding of this medication?
80. Question: Which dermatologic procedure is the safest way to address lesions in patients with bleeding disorders or who are anticoagulated?
81. Question: Your patient has presented with an acute GI bleed. Which scenario is the most probable cause?
82. Question: What is the most specific diagnostic test for gout?
83. Question: A 65-year-old woman with osteoporosis presents with acute severe back pain after lifting a heavy object. What is the most likely diagnosis?
84. Question: A patient has moderate osteoarthritis. Which dietary supplement may reduce pain and joint space narrowing?
85. 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?
86. Question: Which of the following treatments is most successful for patients with chronic fatigue syndrome?
87. Question: Patients who present with decreased joint space of a lumbar vertebrae on x-ray are likely diagnosed with which of the following chronic disease states?
88. Question: Which of the following are not items assessed for compartment syndrome?
89. Question: An 86-year-old patient is experiencing radiculopathy-associated lower back pain that has not improved over the past 4 weeks. The medical history includes a lumbar discectomy. The best type of imaging study for evaluating this patient would be a/an:
90. 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?
91. 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?
92. Question: Which nationality is four times as likely as Caucasians to be diagnosed with kidney disease?
93. Question: A young male presents with dysuria. Dipstick urinalysis is positive for WBCs, shows a pH of 7.0, a specific gravity of 1.015, and is otherwise negative. The nurse practitioner should:
94. Question: A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis?
95. Question: 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?
96. Question: Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis?
97. Question: Which of the following states represents an example of postrenal failure?
98. Question: Which of the following suggest a diagnosis of glomerulonephritis?
99. Question: Patients with uncontrolled hypertension should be started on antihypertensive agents in addition to diet and exercise. Which medication should not be considered for a hypertensive patient with acute kidney injury with a creatinine of 3.1?
100. Question: Patients with an elevated creatinine after receiving contrast from an angiogram are exhibiting which classification of renal dysfunction?
101. Question: 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. He wonders if he has a learning disability or other disorder. The nurse practitioner should respond by:
102. Question: Patients who present with SAIDH should be treated with which of the following regimens?
103. 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?
104. Question: Your anxious 73-year-old male patient who presents to urgent care after a panic attack notices he has a rapid cyclical rate tremor and is concerned he has undiagnosed Parkinson’s disease since his family history includes this diagnosis in his father. Which of the following clinical findings noted above suggest this is an unlikely diagnosis?
105. Question: A 78-year-old male presents with a complaint of paroxysmal dizziness associated with nausea, and a feeling that he is going to “pass out”. Neurological examination and brain imaging studies are negative. EKG is within normal limits. The next diagnostic procedure should be:
106. Question: Which of the following visual defects is associated with loss of vision of the same side of the field in both eyes?
107. Question: 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?
108. Question: A woman with vascular dementia presents with agitation. Your first action should be to do which of the following:
109. Question: Because of the frequency and debilitating nature of an adult patient’s migraine headaches, the NP decides to place the patient on preventive therapy. Which medication would be most appropriate?
110. Question: The patient with urine output of 450 ml/hr for 6 hours straight despite only 100ml/hr of IV fluid after being intubated for a head trauma with increased intracranial pressure should be treated for which condition?
111. Question: An adolescent patient with psoriasis has a positive Auspitz sign. This sign is characterized by:
112. Question: By what age should a child typically be able to walk independently?
113. Question: A mother brings her 8-week-old to the clinic who has been inconsolably crying for the last 4 days. The physical exam shows normal findings. Which of the following diagnostic tests should the nurse practitioner order next?
114. Question: At what age should a child typically be able to sit without support?
115. Question: Which of the following fine motor skills is typically expected of a 3-year-old child?
116. Question: A nurse practitioner is evaluating an infant for possible colic. Which of the following could indicate the need for a more extensive evaluation?
117. Question: A late adolescent patient presents with acute-onset unilateral right eye pain, visual changes, seeing halos around lights, abdominal pain, and intermittent nausea. Physical findings include an erythematous right eye without discharge, a cloudy cornea, and a moderately dilated right pupil that is nonreactive to light. The nurse practitioner should immediately:
118. 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?
119. 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?
120. Question: A pediatric patient presents with wheezing over the past 24 hours, an occasional cough, runny nose, and decreased appetite. The child has been afebrile. The nurse practitioner should begin with:
121. 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?
122. Question: Which of the following represent extrapyramidal symptoms?
123. Question: 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?
124. Question: Which of the following is a common physical sign of bulimia nervosa?
125. Question: Patients with altered mental state should be considered for all the following potential causes except which of the following?
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: First line therapy for patients with a new diagnosis of anxiety includes which of the following strategies?
128. Question: An older patient with diabetes and multiple comorbidities presents for follow up after a recent hospitalization for an acute MI. He is not checking his blood glucose levels and has not been eating regularly. The nurse practitioner’s most important action is to:
129. Question: 1st line treatment for generalized anxiety disorder:
130. Question: A 45-year-old man presents with episodes of feeling extremely happy and energetic for a few days, followed by periods of intense sadness and hopelessness. During the high periods, he engages in risky behaviors and has little need for sleep. What is the most likely diagnosis?
131. Question: An adult female has a lump in the upper outer aspect of her right breast. She had a mammogram when she first found the lump, and it was negative. Physical examination finds that the lump is a hard, nodular mass of about 5-10 mm in diameter. The nurse practitioner’s most appropriate course of action at this time is to:
132. Question: The symptoms of benign prostatic hypertrophy are often overlooked because the older male:
133. 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:
134. Question: A 22-year-old has ASCAS on Pap smear and negative for HPV. The next step is:
135. Question: Unilateral serous nipple discharge from a single duct is most often caused by what?
136. Question: A 28-year-old woman in her first trimester of pregnancy presents with nausea and vomiting. What is the most appropriate initial management?
137. Question: A nurse practitioner examines a female patient with suspected trichomoniasis, which is a disease cause by:
138. Question: A female patient was sexually assaulted with the past 120 hours and is concerned about unwanted pregnancy. The correct prescription would be:
139. Question: An adult male presents with general malaise and concerns about delayed ejaculation. His medication regimen consists of quinapril (Accupril) 20 mg daily; paroxetine (Paxil) 20 mg daily; loratadine (Claritin) 10 mg daily; hydrochlorothiazide (HCTZ) 25 mg daily. The delayed ejaculation is most likely caused by the:
140. Question: A 19-year-old patient who has used oral contraceptives for 3 years plans to discontinue the pill at the end of her current cycle to become pregnant. Which of the following daily supplements would receive the highest priority?
141. Question: An adult presents for f/u regarding asthma. He has been waking up at night twice a week and using his albuterol three days of the week. The next best prescription management would be:
142. Question: Anticholinergic agents treat COPD primarily through which mechanism?
143. Question: A previously healthy patient is diagnosed with community-acquired pneumonia. Which of the following is a prognostic severity criterion that may indicate the need for referral for hospital admission and treatment?
144. Question: An 89-year old presents with a 4-month history of generalized fatigue, along with weight loss, and fever. Which test result would indicate active tuberculosis?
145. Question: An adult female with moderately severe athsma is being treated with metered-dose inhalers, including a steroid and a beta-2 antagonist. 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:
146. 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:
147. Question: Which of the following reflects a reversible cause of pulmonary disease?
148. Question: Your patient has recently traveled to the developing world for a medical service trip and has returned with symptoms of night sweats, weight loss, and hemoptysis. Which of the following interventions represent your priority in their care?
149. Question: Which of the following scenarios suggest a high risk of metabolic acidosis?
150. Question: Which two lobes of the lung are most associated with aspiration pneumonia?