AANP PRACTICE QUESTIONS AND

ANSWERS

A 65-year-old woman presents for a follow-up examination after a new

patient visit. She has not seen a healthcare provider for several years.
She is a smoker and her hypertension is now adequately controlled with
medication. Her mother died at age 40 from a heart attack. The fasting
lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200.
In addition to starting Therapeutic Lifestyle Changes, the nurse
practitioner should start the patient on:

1.bile acid sequestrant.

2. a statin drug.
3. a cholesterol absorption inhibitor.
4. low-dose aspirin. - ANSWER- A statin drug
The most commonly prescribed medication for mild systemic lupus
erythematosus (SLE) is:

1. azathioprine (AZA).
2. belimumab (Benlysta).
3. ibuprofen (Advil).
4. cyclophosphamide (Cytoxan). - ANSWER- ibuprofen (advil)

The most common sign of cervical cancer is:

1. postcoital bleeding.
2. strong odor from vaginal discharge.
3. itching in the vaginal area.
4. molluscum contagiosum. - ANSWER- postcoital bleeding

The nurse practitioner prescribes amitriptyline (Elavil) for a patient with

neuropathic pain secondary to diabetes mellitus. On follow-up, the
patient complains of urine retention and dry mouth. The practitioner
would:

1. discontinue amitriptyline and begin ibuprofen (Motrin).

2. refer to physical therapy.
3. start methocarbamol (Robaxin).
4. discontinue amitriptyline and begin gabapentin (Neurontin). -
ANSWER- discontinue amitriptyline and begin gabapentin (neurontin)

A 17-year-old male with rheumatoid arthritis is being treated with an

NSAID and omeprazole (Prilosec). The patient complains of headache,
abdominal pain, and gas. These symptoms are most likely:

1. associated with the omeprazole.

2. related to the underlying condition.
3. the result of the NSAID.
4. caused by viral gastroenteritis. - ANSWER- associated with the
omeprazole

The medication of choice for the initial treatment of juvenile rheumatoid

arthritis is:

1. acetaminophen.
2. prednisone.
3. aspirin.
4. ibuprofen. - ANSWER- ibuprofen

A 12-year-old with sickle cell anemia has recently experienced a sickle

cell crisis and presents for a follow-up examination after a recent
hospitalization. It is most important to continue monitoring growth,
development, and:
1. white blood cell levels.
2. fecal occult blood test.
3. hemoglobin levels.
4. urine dipsticks. - ANSWER- hemoglobin levels

A 90-year-old female is brought to the clinic by her neighbor. She states

that everything is fine, but the nurse practitioner notes that she has poor
hygiene and bruises on her trunk. The neighbor is concerned that the
patient often has no money to buy food, despite income from social
security and a coal miner's pension. The nurse practitioner suspects
abuse. Which of the following is the nurse practitioner obligated to do
next?
1. Report the case to the proper authorities.
2. Tell the neighbor to check on the woman daily and report back.
3. Document the data and report the information to risk management.
4. Call the patient's family and inquire about the concerns. - ANSWER-
report the case to proper authorities

In most cases, the first manifestation of Alzheimer's disease is:

1. impaired judgment.
2. decrease in short-term memory.
3. disorientation in time and place.
4. decrease in long-term memory. - ANSWER- decrease in short-term
memory

The optimal treatment for latent tuberculosis is:

1. rifampin (Rifadin) for 5 months.

2. isoniazid (Nydrazid) for 9 months.
3. pyrazinamide for 6 months.
4. ethambutol for 6 months. - ANSWER- osioniazid (nydrazid) for 9
months

Unilateral spontaneous serous or serosanguineous discharge from a

single duct of a breast is most often caused by:

1. intraductal papilloma.
2. mucinous breast lesions.
3. Paget's disease.
4. ductal carcinoma in situ. - ANSWER- intraductal papilloma

A young child with asthma presents for follow-up evaluation. After

numerous changes in medications and doses, the parents report that the
child continues to have difficulty with coughing, especially during the
night. Which of the following conditions would be the most likely cause
of the continued asthma symptoms?
1. Vocal cord dysfunction
2. Cystic fibrosis
3. Gastroesophageal reflux
4. Allergic rhinitis - ANSWER- gastroesophageal reflux

A pregnant woman with known HIV infection can reduce the risk of
perinatal transmission through zidovudine (Retrovir) therapy. Based on
current research, optimal therapy is to start daily dosing:

1. post amniocentesis.
2. after 14 weeks of gestation.
3. if premature rupture of membranes occurs.
4. if maternal viral loads are greater than 10,000. - ANSWER- after 14
weeks gestation

T-wave inversion with a normal ST segment on a 12-lead EKG may

represent:

1. acute coronary ischemia.

2. right ventricular hypertrophy.
3. atrial hypertrophy.
4. hyperkalemia. - ANSWER- acute coronary ischemia

The 16-year-old mother of a 2-month-old presents the infant, reporting

that the child is very irritable and does not feed well. During physical
examination, the child's head drops back and the child exhibits sudden
flexing of the extremities. As the flexing stops, the child cries
uncontrollably. Funduscopic examination reveals retinal hemorrhages.
Which of the following diagnostic tests should be ordered?

1. Skull X-rays
2. MRI
3. CT scan
4. Pet scan - ANSWER- CT scan

The most important diagnostic factor in evaluating angina pectoris is the

patient's:

1. King of Heart's monitor.

2. physical examination.
3. history.
4. echocardiogram. - ANSWER- history

There are three reasons for latex allergies. Which of the following does
NOT cause the problem?

1. Immediate hypersensitivity
2. Irritant contact of dermatitis
3. Cytotoxic hypersensitivity
4. Immune complex reaction - ANSWER- cytotoxic hypersensitivity
A patient on warfarin (Coumadin) therapy for recurrent deep vein
thrombosis (DVT) is about to have lumbar spinal fusion surgery. The
patient's warfarin is put on hold starting 5 days prior to the surgery and
subcutaneous Lovenox has been ordered for DVT prophylaxis until the
resumption of the warfarin. The nurse practitioner knows that the
patient's postoperative warfarin dose should be restarted based on the:

1. value of her morning Prothrombin time.

2. loading dose of 10 mg, plus the previous warfarin dose.
3. baseline PT and INR values.
4. target INR of 2. - ANSWER- caseline PT and INR values

An 87-year-old patient presents with round, pruritic plaques and small

vesicles on the lower legs. The most likely diagnosis is:

1. allergic contact dermatitis.

2. plaque psoriasis.
3. cutaneous T-cell lymphoma.
4. nummular eczema - ANSWER- nummular eczema

A 3-year-old presents with a 2-day history of acute diarrhea with a total

of 8 watery stools without blood or mucus, and 2 episodes of vomiting
in the past 48 hours. Assessment reveals no current antibiotic therapy,
dehydration <5%, soft abdomen with hyperactive bowel sounds, no
masses or organomegaly; other physical findings are normal. Which of
the following is the most appropriate management plan?

1. Stool culture; Immodium AD liquid.

2. No laboratory workup; instruct parents on signs and symptoms of
dehydration; diet of clear liquids, advancing to bananas, rice cereal, Jell-
O, and soup.
3. Start diet of clear liquids, advancing to bananas, rice cereal, Jell-O,
and soup over next 72 hours; Imodium AD liquid, 1 mg/sml
4. Stool for ova and parasites; advise parents of likely sources of
Giardia; prescribe furazolidone (Furoxone) - ANSWER- No laboratory
workup; instruct parents on signs and symptoms of dehydration; diet of
clear liquids, advancing to bananas, rice cereal, Jell-O, and soup.

A mother presents her 12-month-old child with concern because the

child does not yet say "mama" or "dada." The mother reports that in the
first months of life, the child loved listening to music and being talked
to. The past medical history is negative for ear infections. The nurse
practitioner should:

1. evaluate for hearing loss.

2. refer to speech therapy.
3. re-evaluate in 3 months.
4. check for cerumen impaction. - ANSWER- evaluate for hearing loss

The most common side effect of the oral ribavirin used in the treatment
of hepatitis C is:
1. hemolytic anemia.
2. weight loss.
3. depression.
4. hypothyroidism. - ANSWER- hemolytic anemia

An 86-year-old patient presents with pinguecula, a yellow triangular

degenerative tissue thickening of the bulbar conjunctiva. This condition
is:

1. cured by eye drops.

2. a genetic process.
3. a malignant growth.
4. a solar-induced lesion - ANSWER- a solar-induced lesion

During a well-child examination of an 18-month-old, premature tooth

decay and inflamed gums, particularly of the maxillary incisors, are
noted. The approach to this problem includes:

1. referring the child to a dentist, assessing for bottle feeding and

fluoride in local water.
2. teaching the mother to brush the child's teeth, encouraging vitamin
supplements.
3. recommending fluoride mouthwash and toothpaste, suggesting celery
sticks for snacks.
4. providing fluoride treatment, teaching dental hygiene, and eating
foods high in calcium. - ANSWER- referring the child to a dentist,
assessing for bottle feeding and fluoride in local water

Which of the following is typically observed in the GI system upon

stimulation of the parasympathetic nervous system?

1. No overall effect
2. Increased sphincter tone
3. Increased peristalsis
4. Decreased secretions - ANSWER- increased peristalsis

Type 2 diabetes mellitus is characterized by which of the following?

1. Decreased production of exogenous glucagon-like peptide

2. Autoimmune beta-cell destruction
3. Relative deficiency of dipeptidyl peptidase-4
4. Decreased reabsorption of sodium-glucose transporters - ANSWER-
decreased reabsorption of sodium-glucose transporters

In pulmonary function testing, forced vital capacity represents the:

1. maximum volume of air that can be forcefully exhaled after maximum

inspiration.
2. total volume of air that is exhaled after normal inspiration.
3. total volume of air that the lungs can hold, minus the expiratory
reserve volume.
4. volume of air that can be forcefully exhaled in 1 second. - ANSWER-
maximum volume of air that can be forcefully exhaled after maximum
inspiration

An adult male presents as first patient of the day after awaking about
5:00 AM with indigestion and chest pressure. On checking his pulse, he
found no change from previous measurements. He states that, while
waiting for the nurse practitioner to arrive, he began to feel a little
clammy. A 12-lead EKG records the following patterns. On the basis of
these EKG readings, the diagnosis is:

1. anterior-septal acute myocardial infarction.

2. lateral acute myocardial infarction.
3. inferior acute myocardial infarction.
4. anterior acute myocardial infarction. - ANSWER- inferior acute
myocardial infarction

During the past 24 hours, a 62-year-old has experienced abdominal pain

that radiates to the back. The patient also reports several episodes of
nausea and vomiting, a low-grade temperature, and a history of
excessive drinking. Physical examination reveals a distended abdomen.
Laboratory serum values indicate elevated alkaline phosphatase,
amylase, and serum lipase. The most likely diagnosis is:

1. alcoholic liver disease.

2. acute mesenteric ischemia.
3. viral hepatitis.
4. acute pancreatitis. - ANSWER- acute pancreatitis

An otherwise healthy adult female presents complaining of vaginal

burning and itching during urination. She has a social history of two
sexual partners. She denies fever or vaginal discharge, but has noted a
lesion on one labium. The nurse practitioner should order all of the
following EXCEPT:

1. wet mount and potassium hydroxide.

2. dark-field microscopy of fluid from the lesion.
3. nucleic acid amplification testing for gonorrhea.
4. serology for Haemophilus ducreyi. - ANSWER- dark-field
microscopy of fluid from lesion

A 3-year-old female has been diagnosed with bacterial meningitis. She

attends preschool daily at a local church day care program. The day
before her diagnosis, she ate lunch with her mother at a local restaurant.
For which contact(s) would chemoprophylaxis with rifampin be
recommended?

1. Preschool contacts in the past 7 days

2. A friend of the patient's sister who visited after school yesterday
3. The checkout employee at the grocery store yesterday
4. Diners at the restaurant during lunch the day the patient ate there -
ANSWER- preschool contacts in past 7 days

Congenital dysplasia of the hip:

1. more commonly affects both hips.

2. occurs more commonly in females.
3. is correctable at any age.
4. typically self-corrects by 12 weeks of age. - ANSWER- more
commonly affects both hips

Anticholinergic agents such as ipratropium (Atrovent) and tiotropium

(Spiriva) are used in COPD primarily to:

1. induce bronchodilation.
2. decrease airway inflammation.
3. expand the lung fields.
4. treat hypoxemia. - ANSWER- induce bronchodilation

The clinical presentation of placenta previa that develops during the

third trimester includes:

1. intermittent dark-red spotting.

2. occult bleeding with abdominal or back pain.
3. sudden onset of painless and profuse bleeding.
4. painless occult bleeding that becomes visible upon onset of labor. -
ANSWER- sudden onset of painless and profuse bleeding

A 27-year-old male patient, who works as a janitor, presents with a 6-

month history of an intermittent rash on his hands. History reveals
itching and occasional burning. Examination reveals irregularly-
distributed scaly maculopapular erythematous patches extending from
the dorsum of the hand several inches up the forearms, and dry palms
with no nail involvement. The most likely diagnosis is:

1. contact dermatitis.
2. scabies infestation.
3. psoriasis.
4. eczema. - ANSWER- contact dermatitis

Anorexia nervosa occurs most commonly in which of the following?

1. Painters
2. Only children
3. High-level athletes
4. Individuals from large families - ANSWER- high level athletes

A frail elderly patient presents with constipation. Which of the following

normal physiologic changes seen with aging is the most likely cause?
1. Decreased bowel muscle tone
2. Increased bile secretion
3. Increased absorption of calcium
4. Decreased pancreatic secretions - ANSWER- decreased bowel muscle
tone

A patient reports to your office, having been struck on the right cheek
with a baseball bat. On examination, you notice tenderness and swelling
over the cheek. The patient is unable to gaze laterally with his left eye,
and he complains of double vision when he attempts to do so. This is
most likely associated with:

1. retinal hemorrhage.
2. orbital rim fracture.
3. subarachnoid hemorrhage.
4. periorbital cellulitis. - ANSWER- orbital rim fractures

A 7-year-old child presents with group A streptococcal infection

confirmed by throat culture. Past history includes treatment for positive
streptococcal infection with erythromycin (EryPed oral suspension) 3
weeks ago. What is the most appropriate next intervention?

1. Treat with amoxicillin for 10 days.

2. Obtain culture for all household members.
3. Treat with azithromycin (Zithromax) for 10 days.
4. Intramuscular Penicillin. - ANSWER- treat with amoxicillin for 10
days

A 16-year-old female adolescent is brought to the nurse practitioner's

office by her mother, who is concerned about her daughter's recent
weight loss. History reveals that the daughter was consistently in the
50th percentile for weight, but is now in the 10th percentile. The mother
states that she is concerned that her daughter is purging herself after
meals since she often goes to the restroom after eating and remains there
for a long period of time. The daughter denies any self-induced
vomiting, starvation or excessive activity. She does state that she jogs
five miles a day and is in good condition. In addition to a complete
blood count with differential, which of the following laboratory tests
will be most helpful for further assessment?

1. Electrolytes, fasting blood sugar

2. Creatine phosphokinase, follicle-stimulating hormone (FSH)
3. Electrolytes, blood urea nitrogen (BUN)/creatinine, urinalysis
4. Electrolyt - ANSWER- electrolytes, blood urea nitrogen
(BUN)/creatinine, urinalysis

An adult female who is homeless presents for an initial obstetric visit at

34 weeks of pregnancy. She is diagnosed with Chlamydia trachomatis
infection. What complication will her newborn be most at risk?

1. Conjunctivitis
2. Hearing loss
3. Pneumonitis
4. Meningitis - ANSWER- conjunctivitis

A 2-year-old male presents for reevaluation. Two days ago, he had four
episodes of vomiting and six diarrheal stools. On physical examination
today, his vital signs reveal P = 120 and capillary refill of 3 seconds. The
patient's eyes are sunken and his extremities are mottled and cool to the
touch. The treatment plan would include:

1. start oral electrolyte mixture every hour.

2. hospitalization for IV fluid replacement.
3. giving the child loperamide for each diarrheal stool.
4. catheterizing the child to obtain accurate urine output. - ANSWER-
hospitalization for IV fluid replacement

A nurse practitioner places a 76-year-old patient on nifedipine

(Procardia) 10 mg t.i.d. for angina. The patient is unable to remember to
take the medication at the scheduled times. The practitioner should:

1. discontinue the issue with the patient's daughter.

2. change the dose to extended release 30 mg daily.
3. reinforce the importance of taking the medication.
4. increase the dosage to 20 mg b.i.d. - ANSWER- change the dose to
extended release 30mg daily
A pediatric male is present with his mother, who states that he is
extremely restless at night and constantly scratches his anal area. Which
diagnostic procedure would confirm a diagnosis of pinworm infestation?

1. The patch test

2. Examination of bed linens
3. Examination of transparent tape sample from perianal skin
4. Blood tests for anemia and eosinophilia - ANSWER- examination of
transparent tape sample from perianal skin

Which of the following microorganisms are most frequently associated

with acute bacterial rhino-sinusitis?

1. Staphylococcus aureus and Mycoplasma pneumonia

2. Staphylococcus aureus and Methicillin Resistant Staph aureus
3. Streptococcus pneumoniae and Haemophilus influenzae
4. Streptococcus pneumoniae and Pseudomonas aeruginosa - ANSWER-
strep pneumo and haemophilus influenzae

A child is being treated with methylphenidate (Ritalin) for attention-

deficit disorder. The following are all side effects of Ritalin EXCEPT:

1. muscle cramps
2. mild irritability.
3. increased heart rate.
4. slight increase in growth velocity. - ANSWER- slight increase in
growth velocity

A geriatric female presents for her annual examination. She has been on
antihypertensive medications for over 20 years, with good control.
Laboratory values are within normal ranges. The nurse practitioner is
concerned about the patient's cardiac health risks, due her to weight and
her waist circumference. According to the AHA guidelines, which of the
following goals is expected for this patient?

1. Physical activity for 60 minutes daily, for a minimum of 6 days a

week
2. Physical activity for 30 minutes daily, 7 days a week
3. Physical activity for 30 minutes daily, for a minimum of 5 days a
week
4. Physical activity for 60 minutes daily, 7 days a week - ANSWER-
physical activity for 30 minutes daily, for a minimum of 5 days a week

The management of COPD in the elderly is best guided by:

1. spirometry.
2. arterial blood gases.
3. radiologic imaging.
4. symptomatology. - ANSWER- symptomatology
A young, athletic adult presents with shoulder pain and inability to raise
the arm above the shoulder. The most likely diagnosis is:

1. frozen shoulder syndrome.

2. cervical radiculopathy.
3. rotator cuff tear.
4. polymyositis. - ANSWER- rotator cuff tear

A 50-year-old male presents with bruises and abrasions on the left leg
and forearm, claiming to have had a number of minor accidents at home
and at work. The patient reports general feelings of depression,
forgetfulness, and, despite the fact that he is regularly employed, a
mounting collection of unpaid and overdue bills. In taking the patient's
history, a significant pattern of parental alcohol abuse, stroke, TIA, and
MI emerges. During questioning to elicit a more thorough diagnosis, the
patient becomes hostile and leaves the clinic without further treatment.
The most likely explanation for this behavior is:

1. Alzheimer's disease.
2. chronic alcoholism.
3. cancer.
4. carotid artery stenosis. - ANSWER- chronic alcoholism

A 28-year-old patient presents with profuse yellow vaginal discharge,

odor, and local irritation. She reports completing a 7-day course of oral
metronidazole (Flagyl), 500 mg b.i.d. 4 weeks ago. She has had multiple
recurrences over the last 18 months. Microscopic examination reveals
presence of clue cells. What is the most appropriate treatment
intervention?

1. Oral metronidazole (Flagyl), 500 mg b.i.d., plus metronidazole

vaginal gel (MetroGel), for 5 days
2. Treat both patient and partner(s) with oral metronidazole (Flagyl), 500
mg b.i.d., for 7 days
3. Metronidazole vaginal gel (MetroGel) twice weekly for 4 to 6 months
4. Treat patient with metronidazole vaginal gel (MetroGel) b.i.d. and
partner(s) with tetracycline, 250 mg q.i.d., for 7 days - ANSWER- Treat
both patient and partner(s) with oral metronidazole (Flagyl), 500 mg
b.i.d., for 7 days

An adult female who recently returned from a business trip to Japan

presents for a recheck appointment. The only remarkable laboratory
result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL
(normal = 0.4-6 microunits/mL). The patient reports that her neck hurts;
examination reveals thyroid tenderness. Which of the following
laboratory tests should the nurse practitioner order now?

1. Triiodothyronine (T3) and free thyroxine (FT4)

2. Triiodothyronine (T3) only
3. Triiodothyronine (T3) resin uptake assay
4. Triiodothyronine (T3) and free triiodothyronine (FT3) - ANSWER-
Triiodothyronine (T3) and free thyroxine (FT4)
In treating a pregnant female with migraine headaches, which of the
following drugs is in Category X?

1. Ergotamine tartrate (Ergomar)

2. Sumitriptan succinate (Imitrex)
3. Frovatriptan (Frova)
4. Amitriptyline (Elavil) - ANSWER- ergotamine tartate (ergomar)

A nurse practitioner is evaluating an infant for possible colic. Which of

the following could indicate the need for a more extensive evaluation?

1. 3-oz (85 g) weight gain over the past 2 weeks

2. Stool negative for occult blood
3. Moist mucus membranes and flat fontanels
4. Onset at 4 weeks of age - ANSWER- 3-oz (85 g) weight gain over the
past 2 weeks

Which of the following is a hallmark of lumbar spinal stenosis?

1. Incontinence of bowel and/or bladder

2. Point tenderness of the lumbar spine
3. Leg, buttock or back pain precipitated by walking.
4. Bilateral leg pain with sitting. - ANSWER- leg, buttock or back pain
precipitated by walking
A 70-year-old patient presents to the clinic complaining of dyspnea,
palpitations, and fatigue. The patient reports a 2-week history of
blackened stools, which the patient attributes to drinking berry juice.
Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb =
4.5 g/dL; Hct = 16%. What is the most appropriate immediate
intervention?

1. Order serum iron, total iron-binding capacity (TIBC), and ferritin.

2. Refer to a gastroenterologist.
3. Send to the emergency room.
4. Order a complete blood count (CBC) with differential. - ANSWER-
Send to emergency room

The symptoms of benign prostatic hypertrophy are often overlooked

because the older male:

1. understands that surgery is the only cure for this condition.

2. considers urinary problems to be a normal part of aging.
3. is fearful of the side effects of additional medication.
4. is concerned that he will no longer be able to obtain an erection. -
ANSWER- considers urinary problems to be normal part of aging

Upon admission to a nursing home, an 85-year-old patient receives a

negative result on the purified protein derivative (PPD) test. To
determine TB status in the frail elderly, a second PPD should be
performed in:

1. 72 hours.
2. 1 week.
3. 3 months.
4. 6 months. - ANSWER- 1 week

Which of the following is NOT used for therapy of an acute attack of

gout?

1. Colchicine (Colcrys)
2. Indomethacin (Indocin)
3. Methylprednisolone (Solumedrol)
4. Allopurinol (Zyloprim) - ANSWER- allopurinol (zyloprim)

A 26-year-old female presents with abdominal distention, bloating, and

intermittent crampy abdominal pain relieved by defecation. She has four
to six loose stools a day when stressed. Between bouts of diarrhea, she
often has constipation. Physical examination results are normal. The
CBC was normal. The most likely diagnosis is:

1. diverticulitis.
2. viral gastroenteritis.
3. inflammatory bowel disease.
4. irritable bowel syndrome - ANSWER- irritable bowel syndrome

A mother has just noticed that her 15-month-old, 15-kg child has
recently ingested an unknown quantity of iron tablets. The mother has
ipecac syrup and activated charcoal on hand. The mother should be
advised to:

1. take the child to the primary care provider.

2. give ipecac per recommendation on the bottle label.
3. take the child to the emergency room.
4. give the child 30 g of activated charcoal diluted with water -
ANSWER- take child to emergency room

A 13-year-old is concerned because she has not yet begun to menstruate.

Physical examination indicates that the patient is at Tanner stage IV and
is of average height and weight. Which of the following would be the
most appropriate response to this patient?

1. "We'll need to refer you to an endocrinologist for a complete workup."

2. "We'll need to do some tests to find out why you are not having
periods."
3. "I'll give you some pills that will make your periods start."
4. "Your development is exactly as expected for your age; you'll
probably begin to have periods within a year." - ANSWER- "Your
development is exactly as expected for your age; you'll probably begin
to have periods within a year."
The most common bacterial cause of cellulitis in patients with diabetes
mellitus is:

1. Pseudomonas aeruginosa.
2. group B beta-hemolytic Streptococcus.
3. Staphylococcus aureus.
4. Staphylococcus saprophyticus. - ANSWER- Staphylococcus aureus

A 46-year-old female found a lump in her breast this morning. History

includes: no prior breast disease; G2P2 (first birth, age 22); maternal
aunt diagnosed with breast cancer at age 72; last menstrual period was
2.5 weeks ago. On examination, a nurse practitioner palpates a 2-cm
round, soft, mobile, tender lesion in the upper outer quadrant of the right
breast. Mammogram is negative. Which of the following actions is most
appropriate?

1. Reassure the patient that no further action is necessary.

2. Repeat unilateral right mammogram in 3 months.
3. Schedule a right-breast ultrasound.
4. Refer for genetic testing if the lump increases in size. - ANSWER-
schedule a right breast ultrasound

Risk factors for genital herpes include:

1. multiple sexual partners and years of sexual activity.
2. genetic transmission.
3. infection with other sexually transmitted diseases before the age of 12.
4. multiple sexual partners and frequent use of public spas. - ANSWER-
multiple sexual partners and years of sexual activity

On physically assessing a newborn's head, you note an enlarged, fluid-

filled area that is subperiosteal and does not cross suture lines. This
finding indicates the presence of:

1. macrocephaly.
2. subgaleal hemorrhage.
3. congenital hypothyroidism.
4. cephalohematoma. - ANSWER- cephalohematoma

A 65-year-old patient being treated with digoxin (Lanoxin) for chronic

heart failure (HF) presents with complaints of palpitations. Three days
ago, the patient was placed on clarithromycin (Biaxin) by another
provider for community-acquired pneumonia. The appropriate course of
action at this point would be to:

1. increase the digoxin dosage by 25%.

2. obtain a digoxin level and change the antibiotic to azithromycin
(Zithromax).
3. obtain a chest X-ray.
4. obtain a serum potassium level and perform a 12-lead EKG. -
ANSWER- obtain a digoxin level and change the antibiotic to
azithromycin (zithromax)

A 54-year-old male who is 30 pounds overweight states that he awakens

at night with heartburn and the taste of hot acid in his mouth. Stress
makes his condition worse, yet baking soda seems to provide some
relief. Findings on examination are normal and the stool for occult blood
is negative. The preliminary diagnosis(es) should be:

1. esophagitis.
2. esophageal spasm.
3. helicobacter pylori.
4. gastroesophageal reflux disease. - ANSWER- GERD

A late adolescent patient presents with complaints of acute-onset

unilateral right eye pain, visual changes, seeing halos around lights,
abdominal pain, and intermittent nausea. Physical findings include an
erythematous right eye without discharge, a cloudy cornea, and a
moderately dilated right pupil that is nonreactive to light. The nurse
practitioner should immediately:

1. apply steroid drops to the right eye.

2. apply mydriatic drops to the eye.
3. refer to the emergency department.
4. make an appointment for him to see an ophthalmologist. - ANSWER-
refer to emergency department
In a 6-year-old child, which of the following is the preferred drug for
stage 1 Lyme disease?

1. Trimethoprim-sulfamethoxazole (Bactrim)
2. Azithromycin (Zithromax)
3. Doxycycline (Doryx)
4. Cefuroxime (Ceftin) - ANSWER- cefuroxime (ceftin)

An 86-year-old patient is experiencing radiculopathy-associated lower

back pain that has not improved over the past 4 weeks. The medical
history includes a lumbar discectomy. The best type of imaging study for
evaluating this patient would be a/an:

1. MRI.
2. spinal X-ray.
3. myelography.
4. nuclear bone scan. - ANSWER- MRI

A 30-month-old with a history of frequent ear infections was seen in

September after a symptom-free summer. Examination revealed bilateral
bulging eardrums. After two separate courses of antibiotics, fluid is
noted in both ears. The parent reports speech difficulties. The most likely
diagnosis is:
1. otitis media with effusion.
2. myringitis.
3. recurrent acute otitis.
4. Esutachian tube dysfunction. - ANSWER- otiti media with effusion

A 19-year-old patient who has used oral contraceptives for 3 years plans
to discontinue the pill at the end of her current cycle to become
pregnant. Which of the following daily supplements would receive the
highest priority?

1. Calcium carbonate
2. Folic acid
3. Ferrous sulfate
4. Multivitamin - ANSWER- folic acid

A frail elderly widow presents to the senior clinic with a 3- to 4-day

history of confusion that became worse the evening before but currently
seems a little better, although her speech is rambling and difficult to
follow. During the examination, the patient is anxious and agitated. She
is on cardiac medications, an antidepressant, and insulin. The most likely
diagnosis is:

1. mild stroke.
2. polypharmacy.
3. electrolyte imbalance.
4. agitated depression. - ANSWER- polypharmacy

A 46-year-old female presents with a complaint of amenorrhea for 3

months. The first-line diagnostic workup is:

1. urine pregnancy test.

2. progesterone challenge.
3. serum prolactin level.
4. thyroid-stimulating hormone (TSH). - ANSWER- urine pregnancy
test