1. You see a 73-year-old woman with a 40 pack year smoking history, chronic obstruction
pulmonary disease and peripheral artery disease who presents with an ulcer on the soul
of her left foot. The also has an irregular
...
1. You see a 73-year-old woman with a 40 pack year smoking history, chronic obstruction
pulmonary disease and peripheral artery disease who presents with an ulcer on the soul
of her left foot. The also has an irregular edge and pale face and punched out
appearance, with the surrounding skin white and shiny. The patient states that the pain is
worse at night in bed and when the legs are elevated. The most likely diagnosis is:
-arterial ulcer
2. Hey 75-year-old man presents with chief complaints of headache, Nausea, and
muscle weakness. His creatinine level is 2.1 MG/DLNGFR is 30 ML/MIN/1.73 m2. He
currently takes a thiazides diuretic for the management of hypertension. Which of the
following statements is false regarding the use of diuretics in the elderly?
-loop diuretics are contraindicated when GFR is <40 ml/min/1.73 m2
3. All of the following practices are recommended when prescribing medication with
confusing or similar-sounding names except:
- including either the generic or brand name on the prescription order, but not both
4. A 19-year-old is diagnosed with meningococcal meningitis. In order to prevent
secondary infections among adults who had close contact with the patient, all of the
following are recommended except:
- Prophylaxis with acyclovir (Zovirax)
5. A 38-year-old woman comes to the emergency department complaining of a rapid
heartbeat, tremors, and chest tightness. She reports early in the day she was feeling a
migraine starting so she took a pill giving to her by her friend who also experience
migraines. Her medical history reveals that she is currently taking a monoamine oxidase
inhibitor for depression. Which migraine medication did see most likely take?
-Almotriptan ( alert)
6. 826-year-old woman presents with uncomplicated UTI. She is otherwise healthy, has
not received any systematic anti microbials in the past year and it’s not taking any
medications. She is currently not pregnant and is using etonogestrel/ estradiol vaginal
ring for contraception. The local E. Coli resistance rate to TMP/SMX is about 12%. The
preferred therapy for this patient is:
- Trimethoprim-sulfamethoxazole
7. As part of the Deficit reduction act of 2005, Medicare will incorporate quality payment
adjustments for certain hospitals-acquired conditions, including all of the following
except:
-Myocardial ischemic
8. Which of the following example describes a potential malpractice scenario?
-A post-myocardial infraction patient is prescribed an inappropriate dose clopidogrel and
experience a severe blessing episode.
9. A 57-year-old woman presents for a flu shot as she has heard reports that it will be “a
bad flu season’. She has had no primary care for more than 10 years she like health
insurance. She admits to a 30 pack here cigarette smoking history, currently smoking
one pack for a day. Her history and examination are unremarkable. Which screening test
would you recommend?
- Mammography
10. A 28-year-old woman presents who complains of tugging chest pain unrelated to
physical activity. She is generally in good health and non-smoker has a BMI of 23
KG/M2, and denies dyspnea of dizziness. Physical examination reveals a grade 2/6 late
systolic murmur that follows a midsystoloc click at the 5th intercostal space, midclavicular line. An echocardiogram Fails to reveal mitral valve tissue redundancy. This
can you go presentation is most consistent with:
- Mitral Valve prolapse
11. A quality improvement plan characterized by Limiting variability and removing defects
in a process best describes:
- six sigma
12. Laboratory findings of a 28-year-old male suspected of a heart stroke can include all
of the following except:
- Hypermatremia
13. A 42-year-old male presents with a sudden onset of inability to tightly close the eye
lid, frown, or smile on the right side. His examination is otherwise unremarkable and past
medical history is unremarkable. This likely represent paralysis of cranial nerve:
- VII
14. You see a 71-year-old man with atrial fibrillation and chronic obstructive pulmonary
Disease who is diagnosed with community-acquired Pneumonia. His medical history
does not show any drug allergies and he completed a course of respiratory
fluoroquindore for the treatment of acute bacterial sinuses within the past month. Which
of the following would you consider The most appropriate choice of anti-microbial?
-High dose amoxicillin
15. According to the Consolidated Omnibus Reconciliation Act ( CORBA), The spouse of
an eligible employee will be eligible for COBRA coverage in all of the following
circumstances except when the eligible employee:
- is terminated for misconduct
16. A 43-year-old woman presents in the emergency department with a chief complaint
of swelling of the ankles, hands, and face. She also reports urine dad is darkly colored
and foamy. Her blood pressure is 184/118 mm hg. All of the following urinalysis findings
will support a diagnosis of glomerulonephritis except:
- Elevated levels of ketones
17. A 78-year-old male is being treated for hypoglycemia episode. He has a long history
of type 2 diabetes mellitus as well as congestive heart failure and COPD. He is currently
taking basal insulin with a sulfonylurea. What is the acceptable a A1C goal for this
patient?
- <8%
18. Tertiary Prevention activities for a 69-year-old woman with congestive heart failure
and type 2 diabetes mellitus include:
- Adjusting therapy to minimize dyspnea
19. A physicians employs an NP to provide service at a satellite acute care clinic. If the
physician is never present at the clinic, which of the following statements is true?
- The NP services should be billed under the NP’s provider number.
20. You see a 48-year-old man with a chief complaint of pain during urination. Imaging
reveals the presence of a kidney stone in the ureter. Do you consider all of the following
management option except:
- Thiazides diuretic use
21. In managing a 58-year-old woman who is admitted for deep vein thrombosis, caution
should be used with which of the following medication due to risk of heparin induced
thrombocytopenia?
- Enoxaparin (lovenox)
22. You see a 76-year-old woman living at home who is accompanied by her home care
provider. She has COPD and type two diabetes mellitus. An example of a secondary
prevention strategy is:
- Checking her blood pressure
23. All of the following persons are eligible for Medicare service except:
- A 69-year-old undocumented resident in the US with atrial fibrillation
24. The NP is called to treat a 43-year-old woman for multiple contusions following a
domestic violence attack. The NP realizes that one of the best predictors of a
subsequent homicide of victims are domestic violence is:
- History of perpetrator attempting to strangle the victim
25. When initiating therapy for a spironolactone for a patient who Is also and ace
inhibitor, you advise the patient to return in 5 days to check which of the following
laboratory parameters?
- Potassium
26. All of the following are examples of primary prevention strategies except:
- performing a hemoglobin A1C for all patients admitted to the hospital
27. When considering HIPAA regulations, all the following are examples of” individual
identifiable health information” except:
- The number of prescriptions of oxycodone written each month by a provider
28. Which of the following statements is false regarding end-of-life decisions making for
a patient that is hopelessly and terminally ill?
- Advance directives are legally binding and recognized in all 50 states
29. While evaluating 833 or female with a two day history of dysuria, which of the
following findings in urinalysis is most suggestive of urinary tract infection caused by a
gram-negative organism?
- Nitrites
30. You are examining a 65-year-old woman with a history of rheumatic heart disease. In
assessing the patient for mitral stenosis, you expect to find a heart heart murmur
characterized as:
-localized low-pitch late diastolic heard best at apex.
31. The privacy rule established by the US health department and human services in
1996 Implemented the requirements for:
- Health insurance portability and accountability act (HIPPA)
32. When managing elderly patients with diminish cognitive function, which of the
following statements is true regarding patient’s competence for making in form
healthcare decisions?
- only a court can appoint a guardian to make decisions for a patient declared
incompetent
33. A 17-year-old male is admitted after experiencing sudden, severe pain in the scrotum
during the night. Physical examination reveals swelling of the scrotum and the loss of
cremasteric reflex. His heart rate is 110 bpm, Blood pressure 150/80 mm hg, and
temperature 99.8 F. There’s most likely represents:
- testicular torsion
34. In considering treatment for Jane in the previous question, which of the following
would be most appropriate if she has a history of penicillin allergy?
- amoxicillin
35. All of the following are required Medicare terms and conditions for paying NP service
except:
- separate charges are billed for NP services and facility charges
36. The NP is called to evaluate a 57-year-old man who reports episodes of acute
angina with physical exertion. He is currently taking an ace inhibitor and low-dose
aspirin. The NP considers which of the following approaches at the start of anginal
symptoms?
- A dose of nitroglycerin via sublingual spray
37. A 41-year-old woman is diagnosed with hypertension that requires medication. She
is otherwise healthy but currently takes drospirenone/ethinyl estradiol for birth control.
Which of the following antihypertensive medication would be least preferred for this
patient?
- Calcium channel blocker
38. The NP is called to evaluate Jane, a 43-year-old woman, who presents with a diffuse
maculopapular rash that began on The trunk but now covers the entire body, including
the palms and soles. The rash is not itchy but wart-like sores are present in the mouth
and genital area as well as skin folds. Initial evaluation reveals generalize
lymphadenopathy And a low-grade fever, and she complains of lethargy and headache.
The patient reports that she had a painless genital ulcer that healed on its own about 3
weeks earlier. Which of the following is the most likely diagnosis?
- Genital Herpes
39. Gary is a 63-year-old African-American male who has been treated for hypertension
with ace inhibitors her monotherapy for the past six weeks. Despite carries insistence
that he is taking his medication as directed, his blood pressure continues to elevated.
Gary mentions that he prefers not having to take multiple medications is day due to the
cost and convenience. Which of the following is the most appropriate course of action?
- switch to a calcium channel blocker
40. A 15-year-old male is brought into the emergency department by his parents
following a 12 hour history of nausea, family, and abdominal pain. Physical examination
reveals obturator and psoas signs and a temperature of 102.6 F. Anticipated white blood
cell with differential results are as follows:
- Total WBC = 16,500/ mm3, Neutrophils=66%, Bands=8%, Lymphocytes=22%
41. A 27-year-old man presents with a chief concern of an abnormal mass within his left
scrotum. He describes it as feeling like a bag of worms in his present when he is
standing but disappears when he lies down. His past medical history is unremarkable
and his BMI is 29 KG/M2. He has been in a monogamous relationship for the past four
months. The most likely diagnosis is:
- Varicocele
42. In a patient diagnosed with infections mononucleosis, the use of amoxicillin should
be avoided due to the risk:
- Rash
43. Mrs. Gonzalez is a 53 old female who is being evaluated for routine follow-up care.
Her medical history includes dyslipidemia; hypertension, and rheumatoid arthritis.
Laboratory animal is reveals elevated serum alanine transaminase and aspartate
transaminase. The long-term use of which of the following medications is the most likely
cause of this finding?
- Methotrexate
44. A 77 year old woman is accompanied by her husband for evaluation. She is currently
being treated for metoprolol for hypertension and digoxin for atrial fibrillation. He reports
that his wife is becoming increasingly forgetful over the past year, fell into note in Porten
family events such as birthdays sometime to come and confused with driving directions
to familiar locations. She has no previous psychiatric history. The most likely diagnosis
is:
- Dementia
45. A 22-year-old college student presents with a two day history of severe sore throat
and difficulty eating or drinking due to trouble swallowing. A physical examination reveals
exudative pharyngitis and minimally tender anterior and posterior cervical
lymphadenopathy. The NP suspects infectious mononucleosis and expects which are
the following laboratory findings?
- Lymphocytosis with atypical lymphocytes
46. Phyllis is a 34-year-old woman who presents with a chief complaint of a migraine
resulting in nausea and vomiting. She reports that she experiences multiple migraines
each month. She has given a prescription for sumatriptan 100-mg tablets orally to treat
acute migraine pain. When counseling Phyllis about the medication, the nurse
practitioner advises about all of the following adverse effects except:
- Sedation
47. A 27-year-old woman is being evaluated for a seven day history of acute bacterial
rhino-sinusitis. She is otherwise healthy and has not received any antimicrobial therapy
in the past six months. She also has no history of drug allergy. In considering a first-line
antimicrobial treatment, which of the following would be most appropriate?
- Amoxicillin-clavulanate
48. A 21-year-old female student presents at the university clinic with a nose bleed. This
is her third bleeding episode in the past week she is otherwise healthy with no history of
bleeding disorders. The NP advises that the appropriate first line intervention of anterior
epistaxis is:
-Firm pressure to the area superior to the nasal alar cartilage
49. A 49-year-old woman presents with a three day history of Burning during urination, a
thin and grayish white vaginal discharge in vagina itching. Laboratory examinations
common you expect to find all-of the following except:
- pseudohyphae
50. You see a 77-year-old male for treatment in lacerations on his forearm. Upon
examination, you notice poor skin turgor what it says on the arms and back of the hands.
This is likely a sign of:
- normal age related change
51. A 26-year-old male presents with a chief complaint of bilateral, intermittent itchy eyes
accompanied by a rope like discharge. This is most consistent with conjunctivitis caused
by:
- Allergen
52. A 32 -year-old woman in her second trimester pregnancy presents with fever, flank
pain, and hematuria. The NP suspects pyelonephritis. Which of The following urinalysis
results would be most indicative of pyelonephritis?
-White blood cell(WBC) casts
53. A 21 year old camp counselor presents for evaluation with a chief complaint of
generalized itchiness. He has just returned after a week of summer camp. Physical
examination reveals excoriated papules along his axillary folds and at the belt line. The
NP suspects scabies and prescribes permethrin lotion. In counseling the patient on the
use of permethrin, the NP mention that:
- itch often persists for a few weeks after successful treatment.
54. Bill is a 46-year-old man who rushed to the emergency department at the
experiencing Senate onset of edema of the lips and face and a sensation of the
tightness and difficulty breathing following a wasp sting. His blood pressure is 78/52 mm
hg, heart rate 120 BPM, and respiratory rate is 32/min. The course of action in caring for
Bill is to administer:
- Epinephrine
55. A 32-year-old man requires evaluation for hepatitis infection prior to taking a job as a
restaurant cook. He Presents with the following Laboratory results:
- Hepatitis A
56. A 57-year-old woman presents with a six month old numbness of the finger tips and
oral irritation. Physical examination reveals pale conjunctiva and the heart murmur. She
is otherwise healthy, exercise regularly, has a BMI of 22 kg/m2, and she states she is a
vegan. Hemogram results are as follows: Hg= 8.2 g/dL (12-16 g/dL) Hct =23% (36% -
42%) MCV = 135 fl ( 80 - 96 fL) - Red Blood Cell distribution width =17%, These findings
are most consistent with:
- vitamin B12 deficiency
57. A 23-year-old man is admitted after experiencing seizures. A witness to the seizure
described how the patient fell to
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