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1. Question: As the nurse practitioner on call at a long-term care facility, a nurse reports that a patient previously in normal sinus rhythm now has extra premature beats occurring about every six normal beats, with an inverted P wave after a narrow QRS complex. What rhythm is being described?
2. Question: A 60-year-old man with hypertension and diabetes presents with new-onset headache, visual disturbances, and a blood pressure of 200/110 mmHg. What is the most appropriate management?
3. Question: You are caring for a patient diagnosed with premature atrial contractions. What should initial treatment include as the priority intervention?
4. Question: A patient has been diagnosed with a 4.5-cm ascending aortic aneurysm. Which imaging modality is the standard of care for serial surveillance?
5. Question: A patient presents with pale, waxy legs, weak peripheral pulses, and calf pain with walking. What is the most appropriate non-invasive test to evaluate leg vascular flow?
6. Question: Which cardiac chamber directly pumps blood into the ascending aorta?
7. Question: A grade III/VI low-pitched diastolic rumbling murmur at the apex, best heard in the left lateral decubitus position, is most indicative of which valve abnormality?
8. Question: A 76-year-old patient on nifedipine 10 mg three times daily for angina cannot remember scheduled doses. What should the nurse practitioner do?
9. Question: Sublingual nitrates are contraindicated in all of the following situations except which one?
10. Question: Which medication is not part of optimal medical therapy for a patient with heart failure with reduced ejection fraction (EF 30%) and normal renal function?
11. Question: An adult patient on levothyroxine presents with tachycardia and nervousness. After ordering TSH, what medication adjustment is anticipated?
12. Question: A patient with well-controlled type 2 diabetes has a rise in HbA1c after starting olanzapine. What is the most likely management step?
13. Question: A 40-year-old female has TSH 0.25, elevated free T4, and positive TSI antibodies. What should you counsel her?
14. Question: A patient with suspected diabetes insipidus presents with polyuria and polydipsia. What initial labs should be ordered?
15. Question: A 50-year-old man has fatigue, muscle weakness, hyperpigmentation, hyponatremia, hyperkalemia, and low cortisol. What is the most likely diagnosis?
16. Question: A 60-year-old man presents with kidney stones, bone pain, and elevated calcium with low phosphate. What is the most likely diagnosis?
17. Question: A woman with hypertension, diabetes, hyperlipidemia, obesity, and mildly abnormal labs presents for routine care. What is the most appropriate management plan?
18. Question: Which hormone produced in the pancreas counteracts hypoglycemia?
19. Question: A 33-year-old woman presents with irregular menses, hirsutism, obesity, elevated testosterone, and LH:FSH ratio >2:1. What is the most appropriate initial treatment?
20. Question: A patient has a 3-cm pituitary mass on CT. What is the next step in evaluation?
21. Question: A 92-year-old with a history of stroke has progressive cognitive decline over several years. What is the most likely diagnosis?
22. Question: An elderly woman presents with poor hygiene, bruising, and suspected financial exploitation. What is the nurse practitioner obligated to do next?
23. Question: Which test is best used to assess fall risk in an 88-year-old adult?
24. Question: A terminally ill patient refuses meals and only wants ice cream. The family is concerned about nutrition. What is the nurse practitioner’s best response?
25. Question: Which gastrointestinal change is associated with normal aging?
26. Question: A patient with acute pancreatitis presents with severe abdominal pain, nausea, vomiting, and elevated lipase. What is the most important acute-phase intervention?
27. Question: A patient with RUQ pain, fever, nausea, gallstones, gallbladder wall thickening, and no bile duct dilation presents to the clinic. What is the most likely diagnosis?
28. Question: A patient on methotrexate and ibuprofen develops severe abdominal pain and dark stools. What condition is suspected?
29. Question: What is the best medication for irritable bowel syndrome with cramping?
30. Question: A young woman has abdominal bloating, alternating diarrhea and constipation, stress-related symptoms, and normal labs. What is the most likely diagnosis?
31. Question: A patient with recurrent alcohol-related pancreatitis presents again with elevated lipase and inflammatory CT findings. What is the most important intervention?
32. Question: A woman with chronic diarrhea, weight loss, abdominal pain, and villous atrophy on endoscopy presents for care. What is the initial management?
33. Question: A middle-aged man has nocturnal heartburn relieved by baking soda and worsened by stress. What is the most likely diagnosis?
34. Question: A patient with hemochromatosis asks about dietary modifications. What should be recommended?
35. Question: A woman presents with large-volume watery stools, bloating, and gas. What is the likely anatomical source of diarrhea?
36. Question: An elderly woman with ovarian cancer wishes to stop chemotherapy despite family objections. What is the nurse practitioner’s most appropriate action?
37. Question: In a mass casualty situation with presumed anthrax exposure, what is the drug of choice for prophylaxis?
38. Question: A sedentary 65-year-old male smoker is concerned about osteoporosis. What is the most appropriate initial recommendation?
39. Question: Multimodal analgesia is designed to reduce reliance on which class of medication?
40. Question: Which option is not a domain of Social Determinants of Health in Healthy People 2030?
41. Question: A patient presents with unilateral eye pain after caustic exposure. Which technique assists in removing the agent?
42. Question: An elderly patient presents with throbbing eye pain, photophobia, blurred vision, and redness around the iris. What is the most likely diagnosis?
43. Question: Which microorganisms are most frequently associated with acute bacterial rhinosinusitis?
44. Question: A postmenopausal woman has chronic nasal congestion with clear discharge and no abnormal findings. What is the diagnosis?
45. Question: A young adult presents with sore throat, dysphagia, and flu-like symptoms. Which life-threatening condition must be ruled out?
46. Question: Which is not one of the four Ds of epiglottitis?
47. Question: A patient is diagnosed with hyphema after a motor vehicle accident. Which medication is commonly included in treatment?
48. Question: A patient awakens with painless bright-red scleral bleeding and no vision changes. What is the most appropriate management?
49. Question: Which bacteria is most commonly associated with pharyngitis?
50. Question: A patient with COPD and diabetes presents with acute angle-closure glaucoma. Which topical medication should be avoided?
51. 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?
52. Question: A patient undergoing concurrent chemotherapy and radiation for glottic squamous cell carcinoma has pancytopenia (WBC 1.3, Hgb 7.5, PLT 45, ANC 0.8). Which condition is this patient most at risk for?
53. Question: In which of the following patients is packed red blood cell (PRBC) transfusion recommended?
54. Question: All of the following thrombocytopenic emergencies require immediate action except which one?
55. Question: A 14-year-old with sickle cell anemia presents for follow-up after a recent sickle cell crisis. What parameter is most important to continue monitoring?
56. Question: What is the best laboratory test to distinguish iron deficiency anemia from other anemias?
57. Question: A patient with chronic liver disease presents with severe epistaxis, petechiae, and hematuria. Which condition have they most likely developed?
58. Question: A man working in an automotive battery factory presents with abdominal pain, constipation, fatigue, and headache. Which laboratory test should be included in the work-up?
59. Question: A patient with iron deficiency anemia requires iron supplementation. Which treatment option would most likely be ineffective?
60. Question: A patient with rheumatoid arthritis has an absolute neutrophil count (ANC) of 1.4 and is asymptomatic. What is the most appropriate level of intervention?
61. Question: A patient presents with progressive ascending weakness now involving the abdomen. What is the priority intervention?
62. Question: Which immunoglobulin provides long-term immunity and is passed from mother to fetus?
63. Question: Which of the following is a common symptom of systemic lupus erythematosus (SLE)?
64. Question: A patient with active herpes zoster is at risk of shedding which contagious virus?
65. Question: Patients with myasthenia gravis are more likely to have increased quantities of which tissue?
66. Question: A patient presents with a vesicular rash along a dermatome preceded by hypersensitivity. Which illness is most likely?
67. Question: A patient is diagnosed with stage IV Hodgkin lymphoma. What is the most likely treatment strategy?
68. Question: A patient presents with two months of progressive leg weakness, loss of coordination, and bladder dysfunction. Which disease should be investigated?
69. Question: What is the first-line chronic treatment for mild systemic lupus erythematosus (SLE)?
70. Question: What is the primary treatment goal for patients diagnosed with HIV?
71. Question: Which of the following is not an effective treatment strategy for verruca?
72. Question: A new 9-mm multicolored mole with irregular borders is identified on physical exam. What is the most likely diagnosis?
73. Question: Which assessment finding suggests insulin resistance in a patient with metabolic syndrome?
74. Question: Which population is not considered at increased risk for skin cancer?
75. Question: A patient has a symptomatic seborrheic keratosis on the forehead. What is the most effective method for removal?
76. Question: A patient treated with disease-modifying antirheumatic drugs presents with plaque-like skin lesions on extensor surfaces. Which condition is most likely?
77. Question: Which medication is used to treat pinworm infection?
78. Question: What is the etiology of actinic keratosis?
79. Question: A draining sebaceous cyst with ascending cellulitis is identified. What is the most appropriate treatment?
80. Question: A fair-skinned Caucasian male with green eyes is at highest risk for which serious skin condition?
81. Question: Which of the following findings is not assessed when evaluating for compartment syndrome?
82. Question: An athlete with a positive anterior drawer test following knee injury most likely has damage to which ligament?
83. Question: Which urate-lowering medication may be used in conjunction with NSAIDs to treat gout?
84. Question: In trauma assessment, which finding is part of the secondary survey?
85. Question: An elderly patient with back pain worsened by standing and relieved by forward flexion most likely has which condition?
86. Question: A woman with osteoporosis develops acute severe back pain after lifting. What is the most likely diagnosis?
87. Question: What is the most specific diagnostic test for gout?
88. Question: What is the recommended non-pharmacologic treatment for an eversion ankle sprain?
89. Question: According to the USPSTF, when should bone density screening be performed for primary prevention of osteoporosis in females?
90. Question: An elderly patient with radiculopathy and prior lumbar surgery has persistent symptoms. What imaging study is most appropriate?
91. Question: What is the most appropriate prostate cancer screening recommendation for a 50-year-old man?
92. Question: A young woman presents with dysuria, urgency, and pyuria on urinalysis. What is the most likely diagnosis?
93. Question: A woman has chronic urinary urgency with normal labs, cultures, and cystoscopy. What is an appropriate treatment option?
94. Question: Which laboratory tests are most important for monitoring progression of chronic kidney disease?
95. Question: A man presents with sudden onset painless hematuria. What is the most likely diagnosis?
96. Question: An older adult with diabetes, COPD, hypertension, and osteoarthritis develops chronic kidney disease. What is the most likely cause?
97. Question: Which bacteria are most commonly associated with pyelonephritis?
98. Question: Which component of the renin-angiotensin-aldosterone system is inhibited by lisinopril?
99. Question: Which diagnostic finding helps differentiate pyelonephritis from cystitis?
100. Question: Which nationality is four times more likely than Caucasians to be diagnosed with kidney disease?
101. Question: Which of the following constellations of symptoms, lasting more than 3 months, is most common in fibromyalgia?
102. Question: What of the following represents an abnormal level for intracranial pressure?
103. Question: A 25-year-old woman presents with a sudden onset of vertigo, nausea, and vomiting with no hearing loss or tinnitus. What is the most appropriate initial management?
104. Question: Medication overuse (analgesia rebound) headaches occur in which group of patients?
105. Question: Which of the following is an accurate description of amaurosis fugax?
106. Question: A 78-year-old male presents with paroxysmal dizziness, nausea, and presyncope with normal neurologic exam, imaging, and EKG. What is the next diagnostic procedure?
107. Question: Ischemic strokes are most often caused by which pathology?
108. Question: A 70-year-old man presents with acute confusion, agitation, hallucinations, and hyponatremia. What is the most likely diagnosis?
109. Question: Which of the following is a common initial symptom of Alzheimer’s disease?
110. Question: What is the primary goal of chronic migraine therapy?
111. Question: During a well-child exam, a 24-month-old is noted to have premature tooth decay and inflamed gums. What is the appropriate approach?
112. Question: A 12-month-old child does not say “mama” or “dada.” What is the most appropriate next step?
113. Question: A 4-year-old child presents with chronic cough, wheezing, and nighttime breathing difficulty. What is the most likely diagnosis?
114. Question: A 3-day-old newborn has rising bilirubin levels despite increased breastfeeding. What intervention is indicated?
115. Question: Which diagnostic procedure confirms pinworm infestation?
116. Question: A 5-year-old child presents with facial puffiness, dark urine, decreased urine output, and a recent sore throat. What is the most likely diagnosis?
117. Question: An 8-week-old infant with inconsolable crying and normal physical exam should receive which diagnostic test?
118. Question: What is the most common trigger for asthma exacerbations in children?
119. Question: After treating otitis media in a toddler with a systolic murmur, what is the next appropriate step?
120. Question: A 5-year-old girl with fever, hacking cough, lymphadenopathy, and a rash spreading from the face is most likely which diagnosis?
121. Question: What must be assessed when determining risk for self-harm or harm to others?
122. Question: A patient on escitalopram presents with FINISH symptoms. What question should be asked?
123. Question: Which class of anti-anxiety medications should be limited to short-term use at the lowest dose possible?
124. Question: Before increasing the dose of SSRIs for postpartum depression, which laboratory test should be obtained?
125. Question: What is the most common cause of hallucinations?
126. Question: How should a healthcare provider respond to a patient experiencing hallucinations?
127. Question: What is first-line therapy for a new diagnosis of anxiety?
128. Question: Patients treated with haloperidol should be warned about which potential adverse effect?
129. Question: Which finding represents extrapyramidal symptoms?
130. Question: What medication is used to treat beta-blocker overdose?
131. Question: What is the drug of choice for anthrax prophylaxis in a mass casualty situation?
132. Question: A newborn exposed to maternal Chlamydia trachomatis infection is most at risk for which complication?
133. Question: What is the appropriate initial treatment for mild nausea and vomiting in early pregnancy?
134. Question: Why are symptoms of benign prostatic hypertrophy often overlooked in older men?
135. Question: What is the classic clinical presentation of placenta previa in the third trimester?
136. Question: When should zidovudine therapy be initiated during pregnancy in a woman with HIV?
137. Question: What is the most effective form of birth control while breastfeeding?
138. Question: A 45-year-old woman with a firm, irregular, non-tender breast lump should receive which next step in care?
139. Question: What screening test should be performed at 24–28 weeks of gestation?
140. Question: Which migraine medication is contraindicated in pregnancy?
141. Question: Which medication class is added for daily management of advanced COPD?
142. Question: What does forced vital capacity (FVC) represent in pulmonary function testing?
143. Question: What is the most appropriate management for a patient with well-controlled asthma?
144. Question: Which cancer stage is ruled out in the absence of lymph node metastasis?
145. Question: Which clinical scenario suggests a high risk for metabolic acidosis?
146. Question: What pulmonary function test finding is expected in morbid obesity?
147. Question: Anticholinergic agents in COPD are primarily used to achieve what effect?
148. Question: Which of the following is not a side effect of albuterol use?
149. Question: Which represents a reversible cause of pulmonary disease?
150. Question: A geriatric patient with regional burning rib pain should be treated initially with which medication?