Description

1. Question: Your 50 year-old male African American (AA) patient was found to have a blood pressure of 160/96 upon arrival to your clinic. He does not have any other medical conditions. For the following 24 hours of self-reported vital signs, it remained between 160-170 systolic and 90-100 diastolic without treatment. After finding all basic metabolic panel (BMP) lab values to be within normal limits, your first choice of antihypertensive is most likely which of the following agents?
2. Question: As the nurse practitioner working in a primary care clinic, you have been notified from a hospitalist that your long-term patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of 40% two years ago who is also not on optimal medical therapy has been diagnosed with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the patient’s medical home who will manage this patient after discharge, which of the following would you expect to be a priority in the patient’s care for their heart failure after an acute MI?
3. 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?
4. 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?
5. Question: The most important diagnostic factor in evaluating angina pectoris is the patient’s:
6. Question: An adult patient recently placed on angiotensin-converting enzyme (ACE) inhibitor for hypertension returns with a report of a dry, persistent cough. On examination, no indication of a respiratory problem is noted. Which of the following is the most appropriate intervention?
7. Question: An otherwise healthy patient reports episodes of palpitations lasting less than 5 minutes and occurring 3-5 times daily. The patient describes a substernal flip-flop sensation with a sudden rapid heart rate, ending with a forceful beat. Holter monitoring would most likely document:
8. Question: Recommendation for lipid check in adolescent with type 1 DM?
9. Question: Which of the following medications is not considered part of optimal medical therapy for a 54 year-old male patient with a diagnosis of heart failure with reduced ejection fraction (HFrEF) with an EF of 30%, known coronary artery disease, and normal renal function?
10. Question: A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely diagnosis?
11. Question: A 33-year-old woman presents with intermittent palpitations, anxiety, and heat Her thyroid function tests reveal low TSH and high free T4. What is the most likely diagnosis?
12. Question: An adult female who recently returned from a business trip to Japan presents for a recheck appointment. The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 4–6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now?
13. Question: An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116 mg/dL [normal
14. = less than 99 mg/dL] and A1c = 3% [normal = less than 7.0%]. In accordance with the American Diabetes Association, the nurse practitioner would recommend that the next follow-up appointment be scheduled for:
15. Question: Pheochromocytoma is best diagnosed by which of the following tests:
16. Question: Which of the following is the most common cause of Cushing’s Question: All the following are factors associated with a development of type II diabetes EXCEPT:
17. Question: Patients on levothyroxine should be monitored for signs of which one of the following:
18. Question: A 50-year-old man presents with fatigue, muscle weakness, and hyperpigmentation of the skin. Laboratory tests show low sodium, high potassium, and low cortisol levels. What is the most likely diagnosis?
19. Question: A patient has a 3 cm pituitary mass noted on What is your next step in evaluating the patient?
20. Question: Patients on levothyroxine should be monitored for signs of:
21. Question: Which is best performed to assess the risk for fall in an 88-year old adult?
22. 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?
23. Question: A 92-year-old presents with a decline in personal care and increasing forgetfulness. They had a CVA a three years ago with mild cognitive changes then which has slowly progressed. The more likely diagnosis in this case is?
24. Question: A frail elderly patient presents with Which of the following normal physiologic changes seen with aging is the most likely cause?
25. Question: How should a nurse practitioner evaluate if palliative care is effective?
26. Question: A 56-year-old male on your service has been diagnosed with colon cancer which is What is the primary management that you should expect to prepare your patient for?
27. Question: A 26-year-old female presents with abdominal distention, bloating, and intermittent crampy abdominal pain relieved by defecation. She has 4 to 6 loose stools a day when stressed. Between bouts of diarrhea, she often has constipation. Physical examination results are normal. The CBC was normal. The most likely diagnosis is:
28. Question: A 64-year-old female with a past medical history significant for hepatitis C and Cirrhosis presents to your office with abdominal pain and distention.
29. Question: Your patient is suspected to have colon cancer. Which labs/marker are important to be performed on this patient?
30. Question: A 70-year-old patient presents to the clinic with dyspnea, palpitations, and fatigue. The patient reports a 2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment reveals vital signs of BP= 110/60, P = 100, R = 24; Hgb = 5 g/dL; Hct = 16%. What is the most appropriate immediate intervention?
31. Question: The most common side effect of the oral ribavirin used in the treatment of hepatitis C is:
32. Question: An older adult patient with new onset GERD, cough, Initial tx
33. 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 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:
34. Question: A 42-year-old female presents with large watery frequent stools. She also reports abdominal pain and cramping, bloating and The likely anatomical source of her diarrhea is where?
35. Question: An adult female returns to the clinic with severe profuse watery diarrhea, abdominal pain, and cramping after treatment with Cipro x 10 days. WBC is 12.5, stool culture is positive for c diff. The NP would recommend:
36. Question: Which following medical term refers to the concept of not intentionally harming the patient while providing care?
37. 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?
38. 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:
39. Question: Evidence based health screening is utilized with an understanding of the limits of interpreting the In this context, the term sensitivity refers to the ability of a test to:
40. Question: Which of the following refers to the primary access point of medical care patients are encouraged to use to aid in providing continuity and reduction of cost per the Affordable Care Act?
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 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:
43. 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?
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: A 19-year-old presents with a sore throat and anterior cervical adenopathy. Which causative agent would be suspected?
46. Question: Your patient with a large bump on their cheek should be evaluated and ruled out for which cardiac complication-linked diagnosis?
47. Question: An adult patient presents with acute onset of right eye pain, redness and decreased Suspecting open-angle glaucoma, the nurse practitioner should:
48. Question: Your patient presents with complaint of a persistent itch in one eye and says it feels like gravel is in their eye. On brief inspection, there is no obvious trauma. What can the prudent nurse practitioner use to aid in diagnosis of this patient’s chief complaint?
49. Question: Your patient has been diagnosed with a detached retina. What treatment is least likely to be curative?
50. Question: The patient has been diagnosed with hyphema after a car accident and airbag deployment. Treatment commonly includes which of the following medications?
51. Question: A geriatric patient with anemia, back pain, osteoporosis, and elevated erythrocyte sedimentation rate should be evaluated for:
52. Question: Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or poorly responsive:
53. Question: Which of the following blood lead levels (BLL) would likely require chelation therapy?
54. Question: A 49 y.o. M patient, who works in an automotive battery factory, presents to urgent care with three-day onset of abdominal pain, constipation, anorexia, muscle aches, headache, and excessive fatigue. Considering the patient’s occupation, the provider should include which of the following labs in his work-up?
55. Question: Which of the following is not a common mechanism of neutrophil expenditure and resultant neutropenia?
56. Question: In which of the following patients is PRBC transfusion recommended?
57. 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:
58. Question: A 73 o. M presents to the ED with complaints of large output hematemesis since early this morning. He endorses chronic alcohol use and his PMH is positive for peptic ulcer. Which of the following symptoms indicate a potentially severe GI bleed and likely need for immediate PRBC transfusion?
59. Question: A 78 y.o. M patient reports chronic infections, bruising, fatigue, SOB, and fevers. He has a history of rectal adenocarcinoma and completed concurrent chemotherapy/radiation earlier this year. His CBC shows Hgb 7.5, PLT 88, WBC 1.2, ANC 0.8, and peripheral smear shows dysplasia. What additional work-up would you anticipate for this patient?
60. Question: A 13 year old female who is diagnosed with iron deficiency anemia is being treated with ferrous sulfate. Proper treatment typically leads to the resolution of anemia within:
61. Question: Which of the following is a common symptom of Systemic Lupus Erythematosus (SLE)?
62. Question: Patients with Stevens-Johnson syndrome should be managed by which of the following mechanisms?
63. 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:
64. Question: Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and has been started on methotrexate. Which of the following diagnoses correlate to this treatment plan?
65. Question: Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis?
66. Question: Patients who present with a vesicular rash along a dermatome with hypersensitivity at the site before the lesion erupted are likely experiencing which illness?
67. Question: A patient who has active herpes zoster is at risk of shedding which contagious virus?
68. Question: Long-term immunoglobulin that is carried from generation to generation is likely which type of immunoglobulin?
69. Question: Patients with a diagnosis of myasthenia gravis are more likely to have the presence of which tissue in greater quantities?
70. 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?
71. Question: Your patient is being treated with disease modifying anti-rheumatic drugs for a plaque-like skin condition located on the extensor surfaces of Which condition is this likely describing?
72. Question: The 61-year-old female patient with lichen sclerosis has been prescribed clobetasol propionate 05% ointment. Which of the following statements made by the patient demonstrates good understand of her new prescription?
73. Question: Which diagnostic test is commonly used to identify fungal infections of the skin?
74. Question: Which of the following is a true statement about squamous cell carcinoma?
75. Question: An adult female with a diagnosis of eczema was given a prescription of hydrocortisone valerate 0.2% (Westcort) ointment last week for increased itching. The patient returns today reporting no improvement and more itching. The nurse practitioner’s examination finds many vesicles and papules on hands, chest, and buttocks. The nurse practitioner also finds a linear burrow between the fingers and prescribes:
76. Question: The treatment of Shigeliosis is:
77. 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?
78. Question: Which of the following treatments is best for children under 9 years of age who are diagnosed with early Lyme disease?
79. Question: A 60-year-old man presents with a thickened, scaly, erythematous plaque on his scalp that has not responded to over-the-counter treatments. What is the most appropriate initial treatment?
80. Question: A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions on the face, ears, and hands presents with a firm erythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is:
81. Question: Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis?
82. Question: An adolescent football player presents to the urgent care with an acute knee injury. He heard a pop when his knee buckled. The nurse practitioner notes a positive anterior drawer test. The most likely diagnosis is injury to the:
83. Question: Which of the following is the non-pharmacological treatment for an eversion ankle sprain?
84. Question: Which of the following are not items assessed for compartment syndrome?
85. Question: The most specific test for gout is:
86. Question: Your patient has presented with an acute GI In working up potential causes, which of the following scenarios is most probable as a reason for the bleed?
87. Question: An adult female with a BMI of 31 has pain and weakness in her legs, buttocks, and upper thighs after prolonged walking or She has osteoporosis of the hips. The patient obtains short term relief by leaning forward (stooping) when grocery shopping or sitting. The suspected diagnosis is:
88. 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?
89. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
90. Question: An adolescent athlete presents with shoulder pain and inability to raise the arm above the shoulder. The most likely diagnosis is:
91. Question: A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer?
92. Question: A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no allergies. What is the most appropriate first-line antibiotic treatment?
93. Question: What disease is the leading cause of kidney failure among American Indians?
94. Question: Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses?
95. Question: Which of the following states represents an example of postrenal failure?
96. Question: An 80-year-old man with a history of chronic kidney disease (CKD) presents with increased fatigue, pruritus, and swelling in his lower Which of the following lab tests would be most important to assess the progression of his CKD?
97. Question: A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is:
98. Question: Which of the following suggest a diagnosis of glomerulonephritis?
99. Question: A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder 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?
100. Question: What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with less than 20% resistance?
101. Question: A 37-year-old woman with a history of chronic migraines presents with unilateral headache, photophobia, and She mentions that her headaches have been progressively worsening. What is the most appropriate next step in evaluation?
102. Question: Medication overuse (analgesia rebound) headaches occur:
103. Question: In treating a pregnant female with migraine headaches, which of the following drugs would be contraindicated?
104. Question: Which of the following are not associated with alcohol abuse?
105. Question: Which of the following visual defects is associated with loss of vision of the same side of the field in both eyes?
106. Question: Which of the following agents does not represent a common cause for bacterial meningitis?
107. Question: Which of the following is an accurate description of amaurosis fugax?
108. Question: Patients who present to the urgent care with a new diagnosis of migraine headaches should be notified of which of the following as the goal of chronic migraine therapy?
109. Question: An elderly female is being treated with gabapentin (Neurontin) for neuropathic 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?
110. Question: Patients who have which of the following comorbidities should avoid ergot and triptan anti-migraine medications?
111. Question: A 13-year-old is concerned because she has not yet begun to menstruate. Physical examination indicates that the patient is at Sexual Maturity Rating IV and is of average height and weight. Which of the following would be the most appropriate response to this patient?
112. Question: A 16-year-old adolescent complains of back pain and frequent urination. Upon examination, you note tenderness in the costovertebral angle. What is the most appropriate initial test to diagnose the suspected condition?
113. 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?
114. 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?
115. 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:
116. Question: What is the most common trigger for asthma exacerbations in children?
117. 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:
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 5-year-old presents with a 3-month history of soiling his pants. The child was successfully toilet trained at What is the most likely diagnosis?
120. Question: A 4-year-old child presents with a chronic cough, wheezing, and difficulty breathing, especially at night. On examination, you hear expiratory wheezing and observe the use of accessory muscles for breathing. What is the most likely diagnosis?
121. Question: Which of the following is a common physical sign of bulimia nervosa?
122. Question: Which of the following represent extrapyramidal symptoms?
123. Question: An older patient with diabetes and multiple comorbidities presents for follow up after a recent hospitalization for an acute He is not checking his blood glucose levels and has not been eating regularly. The nurse practitioner’s most important action is to:
124. Question: Which of the following medications when paired with selective serotonin reuptake inhibitors is not associated with serotonin syndrome?
125. Question: First line therapy for patients with a new diagnosis of anxiety includes which of the following strategies?
126. Question: Which of the following symptoms are not found in anti-depressant discontinuation syndrome?
127. Question: Care of a patient with post-traumatic stress disorder may require the nurse practitioner to focus on discussing which of the following elements during the patient’s care?
128. Question: The schizophrenic patient presents to urgent care with an acute episode. Which of the following agents is likely to be administered?
129. Question: Patients who overdose on beta blockers should be treated with which of the following agents?
130. Question: Which of the following need to be assessed when determining if a patient is a risk of self-harm or harm to others?
131. Question: Your 25-year-old female patient presents with symptoms of hypotension, tachycardia, fever, diarrhea, lower abdominal pain, and erythematous palms. Based on these symptoms, what element should be included in the physical examination?
132. Question: The symptoms of benign prostatic hypertrophy are often overlooked because the older male:
133. Question: A female patient was sexually assaulted with the past 120 hours and is concerned about unwanted pregnancy. The correct prescription would be:
134. Question: A 46-year-old female presents with a complaint of amenorrhea for 3 months. The first-line diagnostic workup is:
135. 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?
136. Question: A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle She has not missed any doses and uses no other medication. Which of the following is appropriate?
137. Question: The preferred treatment for early syphilis is:
138. Question: A 28-year-old woman presents with a history of irregular menstrual cycles, hirsutism, and obesity. Laboratory tests reveal elevated serum testosterone. What is the most likely diagnosis?
139. 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?
140. Question: The drug of choice for treatment of gonorrhea is:
141. Question: Which of the following reflects a reversible cause of pulmonary disease?
142. Question: Appropriate treatment of costochondritis includes:
143. Question: Your adult patient with asthma states she is unhappy you are unwilling to renew her prescription for her albuterol inhaler because it’s only been two weeks and it is completely used already. Which of the following statements made by the nurse practitioner best explains the rationale for this decision?
144. 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:
145. Question: A patient with a solitary nodule in the right upper lobe with no brain or body lesions and a PET scan showing no evidence of other lesions in the body would be ruled out of which of the following stages of lung cancer?
146. Question: A 70-year-old woman presents with symptoms of Clostridioides difficile infection (CDI) after a recent course of antibiotics for What is the most appropriate first-line treatment for CDI?
147. Question: The following are side effects of albuterol use except which of the following?
148. Question: A 60-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with an acute exacerbation, including increased sputum production and dyspnea. He has no known drug allergies. What is the most appropriate initial antibiotic treatment?
149. Question: Which of the following scenarios suggest a high risk of metabolic acidosis?
150. Question: A geriatric female presents with 48 hours of regional burning pain on the right side of the ribs. The nurse practitioner starts drug treatment with: