Description

1. 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?
2. Question: An example of secondary prevention for a diagnosis of coronary artery disease includes which of the following?
3. Question: Which of the following antibiotic agents should be avoided in a 35-year-old female patient with a diagnosis of Marfan’s syndrome?
4. Question: A 60-year-old man with a history of hypertension and diabetes presents with a new-onset headache and visual disturbances. His blood pressure is 200/110 mmHg. What is the most appropriate management?
5. Question: As the nurse practitioner on call at a long-term care facility, telemetry shows extra premature beats every six normal beats with an inverted P wave after a narrow QRS complex. What rhythm disturbance is being described?
6. Question: Effective long-term treatment of systolic heart failure with reduced ejection fraction should include which of the following?
7. Question: The use of sublingual nitrates for patients with chest pain is relatively or absolutely contraindicated in all the following scenarios except which one?
8. Question: A patient with two coronary stents and statin-induced rhabdomyolysis needs lipid control. What is the best next management option?
9. Question: A 45-year-old man presents with exertional chest discomfort relieved by rest. Which diagnostic test is most appropriate to evaluate cardiac function and structural heart disease?
10. Question: Your patient is complaining of paroxysmal atrial fibrillation. Which medical procedure is commonly used to treat this condition?
11. Question: A 27-year-old woman presents with headaches, galactorrhea, and amenorrhea. MRI reveals a pituitary adenoma. What is the most appropriate initial treatment?
12. Question: A patient with type 2 diabetes mellitus has an A1c of 10.4% despite oral agents and basal insulin. What insulin regimen should be recommended?
13. Question: A patient has a 2-cm pituitary adenoma on MRI. Which hormone deficiency is most critical to rule out due to risk of hemodynamic instability?
14. Question: After ruling out diabetes mellitus, which initial laboratory tests should be ordered to evaluate suspected diabetes insipidus?
15. Question: An adult male with a BMI of 31 and sedentary lifestyle presents for an initial visit. Which diabetes screening test should be ordered?
16. Question: A woman with hypertension, diabetes, hyperlipidemia, and obesity has suboptimal lab values. What is the most appropriate management plan to optimize her care?
17. Question: A patient taking levothyroxine presents with tachycardia and nervousness. What adjustment should be anticipated after obtaining a TSH?
18. Question: A 33-year-old woman presents with irregular menses, hirsutism, obesity, and elevated testosterone. What is the most appropriate initial treatment?
19. Question: A patient has low TSH and thyroid tenderness. Which additional thyroid laboratory tests should be ordered?
20. Question: A patient with well-controlled type 2 diabetes has an A1c of 6.3%. According to ADA guidelines, when should the next follow-up visit be scheduled?
21. Question: How should a nurse practitioner evaluate whether palliative care is effective?
22. Question: A 90-year-old woman presents with signs concerning for elder abuse. What is the nurse practitioner legally obligated to do next?
23. Question: Which assessment is best performed to assess fall risk in an 88-year-old adult?
24. Question: Management of COPD in the elderly is best guided by which factor?
25. Question: Which gastrointestinal change is associated with normal aging?
26. Question: A patient with hepatitis C fears progression to liver failure. Which historical factor most strongly predicts disease progression?
27. Question: An older adult presents with new-onset GERD symptoms. What is the most appropriate initial treatment?
28. Question: A patient with acute alcoholic pancreatitis presents with severe abdominal pain. What is the most important initial intervention?
29. Question: A patient with chronic diarrhea, positive occult blood, and negative stool cultures is suspected of having IBD. Which labs are most helpful?
30. Question: A geriatric patient with anemia and guaiac-positive stool should undergo which diagnostic test?
31. Question: What is the most specific physical exam indicator of ascites?
32. Question: A patient with suspected inflammatory bowel disease should be tested for which laboratory marker?
33. Question: A patient with confirmed C. difficile infection cannot afford vancomycin. What is the most appropriate antibiotic treatment?
34. Question: If biliary tract obstruction is suspected, what is the preferred initial imaging modality?
35. Question: A patient presents with large-volume watery diarrhea and abdominal cramping. What is the primary management approach?
36. Question: A patient on involuntary hold threatens harm to a provider. This statement represents which legal concept?
37. Question: In a mass casualty situation with presumed anthrax exposure, what is the drug of choice for prophylaxis?
38. Question: Which healthcare access point is encouraged under the Affordable Care Act to promote continuity and reduce cost?
39. Question: A patient leaves against medical advice and is restrained for an IV placement. What legal charge could result?
40. Question: Which scenario represents an example of implied consent?
41. Question: A young adult with sore throat and nasal congestion but no fever presents for care. What is the most appropriate initial intervention?
42. Question: Which of the following is not one of the four “Ds” of epiglottitis?
43. Question: Why should patients with globe rupture undergo immediate surgical intervention?
44. Question: A patient with allergic rhinitis unresponsive to antihistamines should receive what next-step treatment?
45. Question: A patient with sore throat and anterior cervical lymphadenopathy is most likely infected by which organism?
46. Question: A patient develops a widespread rash after receiving amoxicillin for presumed strep pharyngitis and has splenomegaly. What is the most likely cause?
47. Question: Which bacterium is most commonly associated with pharyngitis?
48. Question: A patient with sore throat and dysphagia should be evaluated urgently for which life-threatening condition?
49. Question: Which treatment is least likely to be curative for retinal detachment?
50. Question: Which factor is most commonly associated with premature gum decay?
51. Question: Which symptoms indicate a severe gastrointestinal bleed requiring immediate transfusion?
52. Question: A patient with microcytic hypochromic anemia most likely has which diagnosis?
53. Question: An asymptomatic patient with neutropenia and rheumatoid arthritis should be managed how?
54. Question: A patient on warfarin has an INR of 5.5. What is the most appropriate management?
55. Question: What is the best laboratory test to distinguish iron deficiency anemia from other anemias?
56. Question: A patient with intrinsic factor autoantibodies is at risk for which condition?
57. Question: What is the most appropriate initial management of an acute sickle cell pain crisis?
58. Question: A patient with chronic liver disease and bleeding symptoms has likely developed which condition?
59. Question: Treatment for symptomatic aplastic anemia includes all except which intervention?
60. Question: A battery factory worker presents with abdominal pain and fatigue. Which laboratory test should be ordered?
61. Question: Patients with myasthenia gravis commonly have enlargement of which tissue?
62. Question: A patient with herpes zoster is contagious for transmission of which virus?
63. Question: Which immunoglobulin provides long-term passive immunity from mother to fetus?
64. Question: Patients with Stevens-Johnson syndrome should be managed similarly to which patient population?
65. Question: What is the primary treatment goal of antiretroviral therapy in HIV?
66. Question: Which patient statement increases suspicion for angioedema?
67. Question: Methotrexate therapy is most consistent with which diagnosis?
68. Question: When should disease-modifying therapy be initiated in multiple sclerosis?
69. Question: What is the first-line chronic treatment for mild systemic lupus erythematosus?
70. Question: A vesicular rash along a dermatome with prodromal hypersensitivity suggests which diagnosis?
71. Question: What is the most appropriate initial management for recurrent herpes simplex virus outbreaks?
72. Question: Which dermatologic procedure best guarantees negative margins for skin cancer?
73. Question: Which population is not considered at increased risk for skin cancer?
74. Question: A patient with pruritic vesicles and burrows between fingers should be treated with which medication?
75. Question: Which medication is prescribed for the treatment of pinworm infection?
76. Question: Which of the following treatments is best for children under 9 years of age who are diagnosed with early Lyme disease?
77. Question: Your patient with a diagnosis of metabolic syndrome was just admitted to the ICU for pneumonia. Which of the following assessment findings suggests insulin resistance?
78. 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?
79. Question: A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions presents with a firm erythematous, ulcerated nodule on the hand. What is the most likely diagnosis?
80. Question: The patient with a sebaceous cyst on the arm that is draining and has cellulitic streaking proximally should receive which treatment?
81. 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?
82. Question: A high school football player presents Monday morning after sustaining an injury Friday night. The injuring play involved a tackle to the lateral right leg. The player walked off the field but was unable to play the rest of the game and has been in pain and limping since. In assessing for a medical meniscus and lateral meniscus injury, the nurse practitioner should perform the:
83. Question: Which of the following are not items assessed for compartment syndrome?
84. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
85. Question: A 25-year-old athlete presents with shoulder impingement syndrome. What is the most appropriate initial treatment?
86. 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?
87. Question: The most specific test for gout is:
88. Question: Which of the following treatments is most successful for patients with chronic fatigue syndrome?
89. Question: A 75-year-old patient with depression and osteoarthritis should be treated with which antidepressant?
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 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:
92. Question: Your ESRD patient on hemodialysis has missed therapy two separate times this week. What potentially life-threatening lab finding would you anticipate to be acutely elevated?
93. Question: The patient you are caring for has experienced a low blood pressure for a period of 2 hours before treatment with a fluid bolus. Which type acute renal dysfunction is being described in this scenario?
94. Question: What disease is the leading cause of kidney failure among American Indians?
95. Question: An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis develops chronic kidney disease. The most likely cause is:
96. Question: Which of the following suggest a diagnosis of glomerulonephritis?
97. Question: What is the standard treatment for uncomplicated UTI in women where resistance exceeds 20%?
98. 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?
99. Question: An older adult patient with chronic renal disease has been experiencing a steady decrease in glomular filtration rate over the past 3 months. Which type(s) of antihypertensive medication would be most appropriate for the patient at this time?
100. Question: A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis?
101. 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?
102. 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?
103. Question: Which of the following is an accurate description of amaurosis fugax?
104. Question: Which of the following agents does not represent a common cause for bacterial meningitis?
105. Question: A 25-year-old woman presents with a sudden onset of vertigo, nausea, and vomiting. She has no hearing loss or tinnitus. What is the most appropriate initial management?
106. 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:
107. Question: In treating a pregnant female with migraine headaches, which of the following drugs would be contraindicated?
108. 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:
109. Question: Patients who have which of the following comorbidities should avoid ergot and triptan anti- migraine medications?
110. 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?
111. 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?
112. Question: A 5-year-old presents with a 3-month history of soiling his pants. The child was successfully toilet trained at 3. What is the most likely diagnosis?
113. Question: Which of the following treatments is best for children under 9 years of age who are diagnosed with early Lyme disease?
114. Question: A 4-year-old boy is brought to the clinic with a rash that started on his face and spread to the trunk. The provider diagnoses the child with Fifth disease. What is the most appropriate initial management?
115. 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:
116. Question: An adolescent patient with psoriasis has a positive Auspitz sign. This sign is characterized by:
117. Question: A 6-year-old child presents with a loud, harsh, holosystolic murmur at the left lower sternal border. What is the most likely diagnosis?
118. Question: What is the most common trigger for asthma exacerbations in children?
119. Question: A nurse practitioner is evaluating an infant for possible colic. Which of the following could indicate the need for a more extensive evaluation?
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: During an exam, your patient is experiencing visual hallucinations. The patient should be responded to in which of the following ways?
122. Question: Patients who present with agitation, confusion, tachycardia and hypertension, dilated pupils, loss of muscle coordination, twitching muscles, muscle rigidity, diaphoresis, and diarrhea should be worked up for which of the following conditions?
123. Question: The schizophrenic patient presents to urgent care with an acute episode. Which of the following agents is likely to be administered?
124. Question: 1st line treatment for generalized anxiety disorder:
125. Question: Which of the following treatments is most successful for patients with chronic fatigue syndrome?
126. 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?
127. Question: Patients with altered mental state should be considered for all of the following potential causes except which of the following?
128. Question: The 32-year-old female patient newly diagnosed with depression is likely to be started on which of the following agents with the fewest risks of extrapyramidal symptoms?
129. Question: Patients who overdose on amitriptyline should be treated with which of the following agents?
130. Question: Treatment for extrapyramidal symptoms should include which of the following?
131. Question: The nurse practitioner is assessing a 12-week pregnant female who presents to the clinic with continuing nausea and vomiting. The patient has not used any therapies for her symptoms. The patient usually vomits once in the morning and once at night. She is able to eat and drink throughout the day without vomiting. The nurse practitioner orders:
132. 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?
133. 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?
134. Question: A 28-year-old woman in her first trimester of pregnancy presents with nausea and vomiting. What is the most appropriate initial management?
135. Question: Which of the following tests is the most effective in differentiating between solid and cystic breast lesions?
136. 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:
137. Question: A 22-year-old has ASCAS on Pap smear and negative for HPV. The next step is:
138. Question: At how many weeks of pregnancy is a woman with a fundal height measurement at the umbilicus?
139. Question: A 41-year-old female enters the clinic with concerns of a lump in her breast. On examination, the nurse practitioner finds a palpable mass in the left outer quadrant that is mobile. A mammogram reveals a hypoechoic mass. The next step the nurse practitioner would take is to order a:
140. Question: A male presents with a painless penile lesion which has been present for 4 weeks. There is no urethral discharge. He is sexually active with multiple partners and does not use a condom. The initial diagnosis is:
141. 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?
142. Question: What does forced vital capacity (FVC) represent in pulmonary function testing?
143. Question: A 40-year-old man presents with chronic cough, night sweats, and unintentional weight loss. He has a history of recent travel to a country with a high prevalence of tuberculosis. On physical examination, he has dullness to percussion and decreased breath sounds in the right upper lobe. What is the most appropriate initial test to confirm the diagnosis?
144. Question: Which treatment of the following is commonly associated with tuberculosis?
145. 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:
146. 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?
147. 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:
148. Question: A patient returns for a follow up 3 days after being diagnosed with pneumonia. The patient has a productive cough. A sputum culture and sensitivity is ordered. Which of the following is the most common cause of community-acquired pneumonia?
149. Question: An adult presents for a 3-month follow-up visit for intermittent asthma. The patient’s current treatment plant is albuterol (Ventolin HFA) as needed. The patient reports coughing, wheezing, and chest tightness that require inhaler use 3 days a week. The patient also reports nighttime coughing about once per week in the last month. What is the nurse practitioners BEST plan of care?
150. Question: A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath, wheezing, and a productive cough. On auscultation, you hear decreased breath sounds and wheezes. What is the most appropriate initial management?