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1. 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?
2. Question: What is the key long-term benefit of using carvedilol for patients with coronary artery disease and heart failure with reduced ejection fraction (HFrEF)?
3. 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?
4. Question: Which of the following medication classes is the foundation of the care of heart failure and has been shown to reduce mortality?
5. Question: A grade III/VI, low-pitched, diastolic, rumbling murmur heard at the apex, and best heard in the left lateral decubitus position, is most indicative of which of the following types of valve problem?
6. Question: A 55-year-old female patient with no previous cardiac history and no family history of hyperlipidemia with an acute myocardial infarction is treated successfully with a drug-eluting stent during a recent hospitalization. As their long-term care provider, you anticipate they were most likely to be also started on which of the following lipid-lowering agents at discharge?
7. Question: As the nurse practitioner on call at a long-term care facility, a nurse calls you to notify you that your patient who was in normal sinus rhythm has started to have extra premature beats noted on bedside telemetry. These beats occur approximately every 6 normal beats and have an inverted P wave located after the narrow QRS complex. What is this nurse likely describing?
8. Question: A nurse practitioner places a 76-year-old patient on nifedipine (Procardia) 10 mg t.i.d. for angina. The patient is unable to remember to take the medication at the scheduled times. What should the practitioner do?
9. Question: Which of the following medications does not cause beta-1 stimulation?
10. Question: Your 50-year-old African American male patient has persistent blood pressure readings between 160–170/90–100 without treatment and normal labs. What is the most appropriate first-line antihypertensive agent?
11. Question: An adult male with well-controlled type 2 diabetes presents with an increase in Hgb A1c from 7% to 9% after starting olanzapine. What is the most likely intervention?
12. Question: All the following are factors associated with the development of type II diabetes EXCEPT which one?
13. Question: A 50-year-old man presents with fatigue, muscle weakness, hyperpigmentation, hyponatremia, hyperkalemia, and low cortisol levels. What is the most likely diagnosis?
14. Question: A patient with type 1 diabetes is treated for DKA and develops recurrent metabolic acidosis after transitioning off IV insulin. What is the most likely cause?
15. Question: A patient presents with low TSH and thyroid tenderness. Which laboratory tests should be ordered next?
16. Question: A patient with hypothyroidism reports excessive use of levothyroxine for weight control. What complication is most likely?
17. Question: A diabetic patient on insulin has frequent episodes of hyperglycemia and hypoglycemia. What is the best intervention?
18. Question: Pheochromocytoma is best diagnosed by which test?
19. Question: Patients on levothyroxine should be monitored for signs of which complications?
20. Question: What is the appropriate starting dose of levothyroxine for an elderly patient with a BMI of 20?
21. Question: Which finding in an elderly patient would trigger a complete falls risk assessment?
22. Question: An elderly patient with end-stage lung cancer refuses meals except ice cream. What is the most appropriate response?
23. Question: Which gastrointestinal change is associated with normal aging?
24. Question: A frail elderly patient presents with constipation. Which physiologic change is the most likely cause?
25. Question: The management of COPD in the elderly is best guided by what?
26. Question: Which sphincter dysfunction is primarily responsible for GERD symptoms?
27. Question: A patient with melena, severe anemia, and tachycardia presents to clinic. What is the most appropriate immediate intervention?
28. Question: A patient presents with abdominal pain, diarrhea, positive occult blood, and negative stool cultures. Which labs provide further diagnostic information?
29. Question: What is the most specific indicator of ascites?
30. Question: A geriatric patient with anemia, guaiac-positive stool, and altered bowel habits should undergo which diagnostic test?
31. Question: A patient with acute pancreatitis presents with elevated lipase and CT findings. What is the most important acute intervention?
32. Question: A patient presents with sudden severe flank pain radiating to the groin with nausea and vomiting. What is the most likely diagnosis?
33. Question: A patient with RUQ pain, fever, gallstones, and gallbladder wall thickening without duct dilation most likely has what condition?
34. Question: What is the most common side effect of oral ribavirin therapy?
35. Question: A patient with nocturnal heartburn relieved by baking soda most likely has which diagnosis?
36. Question: Which of the following is NOT a domain of Social Determinants of Health in Healthy People 2030?
37. Question: Which risk of urgent care use increases the chance of missing subtle changes in a patient’s condition?
38. Question: In a mass casualty situation with suspected anthrax exposure, what is the drug of choice for prophylaxis?
39. Question: A patient threatens to kill a provider after discharge. What legal term best describes this behavior?
40. Question: A competent elderly cancer patient wishes to stop chemotherapy despite family objections. What is the nurse practitioner’s most appropriate action?
41. Question: A patient with hyphema following trauma should be treated with which medication?
42. Question: Which treatment is least likely to be curative for retinal detachment?
43. Question: A patient with sore throat, dysphagia, and flu-like symptoms should be evaluated for which life-threatening condition?
44. Question: A patient with strep viridans endocarditis most likely acquired the infection from which source?
45. Question: A patient with high fever, periorbital swelling, and proptosis should receive which immediate intervention?
46. Question: What is a common complication of a Le Fort III fracture?
47. Question: A patient presents with acute eye pain, redness, and decreased vision suspicious for open-angle glaucoma. What is the appropriate management?
48. Question: Which finding best characterizes presbycusis?
49. Question: Which bacteria is most commonly associated with pharyngitis?
50. Question: A smoker with hoarseness lasting more than 3 months should undergo what next step?
51. Question: A geriatric patient with anemia, bone pain, osteoporosis, and elevated ESR should be evaluated for which condition?
52. Question: A patient receiving chemotherapy with pancytopenia is at risk for which condition?
53. Question: In which patient is PRBC transfusion most clearly indicated?
54. Question: All of the following thrombocytopenic conditions require immediate action EXCEPT which one?
55. Question: Proper treatment of iron deficiency anemia typically leads to resolution within what timeframe?
56. Question: What is the most appropriate initial management of an acute sickle cell pain crisis?
57. Question: A patient with chronic liver disease presents with epistaxis, petechiae, and hematuria. What condition is most likely?
58. Question: A post-chemotherapy patient with pancytopenia and dysplasia requires what additional diagnostic work-up?
59. Question: What is the appropriate long-term treatment for vitamin B12 deficiency after gastric bypass?
60. Question: A patient with microcytic hypochromic anemia most likely has which diagnosis?
61. Question: What is the most likely treatment strategy for stage IV Hodgkin’s lymphoma?
62. Question: Which symptom is most characteristic of systemic lupus erythematosus?
63. Question: Patients with Stevens–Johnson syndrome should be managed similarly to which patient population?
64. Question: Anaphylaxis represents which type of hypersensitivity reaction?
65. Question: Which immunoglobulin is passed from mother to fetus for long-term immunity?
66. Question: Which treatment is NOT recommended for newly diagnosed rheumatoid arthritis?
67. Question: Which symptom is commonly seen in systemic lupus erythematosus?
68. Question: A patient with fatigue, joint pain, and butterfly rash should receive what initial management in primary care?
69. Question: What is the primary goal of HIV treatment?
70. Question: What is the first-line chronic treatment for mild systemic lupus erythematosus?
71. Question: A patient with recurrent painful vesicles on the finger with negative bacterial cultures most likely has which diagnosis?
72. Question: Which statement demonstrates correct understanding of clobetasol treatment for lichen sclerosus?
73. Question: What is the most appropriate technique for removal of melanoma?
74. Question: Herpes zoster is characterized by which rash pattern?
75. Question: A patient treated with DMARDs for plaque-like lesions on extensor surfaces most likely has which condition?
76. Question: Which of the following is a true statement about squamous cell carcinoma?
77. Question: An adult female presents with right leg pain, rash, swelling, erythema, induration, and systemic symptoms. What should the nurse practitioner do?
78. Question: Your patient presents with a red, raised circular lesion on the nose with a bloody-appearing center. Which type of lesion does this represent?
79. Question: Treatment of acute poison ivy includes which of the following?
80. Question: Which diagnostic test is commonly used to identify fungal infections of the skin?
81. Question: A 50-year-old man with osteoarthritis presents with knee pain interfering with daily activities. What is the most appropriate initial non-pharmacological management?
82. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
83. Question: Which of the following treatments is most successful for patients with chronic fatigue syndrome?
84. Question: A geriatric patient with gout resumes allopurinol during an acute flare and pain worsens. What should the nurse practitioner do?
85. Question: A patient in cardiac arrest after a recent fracture should be considered for which potential cause of pulseless electrical activity?
86. Question: What is the most specific test for gout?
87. Question: A 25-year-old athlete presents with shoulder impingement syndrome. What is the most appropriate initial treatment?
88. Question: A 50-year-old woman with osteoporosis presents for routine care. What medication is most appropriate to prevent further bone loss?
89. Question: An adolescent football player with a positive anterior drawer test most likely has injury to which ligament?
90. Question: An 84-year-old with back pain worsened by standing and relieved by flexion most likely has what diagnosis?
91. Question: A 25-year-old woman with dysuria, urgency, and pyuria most likely has which diagnosis?
92. Question: An older adult with chronic renal disease and declining GFR should receive which antihypertensive medications?
93. Question: What is the standard treatment for uncomplicated UTI in women where resistance is under 20%?
94. Question: What disease is the leading cause of kidney failure among American Indians?
95. Question: An older adult with diabetes, COPD, hypertension, and osteoarthritis develops CKD. What is the most likely cause?
96. Question: Inability to reach the bathroom before urinating is consistent with which diagnosis?
97. Question: A woman with confirmed UTI and no allergies—what is the most appropriate first-line antibiotic?
98. Question: Which dialysis modality allows home therapy through an indwelling catheter without being connected during treatment?
99. Question: Elevated creatinine after contrast administration represents which classification of renal dysfunction?
100. Question: An ESRD patient who missed dialysis sessions is at risk for acute elevation of which lab value?
101. Question: An elderly woman with dementia develops acute confusion and somnolence. What should the nurse practitioner do first?
102. Question: Which new headache symptom warrants immediate referral and neuroimaging?
103. Question: A woman should not receive estrogen-containing contraceptives if she has which history?
104. Question: Which incomplete spinal cord injury is associated with cervical flexion trauma?
105. Question: What is the goal of chronic migraine therapy?
106. Question: A patient on paroxetine presents with lethargy and hyponatremia. What is the most likely diagnosis?
107. Question: A patient with paroxysmal dizziness and normal neuro workup—what diagnostic procedure should be performed next?
108. Question: A geriatric male with trigeminal neuralgia unresponsive to gabapentin—what is the drug of choice?
109. Question: Which antibiotic is appropriate for initial treatment of acute bacterial sinusitis?
110. Question: A head-injured patient with high urine output and ICP—what condition should be treated?
111. Question: What is the most common trigger for asthma exacerbations in children?
112. Question: A 13-year-old with headaches—what symptom is most concerning?
113. Question: In evaluating a late adolescent with suspected eating disorder, which lab tests are most helpful?
114. Question: A child with fever, cough, lymphadenopathy, and facial rash spreading downward—what is the diagnosis?
115. Question: A child with a “slapped cheek” rash most likely has which condition?
116. Question: By what age should a child typically walk independently?
117. Question: A teen with CVA tenderness, back pain, and urinary symptoms—what is the most appropriate initial test?
118. Question: A 13-year-old girl at Tanner stage IV without menarche—what is the best response?
119. Question: A child with nighttime cough, wheezing, and accessory muscle use most likely has what diagnosis?
120. Question: An 8-week-old infant with inconsolable crying—what diagnostic test should be ordered first?
121. Question: How should a patient experiencing hallucinations be approached by the clinician?
122. Question: PTSD patient care should focus on discussing which element?
123. Question: A woman with 6 months of depressive symptoms most likely has which diagnosis?
124. Question: A woman with galactorrhea on multiple psych medications—what medication should be changed?
125. Question: What agent is used to treat amitriptyline overdose?
126. Question: A patient stable on venlafaxine wishes to stop therapy—what is the appropriate recommendation?
127. Question: After stabilizing a patient with self-inflicted injury, what is the nurse practitioner’s first priority?
128. Question: What is the treatment for beta-blocker overdose?
129. Question: Which finding represents an extrapyramidal symptom?
130. Question: A patient on amitriptyline develops urinary retention—what should the practitioner do?
131. Question: What imaging study confirms ectopic pregnancy?
132. Question: A patient with a persistent breast lump despite negative mammogram—what is the next step?
133. Question: A woman with recurrent bacterial vaginosis—what is the most appropriate treatment?
134. Question: What is the most effective birth control method while breastfeeding?
135. Question: Symptoms suggestive of toxic shock syndrome require which exam?
136. Question: A woman with a tender mobile breast mass and negative mammogram—what is the next step?
137. Question: A firm irregular breast lump—what is the most appropriate next step?
138. Question: Abruptio placentae is associated with all EXCEPT which finding?
139. Question: What test best differentiates cystic from solid breast lesions?
140. Question: Which factor is most likely to cause intrauterine growth restriction?
141. Question: Acute hyperventilation leads to which acid-base disturbance?
142. Question: Bullous lung disease is NOT associated with which complication?
143. Question: Absence of lymph node metastasis rules out which lung cancer stage?
144. Question: A solitary lung nodule without distant disease rules out which cancer stage?
145. Question: A smoker with chronic cough and dyspnea most likely has what diagnosis?
146. Question: Pleural effusion is NOT associated with which condition?
147. Question: Aspiration pneumonia most commonly affects which lung lobes?
148. Question: Chest X-ray findings obscuring the cardiac silhouette indicate consolidation in which lobe?
149. Question: An asthma patient with nighttime symptoms twice weekly—what is the next best medication?
150. Question: What assessment is most useful in evaluating suspected COPD?