Medical Case Study: Diagnosis and Treatment of Various Conditions, Exams of Nursing

Download Medical Case Study: Diagnosis and Treatment of Various Conditions and more Exams Nursing in PDF only on Docsity! FNP Test (620 Questions With 100% Correct Answers). What is the first-line treatment for asthma? A. Inhaled corticosteroids B. Long-acting beta2-agonists C. Leukotriene inhibitors D. Short-acting beta2-agonists - Correct answer A. Inhaled corticosteroids A young adult patient comes in with diffused generalized abdominal pain. Which of the following signs would support a diagnosis of appendicitis? Select all that apply: A. Murphy's sign B. Obturator sign C. Turner's sign D. Blumberg sign E. Rovsing sign - Correct answer B. Obturator sign D. Blumberg sign E. Rovsing sign An adolescent male patient presents to the office with diffused hives and pruritus that began suddenly this morning. His mother brings him into the clinic as it appears to be getting worse. What would be the next most appropriate action by the nurse practitioner? A. Administer Epinephrine IM in the office B. Prescribe Benadryl 50 mg PO BID until symptoms resolve C. Educate the patient about avoiding triggers in the future D. Assess the patient further - Correct answer D. Assess the patient further A 13 year old female patient was recently diagnosed at an outside facility with pharyngitis and prescribe amoxicillin. A week after starting the antibiotics, the patient develops an erythematous maculopapular rash with healthy skin intervening throughout. What should you educate the mother about? A. This is likely scarlatina and we need to start Keflex instead B. This is a typical side effect of taking amoxicillin, and it will result with use of OTC steroids C. Sometimes this rash occurs when patients are given antibiotics for viral etiologies of strep throat. It will resolve on its own D. This rash is known as scarlatina so I am going to refer you to the ED for further treatment - Correct answer C. Sometimes this rash occurs when patients are given antibiotics for viral etiologies of strep throat. It will resolve on its own When does scarlatina occur? - Correct answer If strep throat is caused by Group A Streptococcus and it goes untreated, we have to worry about scarlet fever and dust, scarlatina rash. Scarlatina rash is sandpapery and bright red. A middle-aged adult male smoker with COPD presents to the clinic complaining of several days of fever, loss of appetite, coughing, and chest pain. The cough is productive of purulent sputum. Physical examination reveals a temperature of 102.0ºF (39.0ºC), pulse of 88, and respiratory rate of 24. The lung exam reveals crackles on the lower right lobe and wheezing on the upper airways. Which of the following bacteria is more likely to be the infectious agent? A. Streptococcus pneumoniae and Mycoplasma pneumoniae B. Staphylococcus aureus and Mycoplasma pneumoniae C. Haemophilus influenzae and Streptococcus pneumoniae D. Legionella pneumophilia and Haemophilus influenzae - Correct answer C. Haemophilus influenzae and Streptococcus pneumoniae What is the preferred treatment for the above patient's condition? A. Amoxicillin B. Doxycycline C. Amoxicillin-clavulanate plus a macrolide D. Azithromycin plus a fluoroquinolone - Correct answer C. Amoxicillin- clavulanate plus a macrolide A male patient has type two diabetes mellitus and a " sensitive stomach". Which medication is least likely to cause him gastrointestinal distress? A. Naproxen sodium B. Aspirin C. Erythromycin D. Sucralfate - Correct answer D. Sucralfate An obese Asian patient with a BMI of 33 complaints of fatigue and excessive thirst and hunger. You suspect type two diabetes mellitus. Initial testing to confirm diagnosis can include: A. Fasting plasma glucose level B. Glycated hemoglobin level (A1C) C. Oral glucose tolerance testing D. All of the above - Correct answer D. All of the above Which one of the following findings is associated with diabetic retinopathy? A. AV nicking B. Copper wire arterioles C. Flame shaped hemorrhages D. Microaneurysms - Correct answer D. Microaneurysms A 30 year old woman with type two diabetes uses regular and intermediate acting insulin in the morning and evening. She denies changes in her diet or any illness, but she recently started attending aerobic classes in the afternoon. Our fasting blood glucose level before breakfast is now elevated. Which of the following is best described? A. Somogyi phenomenon B. Dawn phenomenon C. Raynaud's phenomenon D. Insulin resistance - Correct answer A. Somogyi phenomenon Which of the following best describes Cullen's sign? A. Cessation of inspiration upon deep palpation of the RUQ of the abdomen B. Bruising around the periumbilical area of the abdomen C. Deep palpation of the LLQ of the abdomen that causes pain to radiate to the RLQ D. Blue-black discoloration that is located on the right flank of the trunk - Correct answer B. Bruising around the periumbilical area of the abdomen Which of the following is the screening test for hepatitis C virus (HCV)? A. Anti-HCV B. HBsAg C. Anti-HAV D. HCV RNA polymerase chain reaction (PCR) - Correct answer A. Anti- HCV Which of the following is indicative of gallbladder Inflammation? A. Rovsing's maneuver B. Rebound tenderness C. Murphy's maneuver D. McMurrays maneuver - Correct answer C. Murphy's maneuver A 45 year old female with a BMI of 28 complaints of intermittent burning epigastric pain over the past few months. It is worse at night, especially after a heavy or spicy meal. She goes to sleep about two hours after eating. The pain is partially relieved by antacids or not at all. She's not a smoker and denies radiation of pain to neck, arms, or jaw; diaphoresis; and dyspnea. What is the next step? A. Order a 12 lead EKG B. Prescribe a proton pump inhibitor C. Recommend to stop eating four hours and avoid spicy or heavy meals before bedtime, as well as lose weight D. Schedule a fasting lipid profile, including cholesterol, low density lipoprotein, high density lipoprotein, and triglycerides - Correct answer C. Recommend to stop eating four hours and avoid spicy or heavy meals before bedtime, as well as lose weight A 13 year old middle school student reports that he does not feel like eating and that his stomach has bothered him for the past 24 hours. He states that last night, the middle of his stomach around the umbilicus hurt and then the pain moved to the right lower side of his abdomen. His temperature is 100.8°F, Pulse is 90 bpm, respiratory rate is 20 breaths per minute, and blood pressure is 110/60 4 mmHg. During abdominal exam, the patient has RLQ abdominal tenderness without rebound. Rovsing's sign is negative. Which of the following is the most helpful clue in the patient's diagnosis? A. The manner in which the pain involved B. The patient's vital signs C. The patient poor appetite D. The abdominal exam - Correct answer A. The manner in which the pain involved The best test of cure after treating a patient with Helicobacter pylori infection is: A. CBC with white blood cell differential B. Stool for occult blood x 3 specimens C. H. pylori IgM and IgG serology D. Urea breath test - Correct answer D. Urea breath test An adult with a seizure disorder is experiencing gingival hypertrophy, coarse facial features, and increased hair growth. These are potential side effects of which medication? A. Carbamazepine B. Valproic acid C. Phenytoin D. Venlafaxin - Correct answer C. Phenytoin Among patients with nephrolithiasis, which is the most common type of kidney stone? A. Struvite B. Cystine C. Calcium oxalate D. Uric acid - Correct answer C. Calcium oxalate A 55-year-old female patient presents with symptoms of urinary tract infection. A clean catch midstream urine specimen is obtained and sent to the laboratory for culture and sensitivity testing. Which of the following results is indicative of an uncomplicated urinary tract infection? B. Discontinue the acetaminophen and encourage stress reduction measures as exercise and yoga C. Advised patient to start taking ibuprofen 1 to 2 tablets daily D. Start patient on butalbital and discontinue acetaminophen - Correct answer B. Discontinue the acetaminophen and encourage stress reduction measures as exercise and yoga Which of the following is the recommended treatment for hereditary hemochromatosis? A. Genetic counseling B. Ferrous sulfate supplementation C. Phlebotomy D. Dialysis - Correct answer C. Phlebotomy What is the most common type of hemophilia in the United States? A. Hemophilia B B. Hemophilia C C. Von Willebrand disease D. Factor VIII deficiency (Hemophilia A) - Correct answer D. Factor VIII deficiency An elderly male visits the nurse practitioner in November for an annual physical exam and laboratory tests. The CBC results are hemoglobin of 12 g/dL, Hematocrit of 36%, and MCV of 76 fL. The patient has a history of benign prostatic hyperplasia, hypertension, hyperlipidemia. Which off the following laboratory tests is the next step in this patient's evaluation? A. TIBC, ferritin level, iron B. Homocysteine, folate level C. Vitamin B12 level, folate level D. Hemoglobin electrophoresis - Correct answer A. TIBC, ferritin level, iron During the early stages of iron deficiency anemia, the red blood cells are: A. Microcytic B. Normocytic C. Macrocytic D. Hyperchromic - Correct answer B. Normocytic A black adult male presents with new onset of jaundice, dark urine, fatigue, and anorexia. He was seen a few days previously and treated for a possible urinary tract infection. He is on the third day of nitrofurantoin 100 mg PO BID 7 days. The hemoglobin is 11 g/dL, and hematocrit is 34%. The MCV is 84 fL. The serum indirect bilirubin is elevated. Which of the following conditions is most likely? A. G6PD anemia B. Sickle cell anemia C. Iron deficiency anemia D. Pernicious anemia - Correct answer A. G6PD anemia An 18 year old woman is complaining of right ankle pain. She reports twisting her ankle while jogging the previous day. She states that she "rolled inward" on her ankle. During the physical exam, the nurse practitioner finds a markedly swollen ankle with several areas of ecchymosis. There is tenderness on the tip of the lateral malleolus. The joint is tender on palpation. The patient has problems with weight-bearing and walking. What type of sprain does this patient have? A. Grade I B. Grade II C. Grade III D. Grade IV - Correct answer C. Grade III A 37-year-old male high school teacher complains of an acute onset of pain and tenderness of his left wrist. He denies trauma to the wrist. He reports that the condition occurred on the same wrist before. The symptoms started that morning after he went to a birthday party the previous evening. He reports that he drank a few glasses of white wine. During the physical exam, the left wrist is red, swollen, and tender to palpation. The skin is intact but feels warm to touch. What is the most likely diagnosis? A. Wrist sprain B. Gout C. Osteoarthritis D. Septic joint - Correct answer B. Gout Regarding the previous case, all of the following can be used to treat his condition, except: A. Oral glucocorticoids B. Topical glucocorticoids C. NSAIDs D. Colchicine - Correct answer B. Topical glucocorticoids An adolescent athlete reports a sudden onset of posterior right thigh pain. The injury occurred while she was running during a soccer game. She denies falling. She is limping and walking slowly. On physical examination, the middle portion of the right hamstring muscle is tender to palpation with some bruising noted. Which of the following conditions is most likely in this patient? A. Hamstring muscle strain B. Baker's cyst C. Quadriceps muscle strain D. Piriformis syndrome - Correct answer A. Hamstring muscle strain Which organ system is not affected by chronic NSAID use? A. Cardiovascular system B. Renal system C. Immune system D. Gastrointestinal system - Correct answer C. Immune system An older adult male with alcohol use disorder is scheduled for a physical exam and laboratory testing. The patient's laboratory blood test results may show: A. Increase serum creatinine levels and eGFR B. Decreased number of platelets and increased MCV C. Increased serum potassium and increased triglycerides D. Decreased AST and ALT levels - Correct answer B. Decreased number of platelets and increased MCV The female athlete triad includes all of the following, except: A. Menstrual dysfunction Which of the following factors will not increase a woman's risk of developing breast cancer? A. Moderate to high intake of alcohol B. Onset of menstruation at 10 years of age C. First pregnancy at age 30 years or older D. Body mass index of 23 - Correct answer D. Body mass index of 23 A 25 year old woman with hirsutism, obesity, and oligomenorrhea is diagnosed with PCOS. A woman with PCOS is at higher risk for all of the following except? A. Cervical cancer and atrophic vaginitis B. Endometrial cancer and infertility C. Type two diabetes and heart disease D. Obesity and nonalcoholic fatty liver disease - Correct answer A. Cervical cancer and atrophic vaginitis A 35 year old woman smokes approximately 10 cigarettes per day. She started smoking at the age of 18 years. She has a new male sexual partner and is interested in contraception. She was recently treated for gonorrhea and chlamydia. She is using condoms in consistently. The urine pregnancy test is negative. She denies a history of hypertension, blood clots, liver disease, heart disease, and diabetes. Her last menstrual period was five days ago. Which of the following contraceptive methods is recommended? A. Oral contraceptive pills B. Copper IUD C. Etonogestrel implant (Nexplanon) D. Vaginal ring (NuvaRing) - Correct answer C. Etonogestrel implant (Nexplanon) A 22-year-old presents for her annual gynecology goal exam and testing. The Pap smear results shows ASC - US. Which of the following is the best management for this patient? A. Check for high-risk HPV B. Repeat Pap in 12 months C. Refer patient to colposcopy D. Refer patient for endometrial biopsy - Correct answer B. Repeat Pap in 12 months Hegar's sign is considered a: A. Positive sign of pregnancy B. Probable sign of pregnancy C. Presumptive sign of pregnancy D. Problem in pregnancy - Correct answer B. Probable sign of pregnancy Which of the following statements is true regarding a threatened abortion? A. Vaginal bleeding and cramping are present, but the cervix remains closed B. Vaginal bleeding and cramping are present along with a dilated cervix C. The fetus and placenta are both expelled D. The products of conception and the placenta remain inside the uterus along with a dilated cervix - Correct answer A. Vaginal bleeding and cramping are present, but the cervix remains closed A multigravitable who is at 28 weeks gestation has a funnel height of 29 cm. Which of the following is the best recommendation for this patient? A. Advise mother that her pregnancy is progressing well B. Order an ultrasound of the uterus C. Refer her to an obstetrician for an amniocentesis D. Recommend bed rest with bathroom privileges - Correct answer A. Advise mother that her pregnancy is progressing well Do notice the following results on a routine urinalysis of a 37-year-old primagravida who is at 30 weeks gestation: Leukocytes = trace, nitrite = negative, protein = 2+, blood = negative. Her weight has increased by 5 pounds during the past week. Which of the following is most likely? A. HELLP syndrome B. Pregnancy induced hypertension (preeclampsia) C. Eclampsia of pregnancy D. Primary hypertension - Correct answer B. Pregnancy induced hypertension (preeclampsia) A 28 year old multipara who is at 32 weeks gestation presents to your office complaining of a sudden onset of small amount of bright red vaginal bleeding. She has had several episodes and appears anxious. On exam, her uterus is soft about patient. Which of the following is most likely? A. Placenta abruptio B. Placenta previa C. Acute cervicitis D. Molar pregnancy (hydatidiform mole) - Correct answer B. Placenta previa Which of the following antigens is a component of the HIV 1/2 combination antibody/antigen testing? A. p24 B. p20 C. p18 D. p14 - Correct answer A. p24 A sexually active 16 year old which cervicitis is tested for gonorrhea and chlamydia. The NAAT test results shows that the patient is positive for gonorrhea. Which of the following is appropriate treatment for this patient? A. Cephalosporin B. Cephalosporin and macrolide C. Tetracycline D. Tetracycline and sulfonamide - Correct answer B. Cephalosporin and macrolide The Jarisch-Herxheimer reaction is a response to treatment of which of the following organisms? A. Neisseria gonorrhoeae B. Chlamydia trachomatis C. Treponema pallidum D. Rickettsia rickettsii - Correct answer C. Treponema pallidum Coco All of the following have been classified as nationally notifiable diseases by the Centers for Disease Control and Prevention, except: D. Cerebrovascular accident (CVA) - Correct answer A. BPPV (Benign proximal positional vertigo) Regarding the previous case, which of the following tests will help diagnose this patient? A. Lachman B. Dix-Hallpike C. Obturator D. Finklestein - Correct answer B. Dix-Hallpike Where is Kiesselbach's plexus located? A. The posterior area of the pharynx B. The superior lateral area of the maxillary sinus C. The anterior inferior area of the nasal septum D. The submandibular area of the mouth - Correct answer C. The anterior inferior area of the nasal septum What is the first line treatment for allergic rhinitis? A. Saline nasal spray B. Oral antihistamine C. Topical nasal decongestant spray D. Topical nasal steroid spray - Correct answer D. Topical nasal steroid spray Which of the following conditions is classified as sensory neuro hearing loss? A. Presbycusis B. Otitis media C. Ceruminosis D. Otitis externa - Correct answer A. Presbycusis 40-year-old male who is building a house presents with a two day history of foreign body sensation and excessive tearing of the right eye. What type of exam is recommended initially? A. Cardiac exam B. Visual exam C. Neurologic exam D. Cerebellar exam - Correct answer B. Visual exam An 80-year-old female with a history of hypertension, atrial fibrillation, and type 2 diabetes presents to the clinic with a complaint of painless bright-red blood on the right eye that she noticed on awakening. She denies falling, visual changes, visual loss, eye pain, headache, coryza, and fever. The visual exam is normal, and both pupils are equal and reactive to light and accommodation. The funduscopic exam does not show bleeding. Which of the following conditions is most likely? A. Hyphema B. Subconjunctival hemorrhage C. Ectropion D. Blepharitis - Correct answer B. Subconjunctival hemorrhage A 16 year old male athlete has recently been diagnosed with infectious mononucleosis. During the abdominal exam, the nurse practitioner identifies an enlarged spleen. Abdominal ultrasound confirms this findings. The patient wants to know when he can go back to playing football. Which of the following responses by the nurse practitioner is the most appropriate? A. You may return to play contact sports when your sore throat is gone B. You should avoid all sports and exercise for the next 2 weeks C. You may not play contact sports for 4 to 6 months D. You may return to exercise and sports in 4 to 6 weeks after a follow-up visit to confirm that your splenomegaly has resolved - Correct answer D. You may return to exercise and sports in 4 to 6 weeks after a follow-up visit to confirm that your splenomegaly has resolved A 36-year-old female patient today comes in requesting birth control as she is recently divorced and started dating again. She has no known past medical history and has used the birth control pill Loestrin [norethindrone acetate/ethinyl estradiol) in the past. She is requesting to be placed back on Loestrin. Her vital signs at today's visit are: temp 98.7, heart rate 85, blood pressure 152/89, and O2 sat 99%. How should you respond to this patient? A. We will start you on the Loestrin today. Be sure to follow up if you have any new side effects. B. I can start you on birth control today, but I prefer to either start to an a progesterone only method or a non-hormonal method due to your elevated BP. C. I cannot start you on any birth control methods until your blood pressure has been evaluated. D. Loestrin is no longer FDA approved. I could start you on another combined oral contraceptive method such as Ortho-Tricycl - Correct answer B. I can start you on birth control today, but I prefer to either start to an a progesterone only method or a non-hormonal method due to your elevated BP. A 55-year-old male patient presents to the clinic with a history of hypertension and diabetes. You draw a fasting lipid profile and note the following labs: LDL 191, triglycerides 142, HDL 439, and total cholesterol 276. What medication do you anticipate starting him on? A. Fenofibrate B. Rosuvastatin C. Lovastatin D. Niacin - Correct answer B. Rosuvastatin This same patient comes back into the clinic 4 weeks later with increasing fatigue and muscle weakness. He complains that his urine has become tea colored. What is your priority action as the NP? A. Order LFTs B. Order a CK level C. Educate the patient that this is an expected findings after starting rosuvastatin D. Order a urinalysis - Correct answer B. Order a CK level Your patient comes in complaining of unilateral muffled hearing. When you do the weber test, the test lateral lyses to the bad ear. Which of the following could be a potential cause of the patient's muffled hearing? A. Cerumen impaction B. Age C. Ménière's disease A. Leukocytes B. Nitrates C. RBC casts D. Trace amount of blood - Correct answer C. RBC casts A first time mother comes into the office frantic as she is worried her baby is not receiving enough breastmilk. What education and guidance should be provided to the mother? A. If there is a notable clicking sound when the baby is breast-feeding, then we know the infant has a good latch and is adequately breast-feeding. B. If your baby has 6 to 8 wet diapers a day and is gaining weight appropriately, then we know they are receiving enough breastmilk. C. The baby should only need to eat up to four times per day, so if they eat at all for times we know they are receiving enough. D. There is no need to worry about your baby not breast-feeding enough, they have gained a pound in their first month of life. - Correct answer B. If your baby has 6 to 8 wet diapers a day and he's gaining weight appropriately, then we know they are receiving enough breastmilk. A middle-aged man with a past medical history of diabetes, hyperlipidemia, hypertension and smoking comes into your office stating he is having new blurred vision and trouble seeing. What should the NP do next? A. Write the patient a referral for an ophthalmologist as he is at a high risk of diabetic retinopathy B. Assess the patient's eyes using tonometry and fluorescein staining C. Assess the patient's visual acuity using the Snellen chart D. Assure the patient that this is a normal finding as he is Hgb A1c is 9% and his diabetes is uncontrolled - Correct answer C. Assess the patient's visual acuity using the Snellen chart You recently saw a 57 year old woman two months ago for treatment of a sinus infection. Today, she is complaining of a cough, fever and chills over the last three days. On exam, you note audible expiratory wheezes on auscultation and there is increased tactile fremitus. What should you prescribe for this patient? A. Ciprofloxacin B. High dose amoxicillin C. Doxycycline D. Levofloxacin - Correct answer D. Levofloxacin A 45-year-old female patient with no significant past medical history patient over the last several months. You decide to order diagnostic lab work because of your patient symptoms. Which of the following would be inappropriate to order for this patient? Select all that apply: A. CBC B. TSH C. B12/Folate D. Hgb A1C E. T3/T4 - Correct answer C. B12/folate D. Hgb A1C E. T3/T4 You are referring a patient who was diagnosed with actinic keratosis at today's visit in a primary care clinic to the dermatologist for removal. He states that he is about to go on a vacation abroad and would like to delay seeing the dermatologist until after he gets back from his vacation in two months. What guidance should you provide for this patient? A. It is no issue to delay your dermatology visit until after your return. Just make sure that you make an appointment for the week you return. B. It would be ill advised to delay your dermatology appointment as this has the potential to turn into squamous cell carcinoma. C. It would be you advised to delay your dermatology appointment as this has the potential to turn into basal cell carcinoma. D. On your trip, I would advise you to call the clinic if it becomes also rated or bleeds easier than normal. - Correct answer B. It would be ill advised to delay your dermatology appointment as this has the potential to turn into squamous cell carcinoma. A 12 year old male patient was recently diagnosed with asthma. According to the 2019 GINA guidelines, which of the following is considered to be first line treatment as needed for those with intermittent asthma? A. Salmeterol B. Albuterol C. Budesonide-formoterol D. Tiotropium - Correct answer C. Budesonide-formoterol A patient's daughter brings a 77-year-old male patient into the office after he recently lost his wife of 50 years 2 months ago. The patient's daughter reports that the patient has been withdrawn and will not participate in any family activities. The patient states that he does not know how to cope without the support of his wife, and is unsure of how to handle his grief. A diagnosis of major depression is made. His only history is hypertension and type 2 diabetes. What medication should the client be started on? A. Elavil (amitriptyline) B. Prozac (fluoxetine) C. Lexapro (escitalopram) D. Effexor (venlafaxine) - Correct answer C. Lexapro (escitalopram) The nurse practitioner is following up with a patient who started taking Zoloft (sertraline) 50 mg five weeks ago for new depressive symptoms. The patient reports that she now has had some relief in her symptoms but he's still having symptoms. What should the nurse practitioner do next? A. Discontinue the Zoloft, and start a medication from another drug class such as Elavil B. Increase the Zoloft dose to 75 mg PO daily, and instruct the patient to follow up in approximately one month C. Keep the Zoloft dosing the same as it has not been long enough for the patient to see the medication's full affect D. Discontinue the Zoloft, and encourage the patient to try counseling instead - Correct answer B. Increase the Zoloft dose to 75 mg PO daily, and instruct the patient to follow up in approximately one month Extra tips: if patient has relief of symptoms and wishes to discontinue the med, it can be done after 4 to 6 months. Extra, extra tip: if the patient has G.I. symptoms in the first 4 to 6 weeks of starting Zoloft, such as nausea, vomiting, diarrhea, do not discontinue medication as these symptoms are self limiting. A 56-year-old female patient presents today with increasing wrist pain over the last several months. She has worked as an office secretary over the A 45-year-old male patient reports to her office today for routine physical examination. Upon auscultation of heart sounds, you note a diastolic murmur - mitral stenosis. What should we do next for this patient? A. Educate the patient this is a normal variation and not a cause for concern B. Instruct the patient to follow up with a cardiologist C. Reassure the patient because when you ask auscultated the murmur, it disappeared during expiration D. Ask the patient to follow up with the nurse practitioner in one month for a recheck to see if the murmur is still occurring - Correct answer B. Instruct the patient to follow up with a cardiologist What heart sound is benign if it disappears during expiration? - Correct answer Split S2 A patient who is 32 weeks pregnant comes to your office today for treatment of heartburn. You decide to evaluate the patient further prior to deciding your treatment plan. During your examination of this patient, you note an additional heart sound when auscultating the chest. Which additional heart sound would be normal to hear in this patient? A. Split S2 B. S3 C. S4 D. S5 - Correct answer B. S3 S3 = fluid overload (common in pregnancy and HF patients) S4 = uncontrolled HTN and LV hypertrophy A 12 year old girl in tanner stage 3 presents to your office today for a routine physical examination. What clinical finding would you expect to see in this patient? A. Breast budding B. Straight pubic hairs C. No breast development D. Bilateral small breast mounds - Correct answer D. Bilateral small breast mounds A seven year old female patient has had multiple episodes of acute otitis media throughout her life. She is now complaining again of ear pain and you perform an auto scopic exam. On exam, you find that the patient has a cauliflower like growth present in her middle ear. What should the nurse practitioner do next? A. Prescribe another round of amoxicillin as this is a common finding with chronic otitis media B. Assure the child's parents that is a non-cancerous benign growth that needs no further intervention C. Refer the patient to an ENT for further evaluation D. Educate the parents about risk factors for this condition and how to avoid it in the future - Correct answer C. Refer the patient to an ENT for further evaluation Cholesteotoma: Benign, noncancerous growth; but needs surgical removal A 10-year-old patient is brought to the urgent care clinic after a tick bite. On the right lower leg where the tick was attached, there is a red rash with central clearing present. What medication should be used to treat this condition? A. Doxycycline B. Erythromycin C. Amoxicillin D. Keflex - Correct answer A. Doxycycline (Lyme disease - erythema migrans) An 18 year old male patient presents today with urinary frequency, burning with urination and penile discharge. Upon further investigation, you discover the patient has gonorrhea. If the patient also has a concurrent chlamydia infection, which of the following would be most appropriate to prescribe? A. Azithromycin (Z-Pak) B. Cephalexin (Keflex) C. Amoxicillin (Amoxil) D. Doxycycline (Vibramycin) - Correct answer D. Doxycycline (Vibramycin) A 50 year old female patient presents to the clinic today looking to get a referral for a mammogram. Her friend was recently diagnosed with breast cancer and now she would like to be screened herself. The nurse practitioner understands that receiving a mammogram is what level of prevention? A. Primary B. Secondary C. Tertiary D. Quarternary - Correct answer B. Secondary Screening = Secondary Treatment = Tertiary (recent MI pt going for cardiac rehab) Prevention before it even happens = Primary (seatbelt education to teenagers) A well-controlled asthma patient presents to your office as they are experiencing "white patches" in their mouth. The nurse practitioner diagnoses the patient with oral candidiasis. What education should the nurse practitioner provide to this patient? A. You need to rinse your mouth out after using your fluticasone as this is the medication that led to your developing thrush. B. Do you need to be sure to wait at least an hour before eating or drinking after administering your fluticasone. C. This is an adverse side effect of salmeterol, so I will switch you to another long acting beta agonist. D. This is a very rare occurrence. After we treat you for thrush, you do not need to make any changes because this will likely not happen again. - Correct answer A. You need to rinse your mouth out after using your fluticasone as this is the medication that led to your developing thrush. A three year old is brought into the clinic today by his mother for a lacy net- like rash across his trunk. The mother explains that he had a fever initially, but after the fever broke this rash appeared. The mother is worried because the child is supposed to go to daycare tomorrow. What should the nurse practitioner tell the mother about this condition? What is ginkgo used for? - Correct answer Some people use it for memory and sometimes you can see it used after menopause as well What is kava kava used for? - Correct answer Stress, anxiety and sleep A 34-year-old male patient recently lost his wife unexpectedly. His mother brings him into the clinic and reports that he has not been sleeping and is very withdrawn. The patient does not make eye contact with you during the exam, and hardly responds to any of your questions. Which of the following actions would take priority in this situation? A. Prescribe the patient an SSRI to start taking immediately and have him follow up in one week B. Educate the patient's mother that is a normal expression of grief and he just needs time to acclimate to life without his wife C. Ask the patient whether he has any thoughts of harming himself or others D. Refer the patient to a support group with others who have lost their spouses - Correct answer C. Ask the patient whether he has any thoughts of harming himself or others A young adult female patient presents to the urgent care clinic with thin and foamy vaginal discharge. On the physical exam of this patient, there is a positive whiff test and clue cells are present. The client is diagnosed with bacterial vaginosis. What should the nurse practitioner educate her client about the treatment? A. Until you complete your course of antibiotics, you need to abstain from having sex as you might infect your partner B. Tell your partner to also come to the clinic because he needs to be tested and treated as well C. The antibiotics that I will prescribe you for this issue will make you very sick if you drink alcohol D. This will likely go away on its own shortly so there is no need to treat you with antibiotics - Correct answer C. The antibiotics that I will prescribe you for this issue will make you very sick if you drink alcohol Flagyl (disulfiram-like reaction w/ ETOH) The nurse practitioner knows that a positive hCG pregnancy test is which of the following signs of pregnancy? A. Presumptive B. Probable C. Positive - Correct answer B. Probable A 55-year-old female patient experience menopause approximately two years ago. Due to issues with hot flashes, she was prescribed Paxil which has controlled her symptoms. Today, the patient reports noting some new drops of blood when going to the bathroom and is asking if her period is restarting. What should the nurse practitioner tell the patient? A. Long-term use of Paxil can lead to vaginal bleeding. We will discontinue your Paxil and start you on another SSRI for symptom control. B. It is important that we run some diagnostic lab work today to evaluate you for possible anemia. C. It is abnormal to have vaginal bleeding after menopause. I will refer you to a gynecologist for further evaluation and possible biopsy. D. It is normal to have post menopausal vaginal bleeding for up to 5 years after the start of menopause. - Correct answer C. It is abnormal to have vaginal bleeding after menopause. I will refer you to a gynecologist for further evaluation and possible biopsy. A 54 year old African-American female patient presents today with new fatigue as well as numbness and tingling in her hands and feet. Her past medical history is significant for a gastric bypass approximately three years ago, and since losing weight she has been able to discontinue her diabetes and hypertension medication's. What type of anemia is this patient likely presenting with? A. Folate B. B12 C. Iron D. Sickle cell anemia - Correct answer B. B12 A middle aged patient presents to the clinic with increased urination. She states that she is also more thirsty than normal. The nurse practitioner suspects possible diabetes and orders an Hgb A1cThe patient Hgb A1c today is 6.9%. Which would be appropriate for the nurse practitioner to prescribe? A. Instruct the patient to begin lifestyle modifications and return in three months for a follow up B. Start the patient on Metformin, and encourage the patient to also do additional lifestyle modifications C. Educate the patient that they are now considered "pre-diabetic" and will have to start Metformin D. Start the patient on a long acting insulin such as Lantus as their Hgb A1c is so elevated - Correct answer B. Start the patient on Metformin, and encourage the patient to also do additional lifestyle modifications Your patient has been newly diagnosed with type 2 diabetes, and is requiring lots of education as they do not know anyone with diabetes personally. Who should you refer this patient to? Select all that apply: A. Dietitian B. Podiatrist C. Ophthalmologist D. Diabetes educator - Correct answer A. Dietitian B. Podiatrist C. Ophthalmologist D. Diabetes educator Also check for urine micro albumin and renal function panel A child has recently been diagnosed with allergic rhinitis. What would be the initial treatment in this patient? A. Intranasal corticosteroids (such as Flonase) B. Anti-histamines (such as Benadryl) C. Identifying potential triggers D. Mast cell stabilizers (such as Cromolyn) - Correct answer C. Identifying potential triggers Avoiding potential triggers may be enough to avoid starting the child on medication. Norvasc = we worry about ankle swelling and headache With which comorbidity do we not prescribe beta-blockers? - Correct answer Those with COPD and asthma A 65-year-old female patient presents to the clinic today with a chief complaint of sudden eye pain for the last 3 hours. She states that her vision is blurred, and she is seeing halos around lights. Upon exam, her eyeball is firm and tender to the touch. What should the nurse practitioner initiate next for this patient? A. Refer the patient to the ER for further evaluation B. Conduct florescein staining to evaluate intraocular pressure C. Irrigate the eye with normal saline, as this will likely resolve the issue D. Prescribe the patient corticosteroid eyedrops, as well as an eye lubricant - Correct answer A. Refer the patient to the ER for further evaluation Firm and tender eyeball = acute closed-angle glaucoma = EMERGENCY! FLORESCEIN STAINING = for foreign bodies in the eye/corneal abrasions A 35 year old male patient presents today with generalized crampy abdominal pain. He reports that he is currently going through a divorce, and has been having diarrhea almost daily for the last month. The nurse practitioner orders labs including a CBC, CMP, inflammatory markers and stool for ova and parasites. All tests come back normal. What is the likely diagnosis? A. Inflammatory bowel disease B. Acute gastritis C. Diverticulitis D. Irritable bowel syndrome - Correct answer D. Irritable bowel syndrome All inflammatory markers are negative. Patient is majorly stressed. Diverticulitis pain would be in the left lower quadrant. A nurse practitioner student is seeing a client who was recently diagnosed with hyperlipidemia. His labs were: LDL 150, HDL 38, triglycerides 554, Total cholesterol 388. Which exam findings with the student need to tell her preceptor about immediately? A. Xanthelasma B. Arcus senilis C. Cullen's sign D. Murphy's sign - Correct answer C. Cullen's sign Cullen's sign = pancreatitis, especially possible pancreatic necrosis which has led to intra-abdominal bleeding. Murphy's sign indicates cholecystitis A 45-year-old male patient reports to the clinic today for a chief complaint of headaches. He states that the headaches occur every morning when he wakes up near the back of his head, and goes away once he is up for the day. He has never had an issue with headaches before. What would be the most appropriate action for the nurse practitioner to do next? A. Order a CT scan B. Order an MRI C. Assess vital signs D. Obtain a more thorough history from the patient - Correct answer C. Assess vital signs Daily headaches in the mornings that goes away indicates hypertensive headache An elderly male patient comes into the clinic complaining of hearing loss in his right ear. The nurse practitioner decides to test his hearing using both the Rinne and Weber tests. Which of the following findings would indicate that the patient has an abnormal response to the Rinne test? A. Lateralization to the bad ear B. No lateralization is present C. AC > BC D. BC > AC - Correct answer D. BC > AC A 77 year old male patient presents to the clinic with a new sudden onset of a bilateral tremor. Upon exam, the patient is able to reproduce his symptoms. Which finding would probe further investigation by the nurse practitioner? A. The tremor only occurs at rest B. The tremor is dampened when the patient drinks alcohol C. The tremor is present in the head, which affects the patient's voice D. The patient's handwriting has recently increased in size - Correct answer A. The tremor only occurs at rest Most concerning differential is Parkinson's which is why choice A warrants further investigation Choices B & C are indicative of essential tremors in Parkinson's patients handwriting gets smaller. Thus, choice D is incorrect What are the three main symptoms of Parkinson's disease? - Correct answer Tremor, bradykinesia, and rigidity A middle-aged woman presents with new increasing fatigue and chest congestion. Upon exam, it is noted that the patient's AP diameter is 2:2, and there is hyper resonance on percussion of the chest. Her past medical history is significant for hypertension and a 15 pack a year smoking history. What should the nurse practitioner do next? A. Prescribe albuterol for symptom relief B. Perform spirometry C. Educate the patient about the importance of quitting smoking to limit disease severity D. Refer the patient to a pulmonologist - Correct answer B. Perform spirometry If we suspect COPD, the diagnostic tool is spirometry. To confirm the diagnosis of COPD we have to have an FEV1 over FVC ratio less than 0.70 A patient with a history of HIV comes into the clinic today for increasing symptoms of fatigue. Upon exam, it is noted that the patient has new oral candidiasis. The nurse practitioner orders labs and the patient CD4 count is 150. What education should be provided to the patient? patient's right lower leg with multiple areas producing purulent drainage. The area is edematous and tender to palpation. Which of the following antibiotics would not be appropriate for treating this condition? A. Bactrim B. Clindamycin C. Doxycycline D. Keflex - Correct answer D. Keflex This is purulent cellulitis. Remember BCD - Bactrim, Clindamycin, Doxycycline A three year old is brought to the clinic by his mother do you do increasing irritability and ear tugging. During the otoscopic exam, it is found that the left tympanic membrane has marked erythema and is bulging. What should the nurse practitioner initiate next? A. Prescribe amoxicillin B. Prescribe Augmentin C. Prescribe corticosteroid eardrops D. Educate the mother to follow up in 2 to 3 days if symptoms do not resolve - Correct answer D. Educate the mother to follow up in 2 to 3 days if symptoms do not resolve A majority of otitis media is viral in nature, therefore antibiotic should not immediately be prescribed. Viral otitis media should resolve in 2 to 3 days. A 13 year old patient presents to you with left ear pain after spending a week at summer camp where he swam every day. Upon exam, it is noted that the ear canal is erythematous and edematous. The patient is diagnosed with otitis externa. What bacteria is likely responsible for this issue? A. Staphylococcus aureus B. Aspergillus C. Candida species D. Pseudomonas aeruginosa - Correct answer D. Pseudomonas aeruginosa What type of ear drops do we prescribe for otitis external? - Correct answer Ofloxacin ear drops (fluoroquinolone) A 24 year old patient presents with a persistent dry, hacking cough over the last week. Vital signs are normal and overall your exam is benign except for occasional wheezes throughout the lung fields. The patient does indoors some yellow sputum in the morning. How should the nurse practitioner treat this patient? A. Prescribe high dose amoxicillin B. Prescribe azithromycin C. Prescribe doxycycline D. Initiate supportive treatment measures - Correct answer D. Initiate supportive treatment measures 95% of all bronchitis are viral in nature. Supportive treatments including antitussives, albuterol for wheezing, etc. should be utilized. The only instance we use antibiotics to treat bronchitis is if it is due to pertussis. these people are prescribed macrolides, not to shorten the duration of the disease process, but to prevent spread of this disease to others. A 57 year old patient was recently diagnosed with new type two diabetes. His Hgb A1c is 8.9%. His past medical history includes hypertension, heart failure and smoking. Which of the following medication's would be inappropriate to start this client on? A. Metformin B. Empagliflozin C. Pioglitazone D. Dulaglutide - Correct answer C. Pioglitazone Metformin is contraindicated for poor kidney function. Flozins and GLP-1 are cardioprotective. TZD retain fluids so no in HF patients. The nurse practitioner is evaluating a patient to determine the most appropriate birth control method. When assessing the combination options, the nurse practitioner knows that which of the following places the patient at the highest risk for a possible thrombus? A. Mirena B. Loestrin Fe (Norethindrone acetate/thinyl estradiol) C. Nuva-ring D. Ortho-evra patch - Correct answer D. Ortho-evra patch An elderly female patient was recently diagnosed with osteoporosis and placed on alendronate (Fosamax). Which of the following would be crucial for the nurse practitioner to educate the patient about this medication? A. Educate the client to begin taking vitamin D supplements for better absorption of the medication B. Educate the client to always take the medication with food C. Instruct the client to sit upright for 30 minutes after administration D. Instruct the patient about common side effects including diarrhea and vomiting - Correct answer C. Instruct the client to sit upright for 30 minutes after administration A young adult male patient presents to the clinic with mild jaundice and abdominal discomfort. A hepatitis panel is drawn and the results are: +HBsAg, -Anti-HBs, and +Anti-HBc IgM. which of the following is the correct diagnosis for the patient? A. Chronic hepatitis B infection B. Possible hepatitis B infection C. Acute hepatitis B infection D. Past hepatitis B infection - Correct answer C. Acute hepatitis B infection An elderly male patient presents to the clinic with periumbilical abdominal pain. Initially he states he was having issues with diarrhea but it has now changed to constipation. Upon exam, there is obvious abdominal distention. What should be the nurse practitioners priority action? A. Order a KUB B. Order an EGD D. Investigate further about what the client has done at home for this issue. - Correct answer A. Refer the patient to an ENT for direct laryngeal visualization. Any hoarseness greater than three weeks is a major red flag! Evaluate for cancer! A young adult female patient complains of having her fingers turn white and numb when stressed over a recent exam. After a few minutes, her fingers turned bright red and began to throb. What medication would be appropriate to prescribe for this patient in addition to educating the patient about lifestyle interventions? A. Fluoxetine (Prozac) B. Hydrochlorothiazide (HCTZ) C. Norvasc (amlodipine) D. Losartan - Correct answer C. Norvasc (amlodipine) Raynaud's. First line treatment is a calcium channel blocker. Second line can be fluoxetine and losartan. A 14 year old female patient comes in with a chief complaint of headache and facial pressure. She initially was feeling better but had recurrence of symptoms after about eight days. You diagnosed her with sinusitis and prescribe her Augmentin. The nurse practitioner knows that it's important to treat sinusitis with antibiotic therapy to prevent which of the following from occurring? A. Rheumatic fever B. Scarlatina C. Periorbital cellulitis D. Viral exanthem - Correct answer C. Periorbital cellulitis A mother brings her adolescent son in for a routine physical examination. During the exam, you mentioned that it is recommended that her son received the Gardasil vaccine. The mother responds, "Doesn't Gardasil just prevent cervical cancer in women?" How would you respond to the mother? A. Gardasil protects against the hide risk forms of HPV virus, which can lead to cancer in men as well. B. Gardasil protect women from cervical cancer, and men from prostate cancer. C. The Gardasil vaccine will prevent your child from ever being able to get our spread the HPV virus to anyone else. D. The Gardasil vaccine protect against the HPV virus and the majority of sexually transmitted diseases - Correct answer A. Gardasil protects against the hide risk forms of HPV virus, which can lead to cancer in men as well. A mother comes in with her 14 month old son concerned about whether he's progressing like other children his age. Which finding would indicate the child needs further evaluation? A. He is able to walk to steps, but then falls B. He says "mama/dada" with meaning C. He grasps tightly around whatever is placed in his hand when the palm is stroked D. He consistently reaches up to be held when upset - Correct answer C. He grasps tightly around whatever is placed in his hand when the palm is stroked A middle-aged man presents with a sharp severe stabbing pain on the right side of his face whenever he's trying to eat. The nurse practitioner suspects possible trigeminal neuralgia due to the severity of the patient's symptoms. Which cranial nerve is affected in this patient? A. III B. V C. VII D. VIII - Correct answer B. V What is the first line treatment for trigeminal neuralgia? What is the second line treatment? - Correct answer First line treatment: Tegretol Backup option: tricyclic antidepressants You have a 10 year old patient that you are doing a diagnostic work up on for possible asthma. The nurse practitioner knows which of the following does not impact peak flow reading results? A. Height B. Weight C. Age D. Gender - Correct answer B. Weight Mnemonic: HAG A 46-year-old female patient with a history significant for anxiety comes to the clinic today to discuss possible herbal treatments with the nurse practitioner. The patient states that she understands there is minimal evidence to support herbal supplements for anxiety, but would like to try an herbal anyway. Which of the following is typically indicated for anxiety? A. Saw palmetto B. Kava kava C. Ginkgo D. Valerian root E. Ginseng - Correct answer B. Kava kava Saw palmetto: BPH Ginkgo: memory Valerian root: insomnia Ginseng: boost immunity A 14 year old male patient is brought into the clinic for new issues with acne. Upon exam, it is noted that they are erythematous, pus filled pimples across the patient's chin and hairline. What would be the most appropriate treatment for this patient? A. Benzoyl peroxide B. Topical erythromycin C. PO doxycycline D. Accutane - Correct answer A. Benzoyl peroxide A 39 year old male patient is being seen in the office today for schizophrenia. The nurse practitioner decides to place the patient on olanzapine (Zyprexa) for further management of his disorder. The nurse practitioner knows which of the following should be monitored at the next visit? Select all that apply: A. Keflex B. Ciprofloxacin C. Augmentin D. Ceftriaxone - Correct answer C. Augmentin A middle-aged woman that you're diagnosed with hypothyroidism six months ago comes in to have her TSH level checked. She is currently prescribed Synthroid 100 mcg PO daily. When you receive the results, her TSH is 0.3. Which is the next most appropriate action by the nurse practitioner? A. Decrease the Synthroid dosing B. Discontinue the Synthroid permanently C. Increase the Synthroid dosing D. Assess how the patient has been taking her medication - Correct answer D. Assess how the patient has been taking her medication Which two calcium channel blockers would be inappropriate to prescribe to a patient with heart failure and hypertension - Correct answer Verapamil and Diltiazem A patient comes in complaining of green yellow halos in their vision and feeling extremely weak. Their heart rate is 42. They likely have toxic levels of which cardiac drug? - Correct answer Digoxin Which statements are consistent with polycystic ovarian syndrome (PCOS)? Select all that apply. A. Patients with PCOS are at low risk for endometrial cancer B. The diagnosis of PCOS requires ultrasound studies C. The diagnostic work out for suspected PCOS should be individualized to the patient D. The risks and complications associated with PCOS are numerous and potentially serious - Correct answer C. The diagnostic work out for suspected PCOS should be individualized to the patient D. The risks and complications associated with PCOS are numerous and potentially serious Which statements about contraception are correct? Select all that apply. A. Long-acting reversible contraceptives (LARCs) may be safely used by nulliparous women. B. For patients with PCOS, combined oral contraceptives are generally safe and effective, and can be helpful with PCOS symptoms. C. LARCs should not be inserted by primary care providers. D. The management of heavy menses required low-dose estrogen - and progesterone - containing combined hormonal contraceptives. - Correct answer A. Long-acting reversible contraceptives (LARCs) may be safely used by nulliparous women. B. For patients with PCOS, combined oral contraceptives are generally safe and effective, and can be helpful with PCOS symptoms. Which statements about cervical cancer are correct? Select all that apply. A. Women between ages 21 and 29 years should be screened every 5 years with Pap testing only. B. The cervical cancer screening intervals recommended by the American Cancer Society and the ASCCP are safe and were developed according to evidence-based guidelines. C. Immunization against HPV is most effective when administered before age 26 years. D. Two HPV vaccines doses are recommended for patients who are younger than 15 years and not sexually active. - Correct answer B. The cervical cancer screening intervals recommended by the American Cancer Society and the ASCCP are safe and were developed according to evidence-based guidelines. D. Two HPV vaccines doses are recommended for patients who are younger than 15 years and not sexually active. A 19 year old patient has been diagnosed with bacterial vaginosis. Which choices are appropriate diagnostic or management considerations? Select all that apply. A. This patient should be treated with oral or vaginal metronidazole or an alternative antibiotic. B. While this patient is undergoing treatment, her partner should wear a condom for sexual intercourse. C. This patient should douche for symptom relief. D. This patient should be informed that she has a sexually transmitted infection (STI). E. This patient should be screened for the most common STI's. - Correct answer A. This patient should be treated with oral or vaginal metronidazole or an alternative antibiotic. B. While this patient is undergoing treatment, her partner should wear a condom for sexual intercourse. E. This patient should be screened for the most common STI's. A 24-year-old woman calls the office stating that she thinks she has a vaginal yeast infection again. She requests that her provider called in a prescription. Which statements are correct? Select all that apply. A. Ask her to come in for an exam as soon as possible. B. Take a brief history before deciding if she should be seen in the office. C. Call in a prescription for an anti-fungal; this patient is known to you. D. Recommend an OTC external cream for symptom relief until she can be seen in the office. - Correct answer A. Ask her to come in for an exam as soon as possible. D. Recommend an OTC external cream for symptom relief until she can be seen in the office. Which of the following can be a secondary cause of osteoporosis? Select all that apply. A. Type 1 diabetes B. Long-standing hyperthyroidism C. Oral glucocorticoid use for greater than three months D. Chronic malnutrition E. Chronic kidney disease - Correct answer A. Type 1 diabetes B. Long-standing hyperthyroidism C. Oral glucocorticoid use for greater than three months D. Chronic malnutrition E. Chronic kidney disease D. Cefalexin Which statements about gestational diabetes are correct? Select all that apply. A. Screening for gestational diabetes should be conducted in the second trimester. B. One abnormal reading on the 3-hour oral glucose tolerance test (OGTT) is considered diagnostic for gestational diabetes. C. Gestational diabetes affects about 18% of pregnant women. D. Gestational diabetes is associated with maternal and fetal abnormalities. - Correct answer A. Screening for gestational diabetes should be conducted in the second trimester. C. Gestational diabetes affects about 18% of pregnant women. D. Gestational diabetes is associated with maternal and fetal abnormalities. Which one of the following is not a symptom of ectopic pregnancy? A. Lower abdominal pain B. High fever C. Vaginal bleeding D. Missed menses - Correct answer B. High fever A pregnant mother is Rh negative. When should she receive RhoGAM (anti-D immunoglobulin)? Select all that apply. A. At the time pregnancy is diagnosed B. At 12 to 14 weeks gestation C. At about 28 weeks gestation D. During each trimester E. Within 72 hours of delivery - Correct answer C. At about 28 weeks gestation E. Within 72 hours of delivery A pregnant mother who is Rh negative experienced a suspected miscarriage earlier this morning. Her last menstrual period was eight weeks ago. How should this patient be managed today? A. She does not require RhoGAM. B. She should receive RhoGAM now. C. She does not need RhoGAM because the miscarriage did not occur in the second trimester. D. She does not need RhoGAM because the miscarriage did not occur in the third trimester. - Correct answer B. She should receive RhoGAM now. Which of the following are signs of preterm labor? Select all that apply. A. Low or dull backache B. Increased uterine activity C. Menstruation-like cramps D. Constipation E. Vaginal spotting or bleeding - Correct answer A. Low or dull backache B. Increased uterine activity C. Menstruation-like cramps E. Vaginal spotting or bleeding Which statements are true about placenta previa? Select all that apply. A. It causes painless vaginal bleeding. B. It usually occurs in the second trimester. C. Obstetric referral is not needed unless the symptoms worsen. D. Give me progress to placenta abruptio. - Correct answer A. It causes painless vaginal bleeding. B. It usually occurs in the second trimester. D. Give me progress to placenta abruptio. According to the CDC, what is the recommended daily dose of folic acid for pregnant women? A. 0.5 mcg (500 mg) per day B. 1000 mcg (1 mg) per day C. 0.4 mcg (400 mg) per day D. 2000 mcg (2 mg) per day - Correct answer B. 1000 mcg (1 mg) per day Which statement is not true about ectopic pregnancy? A. Fallopian tube rupture may occur shortly after the onset of symptoms. B. Symptoms typically develop about 6 to 8 weeks after the last menstrual period. C. Serum hCG levels double every 24 to 72 hours. D. Lower abdominal pain me a car on the right or left side. - Correct answer C. Serum hCG levels double every 24 to 72 hours. Folic acid is recommended prior to and during the first three months of pregnancy to prevent neural tube defects. Which of the following answer choices are examples of neural tube defects? Select all that apply. A. Cleft palate B. Spina bifida C. Anencephaly D. Encephalocele - Correct answer B. Spina bifida C. Anencephaly D. Encephalocele A patient has a fundal height measurement of 32 cm. Which of the following is a correct statement about this patient? A. She is 14 to 18 weeks pregnant B. She is 18 to 22 weeks pregnant C. She is 32 weeks pregnant D. She is at term and ready to deliver - Correct answer C. She is 32 weeks pregnant The uterine fundus should be palpable at 20 weeks gestation: A. At the level of the umbilicus B. Just above the level of the symphysis pubis C. Midway between the symphysis pubis and the umbilicus D. Below the symphysis pubis - Correct answer A. At the level of the umbilicus Each of the following children has received the PCV 13 vaccine. Which of them needs the PPSV 23 immunization? Select all that apply. A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant D. A 4-year old patient will be traveling internationally - Correct answer A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant Which of the following is the most useful to a clinician in making a correct diagnosis of asthma? A. Chest x-ray B. Spirometry C. Peak flow monitoring D. History - Correct answer B. Spirometry The mother of a newborn is HBsAg positive. How should immunization for this infant proceed? A. Do not immunized the infant hepatitis B B. Call the CDC for recommendations on how to proceed C. Immunized the newborn against hepatitis B within 24 hours of birth D. Immunized a newborn against hepatitis B and administer hepatitis B immune globulin within 12 hours of birth - Correct answer D. Immunized a newborn against hepatitis B and administer hepatitis B immune globulin within 12 hours of birth Each of the following children has received the PCV 13 vaccine. Which of them needs the PPSV 23 immunization? Select all that apply. A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant D. A 4-year old patient will be traveling internationally - Correct answer A. A 5-year old patient who has cyanotic heart disease B. A 3-year old patient with functional asplenia C. A 7-year old patient with a cochlear implant A 4-month-old infant will be traveling with his parents to South Africa. What should the nurse practitioner do to learn which vaccines this child requires? A. Visit the CDC vaccines and immunizations webpage B. Call the CDC to ask for guidance C. Consult an infectious disease specialist D. Refer the patient to a travel medicine clinic - Correct answer A. Visit the CDC vaccines and immunizations webpage A mother reports that her 1-year old child has an allergy to eggs that produces a nonpruritic rash. The nurse practitioner knows that this: A. Contraindicates most immunizations B. Requires careful monitoring and follow up C. Is not IgE mediated D. Contraindicates influenza immunization - Correct answer C. Is not IgE mediated The CDC recommends monitoring a child after immunization for: A. 15 minutes B. 30 minutes C. 45 minutes D. 60 minutes - Correct answer A. 15 minutes A 48 year old patient who works in a daycare setting asked which immunizations she should receive based on CDC guidance. The nurse practitioner response by advising that: A. She should receive the shingles immunization to prevent chickenpox B. She should receive a Tdap vaccine if she has not had one within the past 10 years C. She should get the pneumococcal vaccine D. The CDC has no specific immunizations for her - Correct answer B. She should receive a Tdap vaccine if she has not had one within the past 10 years A 12 month old girl received the varicella vaccine three weeks ago. How long must she wait before receiving the MMR vaccine? A. 1 week B. 2 weeks C. 3 weeks D. She may receive it today - Correct answer A. 1 week The most commonly prescribed and tested medication's for attention deficit disorder are on schedule II. What does this mean? Select all that apply. A. The medications are highly effective B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence D. The medications are highly abused - Correct answer B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence A 15 year old girl has a viral upper respiratory infection. She has experienced symptoms for three days. She is wheezing but is in no distress. How should the nurse practitioner handle this? A. Monitor her status B. Prescribe nebulized albuterol C. Prescribe an oral steroid D. Prescribe an inhaled steroid - Correct answer B. Prescribe nebulized albuterol The chest x-ray for a seven year old boy shows infiltrates in the left lower lobe. How should this patient be managed? A. Symptomatic treatment only B. Amoxicillin with clavulanate 45 mg/kg/d once daily B. Suspected child abuse requires concrete evidence of abuse C. Child neglect does not constitute child abuse D. The parents should be informed that the report is being made - Correct answer A. Nurse practitioners are mandatory reporters in all states An eight year old girl presents with a spiral fracture of the arm. The nurse practitioner suspects abuse because the mothers explanation of the injury doesn't match the child. How should the nurse practitioner proceed? A. Confront the mother about possible abuse B. Ask the child to repeat her recollection of how the injury occurred C. Separate the child from the mother D. Tell the mother that you are concerned about the child's safety - Correct answer D. Tell the mother that you are concerned about the child's safety An infant has physiologic hyperbilirubinemia. At what age does this usually appear? A. Within 24 hours of birth B. About 2-3 days after birth C. 3-5 days after birth D. Within the first week after birth - Correct answer B. About 2-3 days after birth A four day old term infant who is being breast-fed has hyper bilirubinemia (18 mg/dL). This is most often treated with: A. Cessation of breast feeding B. Photo therapy C. Hydration D. Blood transfusion - Correct answer B. Photo therapy At what age are symptoms of colic most likely to occur? A. 1-2 weeks B. 4-6 weeks C. 3 months D. 6 months - Correct answer B. 4-6 weeks A 6 week old infant has visible peristaltic waves in the upper abdomen just before emesis. Which of the following is likely to be included in the differential diagnosis? A. Gastroesophageal reflux B. Milk protein intolerance C. Intestinal obstruction D. Pyloric stenosis - Correct answer D. Pyloric stenosis At what age are symptoms of pyloric stenosis most likely to develop? A. 3-6 weeks B. 3 months C. 6 months D. 12 months - Correct answer A. 3-6 weeks A 4 week old infant has suspected pyloric stenosis. What imaging study is most commonly used to diagnose this condition? A. Upper endoscopy B. Barium enema C. Ultrasound D. pH manometry - Correct answer C. Ultrasound The nurse practitioner observes abdominal guarding in an 18 month old patient. And abdominal ultrasound reveals a "coiled spring appearance" in the mid upper abdomen. What is the most likely diagnosis? A. Intussusception B. Intestinal obstruction C. Constipation D. Pathologic reflux - Correct answer A. Intussusception Which of the following are symptoms of mild dehydration in pediatric patients? Select all that apply. A. Normal pulse B. Normal systolic blood pressure C. Normal respirations D. Normal anterior fontanel E. Normal skin turgor - Correct answer A. Normal pulse B. Normal systolic blood pressure C. Normal respirations D. Normal anterior fontanel E. Normal skin turgor What is the preferred means of rehydration for a child who has a viral gastroenteritis? A. Beverage of choice B. IV rehydration C. Commercially prepared electrolyte solution D. Chicken broth or other salty beverage - Correct answer C. Commercially prepared electrolyte solution The nurse practitioner is assessing a 6 month old boy and identifies a single palpable testicle in the scrotum. This increases the infant's risk for: A. Testicular cancer B. Penile cancer C. Epididymitis D. Hydrocele - Correct answer A. Testicular cancer A 6 month old boy has one palpable testicle. When should the nurse practitioner refer this patient to urology? A. Now B. At age 3 months C. At age 6 months D. At age 1 year - Correct answer A. Now A 4 month old boy has a hydrocele. At what age is a hydrocele expected to resolve? A. Between ages 4 and 6 months B. Around, age 6 months C. Between ages 6 and 9 months D. Before age 12 months. - Correct answer D. Before age 12 months. B. Development of secondary sexual characteristics C. A rapid growth spurt D. Increasing bone and muscle density - Correct answer C. A rapid growth spurt Which findings are characteristic of Osgood-Schlatter disease? Select all that apply. A. Erythema, warmth of the tibial tuberosity B. Pain reproduce by extending the knee against resistance C. Pain over the patellar tendon D. Straight leg raise is painless - Correct answer B. Pain reproduce by extending the knee against resistance D. Straight leg raise is painless A three week old infant has white pinpoint papules on his face and cheeks. What is this? A. Mongolian spots B. Eczema C. Milia D. Hemangioma - Correct answer C. Milia What lip/oral cavity symptoms are characteristics in the patient who has herpangina? A. The pharynx is unaffected B. Tonsillar exudate is present C. Painful vesicles are present on the soft palate and mouth D. Pustules appear unilaterally on tonsils, and blisters appear on the lips - Correct answer C. Painful vesicles are present on the soft palate and mouth A four year old patient presents with lacy macular rash and fever. What illness is a common cause of these symptoms? A. Herpangina B. Hand, foot and mouth disease C. Fifth disease D. Measles - Correct answer C. Fifth disease A three year old girl is diagnosed with fifth disease. Her mother is in the first trimester of pregnancy and has had significant exposure to the sick child. If her mother has a positive IgM test (Parvo B 19), what is the risk to the fetus? A. Intrauterine fetal death B. Significant fetal neurologic delay C. Congenital heart defects D. Significant orthopedic anomalies - Correct answer A. Intrauterine fetal death A nurse practitioner has diagnosed a child with roseola. How old is this child likely to be? A. 7-13 months old B. 2-4 years old C. 3-6 years old D. 6-12 years old - Correct answer A. 7-13 months old Measles is characterized by what clinical findings? Select all that apply. A. Cough B. Runny nose C. Conjunctivitis D. Anemia - Correct answer A. Cough B. Runny nose C. Conjunctivitis The nurse practitioner has exam is Mr. Jones. He has mild dyspnea and bilateral lower extremity edema. What diagnostic test or finding is sensitive in identifying heart failure? A. Calcium score B. BNP >100 pg/mL C. Atrial fibrillation D. A three lead EKG - Correct answer B. BNP >100 pg/mL A 67-year-old man complains of pain in his left calf when he walks. The pain is relieved by rest. The patient's ankle brachial index (ABI) is 0.75. He probably: A. Has peripheral vascular disease B. Does not have peripheral vascular disease C. Has atypical leg symptoms D. Has normal pedal pulses - Correct answer A. Has peripheral vascular disease A 34 year old pregnant patient has mitral valve prolapse. Where is this best auscultated? A. Mitral listening point B. Aortic listening point C. Tricuspid listening point D. Pulmonic listening point - Correct answer A. Mitral listening point A 46 year old sales clerk has been diagnosed with mitral stenosis. What choice best describes this murmur? A. A late systolic click near the apex B. Radiation of soft diastolic sounds into the neck and carotid arteries C. Diastolic sounds heard loudest near the apex D. Soft diastolic sounds in the left midclavicular area - Correct answer C. Diastolic sounds heard loudest near the apex An 80-year-old man complains of chest pressure when walking up a flight of stairs at his home. The nurse practitioner auscultates a 2/6 systolic murmur near the second intercostal space to the right of the store now. Which murmur is likely present? A. Aortic regurgitation B. Mitral valve prolapse C. Aortic stenosis D. Mitral stenosis - Correct answer C. Aortic stenosis A 62 year old truck driver has aortic regurgitation. What would you expect to hear when auscultating the murmur? A. Muscle strain B. Bursitis C. Tendinitis D. Rotator cuff dislocation - Correct answer A. Muscle strain B. Bursitis C. Tendinitis A nurse practitioner student has severe test anxiety. Which medication could it take to relieve his anxiety prior to taking his certification exam? A. 50 mg sertraline for 6-8 weeks before exam B. Low dose alprazolam 45 minutes before the exam C. Propranolol 60 minutes before the exam D. Buspirone 60 minutes before the exam - Correct answer C. Propranolol 60 minutes before the exam What history or actions are expected for a presentation of primary dysmenorrhea in a 28 year old woman? A. Dysmenorrhea since menarche B. OB-GYN referral C. Worsening dysmenorrhea over time D. NSAIDs and/or oral contraceptives for symptom relief - Correct answer A. Dysmenorrhea since menarche D. NSAIDs and/or oral contraceptives for symptom relief A 20 year old man has suspected acute HIV infection. Which lab test should be ordered? A. HIV IgM antibodies B. Antigen/antibody immunoassay (ELISA/EIA) C. HIV1/HIV2 antibody differentiation immunoassay D. HIV-1 RNA assay (NAT) - Correct answer C. HIV1/HIV2 antibody differentiation immunoassay Which treatment is inappropriate for treatment of a patient who has acute rhinosinusitis? A. Analgesics B. Saline irrigation C. Intranasal glucocorticoids D. Antihistamines - Correct answer D. Antihistamines A 30 year old patient with allergic rhinitis has been using OTC oxymetazoline for the past three months. She has developed rhinitis medicamentosa. What symptom is associated with this? A. Rhinorrhea B. Nasal congestion C. Cough D. Epistaxis - Correct answer B. Nasal congestion A patient has allergic rhinosinusitis. What would be unusual to find in him? A. Infraorbital edema B. Accentuated lower eyelid folds C. Transverse nasal crease D. Erythematous sclera - Correct answer D. Erythematous sclera What is the most common bacterial cause of pharyngitis? A. Mycoplasma pneumoniae B. Streptococcus Group A C. Streptococcus Group C D. Haemophilus influenzae - Correct answer B. Streptococcus Group A Which agent used to treat otitis externa is most associated with allergic reactions? A. Ofloxacin B. Levofloxacin C. Neomycin-polymyxin B D. Acetic acid - Correct answer C. Neomycin-polymyxin B A patient who has been diagnosed with otitis external should be taught: A. To avoid swimming while OE is present B. That hearing will be diminished for about one week after OE resolution C. That tinnitus is common with OE D. That the infection rarely occurs unilaterally - Correct answer A. To avoid swimming while OE is present 36 year old woman complaints of irritated, dry, itchy eyes. There is eyelid margin erythema. What is the likely diagnosis? A. Conjunctivitis B. Blepharitis C. Iritis D. Chalazion - Correct answer B. Blepharitis A 60 year old woman with a 30 pack year smoking history visits the nurse practitioner clinic for an initial visit. How should she be screened for lung cancer? A. Chest x-ray B. Low-dose CT of chest C. MRI of chest D. No screening as indicated in this patient - Correct answer B. Low-dose CT of chest A patient has been diagnosed with thrombocytopenia. If this is secondary to poorly controlled lupus, what lab tests might be expected to be abnormal? Select all that apply. A. INR B. PT/PTT C. Hgb/Hct D. Platelet count - Correct answer C. Hgb/Hct D. Platelet count Which condition may be associated with gout? A. Peptic ulcer disease B. Nonalcoholic fatty liver disease C. Chronic renal disease D. Gastric ulcer disease - Correct answer C. Chronic renal disease Mr. Boudreaux's only symptom is urinary frequency. What might be in the differential diagnosis? Select all that apply. A. Undiagnosed diabetes B. Urinary tract infection C. Acute prostatitis D. Prostate cancer - Correct answer A. Undiagnosed diabetes B. Urinary tract infection If Mr. Boudreaux's finding/symptoms include microscopic hematuria and urinary frequency, what might be included in the differential diagnosis? A. Undiagnosed diabetes B. Urinary tract infection C. Acute prostatitis D. Prostate cancer - Correct answer B. Urinary tract infection Mr. Boudreaux has been diagnosed with benign prostatic hyperplasia (BPH). His daily symptoms include frequency, urgency, and weakened urinary stream. What might help to manage his symptoms quickly? Select all that apply. A. Tamsulosin (Flomax) B. Dutasteride (Avodart) C. HCTZ D. Tadalafil (Cialis) - Correct answer A. Tamsulosin (Flomax) D. Tadalafil (Cialis) Mrs. Boudreaux calls your office the day after Mr. Boudreaux's visit and states that he is not taking the tamsulosin you prescribed. The most likely reason is: A. The high cost B. New onset erectile dysfunction C. Somnolence D. Dizziness - Correct answer D. Dizziness When prescribing tamsulosin, the nurse practitioner should educate the patient about common side effects, such as: A. Abdominal pain B. Dizziness C. Urinary hesitancy D. Fatigue - Correct answer B. Dizziness A 50-year-old man presents with fevers, chills, tenderness on digital rectal exam, and pelvic pain. What should be included in the differential diagnosis? A. Urinary tract infection B. Benign prostatic hypertrophy C. Acute prostatitis D. Epididymitis - Correct answer C. Acute prostatitis When are symptoms of groin hernias most evident? Select all that apply. A. After eating B. Before a bowel movement C. After sitting for an extended period of time D. With heavy lifting E. After prolonged standing - Correct answer C. After sitting for an extended period of time D. With heavy lifting E. After prolonged standing In what position should a patient be examined to identify the presence of a hernia? A. Seated B. Lying supine C. Standing D. Squatting - Correct answer C. Standing How is an inguinal hernia most commonly diagnosed? A. Ultrasound B. CT scan of the groin C. Physical examination D. MRI of the groin - Correct answer C. Physical examination Which of the following conditions would contribute to diastasis recti? Select all that apply. A. Obesity B. Pregnancy C. Prior abdominal surgery D. Constipation - Correct answer A. Obesity B. Pregnancy C. Prior abdominal surgery A 17 year old boy presents with a sensation of heaviness in his scrotum. On exam, the nurse practitioner palpates a small nodule on the left testicle. How should the nurse practitioner proceed? A. Urethral swab B. Abdominal CT C. Scrotal ultrasound D. Evaluation of cremasteric reflex - Correct answer C. Scrotal ultrasound A 19 year old patient is in the urgent care center with a complaint of scrotal pain 9/10. He has an absent cremasteric reflex. Which of the following should the nurse practitioners differential diagnosis include? A. Testicular torsion B. Epididymitis C. Testicular cancer D. Possible sexually transmitted infection - Correct answer A. Testicular torsion Which conditions make NSAID use for osteoarthritis riskier? Select all that apply. A. Heart failure The nurse practitioner is evaluating a patient who has subclinical hypothyroidism (TSH 6.2). What are the major risks of prescribing levothyroxine? A. The risks are very few B. Hyperlipidemia and atrial fibrillation are risks C. Accelerated bone loss and atrial fibrillation are risks D. The patient may develop hypertension and tachycardia - Correct answer C. Accelerated bone loss and atrial fibrillation are risks You have diagnosed a 28 year old woman with primary hypothyroidism. Her calculated thyroid hormone replacement is 108 mcg daily. How much should she be given initially? A. 25 mcg daily B. 50 mcg daily C. 100 mcg daily D. 112 mcg daily - Correct answer C. 100 mcg daily The appropriate pharmacology management choice for a patient with symptomatic hyperthyroidism is: A. A beta blocker B. An ACE inhibitor C. Thyroid hormone D. Aspirin - Correct answer A. A beta blocker A 44 year old obese woman presents with abdominal pain. She is afebrile. What is the most likely etiology? A. Appendicitis B. Cholecystitis C. Diverticulitis D. Pancreatitis - Correct answer B. Cholecystitis A 36-year-old obese woman presents with abdominal pain. If the most likely differential diagnosis is cholecystitis, what is the diagnostic test of choice? A. CT of the abdomen B. MRI of the abdomen C. Ultrasound of the abdomen D. Kidney, ureter and bladder x-ray - Correct answer C. Ultrasound of the abdomen A 46 year old woman with abdominal pain in the right lower quadrant has suspected diverticulitis. What should be part of the initial workout? Choose all that apply. A. CBC B. Electrolytes C. Pregnancy test D. Urinalysis E. CT scan with and without contrast - Correct answer A. CBC B. Electrolytes C. Pregnancy test D. Urinalysis E. CT scan with and without contrast What is the gold standard treatment for gastroesophageal reflux disease? A. Antacids B. H2 receptor agonist (H2RAs) C. Proton pump inhibitors (PPIs) D. PPIs plus H2RAs - Correct answer C. Proton pump inhibitors (PPIs) How many weeks should a patient with GERD be treated with a proton pump in a better (PPI)? A. 2 weeks B. 4 weeks C. 8 weeks D. 12 weeks - Correct answer C. 8 weeks A 56-year-old man has relocated to your area from another state. You will be his primary care provider. He is a past smoker, and he has an elevated BMI and a history of Barrett's esophagus. He takes OTC proton pump inhibitor and is asymptomatic. What should be part of his plan of care? A. Use of OTC PPIs B. Referral to a gastroenterologist due to the history of Barrett's esophagus C. Weaning of PPIs and using H2 blockers D. Prescribing regular usage of prescription strength PPIs - Correct answer B. Referral to a gastroenterologist due to the history of Barrett's esophagus Which of the following health conditions may be associated with constipation? Select all that apply. A. Hemorrhoids B. Anal fissure C. Anorexia nervosa D. Parkinson's disease E. Hypothyroidism - Correct answer A. Hemorrhoids B. Anal fissure C. Anorexia nervosa D. Parkinson's disease E. Hypothyroidism A 52-year-old woman states that for the last three mornings, she has seen pink drops of "blood" in the toilet water after she has a bowel movement. She had a normal colonoscopy at age 50 and has no family history of colorectal cancer. What should be done first? A. Abdominal CT B. CBC with ferritin level C. Stool for occult blood D. Refer to G.I. for a repeat colonoscopy - Correct answer B. CBC with ferritin level A 57-year-old woman was diagnosed with Crohn's disease about five years ago. You are her primary care provider. Which findings today might be related to her Crohn's disease? Select all that apply. A. Likely deep vein thrombosis in her right calf B. Elevated platelet count C. Iritis D. Arthritis - Correct answer A. Likely deep vein thrombosis in her right calf C. 45 minutes D. 60 minutes - Correct answer A. 15 minutes A 48 year old patient who works in a daycare setting asked which immunizations she should receive based on CDC guidance. The nurse practitioner response by advising that: A. She should receive the shingles immunization to prevent chickenpox B. She should receive a Tdap vaccine if she has not had one within the past 10 years C. She should get the pneumococcal vaccine D. The CDC has no specific immunizations for her - Correct answer B. She should receive a Tdap vaccine if she has not had one within the past 10 years A 12 month old girl received the varicella vaccine three weeks ago. How long must she wait before receiving the MMR vaccine? A. 1 week B. 2 weeks C. 3 weeks D. She may receive it today - Correct answer A. 1 week The most commonly prescribed and tested medication's for attention deficit disorder are on schedule II. What does this mean? Select all that apply. A. The medications are highly effective B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence D. The medications are highly abused - Correct answer B. The medications have a high potential for abuse C. Use of the medications may lead to physical and psychological dependence A 15 year old girl has a viral upper respiratory infection. She has experienced symptoms for three days. She is wheezing but is in no distress. How should the nurse practitioner handle this? A. Monitor her status B. Prescribe nebulized albuterol C. Prescribe an oral steroid D. Prescribe an inhaled steroid - Correct answer B. Prescribe nebulized albuterol The chest x-ray for a seven year old boy shows infiltrates in the left lower lobe. How should this patient be managed? A. Symptomatic treatment only B. Amoxicillin with clavulanate 45 mg/kg/d once daily C. Azithromycin 10 mg/kg x5 days D. Amoxicillin 90 mg/kg/d - Correct answer D. Amoxicillin 90 mg/kg/d A 16 month old child has been diagnosed with bronchiolitis. He has nasal flaring, intercostal retractions, and poor appetite. How should he be managed? A. As an outpatient with close follow up B. As an outpatient with nebulized albuterol C. As an inpatient, due to his age D. As an inpatient because of his symptoms - Correct answer D. As an inpatient because of his symptoms A three year old child with a history of asthma presents with symptoms of croup. The nurse practitioner notes mild intercostal retractions in the patient. How should this be managed? A. Nebulized albuterol for cough B. Guaifenesin/dextromethorphan PRN for cough C. Single dose of oral dexamethasone (0.6 mg/kg) D. Oral prednisone for three days - Correct answer C. Single dose of oral dexamethasone (0.6 mg/kg) A febrile child is in the exam room with his mother and your office nurse. Assessment findings include a croupy cough, intercostal retractions, stridor and drooling. How should this patient be managed right now? Select all that apply. A. Call 911 B. Administer nebulized epinephrine C. Administer a steroid injection D. Instruct the mother to drive the child to the nearest emergency department E. Administer nebulized coolmist until EMS arrives - Correct answer A. Call 911 B. Administer nebulized epinephrine An infant who has suspected cystic fibrosis (CF) has a positive sweat test. This means: A. He has cystic fibrosis B. He should be screened again in six months C. The test should be repeated D. He should be referred to a cystic fibrosis clinic - Correct answer C. The test should be repeated What symptoms might be present in a child with cystic fibrosis? A. Excessive sweating B. Frequent episodes of diarrhea C. Persistent productive cough D. Persistent watery eyes and tears - Correct answer C. Persistent productive cough A pediatric patient has sickle cell disease. Which of the following should not be performed or provided at the 1 year well child check? A. Assessment of growth and development B. Review of immunization status C. Caregiver education about the importance of adequate hydration D. Discontinuation of daily penicillin for prophylaxis - Correct answer D. Discontinuation of daily penicillin for prophylaxis Which findings are typically associated with leukemia? A. Bruising B. Bleeding C. Frequent nosebleeds