In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of:
Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?
Which of the following is the most important question to ask during cardiovascular health history?
Rheumatic heart disease is a complication that can arise from which type of infection?
A cough is described as chronic if it has been present for:
A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
A woman with an X-linked dominant disorder will:
A 55-year-old post-menopausal woman with a history of hypertension complains of jaw pain on heavy exertion. There were no complaints of chest pain. Her ECG indicates normal sinus rhythm without ST segment abnormalities. Your plan may include:
The aging process causes what normal physiological changes in the heart?
It is important to not dilate the eye if ____ is suspected
Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:
In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion?\
A 20-year-old engineering student complains of episodes of abdominal discomfort, bloating, and episodes of diarrhea. The symptoms usually occur after eating, and pain is frequently relieved with bowel movement. She is on a “celiac diet” and the episodic symptoms persist. Physical examination and diagnostic tests are negative. Colonoscopy is negative for any abnormalities. This is a history and physical consistent with:
The most common cause of eye redness is:
In AR disorders, carriers have:
According to the Genetic Information Nondiscrimination Act (GINA):
Aortic regurgitation requires medical treatment for early signs of CHF with:
Which of the following is the most common cause of heartburn-type epigastric pain?
The best way to diagnose structural heart disease/dysfunction non-invasively is:
Essential parts of a health history include all of the following except
Men have faster and more efficient biotransformation of drugs and this is thought to be due to:
Testosterone (one option is repeated)The main focus of treatment of patients with ACD is:
A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?
Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is:
The first assessment to complete related to the eyes is:
A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less, often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a heavy, fatty meal.
Which of the following conditions is the most common cause of nausea, vomiting, and diarrhea?
Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
In order to provide a comprehensive genetic history of a patient, the NP should:
Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following?
Question 31 options:
Sinus pain, increased vascular permeability, and bronchodilation
A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of:
When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity?
A common auscultatory finding in advanced CHF is:
A nurse practitioner reports that your patient’s abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in:
The most common etiologic organism for community-acquired pneumonia is:
What test is used to confirm the diagnosis of appendicitis?CT of abdomen with attention to appendix
A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:
Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:
Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.
In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA?
What is the most common valvular heart disease in the older adult?
Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?
A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of:
Which of the following details are NOT considered while staging asthma?
Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago, intermittent, aggravated by exercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely?
The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home:
Your 2-year-old patient shows facial features, such as epicanthal folds, up-slanted palpebral fissures, single transverse palmar crease, and a low nasal bridge. These are referred to as:
A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:
Your patient has been treated for glaucoma for 5 years. Which of the following will provide indication of the level of progression during the funduscopic examination for this patient?
Which of the following medications are commonly associated with the side effect of cough?
When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):
The first step in the genomic assessment of a patient is obtaining information regarding:
In assessing the eyes, which of the following is considered a “red flag” finding when associated with eye redness?
During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with:
Which test is the clinical standard for the assessment of aortic stenosis?
Which of the following would be considered a “red flag” that requires more investigation in a patient assessment?
When counseling clients regarding the use of antidiarrheal drugs such as Imodium anti-diarrheal and Kaopectate, the nurse practitioner advises patients to:
Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?
A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest. On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?
Emphysematous changes in the lungs produce the following characteristic in COPD patients?
Which of the following findings would indicate a need for another endoscopy in clients with peptic ulcer disease?
Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:\
The cytochrome p system involves enzymes that are generally:
Functional abilities are best assessed by:
Epistaxis can be a symptom of:
Which of the following is not a contributing factor to the development of esophagitis in older adults?
A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:
You have a patient complaining of vertigo and want to know what could be the cause. Knowing there are many causes for vertigo, you question the length of time the sensation lasts. She tells you several hours to days and is accompanied by tinnitus and hearing loss. You suspect which of the following conditions?
An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is:
The major impact of the physiological changes that occur with aging is:
The pathophysiological hallmark of ACD is:
Which symptom is more characteristic of Non-Cardiac chest pain?
A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:
A specific exam used to evaluate the gall bladder is:
Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?
Question 80 options:
Question 81 (2 points)
Your 35-year-old female patient complains of feeling palpitations on occasion. The clinician should recognize that palpitations are often a sign of:
Question 81 options:
All of the above
Question 82 (2 points)
A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical examination, you note ascites and caput medusa. A likely cause for the hematemesis is:
Question 82 options:
Peptic ulcer disease
Question 83 (2 points)
A 74-year-old obese female presents complaining of persistent right upper quadrant pain. She reports that she has not had any prior abdominal surgeries. Which of the following laboratory studies would be most indicative of acute cholecystitis?
Question 83 options:
C-reactive protein level of 3 mg
White blood cell count of 11,000
Direct serum bilirubin level of 0.3 mg/dl
Serum amylase level of 145 U/L
Question 84 (2 points)
In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen?
Question 84 options:
Left upper quadrant
Right upper quadrant
Left lower quadrant
Right lower quadrant
Question 85 (2 points)
Which of the following statements is true concerning anti-arrhythmic drugs?
Question 85 options:
Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile.
Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality.
Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.
Anti-arrhythmic therapy should be initiated in the hospital for all patients.
Question 86 (2 points)
In autosomal recessive (AR) disorders, individuals need:
Question 86 options:
Only one mutated gene on the sex chromosomes to acquire the disease
Only one mutated gene to acquire the disease
Two mutated genes to acquire the disease
Two mutated genes to become carriers
Question 87 (2 points)
Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
Question 87 options:
Clinical practice guideline
Clinical decision rule
Question 88 (2 points)
Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except:
Question 88 options:
Question 89 (2 points)
An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to:
Question 89 options:
Question 90 (2 points)
A patient complains of fever, fatigue, and pharyngitis. On physical examination there is pronounced cervical lymphadenopathy. Which of the following diagnostic tests should be considered?
Question 90 options:
All of the above
Question 91 (2 points)
Which of the following symptoms is common with acute otitis media?
Question 91 options:
Bulging tympanic membrane
Bright light reflex of tympanic membrane
Increased tympanic membrane mobility
All of the above
Question 92 (2 points)
A 64-year-old male presents with erythema of the sclera, tearing, and bilateral pruritus of the eyes. The symptoms occur intermittently throughout the year and he has associated clear nasal discharge. Which of the following is most likely because of the inflammation?Allergen
An obese middle-aged client presents with a month of nonproductive irritating cough without fever. He also reports occasional morning hoarseness. What should the differential include?
Peptic ulcer disease
Question 94 (2 points)
When teaching a group of older adults regarding prevention of gastroesophageal reflux disease symptoms, the nurse practitioner will include which of the following instructions?
Question 94 options:
Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins.
Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime.
Sit up for an hour after taking any medication and restrict fluid intake.
Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal.
Question 95 (2 points)
Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest pain does seem to ease off. Upon examination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung sounds are clear. With these presenting symptoms your initial diagnosis would be:
Question 95 options:
Mitral Valve Prolapse
Referred Pain from Cholecystitis
Question 96 (2 points)
A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:
Requires hospitalization for treatment
Requires a high dose of parenteral antibiotic
The best evidence rating drugs to consider in a post myocardial infarction patient include:
Question 97 options:
ASA, ACE/ARB, beta-blocker, aldosterone blockade
ACE, ARB, Calcium channel blocker, ASA
Long-acting nitrates, warfarin, ACE, and ARB
ASA, clopidogrel, nitrates
Your patient complains of lower abdominal pain, anorexia, extreme fatigue, unintentional weight loss of 10 pounds in last 3 weeks, and you find a positive hemoccult on digital rectal examination. Laboratory tests show iron deficiency anemia. The clinician needs to consider:
An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD?
Identification of a fluid wave
Positive Murphy’s sign
Midepigastric pain that is not reproducible with palpation
During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with: