Download Test Set-1 - Teddie Joe Snodgrass

ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
1. The NP knows which drugs is most appropriate for comorbid anxiety and depression?
a. Selective serotonin reuptake inhibitors (SSRIs)
b. Tricyclic antidepressants (TCAs)
c. Benzodiazepines
d. Monoamine oxidase inhibitors (MAOIs)
SSRIs block the transport mechanism that returns unbound 5-HT into presynaptic neurons. This
action maintains high levels of 5-HT that increase communication between nerve cells and thus
improves mood. SSRIs have the least adverse effects of all classes of anxiolytics and
antidepressants.
2. The primary goal(s) of treatment for alcohol abuse is/are:
a. Abstinence from alcohol.
b. Achieve marital satisfaction, improve family relations, and reduce psychiatric
impairment.
c. Reduction in withdrawal symptoms and production desire for alcohol.
d. Reduction in withdrawal symptoms and reduction in desire for alcohol
psychotherapeutic and pharmacological interventions to decreased desire for alcohol.
Abstinence from alcohol use is the primary goal and most effective treatment to prevent alcohol
abuse relapse. After a period of detoxification, alcohol abusers should be in rehabilitation for a
period of time.
3. The nurse practitioner’s counsel the family of a dying 88-year-old patient with dementia who
has stopped eating what is the correct information about artificial feeding at the end of life?
a. The patient or is or her legal guardian has the right to refuse artificial nutrition at the
end of life.
b. Feeding tubes improve quality of life and function.
c. Feeding to prevent aspiration dementia patients.
d. There are clear benefits providing a feeding to end-of-life.
Legally, artificial nutrition and hydration are considered medical treatments that may be refused
at the end of life. Every state allows individuals to refuse artificial nutrition and nutrition through
an advanced directive. The patient’s and legal guardian’s wishes should be the primary focus of
treatment goals. The goal is to provide comfort care. Hydration and artificial nutrition are not
always appropriate and may add to the patient’s discomfort.
4. Upon examining the patient, you notice taking the nails. This irregularity is associated with:
a. Malnutrition.
b. Iron deficiency.
c. Psoriasis.
d. Hyperthyroidism.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
Psoriasis can affect the nails. Psoriatic nails may be pitted; have horizontal lines (Beau lines),
reddened lunula, or thickened skin around nail; be loose or crumbling; or be discolored yellow,
5. During a wellness visit by a 62-year-old patient, the nurse practitioner hears a systolic ejection
murmur loudness the second right sternal border. This is typical of:
a. Mitral stenosis.
b. Aortic regurgitation.
c. Mitral regurgitation.
d. Aortic stenosis.
This is the description of the murmur of aortic stenosis. Reduction of the aortic valve orifice
causes a systolic pressure gradient between the left ventricle and the aorta.
6. The nurse practitioner is eliciting a medical history from a patient complaining of dyspnea.
Which is the most effective communication technique?
a. “Do you have trouble breathing?”
b. “Have you ever had a heart attack, heart rhythm problems, or chest pain?”
c. “You don’t have any pain with breathing, do you?”
d. “How many steps can you climb before you get short of breath?”
Ask a question that elicits a graded response rather than a single answer. Questions should be
asked one at a time, and leading questions should be avoided.
7. Which test should be done every two weeks for the first month of antithyroid treatment for
Graves’ disease before initiating antithyroid meds?
a. White blood cell (WBC) count
b. electrolytes
c. cardiac enzymes
d. liver function
Graves’ disease may be accompanied by normocytic anemia and low WBC and platelet counts.
Treatment with oral antithyroid medications such as methimazole can further depress WBCs.
Close watch of blood count is important.
8. The nurse practitioner is evaluating a 43-year-old patient for anemia. Which of the following is a
microcytic anemia?
a. Iron deficiency anemia
b. Aplastic anemia
c. Glucose – 6 – phosphate dehydrogenase deficiency
d. vitamin B12 deficiency
Anemias are often classified according to red blood cell (RBC) size. Mean corpuscular volume
indicates RBC size. MCV less than 80 fl indicates a microcytic anemia. Iron deficiency anemia is the
most common microcytic anemia.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
9. How is primary adrenocortical insufficiency (Addison’s disease) distinguished from secondary
adrenocortical insufficiency?
a. Hypopigmentation
b. elevated plasma adrenocorticotropic hormone (ACTH) level after a rapid ACTH
stimulation test
c. no significant impairment of aldosterone secretion
d. In primary adrenocortical insufficiency (Addison’s disease), cortisol and aldosterone
production is low.
In primary adrenocortical insufficiency, glucocorticoid and mineralocorticoid properties are lost
and skin hyperpigmentation is present. Elevated ACTH level after a ACTH stimulation test is
indicative of adrenal insufficiency. In secondary Addison’s disease, ACTH and cortisol levels are
low, suggesting secondary adrenal insufficiency.
10. An elderly woman presents with tender irritation her breasts. On examination you know the
very inflamed moist area macules and papules. What treatment would you prescribe?
a. Gently wash area, remove crusts, and apply antibiotic
b. Take the entire file treatment (acyclovir) and apply to prevent secondary infection
c. Thoroughly dry area can exposed to light/hair, and apply Nystatin cream two – three
times daily for 10 days.
d. Soak with least NSS pads and take anti-staphylococcal antibiotics
Warm, moist areas of skin that are moist for periods of time are common for the development of
fungal infections.
11. Which diagnostic tests abnormality would be expected in a patient with giant cell arteritis?
a. Serum testing is not diagnostic
b. Decreased ESR, elevated alkaline phosphatase, and normal platelets
c. Decrease ESR, platelets, and alkaline phosphatase
d. Elevated erythrocyte sedimentation rate (ESR), platelets, and alkaline phosphatase
Elevated ESR, platelets, and alkaline phoshoras are serum indicators for giant cell arteritis.
12. A 67-year-old patient has not received any immunizations and since age 50 years. The patient
had one episode of ophthalmic herpes zoster at age 56. Which vaccine(s) is/are indicated for
this patient?
a. Tetanus diphtheria toxoid acellular pertussis (Tdap)
b. Tetanus diphtheria toxoid acellular pertussis (Tdap), zoster vaccine (Zostavax®), a
single dose of pneumococcal vaccine, and an annual influenza vaccine
c. Tetanus diphtheria toxoid (Td)
d. Tetanus diphtheria toxoid (Td) and zoster vaccine (Zostavax®)
The Advisory Committee on Immunization Practices recommends that all adults age 19 years or
older who have not yet received a dose of Tdap should receive a single dose. A onetime dose of
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
zoster vaccine is indicted for adults 60 years or older regardless of prior zoster episodes. A
pneumococcal vaccination is recommended for adults 65 years or older. An annual influenza
vaccination is recommended for adults age 19 years or older.
13. During a wellness visit by 62-year-old patient, the nurse practitioner hears a low pitched
rumbling diagnostic murmur loudness that the apex. This is typical of:
a. Mitral regurgitation.
b. Tricuspid regurgitation.
c. Mitral stenosis.
d. Aortic stenosis
The murmur of mitral stenosis is a low-pitched diastolic rumble, best heard at the apex with the
bell in the left lateral position.
14. The Mother of a 15-year-old male asks the NP if human papillomavirus vaccine (HPV4
quadrivalent vaccine) is recommended for her son. Which recommendation about HPV4 by the
Advisory Committee on Immunization Practices (ACIP) is correct?
a. The HPV4 vaccine is recommended for females age 9 to 26 years.
b. The HPV4 vaccine is recommended only for men age 22 to 26 years who have sex with
men.
c. The HPV4 vaccine is recommended only for females after menarche.
d. The HPV4 vaccine is recommended to be started in males 11 to 12 years.
The ACIP recommends HPV4 (Gardasil in males age 11 to 12 years. Males age 13 to 21 years
who have not been vaccinated previously or who have not completed the three-dose series
should have the HPV4 three-dose series. Males age 22 to 26 years may be vaccinated with
HPV4. Only one HPV4 vaccine can be given to boys and young men.
15. The NP is testing for carpal tunnel syndrome in addition to examining the wrist for swelling,
warmth, tenderness, deformity, and discoloration. What test involves flexing the hands back-toback at 90° angles to elicit tingling in the hands?
a. Finkelstein’s sign
b. Phalen’s maneuver
c. Murphy’s sign
d. Tinel’s sign
Phalen’s maneuver is considered positive when full flexion of the wrists back-to-back at 90⁰ angles
for 60 seconds causes paresthesia in the median nerve. If carpal tunnel syndrome is present,
numbness and tingling will occur within 1 to 2 minutes. Tinel’s sign and the carpal compression
test are additional tests for assessing carpal tunnel syndrome.
16. Of the following, which would be the most appropriate consideration for the NP to use to treat a
75-year-old patient cannot fall asleep?
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
a. Biofeedback is not effective in the elderly.
b. Benzodiazepines are the drug of choice for insomnia.
c. Long-term use of hypnotics contributes to increased incidence of falls and other
adverse effects.
d. Learned insomnia cannot be treated.
Taking a history regarding factors related to insomnia and ruling out underlying causes may reveal
nonpharmacological interventions.
17. The Helicobacter pylori (H. pylori) test result comes back positive. The NP correlates this with:
a. Duodenal ulcer.
b. Gastroesophageal reflux disease.
c. Hepatitis A.
d. Irritable bowel syndrome.
H. pylori is identified in 75% of duodenal ulcers and the majority of gastric ulcers. In the presence
of an ulcer, H. pylori testing confirms that H. pylori bacteria is present, and after-treatment H.
pylori testing shows if treatment has been successful.
18. Joan has asthma and has been taking corticosteroids for two years. She stopped all of her
medications. What condition may develop?
a. Myxedema crisis
b. Hypoparathyroidism
c. Diabetes insipidus
d. Addisonian crisis
Addisonian crisis can occur with the sudden termination of steroids.
19. What is the most common environment hazard for older adults (excluding stairs)?
a. Dim lighting shadows or glare
b. Low, wobbly toilet seats
c. Grab bars not present in tub/shower
d. Loose throw rugs
A study exploring environmental hazards in homes of older adults found that 78% of homes had
loose throw rugs, runners, or mats or other slip or trip hazards.
20. A patient presents with visual disturbances, intermittent claudication of the jaw and tongue
when chewing, and a headache with marked scalp tenderness. What should you include in your
differential diagnosis?
a. Giant cell arteritis
b. Bell’s palsy
c. TMJ
d. Head trauma
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
Giant cell arteritis symptoms include unilateral headache, scalp tenderness, jaw or facial pain,
diaphoresis.
21. A client has a history of colon polyps. Regarding colon polyps, the NP knows that:
a. Polyps than 1 cm are more suggestive of malignancy.
b. Hyperplastic polyps are rarely malignant.
c. Adenomatous polyps are least likely to become cancerous.
d. Hyperplastic polyps often become cancerous.
There are three main classification of polyps: hyperplastic (nonneoplastic), adenomatous
(neoplastic), and submucosal (lipomas). Adenomatous polyps comprise 95% of all malignant
tumors of the colon.
22. The NP and the patient speak different languages. What is the best way to interview a patient
across language barrier?
a. Ask a hospital worker who speaks the patient’s language to interpret.
b. As a volunteer who speaks the patient’s language to interpret.
c. Arrange for a trained interpreter to interpret
d. Allow the patient’s family member to interpret
Using a trained interpreter enhances accuracy of information and confidentiality.
23. Migraine headaches typically:
a. Are pulsating, unilateral, and may be preceded by an aura.
b. Are localized to the frontal region of the head.
c. Are sharp and bilateral with photophobia.
d. Last for weeks.
Migraine headaches are distinguished from other types of headaches by their pulsating, unilateral
nature and because they may be preceded by an aura. Sinus headaches are usually localized to the
frontal region of the head. Tension headaches are sharp and bilateral and may be accompanied by
photophobia. Cluster headaches may last for weeks.
24. An HIV-positive client presents with white, “hairy” lesions on the bottom and sides of the
tongue. You suspect:
a. Kaposi’s sarcoma.
b. Hairy leukoplakia.
c. Seborrheic dermatitis.
d. Molluscum contagiosum
Hairy leukoplakia is caused by the Epstein-Baar virus. Like candidiasis, hairy leukoplakia is one of
the most common viruses associated with HIV.
25. The NP is evaluating a healthy 25-year-old patient with chief complaint of right lower quadrant
abdominal pain. The patient initially developed pain in the epigastrium that next localized to the
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
right lower quadrant. Accompanying symptoms include nausea, vomiting, and decreased
appetite. What is the most reliable historical feature for acute appendicitis?
a. The location of symptoms
b. The sequence of symptoms
c. The accompanying symptoms
d. The character of the pain
The sequence of pain that starts in the epigastrium or periumbilical area and then localizes to the
right lower quadrant is the most reliable historical feature of acute appendicitis.
26. The NP knows that once a competent adult client is identified as a victim of domestic abuse, the
best plan is to:
a. Suggest resources that will help the victim develop survival skills.
b. Recommend joint counseling sessions for the couple.
c. Refer the abuser for individual psychological counseling.
d. Insist that the victim leave the abusive environment immediately.
Suggest resources that will help the victim develop survival skills that decrease isolation and
helplessness, develop a safety plan to alert family and friends to notify police, and create a safe
place to store important items in the event that leaving a dangerous environment is necessary.
27. A 45-year-old female complains of diffuse musculoskeletal pain, stiffness, and fatigue for several
months’ duration. The pain is worse in the morning and with weather changes. She wakes each
morning feeling tired. Physical findings are normal except for pain upon palpation in 12 tender
points. The most likely diagnosis is:
a. Rheumatoid arthritis.
b. Depression
c. Myofascial syndrome.
d. Fibromyalgia.
Fibromyalgia is characterized by a pattern of pain that is reproduced when pressure is applied to
tender points. Pain is worse in the morning and is aggravated by weather changes. Fatigue and
disturbed sleep are common complaints.
28. What does the U.S. Preventive Services Task Force (USPSTF) recommend about prostate-specific
antigen- (PSA-) based screening for prostate cancer?
a. The USPSTF recommends annual PSA-based screening for prostate cancer only for men
at increased risk beginning at age 40 years.
b. The USPSTF recommends against routinely providing PSA-based screening for prostate
cancer in asymptomatic men.
c. The USPSTF recommends annual PSA-based screening for prostate cancer for all men
beginning at age 50 years.
d. The USPSTF recommends against the use of the PSA test for surveillance after diagnosis
or treatment of prostate cancer.
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ANCC
Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
The USPSTF concludes that there is moderate certainty that the benefits of PSA-based screening
for prostate cancer do not outweigh the harms.
29. An HIV-positive client presents with several painless, purple, persistent facial plaques. The most
likely cause is:
a. Seborrheic dermatitis.
b. Molluscum contagiosum.
c. Kaposi’s sarcoma.
d. Fungal infection.
Kaposi’s sarcoma is a cancer that develops from the lining of lymph and blood vessels and appears
as painless, purple, red, or brown plaques or tumors on the skin.
30. A patient complains that for the past 3 weeks he has experienced recurrent intense, unilateral
headache around his left orbit and lasts 1-4 hours. During these episodes he also feels agitated
and has increased lacrimation, edema of his left eyelid, and nasal congestion. The most likely
diagnosis is:
a. Arteritis.
b. Migraine headache.
c. Sinus headache.
d. Cluster headache.
Cluster headaches present with unilateral, sharp, penetrating orbital, supraorbital, and/or
temporal pain, in conjunction with increased tearing; conjunctival injection; eyelid, forehead, or
facial edema; nasal congestion; and/or rhinorrhea. Cluster headache pain may last several hours
and “cluster” in a timed pattern, e.g., seasonally. Headaches caused by arteritis tend to be
unilateral, with temporal artery pain and scalp tenderness, decreased temporal artery pulsation
on the affected side, and decreased or absent upper-extremity pulses. Migraine headaches are
unilateral, starting with a dull ache and progressing to constant throbbing and sensitivity to light
and noise. Sinus headaches are usually felt in the forehead, across the bridge of the nose, and are
aggravated by head movement and accompanied by nasal discharge congestion and ear fullness.
31. The NP treating someone for an acute episode of gout should take into consideration that:
a. Systemic therapy is effective only when more than one joint is involved.
b. Monoarticular gout responds poorly to corticosteroids given by intra-articular injection.
c. Dosage adjustment is required in elderly patients and those with chronic renal or
hepatic failure.
d. Corticosteroids are most effective for patients with diabetes mellitus.
Dosage adjustment is required in elderly patients and those with chronic renal or hepatic failure
because of the effect that gout medications have on liver and kidney function. These physiologic
aging changes and comorbidities make the elderly more apt to experience adverse drug effects.
32. What would you tell a client who is using high-potency steroid cream?
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Adult-Gerontological Primary Care NP Questions – Set 1
a.
b.
c.
d.
11 Jan 2014
Use it for an extended period of time
Use large amounts over affective areas
It will work better if you occlude the lesion.
Steroid use may exacerbate bacterial and fungal infections.
Topical steroids may exacerbate or promote bacterial and fungal skin infections. The higher the
potency and longer that a topical steroid is used, the higher the risk for infection to occur.
33. What is the first step in evaluating an 86-year-old who has recently experienced several falls?
a. Realize that learning ability and retention are reduced with age.
b. Develop an exercise plan for strength and balance
c. Perform a complete blood count, electrolyte test, liver panel, kidney panel, and thyroid
studies.
d. Obtain a thorough history and perform a physical examination and a medication
review.
Obtaining a thorough history and performing a physical examination and a medication review will
provide a history of falls and risks (multifactorial risk assessment) for falls, such as balance, gait,
strength, and medications associated with falls, to develop a plan to prevent future falls.
34. The NP is obtaining a history from a 16-year-old adolescent. What is true about assessing
adolescents?
a. Because adolescents are underage, the entire medical history must be obtained in the
presence of the parent.
b. Because adolescents are underage, confidentiality is irrelevant during an adolescent
encounter.
c. The best health care for adolescents allows a degree of independence and
confidentiality
d. The adolescent must understand that confidentiality between provider and patient is
unlimited.
Providing privacy during part of the adolescent health encounter increases the chances of
obtaining accurate information about health promotion topics such as sexuality, addiction, mental
health, and eating disorders.
35. The NP is evaluating a 43-year-old patient for anemia. Which of the following is a hemolytic
anemia?
a. Aplastic anemia
b. Glucose-6-phophate dehydrogenase (G6PD) deficiency
c. Iron deficiency anemia
d. Vitamin B12 deficiency
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Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
All hemolytic anemias are associated with red blood cell destruction. G6PD deficiency is an
inherited enzyme deficiency that can cause acute hemolytic anemia. G6PD hemolysis is usually
precipitated by certain drugs or infections.
36. Which of the following describes a positive Rovsing’s sign?
a. Right lower quadrant pain intensified by left lower quadrant palpation
b. Right lower quadrant pain elicited when patient raises right knee as examiner presses
down on right thigh just above the knee
c. Right lower quadrant pain elicited with the right hip internally rotated as patient flexes
right thigh at hip with knee bent
d. Rebound tenderness and sharp pain palpated over an area halfway between the
umbilicus and the right anterior superior iliac spine.
This describes Rovsing’s sign, indicating peritoneal irritation.
37. Which would you assess for a person with hypoparathyroidism?
a. Heart tones
b. Homans’ sign
c. Chvostek’s sign
d. Skin turgor
Chvostek’s sign is elicited by tapping along the facial nerve of a person with hypoparathyroidism
as you would a person with hypocalcemia. Tapping causes contraction of the muscles of the eye,
mouth, or nose.
38. An 85-year-old with osteoarthritis takes 400 mg of ibuprofen (Motrin) every 4 hours for joint
discomfort. Besides an increased risk for gastrointestinal bleed, what is a serious side effect of
ibuprofen in the elderly?
a. Neuropathy
b. Respiratory failure
c. Rebound headaches
d. Impaired renal function
Impaired renal function is common in aging patients. Introducing medications that increase the
workload of the kidneys increases the risk of renal failure.
39. The NP is assessing the growth and development of a 13-year-old male. The patient has
enlargement of the scrotum and testes. The skin of the scrotum is reddened and wrinkled but
the penis is not enlarged. The correct sexual maturation rating for this patient is:
a. Tanner 2.
b. Tanner 4.
c. Tanner 1.
d. Tanner 3.
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Adult-Gerontological Primary Care NP Questions – Set 1
11 Jan 2014
This describes Tanner 2 penis/scrotum/testes development.
40. The NP is evaluating a 19-year-old male college student for sports participation. The patient has
had 3 sexual partners, has never had symptoms of a sexually transmitted disease, and does not
smoke. According to the U.S. Preventive Services Task Force, which preventive service is a “D”
recommendation (not recommended) for this patient?
a. Alcohol misuse screening
b. HIV screening
c. High blood pressure screening
d. Serologic tests for herpes simplex virus (HSV) antibody
The USPSTF Grade D recommends against a service when there is moderate or high certainty that
the service has no net benefit or that the harms outweigh the benefits. As such, the USPSTF
recommends against routine serological screening for HSV in asymptomatic adolescents and
adults.
41. What explains the pathophysiology of Addison’s disease?
a. Abnormal production of epinephrine and norepinephrine due to a tumor usually located
on the adrenal medulla that causes multisystem effects
b. Elevated cortisol and ACTH levels due to an ACTH-secreting tumor of the pituitary gland
or occasionally other conditions
c. Underproduction of corticosteroids as a result of partial or complete destruction of
the adrenal glands, most commonly due to autoimmune cause
d. Insufficient synthesis of thyroid hormone due to destruction of the thyroid gland by
autoimmune causes or other diseases
This describes Addison’s disease. Cushing’s disease is associated with an ACTH-secreting tumor of
the pituitary gland; an adrenal tumor that secretes an abnormal amount of epinephrine and
norepinephrine describes pheochromocytoma; insufficient thyroid hormone synthesis is typical of
hypothyroidism.
42. A patient has been on an established dose of methotrexate (Rheumatrex) for 6 weeks. Base on
the toxic effects of the drug, what laboratory studies should the NP monitor?
a. Coagulation studies, vitamin D, and chest X-ray
b. Platelets, complete blood count with differential, and liver enzymes
c. Complete blood count, electrolytes, and renal panel
d. Urinalysis, fasting blood glucose, and electrocardiogram
These are important to monitor because methotrexate may suppress bone marrow production of
blood cells, causing pancytopenia. Liver damage may occur in long-term use of methotrexate.
43. An elderly woman has an area of vesicles extending laterally from her spine to and under her
left arm and breast to her sternum. She says the area was very tender last week and vesicles
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started to appear yesterday. She is complaining of severe pain in the area. What is the
diagnosis?
a. Contact dermatitis
b. Pityriais rosea
c. Herpes zoster
d. Psoriasis
Herpes zoster, known as shingles, unilaterally travels along one dermatome. It may start with
tingling sensation before a rash. The appearance of vesicles and crusting of lesions complete the
cycle.
44. When beginning the medical interview, which communication technique is most effective to
establish a connection with the patient?
a. Direct question
b. Leading question
c. Clarifying question
d. Open-ended question
After greeting the patient and those with the patient, begin with an open-ended question to set
the agenda for the visit. Ask more specific questions later.
45. Which of the following is a modifiable risk factor for osteoporotic fracture?
a. Advanced age
b. Caucasian or Asian race
c. Female gender
d. Recurrent falls
Gender, age, and race are unmodifiable risk factors. The frequency of recurrent falls, and
therefore fracture risk, can be modified by fall-prevention strategies.
46. A 58-year-old patient wishes to discuss advanced directives before surgery. What is inaccurate
information about advanced directives?
a. Oral advanced directives are always recognized in court.
b. Advanced directives include a living will, a healthcare proxy/surrogate, or both.
c. Statutory laws regarding advanced directives differ by state.
d. The patient should update advanced directives annually or with life changes.
Written advanced directives are considered to be more accurate than oral advanced directives.
Oral advanced directives are not recognized in every state.
47. The NP is evaluating a 53-year-old patient with chief complaint of polydipsia. Which of the
following is not included in the criteria for diagnosis of diabetes, according to the American
Diabetes Association (ADA) Standards of Medical Care?
a. Random plasma glucose greater than or equal to 126 mg/dL
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b. 2-hour plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) during a 75
gram oral glucose tolerance test
c. A1c greater than or equal to 6.5%. Test performed in a qualified laboratory per ADA
criteria
d. Fasting plasma glucose greater than or equal to 126 mg/dL (7 mmol/L) (no caloric intake
for 8 hours)
A random plasma glucose greater than or equal to 200 mg/dL (11.1 mmol/L) in a patient with
classic signs of hyperglycemia or hyperglycemic crisis meets ADA criteria for diagnosis of diabetes.
48. What is true about visual assessment for safe driving for the older driver?
a. Visual fields must be at least 100 degrees along the horizontal meridian.
b. Visual acuity must be at least 20/70 in all states.
c. Suspected visual field deficit requires ophthalmologist referral.
d. Only adequate far vision is required; near vision does not impact driving ability.
There is no evidence to determine adequacy of visual field for safe driving. A visual field deficit
may be a manifestation of occipital stroke or early glaucoma.
49. Which is true regarding treatment of Graves’ disease?
a. Diuretics are contraindicated.
b. Severe cases may require radiation or surgical decompression.
c. Propranolol initially helps control symptoms related to ophthalmopathy.
d. Radioactive iodine worsens symptoms.
Severe cases may require radiation or surgical decompression of the thyroid. Beta blockers like
propranolol are used to treat irregular heartbeat, tremors, anxiety, or irritability. Steroids and
diuretics may be used to treat ophthalmopathic symptoms of pressure, congestion, and
inflammation. Radioactive iodine is used to suppress thyroid production.
50. When obtaining a history from a 28-year-old female patient with abdominal pain, the following
priority area must be assessed:
a. First day of last menstrual period
b. Pain location and symptoms
c. Food preferences and dislikes
d. Medical and medication history
The first assessment priority is to ascertain if there is a life-threatening reproductive condition
such as ectopic pregnancy, ruptured ovarian cyst, pelvic inflammatory disease, or ovarian torsion.
Assessment also includes inquiring about and evaluating for pregnancy before running diagnostic
tests that may be detrimental to a fetus.
51. The NP is advising a healthy 56-year-old female about fasting lipid profile results. The patient is a
nonsmoker and works out in the gym daily for 30 minutes. The patient’s father had a myocardial
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infarction at age 50 years. Her mother died of a myocardial infarction at age 85 years. Results of
a fasting lipid profile are: total cholesterol = 220 mg/dL, HDL = 65 mg/dL, LDL = 130 mg/dL.
According to Adult Treatment Panel III (ATP III) guidelines for cholesterol management, how
many major coronary heart disease risk factors does she have (other than LDL)?
a. 4
b. 2
c. 3
d. 1
According to ATP III, the patient has two major risk factors: female age > 55 years and premature
CHD in father. One negative risk factor is high HDL (> 60 mg/dL), so her total number of major CHD
risk factors is one.
52. The NP examines a 62-year-old patient who has a BMI of 36, a total serum cholesterol of 240,
and a family history of type II diabetes. The patient’s blood pressure has been 142/98 on two
separate occasions. According to the Seventh Report of Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), this blood
pressure measurement is in what category?
a. Stage I hypertension
b. Prehypertension
c. Normal
d. Stage II hypertension
JNC 7 describes stage I hypertension as 140-159 mm Hg systolic or 90-99 mm Hg diastolic.
53. The NP is evaluating a 62-year-old patient whose blood pressure is 180/110. When initially
evaluating elevated blood pressure, what is most important to do?
a. Measure serum creatinine level
b. Determine the presence of renal artery bruits
c. Perform a respiratory assessment
d. Confirm accuracy of blood pressure measurement
Accurate assessment of BP is crucial. According to the JNC 7 and the American Heart Association,
the patient must be correctly positioned, the cuff must be the appropriate size and applied
correctly, two measurements of BP should be averaged, and the patient must abstain from
nicotine and caffeine 30 minutes before measurement of the BP.
54. Mr. Jones, age 27, is complaining of acute-onset, right-sided low back pain that shoot down the
back of his right calf and causes numbness over the lateral portion of his right foot. He has
weakness in his right great toe flexor, is unable to tiptoe, and his ankle reflex is asymmetric. He
has no history of previous back injury or trauma. He relates that sneezing and coughing
exacerbate the pain. The intervertebral space most likely affected is:
a. Lumbar 5-Sacral 1(L5-S1).
b. Lumbar 3-4 (L3-4).
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c. Lumbar 4-5 (L4-5).
d. Thoracic 10-Lumbar 1 (T10-L1).
L5-S1 herniated disk findings include weakness in the gastrocnemius and great toe flexor,
numbness in the calf and lateral foot, an asymmetric ankle reflex, and the inability to tiptoe. L4-5
herniated disk findings include great toe extension weakness, posterolateral thigh and calf pain,
and numbness of top of the foot and the first web space. L3-L4 herniated disk findings include
thigh pain, anterior tibalis weakness, shin numbness, and asymmetric knee reflex.
55. The mother of a 15-year-old female asks the NP if her daughter needs a Papanicolaou test.
When should a female get her first Papanicolaou test?
a. Age 21 years
b. One year after menarche
c. Age 16 years
d. After sexual activity has started
Cervical cancer is very rare under age 21 years, and screening may cause more harm than benefit.
Screening for cervical cancer in women younger than age 21 years is complicated by lower rates of
detection and higher rates of false-positive results. This guideline does not apply to females who
are immunocompromised, have had a previous high-grade precancerous cervical lesion, or were
exposed to diethylstilbestrol in utero. Screening for cervical cancer in this age group is
complicated by lower rates of detection and higher rates of false-positive results than I older
women.
56. Which of the following is an Instrumental Activity of Daily Living (IADL)?
a. Bathing
b. Dressing
c. Feeding
d. Shopping
Basic Activities of Daily Living (BADLs) are the essential elements of self-care, such as feeding,
dressing, bathing, toileting, transferring, continence, and feeding. IADLs are more complex
activities that an individual needs to live independently. Examples of IADLs include shopping,
climbing stairs, doing laundry, and managing medications.
57. An 83-year-old women has a change in mental status. Her vital signs are: temperature=96.8
degrees; BP=110/74 mm Hg; pulse=48 beats/minute; respirations=12 breaths/minute. Her skin
has a yellowish pigmentation and you note periorbital edema. Her daughter states that the
patient has a “thyroid problem” and is noncompliant with taking medication. The patient is
admitted with hypothyroid crisis. Which of the following electrolyte abnormality would you
expect to be present?
a. Hypernatremia
b. Hyperglycemia
c. Hyponatremia
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d. Hypocalcemia
Hyponatremia, altered mental status, bradycardia, hypotension, and abnormal reflexes are
common signs of hypothyroid crisis (myxedema coma) in a person who has stopped taking thyroid
supplementation.
58. A 17-year-old presents with right knee pain. He states that he heard a “pop” and felt sharp knee
pain while playing basketball. Now his knee “catches,” feels unstable, and is stiff. You suspect a
meniscal tear. What circumstances most often cause a meniscal tear?
a. The knee is twisted.
b. An external force is applied and causes external rotation or hyperextension of the
knee.
c. Valgus or varus pressure on the knee occurs at full extension and at 30⁰ flexion.
d. The knee is almost completely extended and the tibia externally rotated.
An external force is applied and causes external rotation or hyperextension of the knee and most
often occurs while playing sports or lifting heavy objects.
59. What is an example of a secondary prevention measure for a 50-year-old adult with type II
diabetes?
a. Adjusting insulin dosage to normalize blood glucose levels
b. Recommending a colonoscopy
c. Administering tetanus-diphtheria toxoid
d. Determining lifestyle and genetic history
Secondary prevention encompasses early screening and detection of disease or illness.
60. You are taking a history of a 65-year-old patient with unilateral pain in weight-bearing joints.
Which of the following questions would be most helpful in identifying osteoarthritis (OA)?
a. Have you experienced fatigue, weakness, or weight loss?
b. Does joint stiffness last most of the day and worsen as the day progresses?
c. Is you joint pain asymmetrical, worsen on movement, and relieved with rest?
d. Is joint pain most noticeable in the early morning or after period of inactivity?
Asking if joint pain is most noticeable in the morning and/or after periods of inactivity will help
distinguish OA pain, which is usually worse in the morning and after periods of inactivity (referred
to as the gel phenomenon).
61. Often the first symptom noticed in Parkinson’s disease is:
a. Slurred speech
b. Intention tremors
c. Resting tremors
d. Shuffling gait
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The classic triad of Parkinson’s is resting tremor, akinesia, and rigidity. Resting tremor in
Parkinson’s is the result of dopamine depletion that alters the activity in the basal ganglia.
62. A 45-year-old male with a 30-pack-a-year smoking history has no interest in smoking cessation
and denies that smoking is a health problem. According to the Transtheoretical Model of
Behavioral Change, what is the best intervention by the NP?
a. Focus on the long-term goal of achieving smoking cessation
b. Teach the patient about ways to modify behavior
c. Provide information about risks of smoking/benefits of smoking cessation
d. Discuss the barriers to behavior change
The patient is in the pre-contemplative stage of change. The most appropriate response to a
patient in this stage is to raise awareness by providing information about the risks of smoking and
the benefits of smoking cessation.
63. The NP is evaluating a 16-year-old nonsmoking patient with chief complaint of intermittent
coughing, wheezing, and shortness of breath for 2 weeks. Symptoms worsen at night and are
triggered by exercise. In the presence of these symptoms and exclusion of alternative diagnoses,
which of the following spirometry measurements confirms asthma? (FEV1=forced expiratory
volume in 1 second).
a. FEV1 decreases by 200 ml or 12% of baseline measure after inhalation of a long-acting
beta agonist
b. FEV1 increases by 200 ml or 12% of baseline measure after inhalation of a long-acting
beta agonist
c. FEV1 decreases by 200 ml or 12% baseline measure after inhalation of a short-acting
beta agonist
d. FEV1 increases by 200 ml or 12% of baseline measure after inhalation of a short-acting
beta agonist
In the presence of symptoms of airflow abstruction/hyperresponsiveness and exclusion of
alternative diagnoses, the reversibility of airflow obstruction confirms the diagnosis of asthma. An
increase of FEV1 by 200 ml or 12% improvement from baseline after use of a short-acting beta
agonist demonstrates reversibility of obstructed airflow.
64. Which of the following is true about health education and risk-reduction strategies for male
college students age 16 to 20 years?
a. The opportunities for health education and risk-reduction strategies are equal among
male and female college students.
b. There are fewer opportunities for health education or risk-reduction strategies among
male college students as compared to younger males age 11 to 15 years.
c. There are fewer opportunities for health education or risk-reduction strategies among
male college students as compared to female college students.
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d. There are greater opportunities for health education and risk-reduction strategies
among male college students as compared to female college students.
Male college students tend to visit college health centers episodically for injuries and sick visits.
65. Which of the following are symptoms (subjective data)?
a. Dysphagia, tonsillar exudate, bowel sounds present
b. Tinnitus, 2+ pitting edema of ankles, urinary frequency
c. Nausea, dyspepsia, abdomen tender to palpation
d. Leg cramps, headache, blurred vision
Subjective data are information the patient offers about his or her condition. Objective data are
findings from direct observation (see, hear, touch) by the examiner.
66. A type II diabetic patient is poorly controlled on glipizide (Glucotrol). What would you do?
a. Add metformin to the sulfonylurea
b. Add insulin with the sulfonylurea
c. Stop the sulfonylurea and start metformin
d. Increase the dose of the sulfonylurea
Sulfonylureas stimulate release of insulin, while metformin (a biguanide) reduces the amount of
glucose produced in the liver and absorbed in the intestines and increases cell sensitivity to
insulin. In combination, they are first-line agents in the treatment of type II diabetes if there are
no contraindications.
67. When performing a skin assessment, the NP understands that which of the following
characteristics of a nevus necessitates immediate intervention?
a. Greater than 5 cm symmetrical, uniform brow nevus on the thigh unchanged for 5 years
b. 3 cm waxy facial papule with “stuck on” appearance
c. New 2 cm brown nevus with red, irregular border that is occasionally pruritic
d. Multiple small, round, flat, dark brown nevi with smooth edges across the upper back
Appearance of new mole with these features is highly suspicious. According to the American
Cancer Institute, atypical nevi are more likely to develop into melanoma.
68. Prehypertension is a new classification of blood pressure (BP) in the Seventh Report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure (JNC 7). According to the JNC 7, which of the following is true about prehypertension?
a. Prehypertension is a designation used to identify persons at high risk for developing
future hypertension, so medication can delay or prevent it.
b. Prehypertension is a new disease category that stratifies hypertensive persons by
presence or absence of risk factors.
c. Prehypertension is a category that identifies persons who are candidates for drug
therapy based on level of BP regardless of coexisting renal disease or diabetes.
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d. Prehypertension is a designation to identify persons at high risk of developing future
hypertension, so lifestyle modification can be implemented to delay or prevent it.
Prehypertension is not a disease category; rather it is a designation to identify persons at high
risk. Lifestyle modification is the cornerstone of therapy for prehypertension. Persons with
prehypertension are not candidates for drug therapy unless they have renal disease or diabetes
and lifestyle modification does not lower BP to goal.
69. A medical emergency that the NP knows may be attributed to acute cocaine intoxication
includes:
a. Depression of cardiac conduction and contractility, resulting in arrhythmias and MI.
b. Hyperthermia, leading to extreme rhabdomyolysis.
c. Hypotension with or without vasculitis, causing CVA.
d. Decrease heart rate and vasodilation, leading to hypersomnia.
Extreme rhabdomyolysis as well as pupillary dilation, cardiac arrhythmia, respiratory depression,
chest pain, agitation seizures, or coma, as caused by hyperthermia, are all medical emergencies
related to cocaine intoxication.
70. A careful history reveals that a patient has abdominal pain with diarrhea alternating with
constipation over the past several months. These symptoms lead you to consider a diagnosis of:
a. Drug-induced diarrhea.
b. Irritable bowel syndrome.
c. Giardiasis
d. Cholecystitis
Irritable bowel syndrome is characterized by a change in bowel habits, alternating diarrhea and
constipation, flatulence, and abdominal pain, and distension.
71. Which is true of peptic ulcer disease (PUD) in the elderly?
a. Weight loss and anorexia are often the only symptoms.
b. Duodenal ulcers are more common in elderly.
c. Smoking does not increase the risk for PUD development.
d. Perforation is rare in PUD.
Weight loss and anorexia are often the only symptoms presented by elderly with PUD. Unlike
young adults, who experience epigastric pain that comes and goes and improves with food, only
30% of those 60 years or older relate painful symptoms. Normal aging and pathological brain
changes that impair pain-gating mechanisms are thought to alter pain experiences among elderly.
72. Which of the following is the best response by the NP to a woman who has just admitted she is
a victim of spousal abuse?
a. “I am going to call a shelter for you.”
b. “What was it you did to make him angry?”
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c. “I am concerned about your safety.”
d. “You must seek refuge immediately.”
Showing empathy and understanding in a nonjudgmental manner may open doors for the victim
to relate domestic violence situations.
73. An older client complains of confusion. Her daughter is concerned that she has Alzheimer’s.
Which would be indicative of delirium versus dementia?
a. Her attention span has not been affected.
b. She has sudden mood swings.
c. Confusion started after starting cimetidine (Tagamet).
d. Confusion has been slowly developing.
Individuals with impaired renal function, like the elderly, clear Tagamet from the body less
effectively and may experience confusion, agitation, hallucinations, and/or depression.
74. The NP is evaluating a healthy 25-year-old patient with chief complaint of right lower quadrant
abdominal pain. The patient initially developed pain in the epigastrium that next localized to the
right lower quadrant. Symptoms include nausea, vomiting, and decreased appetite. What is the
most appropriate and cost-effective imaging study to evaluate for acute appendicitis?
a. Flat abdominal radiograph
b. Abdominal ultrasound
c. Computerized axial tomography scan
d. Abdominal magnetic resonance imaging
Both ultrasound and CT scan have utility in the diagnosis of appendicitis, but ultrasound is less
costly. Barium enema has limited utility, and flat abdominal radiograph is nonspecific.
75. What is the mainstay of fall prevention among community-dwelling older adults?
a. Structured living environment
b. Vision correction
c. Use of assistive devices
d. Exercise
Exercise that is high dose and challenges balance reduces fall risk.
76. The NP is reviewing the immunization record of a 22-year-old pregnant female who is going to
work in a healthcare facility. The immunization record indicates that the patient received one
does of measles, mumps, and rubella (MMR) vaccine at age 6 years. What is the correct
intervention to be sure this patient has immunity to measles, mumps, and rubella?
a. Assure the patient that the prior dose of MMR administered at age 6 years is sufficient
to provide immunity.
b. Do not test for immunity; administer a second, final dose of MMR vaccine today.
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c. Determine immunity to MMR; if not immune, administer a second, final dose of MMR
vaccine today.
d. Determine immunity to MMR; if not immune, administer MMR when the patient is no
longer pregnant.
MMR should not be given to pregnant women. Adults born after 1957 should have one or two
doses of MMR (except in the case of immunity or medical contraindication), and adults working in
healthcare facilities should have two doses given at least 28 days apart.
77. The NP is assessing the growth and development of a 13-year-old female. The patient’s breasts
and areolae are enlarged without contour separation. The correct sexual maturation rating for
this patient is:
a. Tanner 2.
b. Tanner 4.
c. Tanner 1.
d. Tanner 3.
This describes Tanner 3 stage breast development.
78. A hospitalized 78-year-old patient has abrupt onset of confusion for 2 hours. Attention is
impaired, speech is intermittently rambling and disorganized, and attention is fluctuating. The
vital signs are within normal ranges, and there are no sensorimotor deficits. These findings are
consistent with a diagnosis of:
a. Delirium
b. Dementia
c. Depression
d. Stroke
Abrupt onset, short duration, fluctuating attention, variable ability to perform complex tasks,
incoherent rambling speech, and intermittent ability to understand written/spoken word are
typical of delirium. Dementia typically involves insidious onset, duration of months to years,
inability to perform complex tasks, usually constant alertness, speech that does not usually
fluctuate, and often an inability to process written/spoken word. Although cognitive changes may
accompany depression in older adults, more typical symptoms include somatization, insomnia,
and anxiety. Sensorimotor deficits usually accompany stroke.
79. How would you differentiate delirium from dementia?
a. Dementia always results from underlying psychological problems.
b. Delirium is characterized by a slow decline in intellectual functioning.
c. Dementia is a progressive disorder in cognition.
d. Delirium is a disorder of memory that evolves quickly.
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Dementia is a progressive process that manifests with decreased mental function, memory
impairment, and altered judgment and affect. Delirium is usually a reversible condition that
manifest with acute onset of fragmented, disorganized thinking.
80. When evaluating a patient with spinal stenosis, the NP should remember that:
a. Most congenital spinal stenosis cases are diagnosed before the age of 30.
b. Stenosis does not result from traumatic injuries.
c. Exterior cracks in a disk allow disk tissue to press on the spinal cord or nerves.
d. Spinal ligaments do not change with age.
Congenital form of spinal stenosis is seen in individuals who are born with a narrow spinal canal.
81. A 67-year-old healthy patient with no prior mental illness confides that at times he thinks he
hears the voice of his recently deceased spouse. What is the most appropriate intervention?
a. Refer to psychiatry for management of manic depression
b. Prescribe a long-acting benzodiazepine for anxiety
c. Refer to psychiatry to confirm diagnosis of psychotic depression
d. Reassure this is a normal response to bereavement; and offer grief counseling.
Emotions of grief are complex, and bereaved people may feel they are losing their minds. It is not
unusual for bereaved persons to hear the voice of their loved one or feel that person’s presence.
Reassurance that these are normal responses is indicated.
82. The NP is advising a 46-year-old male about his fasting lipid profile. The patient has a normal
BMI and is healthy other than hypertension controlled with an antihypertensive. He engages in
aerobic exercise 30 minutes per day and is a nonsmoker. The patient’s father had a myocardial
infarction at age 50 years. Results of his fasting lipid profile are: total cholesterol = 204 mg/dL,
HDL = 35 mg/dL, LDL = 160 mg/dL. According to Adult Treatment Panel III (ATP III) guidelines,
how many major risk factors for coronary heart disease (other than high LDL) does this patient
have?
a. 1
b. 3
c. 4
d. 2
According to ATP III, the patient has four major risk factors for coronary heart disease: male > age
45 years, family history of premature CHD in first-degree relative, on an antihypertensive, and low
HDL (< 40 mg/dL).
83. An insulin-dependent patient’s blood glucose ranges from 250 to 280 mg/dL in the morning,
around 140 mg/dL at lunch, about 120 mg/dL at dinner, and 100 mg/dL at bedtime. Insulin
adjustments over the past month have not controlled her elevated AM glucose levels. She takes
NPH insulin 30 Units and Regular insulin 4 Units every AM. What would you do?
a. Check blood glucose between 2 Am and 4 Am for the next few days
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b. Increase evening NPH by 2 Units
c. Increase AM Regular insulin by 2 Units
d. Order a fasting blood sugar test
Checking blood glucose during the early-morning hours will identify peaks and troughs in glucose
levels. Low blood glucose levels in the early-morning hours in conjunction with elevated blood
glucose levels upon waking in the morning are often triggered by an excess dose of insulin at night
or neglecting to eat a bedtime snack. This is called the Somogyi effect, or “rebound
hypoglycemia.” Treatment includes adjusting bedtime insulin dosage and eating an adequate
bedtime snack.
84. The NP is performing a comprehensive history and physical on a 50-year-old patient with a BMI
of 37. The patient expresses a desire to lose weight but does not think this is possible at this
time, due to increase job stress. According to the Transtheoretical Model of Behavioral Change,
this patient is in what stage of change?
a. Preparation
b. Contemplation
c. Action
d. Pre-contemplation
The patient is thinking about behavior change. The most appropriate response to this stage of
change is to help resolve ambivalence and discuss the barriers to change.
85. What is true about standards of care?
a. Provide a reference point and general direction for decision-making
b. Are inflexible and are intended to be used under all circumstances
c. Define a framework that can be tailored to fit different contexts
d. Are based on the premise that common practice is correct practice
Stands of care are intended to define correct practice in all contexts.
86. The NP is assessing the growth and development of a 13-year-old female. The patient has
sparse, dark, visibly pigmented curly pubic hair on labia, The correct sexual maturation rating for
this patient is:
a. Tanner 2.
b. Tanner 4.
c. Tanner 3.
d. Tanner 1.
This describes Tanner 3 pubic hair development.
87. The NP is evaluating a lethargic, afebrile 84-year-old patient with chief complaint of
intermittent, crampy, severe, progressive abdominal pain for 4 hours. Accompanying symptoms
include vomiting and obstipation. The abdomen is distended and tympanic to percussion, with
diffuse tenderness and absent bowel sounds. An upright abdominal radiograph indicates some
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distended bowel loops and air-fluid levels. Which of the following is the most likely diagnosis for
this patient?
a. Paralytic ileus
b. Small bowel obstruction
c. Acute gastroenteritis
d. Acute appendicitis
This patient’s presentation is consistent with a small bowel obstruction in an older adult. Acute
gastroenteritis involves nausea, vomiting, and diarrhea, with hyperactive bowel sounds. Paralytic
ileus can produce a variety of symptoms, such as a distended abdomen, fullness, gas, abdominal
spasms, constipation, diarrhea, nausea with or without vomiting, and foul-smelling breath. Acute
appendicitis generally presents with initial epigastric pain that localizes to the right lower
quadrant.
88. A 45-year-old has a 30-pack-a-smoking history and a diagnosis of chronic obstructive pulmonary
disease. What is an example of a tertiary care prevention measure for this patient?
a. Administering pneumococcal vaccine
b. Measuring blood pressure
c. Prescribing a long-acting beta-agonist inhaler
d. Recommending use of a helmet when riding a motorcycle
Tertiary prevention is the restoration of health after illness or disease has occurred.
89. In most cases of herniated disk, what is the most appropriate means to make a diagnosis of a
spinal disk herniation?
a. CAT scan
b. X-ray
c. A physical exam and a medical history, plus neurologic evaluation
d. MRI
A physical exam and medical history, plus neurologic evaluation, will reveal defects in the
vertebral column. Initial examination includes visualization, palpation, and range of motion.
90. What statement is true about psoriasis?
a. It can be aggravated by stress.
b. It is worse in summer.
c. All clients have accompanying pruritus.
d. It is highly contagious.
There is a link between levels of stress and severity of psoriasis. Higher levels of stress increase
severity of psoriasis.
91. The NP is obtaining a history from an 86-year-old patient. What is true about assessing older
adults?
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a.
b.
c.
d.
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The provider should avoid the use of brief screening tools
The presentation of acute illnesses does not differ between older and younger adults.
Older adults tend to underreport symptoms.
The provider should adapt the office environment to provide low light.
Older adults tend to accidentally or purposefully underreport symptoms.
92. The NP is evaluating a 30-year-old patient who fell on an outstretched right arm 2 hours ago.
The chief complaint is radial side Right wrist pain. There is mild radial side selling, positive right
snuff box tenderness, and pain and decreased strength on gripping. There is no deformity, and
wrist range of motion is not limited. Finkelstein’s test and wrist X-rays are negative. What is the
most likely diagnosis?
a. Scaphoid fracture
b. Colles’ fracture
c. DeQuervain’s tendinitis
d. Wrist sprain
The scaphoid is vulnerable to falls on the outstretched hand. Pain on palpation of the anatomic
snuff box is a characteristic finding. X-rays may initially be negative.
93. A 60-year-old male has a daily alcohol intake of three 12-once beers per day. According to the
U.S. Preventive Services Task Force, what are current recommended low-risk drinking guidelines
for males?
a. Do not exceed 4 standard drinks per day or 6 drinks per week
b. Do not exceed 3 standard drinks per day or 7 drinks per week
c. Do not exceed 3 standard drinks per day or 14 standard drinks per week
d. Do not exceed 4 standard drinks per day or 14 standard drinks per week
“Risky” or “hazardous” drinking has been defined in the U.S. as more than 7 drinks per week or
more than 3 drinks per occasion for women, and more than 14 drinks per week or more than 4
drinks per occasion for men.
94. Which of the following is an example of patient-centered information?
a. “Have you ever had a head injury?”
b. “Where is the headache located?”
c. “What concerns you most about this headache?”
d. “When did the headache start?”
How the patient feels about the problem is one of the four domains of patient-centered
communication.
95. Which of the following cardiac medications is used for migraine headaches?
a. Nitrates
b. ACEs
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c. Beta blockers
d. ARBs
Beta blockers block beta-adrenergic receptors and inhibit norepinephrine release, thus stabilizing
vascular tone. As a result, blood vessels relax and circulation is improved so that severity and
frequency of migraine headaches are reduced.
96. A client has been taking fluoxetine (Prozac) since being diagnosed with major depression 2
months ago and has experienced considerable improvement in here symptoms. She states she
would like to discontinue the medication. What should the NP recommend?
a. Discuss with the client the need to take the antidepressant medication indefinitely
b. Recommend that she continue Prozac for at least 4 months
c. Advise to stop taking Prozac
d. Question her to verify that her assessment is correct
Continued therapy helps suppress the symptoms of a current depressive episode. Therapy lasts 46 months after a patient has responded to treatment.
97. A 35-year-old male has been identified as having prehypertension. Prehypertension is a new
classification of blood pressure (BP)in the Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). According to
the JNC 7, which of the following is not an appropriate intervention for prehypertension?
a. Walking briskly for 30 minutes per day
b. Lowering sodium intake
c. Low-dose thiazide diuretic
d. Smoking cessation
Individuals who are prehypertensive are not candidates for drug therapy based on their level of
BP and should be advised to practice lifestyle modification in order to reduce their risk of
developing future hypertension.
98. Which classification of drugs has the potential to aggravate psoriasis?
a. Monomine oxidase inhibitors
b. Thiazide diuretics
c. Vasodilators
d. Beta blockers
Beta blockers are believed to decrease cyclic AMP-dependent protein kinase, which inhibits cell
proliferation.
99. In examining a patient with back pain, what symptoms would alert you to potential serious
injury?
a. Spinal curvature increases and causes the head to appear off center, or asymmetrical
appearance of hip or shoulder.
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b. Neurological deficit, decreased or absent pulses, or dysfunction in bowel or bladder
behavior
c. Deep, severe pain on one side of the back shooting down the buttock and leg
d. Pain in the buttocks that worsens when sitting up
These symptoms are indicative of cauda equine syndrome. It is caused by direct irritation to
nerves at the end of the spinal cord. Cauda equine syndrome is a medical emergency because
spinal nerve compression can lead to permanent dysfunction of the lower extremities, bladder,
and bowels.
100.
Which substance in a patient’s urine can cause a false negative result by a urine dipstick
test?
a. Ascorbic acid
An oral dose of 100mg of vitamin C caused falsely negative dipstick tests for blood, glucose
and leukocyte esterase in urine samples tested within 4 hours of ingestion. Vitamin C
consumption is a likely cause of discrepancies between urine dipstick and microscopic
analysis.
101.
A 32-year-old female presents with complaints of painful joints and red malar rash in
the shape of butterfly on her face. The NP most likely suspects:
a. Systemic lupus erythematosus
b. Relapsing polychondritis
c. Cystic acne
d. Lymphocytoma cutis
A rash across the nose and cheeks is a distinguishing symptom of lupus and is due to the
immune system attacking healthy skin tissue.
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