1. An older adult presents with severe abdominal pain. The husband reports that earlier in the afternoon, the patient's abdominal hernia had been firm and
... [Show More] bulged out 4 inches (10.2 cm). The patient had him press on the hernia and immediately felt burning pain throughout the abdomen. Which of the following is the nurse practitioners' NEXT action?
1. Abdominal CT scan
2. Complete blood count with differential
3. Abdominal ultrasound
4. Referral to the ED
4. Referral to the ED
2. A young adult female who is 34 weeks pregnant presents with the complaint of urinary frequency every 1 to 2 hours. The patient has no fever and denies back pain. A urine dipstick test is positive for leukocyte esterase and nitrites. Microscopic analysis reveals 15-20 WBCs/hpf and a few bacteria. The BEST choice for treatment of this patient's urinary tract infection would be:
1. trimethoprim-sulfamethoxazole (Bactrim), 160 mg/800 mg twice daily for 3 days.
2. cephalexin (Keflex), 500 mg four times daily for 7 days.
3. ciprofloxacin (Cipro), 500 mg twice daily for 7 days.
4. erythromycin, 250 mg three times daily for 5 days.
2. cephalexin (Keflex), 500 mg four times daily for 7 days.
3. An adult male presents with new-onset pain and tenderness in the low back and pain in the right great toe after a weekend of golf. He denies experiencing numbness and tingling. Which of the following would the nurse practitioner expect to find an investigation of this patient's low back pain?
1. Exacerbation of extremity symptoms with straight-leg raising
2. Loss of bowel and bladder function
3. Increased ankle jerk on evaluation of deep tendon reflexes
4. Increased lumbar lordosis
1. Exacerbation of extremity symptoms with straight-leg raising
4. A true statement about essential tremors is that they:
1. often begin with "pill-rolling" of one hand and may affect the legs, feet, and toes.
2. are often barely visible, rapid tremors.
3. are a characteristic of Parkinson's disease.
4. are slow tremors that are absent or minimal at rest and usually involve the hands.
4. are slow tremors that are absent or minimal at rest and usually involve the hands.
5. Which opioid medication is the MOST potent?
1. Codeine
2. Morphine
3. Oxycodone
4. Hydromorphone
4. Hydromorphone
6. Which symptom documented in a menstrual diary is diagnostic of PMS?
1. Irritability
2. Decreased libido
3. Menstrual cramps
4. Dyspareunia
1. Irritability
7. Which of the following is the medication of choice for monotherapy of an older adult with hypertension and
no related comorbid conditions?
1.Alpha-blocker
2.Vasodilator
3.Thiazide diuretic
4.Beta-blocker
3.Thiazide diuretic
8. An elderly, obese female presents for evaluation of a painful rash, first noticed 2 weeks ago, located under both breasts. The rash is visible as an area of confluent, beefy-red, excoriated lesions with smaller satellite lesions extending beyond the borders of the main lesions. The KOH prep reveals pseudohyphae. The nurse practitioner
would recommend a/an:
1. course of oral steroids and air drying of skin after showers.
2. topical antifungal and order a fasting blood glucose.
3. oral antibiotic and order a hemoglobin A1c.
4. high-potency topical corticosteroid and use of dry dressings.
2. topical antifungal and order a fasting blood glucose.
9. An older adult female complains of problems with urination. She reports that whenever she feels the need to urinate, she is unable to "make it to the bathroom in time," and wets herself. Which type of incontinence is MOST likely?
1. Urge
2. Overflow
3. Transient
4. Stress
1. Urge
10. A young adult female presents with painful swelling of the right cheek anterior to the TMJ. The diagnosis is sialadenitis. In addition to antibiotics, treatment for this patient should include:
1. hot soaks and lemon drops.
2. alternating heat and cold.
3. cold compresses and massage.
4. hot soaks and mucolytics.
1. hot soaks and lemon drops.
11. Initial therapy for older adult patients with arthritic joints is:
1. naproxen, 1000 mg twice daily.
2. ibuprofen, 600 mg four times daily.
3. glucosamine, 750 mg twice daily.
4. acetaminophen, 1000 mg four times daily.
4. acetaminophen, 1000 mg four times daily.
12. Which of the following is an example of gross negligence?
1. Prescription of a drug that causes a fatal allergic reaction
2. Misdiagnosis of appendicitis, resulting in peritonitis and a prolonged hospital stay
3. Refusal to return the emergency phone call of a patient who has chest pain evolving into an MI
4. Failure to diagnose a problem at an unrelated routine visit
3. Refusal to return the emergency phone call of a patient who has chest pain evolving into an MI
13. What is the correct order of pharmacokinetics of drugs in the body?
1. absorption, distribution, metabolism, excretion
2. distribution, absorption, metabolism, excretion
3. absorption, metabolism, distribution, excretion
4. metabolism, distribution, absorption, excretion
1. absorption, distribution, metabolism, excretion
14. An older adult female is brought in by her daughter, who has been visiting her. The daughter reports that her mother seems confused and anxious, and is moving oddly as if she is stiff. The daughter has brought along the mother's medications. She is taking hydrochlorothiazide, levothyroxine (Synthroid), sertraline (Zoloft), baby aspirin, a multivitamin, and St. John's wort. Which condition would the nurse practitioner MOST urgently suspect?
1. Alzheimer's disease
2. Serotonin syndrome
3. Vascular dementia
4. Aspirin toxicity
2. Serotonin syndrome
15. An adolescent male presents with marked itching in the inguinal region but not on the scrotum. Examination shows a peripherally-spreading, sharply-demarcated, centrally-clearing, erythematous lesion. The MOST likely diagnosis is:
1. poor hygiene.
2. tinea versicolor.
3. pediculosis pubis.
4. tinea cruris.
4. tinea cruris.
16. A young adult presents with a 3-day history of a sore throat, fever [102°F (38.9°C)], and malaise. Physical examination reveals posterior cervical lymphadenopathy and splenomegaly. A complete blood count (CBC) reveals a lymphocytosis. Which of the following patient care instructions is MOST appropriate?
1. Avoid strenuous activity and contact sports until advised.
2. Restrict symptomatic antipyretic therapy to acetaminophen.
3. Restrict symptomatic antipyretic therapy to NSAIDs.
4. Avoid close contact with others for 2 weeks.
1. Avoid strenuous activity and contact sports until advised.
17. A nurse practitioner is treating an adult with iron deficiency anemia. At what point would the hematocrit level be expected to return to baseline?
1. 3 weeks
2. 2 months
3. 6 months
4. 1 year
2. 2 months
18. An older adult complains of fatigue, stiffness in the shoulders and neck, recent onset of temporal headache, and an episode of transient visual loss in one eye. Erythrocyte sedimentation rate (ESR) is 72 mm/h [normal value = <15 mm/h]. These findings are consistent with:
1. migraine headache.
2. glaucoma.
3. giant cell (temporal) arteritis.
4. Sjögren's syndrome.
3. giant cell (temporal) arteritis.
19. The triple approach for evaluation of a dominant breast mass in an adult female includes a clinical breast examination, mammography, and:
1. bilateral ultrasound.
2. ductal lavage.
3. fine-needle aspiration.
4. MRI.
3. fine-needle aspiration.
20. Which of the following drugs is the BEST choice for prevention of coronary artery disease in elderly patients?
1. Enteric-coated ASA
2. Warfarin (Coumadin)
3. Dipyridamole-ASA (Aggrenox)
4. Clopidogrel (Plavix)
1. Enteric-coated ASA
21. An older adult presents with vague epigastric pain occurring at night, causing early morning awakening, and decreased appetite with early satiety. Significant history includes recent use of ibuprofen for headaches. Which is the MOST likely diagnosis?
1. Gastroparesis
2. Reflux esophagitis
3. Duodenal ulcer
4. Crohn's disease
3. Duodenal ulcer
22. An older adult female is diagnosed with urge urinary incontinence. The patient is alert and cognitively intact. The MOST appropriate management is:
1. urinating frequently to avoid urgency.
2. bladder retraining.
3. wearing protective garments, such as continence pads.
4. reducing fluid intake to four 8-oz glasses a day.
2. bladder retraining.
23. Which of the following asymptomatic skin conditions can an older adult manage at home?
1. Actinic keratosis
2. Basal cell lesions
3. Seborrheic keratosis
4. Squamous cell lesions
3. Seborrheic keratosis
24. The MOST common bacterial cause of cellulitis in patients with diabetes mellitus is:
1. group A beta-hemolytic Streptococcus.
2. Vibrio vulnificus.
3. Pseudomonas aeruginosa.
4. Staphylococcus aureus.
4. Staphylococcus aureus.
25. An adult with coronary artery disease has had angioplasty twice, as well as a two-vessel bypass graft. The patient presents with increasing shortness of breath, dyspnea on exertion, paroxysmal and nocturnal dyspnea, and mild edema of the lower extremities. Which of the following findings is MOST likely?
1. Diastolic murmur
2. Systolic ejection murmur
3. Pericardial friction rub
4. Third heart sound
4. Third heart sound [Show Less]