NR 603 MIDTERM APEA 2023
NEW REAL EXAM
A 30-year-old female comes into a clinic with classic signs and symptoms of
appendicitis. The nurse practiti... [Show More] oner fails to refer the patient tree surgeon. D appendix
ruptured and the woman dies. This is an example of:
a. Malpractice
And elderly patient is being seen in the clinic for a complaint of “weak spells”
relieved by sitting or lying down. The nurse practitioner checks the patient’s blood pressure
while he is lying, sitting, and standing. The nurse practitioner suspects:
a. Orthostatic hypertension
The nurse practitioner knows that the frail elderly alright high risk for
malnutrition. Indicators of malnutrition in this population included all of the following
except:
a. Hunger and increased appetite
The patient reports, “something flew in my eyes” about an hour ago while hewas
splitting logs. If there was a foreign body in his eye, the nurse practitioner would expect to
find all except:
a. A purulent discharge
Inappropriate initial treatment for external genital warts caused by human
papilloma virus (HPV) in a non-pregnant patient is:
a. Topical trichloroacetic acid (TCA)
A new patient presents to the nurse practitioner clinic stating she wants a
second opinion. She started propylthioutacil (PTU, Propyl-Thyracil) 75 mg threetimes
today a week ago as therapy for newly diagnosed Graves’ disease. She still feels
irritable and jittery. How should the nurse practitioner respond?
a. Inform the patient that improvement requires 2 to 3 weeks
What advice should be given to the parents of an infant at risk for SIDS?
a. Place the baby in the supine position for sleeping
A six-month-old patient with type III metatarsus adductus (i.e., rigid anddoes
not correct to neutral) should be treated with:
a. Surgical intervention
Patient should be advised to purchase the same brand name for each of the
following drugs except:
a. Hydrochlorothiazide
Which activity during the first trimester could be deleterious to the fetus?
a. Dieting
The mother of an 18-month-old child is in the office. She is not yet immunized her
child because the child’s grandmother “doesn’t believe in that.” Thenurse practitioner
should:
a. Provide education and recommend beginning of the series of vaccines
The nurse practitioner is conducting a routine health assessment of a 28- year-old
patient. He states he is very “Health conscious” and that he ran 6 miles daily. He denies
current Health problems and his past medical history is unremarkable. Routine urinalysis
reveals proteinuria. What is the most likely causeof the proteinuria?
a. Exercise
What is the earliest age that MMR immunization can be administered?
a. One year
The nurse practitioner examines a six-year-old who has had a sore throat andfever
for less than 24 hours. Based on the most common cause of pharyngitis in this age group,
the most appropriate action is to:
a. Encourage supportive and symptomatic care
Physical examination findings consistent with emphysema include all of the
following except:
a. Pallor and cyanosis of the mucosa nail beds
Which choice below is not a contraindication to receiving the diphtheria,
pertussis, and tetanus (DPT) vaccine?
a. Current antibiotic use
All of the following are included in the differential diagnosis of
hyperthyroidism except:
a. Plummer’s disease
A middle-aged patient has a history of smoking, chronic cough, and sputum production.He
reports chronic dyspnea. A diagnosis of COPD should be confirmed with:
a. Spirometry
A patient requests information about foods to include in his diet while
vacationing in Mexico to avoid “Montezuma’s revenge.” The nurse practitionershould
advise him to ingest only:
a. Cooked vegetables in soup, bottled water, and wine
An eight-month-old male presents with hemarthrosis of both knees and
hematuria. The parents gave no history of trauma but say “he has always bruisedeasily.”
The most likely diagnosis is:
a. A type of hemophilia
Of the following for malpractice issues for which an APRN may incur
liability, which is the most prevalent cause of action?
a. Failure to refer when the APRN and skills are exceeded
Which of the following factors is (are) associated with increased incidence of cervical
cancer?
a. Smoking and sexual activity at an early age with multiple partners
Following the finding of prostate gland abnormalities on DRE, the nurse
practitioner orders appropriate labs. When preparing to view lab reports with thepatient,
and Nurse practitioner knows all of the following are true except:
a. Normal PSA it’s 10ng/ml or less
Which characteristic is not indicative of heart failure?
a. Purulent sputum
A patient report that she is taking kava kava regularly for anxiety with theresults.
What should the nurse practitioners evaluate?
a. Liver function studies
A person with 20/80 vision: HAS POORER VISION THAN SOMEONE WITH 20/40VISION
One exception to the recommendation to limit dietary fat intake is CHILDREN UNDER2 YEARS
OF AGE
The most effective treatment for anemia of chronic disease is: TREATMENT OF
UNDERLYING DISEASE
Rationale: The key phrase is “anemia of chronic disease” and with this, the pt’s chronic
disease has caused the deficiency so once you correct and or treat the chronicdisease, then
the anemia will correct itself.
Salicylates and other non-steroidal anti-inflammatory agents have all of the followingactions
EXCEPT- ANTI-EMETIC EFFECTS VIA SUPPRESSION OF GASTRIC ACID SECRETION
Which of the following does NOT increase a woman’s risk of developing cervical
cancer? NULLIPARITY
All of the following principles apply to drug therapy for elders except ENCOURAGETHE
ELDERLY TO CONTINUE SELF-MEDICATION ADMINISTRATION TO FACILITATE
INDEPENDENCE AND SELF-SUFFIENCY
A female patient believes that she was exposed to HIV through sexual intercourse several
months ago. She asks for “the test for AIDS.” Which statement is NOT correct?THE ELISA IS
USED FOR SCREENING, BUT MAY YIELD A FALSE NEGATIVE THISSOON AFTER EXPOSURE
The nurse practitioner teaches the parents of a 2-month-old infant with GERD that treatment
typically includes all of the following interventions except MAINTAININGTHE USUAL
FEEDING REGIMEN AND BURPING THE INFANT WELL WHEN THEFEEDING IS COMPLETED
A widowed 85-year-old was recently moved from her home of 65 years to a bedroom inher
daughter’s home. According to reports by family members, she is now
“cantankerous” gets “mixed up” easily and cries for no apparent reason. Factors in theclient
history that are consistent with delirium may include all of the following except
a. INSIDIOUS ONSET AND CHRONIC PROGRESSIVE COURSE
The two tests that can indicate current infection with hep B are:
a. Presents of hep B antigen and IgM
A characteristic of elders which affects the pharmacotherapeutics of drug therapy inthat
population is an increase in PERCENT OF BODY FAT
An elder’s caretaker is planning the elder’s menu. The elder is on a bland diet. The nurse
practitioner reviews the meal plans and notes that which of the following is NOTappropriate?
a. Coffee, tea, carbonated sodas, Orange juice
The leading cause of death from injury in childhood is MOTOR VEHICE ACCIDENTS
Therapeutic International normalized ratio (INR) for a patient taking warfarin
(coumadin) for a chronic atrial fibrillation is expected to be:
a. Increased
The most accepted recommendation regarding a skin cancer prevention is:
a. Avoidance of excessive sun exposure
Antibiotic administration has been demonstrated to be of little benefit in the treatmentof which
of the following disease processes?
a. Acute bronchitis
An anxious parent brings her three-day old female infant to see the nurse practitionerbecause
of the serosanguineous vaginal discharge. The nurse practitioner tells the mother:
a. This is a normal finding in female newborns
A common finding associated with temporal arteritis is:
a. Severe headache
What information would best help the parent who is concerned about a school age childeating
habits?
a. Establish a consistent schedule for meals and allow the child to participate in mealplanning
Which of the following scenarios in a 75-year-old patient would be inappropriately
managed in an outpatient setting (i.e. the patient should be referred for hospital admission)?
a. UNSTABLE ANGINA
A patient with diabetes brings his glucose diary from the past seven days for the nurse
practitioner to review and evaluate. What changes should be made? Day one through seven
AM 67, 52, 61, 48, 39, 68, 70 PM 138, 161, 148, 168, 121, 142, 176.
a. Decreased the PM dose of NPH insulin
Appropriate nutritional guidance for the pregnant patient is:
a. Increase caloric intake buy 300 cal/day and add iron and folic acid
supplementation
The most successful patient interview is likely to:
a. Be a collaborative process
RhoGAM is not administered to an Rh-negative mother with negative anti-d antibodies
WITHIN 72 HOURS OF BIRTH OF AN RH-NEGATIVE INFANT
The most common presentation of thyroid cancer is A SOLITARY THYROID NODULE
A benign thyroid nodule, that’s painless presents as SMOOTH
Initial treatment of a child presenting with a severe head injury is:
a. Aimed at resuscitation, then maintenance of oxygenation and blood flow
Which red blood cell (RBC) index is most useful for differentiating types of anemias?
a. Mean corpuscular volume (MCV)
A 31-year-old female is informed that her pregnancy test is positive, and she is about three
weeks pregnant. The nurse practitioner is very concerned about the patient reported history
of alcohol use. She correctly tells the patient that babies born to women who drink alcohol
during pregnancy are at risk for all of the following except:
a. Post maturity delivery
According to Erikson, the developmental task of the early adult is:
a. Ego integrity vs. despair
The parents of a two-year-old Report that she is not saying any words, but make sounds,
babbles, and understand simple commands from her parents. The parents arenot concerned.
The nurse practitioner responds:
a. Your child should be saying a few words by this time. She should be referred forfurther
assessment
Which group is considered to be at high risk for the development of testicular tumors?
a. Late adolescence to early adulthood (you need to know the actual age groups)
An urgent call is received from a patient’s wife who states that her husband is having chest
pain I’m relieved by three nitroglycerin tablets. The nearest hospital is 40 minutesaway. Besides
having the patient reach the hospital as soon as possible, what intervention can the nurse
practitioners suggest might influence a positive outcome?
A. Have the patient to an aspirin on the way to the hospital
Which of the following postpartum mothers should receive RhoGAM (BayRho-D) toprevent
Rh iso-immunization?
a. A G1 P1 mother who is Rh negative without Rh antibodies; cord blood is Coombsnegative;
newborn is Rh positive.
A patient with a history of alcohol abuse presents with acute nausea, vomiting, and severe
retrosternal pain that radiates to the back. Based on the most probable diagnosis, the nurse
practitioner would appropriately order a CBC, chemistry profile,and:
a. serum amylase and lipase, and liver function studies
A female patient asks, “how do I calculate my ideal body weight?” The nurse
practitioner response:
a. Start with 100 pounds, and add 5 pounds for every inch in height over 5 feet
A 35-year-old woman with prior history of extreme nervousness has been treated with
diazepam (valium) for four weeks. She reports improvement. Today her pulse is 112bpm and
blood pressure is 130/92 mmHg. She is 5’4” in weighs 105 pounds. What isthe most likely
diagnosis?
a. Hyperthyroidism
Which of the following is not a common early sign of benign prosthetic hyperplasia(BPH)?
a. Increased force of urine flow
Acute idiopathic thrombocytopenia purpura (ITP) is most commonly seen in childhood
following:
a. Acute infection
The nurse practitioner diagnosis epididymitis in a 24-year-old sexually active malepatient.
The drug of choice for treatment of this patient is:
a. Oral doxycycline (Vibramycin) plus intramuscular ceftriaxone
A 55-year-old man is diagnosed with basal cell carcinoma. The nurse practitioner
correctly tells him:
a. It can be cured with surgical excision or radiation therapy.
A characteristic of delirium that is typically absent and dementia is:
a. Acute onset of confusion in a previously alert and oriented patient
A 42-year-old male executive has been diagnosed with depression. He is otherwise
healthy. And appropriate initial treatment choice is a:
a. Selective serotonin reuptake inhibitor (SSRI)
the CAGE/ AUDIT questionnaire is useful to assess:
a. alcohol use disorders (but you need to know a little more about
A 16-year-old athlete complains of pain underneath his heel every time he walks. Thereis
verrucous surface level with the skin of the heel. What pharmacologic intervention should the
nurse practitioner prescribed for this patient?
a. Salicylic acid plasters
Previously immunized elderly patients should receive a tetanus and diphtheria (Td)booster
every:
a. 10 years
The nurse practitioner is canceling a young woman who desires pregnancy. She
discontinued her oral contraceptives for months ago. Her urine pregnancy test is negative.
She expresses concern that she might have an infertility problem. The nurse
practitioner accurately tells her that a couple is not considered infertile until there hasbeen
unprotected intercourse without conception for what period of time?
A. One year
When a patient presents with symptoms of acute gallbladder disease, what is the
appropriate nurse practitioner action?
a. Order abdominal ultrasound
An eight-year-old female has been brought to the nurse practitioner on five occasions inthe
past nine weeks with a complaint of abdominal pain. The evaluation each time is negative, but
her mother is convinced the child is truly experiencing pain. The most likely diagnosis is:
a. Recurrent abdominal pain
What is the most common cause of Cushing’s syndrome?
a. Administration of a glucocorticoid or ACTH
Which of the following maternal situations is considered an absolute
contraindication to breast-feeding?
a. Early HIV infection
A three-year-old male patient is being evaluated by a nurse practitioner for frequent
respiratory infections and fatigue. His laboratory test show thrombocytopenia,granulocytopenia,
and anemia. Which of the following is consistent with these lab bindings?
a. Acute lymphocytic leukemia (ALL)
Factors known to be associated with early sexual activity include:
a. Lower socioeconomic status, use of tobacco, alcohol or other drugs, and
single parent household
A 26-year-old female presents with elbow pain that is described as aching in burning.
There is point tenderness along the lateral aspect of the elbow and painful passive flexion and
extension. She reports she has been playing tennis almost daily forthe past month. The most
likely diagnosis is:
A. Lateral epicondylitis ------------tennis elbow
A two-year-old African-American child is being evaluated by the nurse practitioner. His
clinical appearance and history are consistent with sickle cell anemia.What is the appropriate
laboratory test to diagnose sickle cell anemia?
a. Hemoglobin electrophoresis
Which activities are not characteristic of preschool children?
a. Always follow rules during playground games
What type of question is most useful when opening an interview?
a. Open ended
All of the following agents/ medication classes are generally contraindicated in
pregnancy except:
a. Cephalosporins, parenteral insulin, parenteral heparin.
A 35-year-old female with a history of mitral valve prolapse is scheduled forroutine
dental cleaning. According to the 2007 American Heart Association’s guidelines for
endocarditis prophylaxis, what would you advise this patient?
a. She does not need prophylaxis for any dental procedure
What diabetic complications result from hyperglycemia?
a. (1) Retinopathy, (3) peripheral neuropathy, (4) accelerated atherogenesis
Which of the following diagnostic assessments must be considered before
developing any plan of care for a 27-year-old female presenting to a family practiceclinic?
a. Pregnancy test
The process by which a professional association confers recognition that a
licensed professional has demonstrated mastery of a specialized body of knowledgeand
skills is termed:
a. Certification
A 15-year-old male has a history of cryptorchidism which was surgically repaired.
Because of this information, it is essential for a nurse practitioner to teachhim about:
a. Testicular self-examination
A 32-year-old male patient complains of urinary frequency and burning on
urination for three days. Urinalysis reveals bacteriuria and positive nitrates. He denies
any past history of urinary tract infections. The initial treatment should be:
a. Trimethoprim-sulfamethoxazole (Bactrim, sulfatrim) for 7 to 10 days
On trans illumination of the scrotum, the nurse practitioner identifies a
hydrocele in a three-month-old infant. What course of action should be taken?
a. Monitor the infants until 12 months of age
Which of the following is an appropriate drug for initial treatment of
gastroesophageal reflux disease (GERD) in adults?
a. Famotidine (Pepcid)/ You need to know the drug class [Show Less]
