Description

1. Question: Your patient presents with a blowing systolic murmur rated 3/6 that is heard best over the left chest at the 5th intercostal space, left midclavicular space, radiating to the left axilla. This likely represents which cardiac finding?
2. Question: A patient has been complaining of palpitations for the past week and presents to you at an urgent care clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a hear rate of 122 beats per minute. What is your next order?
3. Question: Which of the following medications does not cause beta 1 stimulation?
4. Question: A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse practitioner should start the patient on:
5. Question: Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which of the following?
6. 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?
7. Question: The use of sublingual nitrates for patients with chest pain is relatively or absolutely contraindicated in all the following scenarios except:
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: Recommendation for lipid check in adolescent with type 1 DM?
10. Question: Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the EKG. Which region of the heart is most likely involved?
11. Question: A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine
12. Question: After confirming your patient is hypercortisolemic, a critical part of the diagnostic work up is to do which next?
13. Question: Which of the following is the most common cause of Cushing’s Syndrome?
14. Question: A 39-year-old male with type 1 DM is seen in the urgent care after a recent hospitalization for DKA. Treated with IV fluids, IV insulin, and potassium correction, His BS decreases to 120 mg/dL and is transitioned from IV insulin to Sub Q. After 6 hours he begins vomiting and ABG is done: pH 7.19, CO2 13, K+ 5.5, glucose 180. Which of the following is the most likely reason for persistent acidosis?
15. Question: Classic findings in a patient with a pheochromocytoma include which of the following?
16. Question: Pheochromocytoma is best diagnosed by which of the following tests:
17. Question: Which of the following is produced in the pancreas and counteracts hypoglycemia?
18. Question: A patient is having increased thirst and urination. You have ruled out diabetes mellitus. After a compete history and physical you suspect diabetes insipidus. Your initial lab tests should include?
19. Question: Group of answer choices
20. Question: A 60-year-old man presents with recurrent kidney stones, abdominal pain, and bone pain. Laboratory results show elevated serum calcium and low phosphate levels. What is the most likely diagnosis?
21. Question: An adult male who has managed type 2 diabetes mellitus well for many years presents for a 6-month follow up. His Hgb A1c has risen from 7% to 9% over the interval. All other laboratory values are normal and his BMI is still 25. His psychiatrist recently added olanzapine (Zypreza) to the medical regimen. The nurse practitioner will most likely:
22. 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?
23. 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?
24. Question: The management of COPD in the elderly is best guided by:
25. Question: Which of the following gastrointestinal changes is associated with normal aging?
26. 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?
27. Question: A 36-year-old female presents to your service with RUQ pain, fever, nausea and vomiting, and loss of appetite. Imagining shows stones present in the gallbladder, no dilation in the biliary duct, US shows edema and wall thickening. What is the patients most likely diagnosis?
28. Question: An adult patient presents with left lower quadrant abdominal tenderness and a history of diverticular disease. The patient denies any fever or vomiting, and the last episode was over 10 years ago. Suspecting this is a mild and uncomplicated episode the best treatment plan is:
29. Question: During the past 24 hours, a 62-year-old has experienced abdominal pain that radiates to the back. The patient also reports several episodes of nausea and vomiting, a low-grade temperature, and a history of excessive drinking. Physical examination reveals a distended abdomen. Laboratory serum values indicate elevated alkaline phosphatase, amylase, and serum lipase. The most likely diagnosis is:
30. Question: A 43-year-old male with past medical history significant for GERD, smoking, and obesity presents to your clinic for worsening GERD symptoms, he has been taking Protonix 40mg daily with no improvement. He had an EGD done with biopsy. Which findings would diagnose the patient with Barret’s esophagus?
31. Question: Where can Crohn’s disease be located within the GI tract and how does it present (continuous or patchy)?
32. Question: A 29-year-old male presents with severe abdominal pain, he has a history of alcohol abuse, and recurrent pancreatitis. Patients 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?
33. Question: An adult presents with increasing abdominal girth. The nurse practitioner suspects ascites. Which finding on physical exam would confirm the suspicion of ascites?
34. Question: A 56-year-old male with recurrent upper GI bleeds has had an upper endoscopy with no signs of bleeding found. Which procedure could be done to further investigate his source of bleeding?
35. 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?
36. Question: Anorexia nervosa occurs most commonly in which of the following?
37. Question: The nurse practitioner is caring for an acutely-ill 92 year old ICU intubated patient not responding to the best available care after a perforated gastric ulcer who underwent surgical exploration and washout two weeks ago. They have gone into ventricular tachycardia twice this morning and resuscitated with the use of DC cardioversion and IV amiodarone. Subsequent labs reveal profound lactic acidosis and they are not expected to survive the day due to a presumed diagnosis of mesenteric infarct. Before the first surgery, the patient told you and the family they did not want to undergo extreme measures to sustain their life and would like to “go out with some dignity”. Which of the following would NOT be an appropriate consult to make at this time?
38. Question: Which of the following is not a domain of Social Determinants of Health as identified in Healthy People 2030?
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: Multimodal analgesia involves the use of multiple agents to avoid reliance on which particular class of medication?
41. 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:
42. Question: Initial management for a patient with dry eyes should include:
43. Question: Your patient has been diagnosed with a detached retina. What treatment is least likely to be curative?
44. Question: Which of the following microorganisms are most frequently associated with acute bacterial rhino-sinusitis?
45. Question: A young adult female presents with painful swelling of the right cheek anterior to the TMJ. The diagnosis is sialadenitis. To determine the appropriate treatment for this patient, the most common infecting organism in bacterial sialadenitis is:
46. 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?
47. 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?
48. Question: An adult patient presents with complaints of 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 non-reactive to light. The nurse practitioner should immediately:
49. Question: A 35-year-old woman presents with allergic rhinitis, experiencing significant nasal congestion, sneezing, and itchy eyes. She has tried over-the-counter antihistamines with limited relief. What is the most appropriate next step in management?
50. Question: An adult patient diagnosed with retropharyngeal abscess should be treated with which of the following antibiotics?
51. Question: A patient presents with blood present in the anterior portion of their eye covering the lower half of their iris. With which of the following diagnoses is this most consistent?
52. Question: In which of the following patients is PRBC transfusion recommended?
53. 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:
54. Question: A 60-year-old woman with a history of hypertension and diabetes presents with progressive fatigue and anemia. Her laboratory results show microcytic hypochromic anemia. What is the most likely diagnosis?
55. Question: Treatment for symptomatic aplastic anemia includes all the following except:
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: 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?
58. Question: A patient with chronic liver disease presents to Urgent Care after developing frequent, severe epistaxis, petechia, and hematuria. Which of the following conditions have they likely developed?
59. Question: Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following?
60. Question: A 35-year-old man presents with recurrent episodes of severe pain in his back, chest, and extremities. He has a history of sickle cell disease. What is the most appropriate initial management during a pain crisis?
61. Question: A patient is taking warfarin, 4 mg daily for atrial fibrillation. The patient’s current International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner would:
62. Question: Long-term immunoglobulin that is carried from generation to generation is likely which type of immunoglobulin?
63. Question: What is the first-line chronic treatment for mild systemic lupus erythematosus (SLE) management?
64. 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?
65. 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?
66. 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?
67. Question: Which of the following categories of medication are not likely to be included in the medication regimen for a patient with HIV?
68. 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?
69. 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?
70. Question: Your patient has been diagnosed with stage 4 Hodgkin’s lymphoma. Which is the most likely treatment strategy to be used for this patient?
71. 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:
72. 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?
73. Question: What is the following is not an effective strategy of treatment for verruca?
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: What is the definitive treatment for uncomplicated skin abscess on the arm?
76. 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:
77. Question: Your patient is being treated with disease modifying anti-rheumatic drugs for a plaque-like skin condition located on the extensor surfaces of joints. Which condition is this likely describing?
78. Question: Your patient presents with darkened, velvety creases of the groin, neck, and axilla with skin tags present. What does this possibly indicate?
79. 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?
80. Question: A 35-year-old woman presents with a new, darkly pigmented lesion on her back that she noticed a few months ago. The lesion is asymmetrical, has irregular borders, and varies in color. What is the most appropriate next step in management?
81. Question: Herpes zoster can be difficult to diagnose in the prodromal stage, but can later be identified by the presence of characteristic:
82. 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?
83. 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?
84. Question: Elevated calcium levels may suggest which of the following?
85. Question: A 65-year-old man presents for follow-up of his well-controlled hypertension and expresses concerns about maintaining bone health. He is a smoker and has a sedentary lifestyle. What is the most appropriate initial recommendation to reduce his risk of osteoporosis?
86. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
87. 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?
88. 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?
89. Question: Your patient has presented with an acute GI bleed. In working up potential causes, which of the following scenarios is most probable as a reason for the bleed?
90. Question: Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis?
91. 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?
92. Question: A 25-year-old woman presents with dysuria, frequency, and urgency. She reports chronic pelvic pain that worsens as the bladder fills and improves after voiding. Urinalysis is unremarkable with no evidence of infection. What is the most likely diagnosis?
93. Question: Which of the following suggest a diagnosis of glomerulonephritis?
94. 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?
95. Question: Your patient has presented with flank pain, CVA tenderness, frequency. Which diagnostic finding would be useful to differentiate between cystitis and pyelonephritis?
96. Question: Patients with an elevated creatinine after receiving contrast from an angiogram are exhibiting which classification of renal dysfunction?
97. Question: An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis develops chronic kidney disease. The most likely cause is:
98. 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?
99. Question: Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses?
100. Question: Which of the following bacteria are commonly associated with pyelonephritis?
101. Question: A male adult patient presents to the clinic with sudden onset of painful hematuria. The most likely diagnosis is:
102. Question: Patients who take chronic anti-seizure medication should be notified of which risk of abrupt change or discontinuation of these medications?
103. Question: An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose?
104. Question: An adult patient presents with a history of headaches. Which new symptom should immediately cause the patient to be referred for further evaluation and possible neuroimaging?
105. Question: Patients who present with SAIDH should be treated with which of the following regimens?
106. 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:
107. Question: An adult female presents with the following symptoms: clear nasal discharge, nasal obstruction and tenderness over the antrum, throbbing facial pain referred to the supraorbital area and worsened by head movements or stooping for 15 days. Which antibiotic is appropriate for initial treatment of sinusitis?
108. Question: Which of the following visual defects is associated with loss of vision of the same side of the field in both eyes?
109. Question: Which of the following agents does not represent a common cause for bacterial meningitis?
110. 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?
111. Question: A 28-year-old female requests contraceptive pills. The nurse practitioner knows that the patient is not a candidate for estrogen-containing contraceptive if she:
112. 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?
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 3-year-old child presents with a swollen, red, and tender knee. The child has a fever and refuses to bear weight on the leg. What is the most likely diagnosis?
115. Question: A 5-year-old child presents with facial puffiness, decreased urine output, and dark-colored urine. The parents report that the child had a sore throat about two weeks ago. Which condition is most likely?
116. Question: A 7-year-old boy presents with recurrent abdominal pain, diarrhea, and weight loss. What is the most appropriate initial test?
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 late adolescent is brought to the nurse practitioner’s office by her mother, who is concerned about her daughter’s recent weight loss and the potential of purging herself after meals. The daughter denies any self-induced vomiting, starvation or excessive activity. History reveals that the daughter was consistently in the 50th percentile for weight but is now in the 10th percentile. She does state that she jogs 5 miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment?
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 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?
121. Question: A high school freshman presents complaining of shortness of breath while playing soccer. The patient has been experiencing this symptom more than 2 days per week but not daily. The patient has also been awakening at night with this symptom at least once per week. Testing indicates FEV1>80% of predicted. The nurse practitioner classifies this patient’s asthma as:
122. Question: A patient and family education program for patients with clinical depression should include which of the following explanations?
123. Question: During an exam, your patient is experiencing visual hallucinations. The patient should be responded to in which of the following ways?
124. Question: An adult female was treated for postpartum depression with selective serotonin reuptake inhibitors (SSRIs) by another healthcare provider. The patient reports continuing lethargy and depression. Before the dose of SSRIs is increased, it is most important to obtain:
125. Question: Treatment for extrapyramidal symptoms should include which of the following?
126. Question: Which of the following represent precipitating factors for excited delirium?
127. 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?
128. Question: Patients who overdose on amitriptyline should be treated with which of the following agents?
129. Question: 1st line treatment for generalized anxiety disorder:
130. 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?
131. Question: The schizophrenic patient presents to urgent care with an acute episode. Which of the following agents is likely to be administered?
132. Question: An adult female Pap smear results reveals high-grade squamous intraepithelial lesion. What should the nurse practitioner do next?
133. Question: A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate?
134. Question: An adult female patient presents to the clinic for a sudden onset of severe lower abdominal pain. She describes the pain as stabbing, and denies nausea, vomiting, fever, or chills. The pain does not radiate. To confirm the diagnosis of an ectopic pregnancy, the nurse practitioner should order which imaging study?
135. Question: The most common sign of cervical cancer is:
136. Question: An adult smoker who is 10 weeks pregnant presents with blood-tinged greenish sputum. She reports a 1-week history of sore throat and cough. Temperature = 100 degrees F (37.8 degrees C), she is positive for submandibular lymphadenopathy, her throat is red, and a few scattered crackles are present. She has a history of penicillin allergy. The nurse practitioner should order:
137. Question: Group of answer choices
138. Question: A nurse practitioner examines a female patient with suspected trichomoniasis, which is a disease cause by:
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 22-year-old has ASCAS on Pap smear and negative for HPV. The next step is:
141. Question: A 28-year-old woman in her first trimester of pregnancy presents with nausea and vomiting. What is the most appropriate initial management?
142. Question: A female who is 1 year post menopause presents with fatigue and a 2- week history of moderate vaginal bleeding. Her complete blood count (CBC) reveals low Hgb and Hct. The most appropriate diagnostic procedure to be performed is a/an:
143. 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:
144. Question: A 70-year-old woman presents with symptoms of Clostridioides difficile infection (CDI) after a recent course of antibiotics for pneumonia. What is the most appropriate first-line treatment for CDI?
145. Question: In emphysema management the first step in treating patients with mild disease is the use of:
146. Question: everity of COPD is most effectively evaluated with the use of which diagnostic test?
147. 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?
148. Question: Your patient with a history of COPD is being evaluated in urgent care with respiratory distress. Which of the following interventions would NOT cause the patient to potentially develop worsening of respiratory acidosis?
149. Question: Which of the following assessments is most useful for evaluating respiratory function in a patient with suspected chronic obstructive pulmonary disease (COPD)?
150. Question: Which of the following scenarios suggest a high risk of metabolic acidosis?