27 Dec A 21 year old college student
A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:
Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:
Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?
A 55 year old patient has a work-up for hypertension and is noted to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect?
Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?
Risk factors for acute arterial insufficiency include which of the following?
What is the Gold standard for the diagnosis of asthma?
Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?
Amaurosis fugax is described as a:
Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:
Which of the following patient characteristics are associated with chronic bronchitis?
In the initial evaluation of a patient with new onset hypertension, the nurse practitioner should:
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?
Expected spirometry readings when the patient has chronic emphysema include:
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:
A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?
A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should:
An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent?
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:
Treatment of H.pylori includes which of the following?
Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?
A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?
Your patient Jerry has gout. What do you suggest?
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:
Martha had a less than 7% value on her Schilling test. What medication do you anticipate she might need?
The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is:
Which statement below is correct about pertussis?
An AST that is more than twice the level of ALT is suggestive of:
Your 31-year-old patient, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?
Acute rheumatic fever is an inflammatory disease which can follow infection with:
A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:
Of the following, the patient who should be referred for periodic colonoscopy is the patient with:
Which type of lung cancer has the poorest prognosis?
Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:
Treatment of acute vertigo includes:
Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?
A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:
Of the following choices, the least likely cause of cough is:
An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:
An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination?
The Centor criteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?
Group A ?-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?
Which of the following statements about malignant melanomas is true?
What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?
Appropriate therapy for peptic ulcer disease (PUD) is:
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?
A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?
Risk factors for acute otitis media (AOM) include all of the following except:
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?
The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:
A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?
The most common cancer found on the auricle is:
A 58 year old complains of tightness in his chest while cutting firewood. It disappears quickly if he stops chopping. He denies shortness of breath, his total cholesterol level is less than 200 mg/dL, and he is a non-smoker. What is the most appropriate action for the nurse practitioner to take with this patient?
A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?
Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?
Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?
Management of a patient with hypertension and an abdominal aortic aneurysm would include:
An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis?
Impetigo and folliculitis are usually successfully treated with:
Which of the following color changes in a pigmented lesion suggests malignant transformation?
A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?
A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:
An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:
When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?
Sandra has celiac disease. You place her on which diet?
Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?
A 12 year old patient is afebrile and complains of severe left ear pain. On examination, the TM is gray and intact and there is a green discharge in the external canal. What action by the nurse practitioner is most appropriate?
The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?
A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?
What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?
A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?
A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests:
The nurse practitioner is reviewing a patient’s lab report who completed the hepatitis B series 3 months ago. Which of the following lab results would you expect to see in this patient?
A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best initial treatment option for this patient?
Which of the following is not a risk factor for coronary arterial insufficiency?
A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include:
Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?
A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?
A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?
Which intervention listed below is safe for long term use by an adult with constipation?
Which of the following is a secondary cause of hyperlipidemia?
What condition is associated with mucus production greater than 3 months per year for at least 2 consecutive years?
In order to decrease deaths from lung cancer:
Marian, age 52, is obese. She complains of a rapid onset of severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your differential diagnosis might be:
A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:
Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?
The differential diagnosis for a patient complaining of a sore throat includes which of the following?
Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?
Diagnosis of Crohn’s disease is made considering signs, symptoms and:
A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:
A false-positive result with the fecal occult blood test can result from:
Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?
A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:
Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions?
A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?
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