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NR 511 Week 8 Final Exam – Real Exam Compilation

1. Question: Harriet, age 62, has type 1 diabetes that is well controlled by insulin. Recently, she has been having marital difficulties that have left her emotionally upset. As a result of this stress, it is possible that she will: 
2. Question: Mason, age 52, has diabetes mellitus (DM) and is overweight. You now find that he is hypertensive. How should you treat his hypertension? 
3. Question: Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He has heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? 
4. Question: When you inspect the integumentary system of clients with endocrine disorders, a finding of coarse hair may be an indicator of: 
5. Question: Which of the following is not a risk factor for diabetes mellitus type 2? 
6. Question: Bill, age 43, appears with a tender, ulcerated, exudative, papular lesion on his penis. It has an erythematous halo, surrounding edema, and friable base. The nurse practitioner should suspect: 
7. Question: Josh and Martha have 5 children and do not want any more. Josh said he heard about a no-scalpel vasectomy (NSV) and asks the nurse practitioner how it works. What would be the best response? 
8. Question: Susan, age 28, is 9 months pregnant and asks you about using umbilical cord blood after birth for newborn DNA identification. What do you tell her? 
9. Question:  Russo, age 59, is a postmenopausal woman who comes to your office complaining of vaginal dryness. She has been sexually active with a new partner and says that penetration is very painful. She has tried over-the-counter lubricants but has not found one that works. Her history is significant for hypertension only. After examination and wet prep, you diagnose her with atrophic vaginitis. The treatment for this condition includes: 
10. Question: Sherri’s blood work returns with a decreased mean corpuscular volume (MCV) and a decreased mean corpuscular hemoglobin concentration (MCHC). What should you do next? 
11. Question: Which of the following is a benign neoplasm? 
12. Question: Sally has human immunodeficiency virus (HIV) and asks which method of birth control, other than abstinence, would be best for her. You suggest: 
13. Question: Cass, age 67, tells the nurse practitioner (NP) that she has been diagnosed with a condition that causes sudden flares of pain, swelling, and redness of the joints in her toes. She cannot remember the name of the diagnosis, but she knows it is caused by urate crystals that “get stuck in the joint and cause pain.” She is on hydrochlorothiazide (HCTZ) for management of her hypertension. The NP should suspect a diagnosis of: 
14. Question: Matthew, age 52, is a chef who just severed 2 of his fingers with a meat cutter. You would recommend that he: 
15. Question: Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome? 
16. Question: June, age 67, presents with back pain with no precipitating event. The pain is located over her lower back muscles and spine, without sciatica, and it is aggravated by sitting, standing, and certain movements. It is alleviated with rest. Palpation localizes the pain, and muscle spasms are felt. There was an insidious onset with progressive improvement. What is the most likely diagnosis? 
17. Question: Sam, age 50, presents with Paget disease that has been stable for several years. Recently, his serum alkaline phosphatase level has been steadily rising. The nurse practitioner determines that it is time to start him on pharmacologic management. Which of the following should she initially prescribe? 
18. Question: A 55-year-old patient is able to complete range of motion (ROM) against gravity with some resistance. The nurse practitioner would assign which of the following numerical grades to this manual muscle testing description? 
19. Question: Paul has a malignant fibrosarcoma of the femur. He recently had surgery and is now on radiation therapy. You want to order a test to determine the extent of the tumor invasion of the surrounding tissues and the response of the bone tumor to the radiation. Which of the following tests should you order? 
20. Question: Karen, who is postmenopausal, is taking 1200 mg of calcium daily but does not understand why she also needs to take vitamin D. You tell her that:
    

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NR 511 Week 8 Final Exam – Practice Questions

1. Question: which test is used to confirm a diagnosis of epididymitis?
2. Question: Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?
3. Question: Reuben, age 24 years old has HIV and just had a routine viral load test done. The results show a falling viral load. What does this indicates?
4. Question: The patient with gastro esophageal reflux disease (GERD) should be instructed to eliminate which of these activities?
5. Question: you have detected the presence of crepitus on examination of a patient with a musculoskeletal complaint. Additionally, there is limited range of motion with both active and passive movement. These findings suggest that the origin of the musculoskeletal complaint is
6. Question: A 25 years old patient presents to the clinic with fatigue, cold intolerance, weight gain and constipation for the past 3 months. On physical exam, the clinician notice a sinus bradycardia, muscular stiffness, coarse, dry hair, and a delay in relaxation in deep tendon reflexes (DTRs). Which of the following test should be ordered next?
7. Question: Sam is a 25years old man who has been diagnosis with low back stain based on his history of localized low back pain and muscle spasm along with a  normal numerological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
8. Question: Which of the following data is indication of testicular torsion?
9. Question: What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
10. Question: A 14 years old is seen with complaint of severe testicular pain. The clinician suspect testicular torsion. Which of the following is the appropriate action?
11. Question: Which of the following data are indicative of testicular torsion?
12. Question: A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis, in addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses?
13. Question: The patient is seen in the office complaining flank pain. The clinician should assess this patient for which risk factor for kidney stones?
14. Question: A 76 years old man is seen in the office for complaint of urinary incontinence. The clinician should suspect which causes of incontinence in men?
15. Question: Harvey has a rubbery smooth, round mass on his chest which is compressible and has a soft to to very firm texture. What do you diagnose this as?
16. Question: The patient is prescribed radioactive iodine (RA) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
17. Question: Most nosocomial pneumonias are caused by
18. Question: Which of the following signs or symptoms indicate an inflammatory etiology to musculoskeletal pain?
19. Question: A patient presents to the clinician with a sore throat, fever, of 100.7f and tender anterior cervical lymphadenopathy. The clinician suspect strep throat and performed a rapid strep test that is negative. What would the nest step be?
20. Question: Most Nosocomial pneumonias are caused by…….
21. Question: A patient is diagnosed with Giardia after a backpacking trip in the mountains. Which of the following would be the appropriate treatment?
22. Question: Which causes the greatest percentage of mammalian bites?
23. Question: One of the initial steps in assessing patient with musculoskeletal complaints is to determine whether the complaint is articular or non-articular in origin. Which of the following is an example of an articular structure?
24. Question: Cat bites are commonly associated with which of the following pathogens?
25. Question: Which of the following should be considered in a patient presenting with erectile dysfunction?
26. Question: Tori is on systemic antifungals for a tines infect. You understand that serum labs monitored for
27. Question: Fluctuation and reductions in estrogen may be a contributing factor in which type of rhinitis?
28. Question: Severe pain associated with acute otitis media signifies perforation of the tympanic membrane
29. Question: The Patient is diagnosed with overactive bladder (OAb).Which of the following instructions should be given to the woman?
30. Question: Sally aged 25, present with impetigo that has been diagnosed as infected with staphylococcus. The clinical presentation in pruritic, tender, red vesicles surrounded y erythema with a rash that is ulcerating. Which types of impetigo is this?
31. Question: Which of the following instructions should be given to the patient with nephrolithiasis?
32. Question: A 63 years old man is seen in the clinic with a chief complaint of nocturia . Which of the following should be included in the differential diagnosis?
33. Question: Which of the following are predisposing factors for pyelonephritis?
34. Question: Which of the following statements is true regarding the treatment of carpal tunnel syndrome?
35. Question: A patient is diagnosed with Giardia after a backpacking trip in the mountains. Which of the following would be the appropriate treatment?
36. Question: Sinusitis is considered chronic when there are episodes of prolonged inflammation with repeated or inadequately treated acute infection lasting greater than
37. Question: A patient is seen in the clinic with right upper quadrant (RUQ) pain that is radiating to the middle of the back. The clinician suspects acute cholelithiasis. The clinician should expect which of the following laboratory findings?
38. Question: SNAPPS is pneumonic used to described a technique in orally presenting a patient
39. Question: The clinician is caring for Diane a 22 years old woman who presents with an injured ankle. Diane asks the clinician if she will need an X-ray. The clinician explains to Diane that X-ray is not always necessary for an injured ankle and that the decision to obtain radiographs is dependent on the exam and Diane’s description of her injury. Which of the following clues in Diane’s exam or history would alert the clinician to the need for obtaining radiography?
40. Question: The 56 years old man with chronic prostatitis should be treated with trimethoprim 80mg sulfamethoxazole 400mg (TMP-SMX. Actrim) for how long?
41. Question: A 23 years old sexually active man is seen in the clinic with unilateral painful testicular swelling and diagnosed with epididymitis in order to prescribe the correct drug the clinician understands that which of these is the most common causative organism?
42. Question: A 30 years old patient presents with pain on urination. The urine microscopy of unspun urine showed greater than leukocytes/ml and a dipstick was positive for nitrites> What is probable diagnosis?
43. Question: Acute angl-closure glaucoma involves a sudden severe rise in intraocular pressure. Which of the following ranges represents normal intraocular pressure?
44. Question: Joyce is taking a long-acting beta agonist for moderate persistent asthma. Which additional medication should she be taking?
45. Question: A patient is seen in the clinic with a chief complaint of hematuria. Which of the following data should be collected in order to make a differential diagnosis?
46. Question: Which information should be included when you are teaching your patient about the use of nicotine gum?
47. Question: Parkinson’s disease is a progressive neurological disorder that is associated with which type of tremor
48. Question: If your preceptor is out ill on a day that you are scheduled to be in the clinical setting, another preceptor can supervise you as long as they are willing to take you on as a student and they meet the minimum preceptor qualifications
49. Question: A 42 years old woman is seen in the clinic with fever, chills vomiting, and severe dysuria. She is diagnosed with acute pyelonephritis. How should this patient be manged?
50. Question: The “B” in the ABCDE’s of assessing skin cancer represents
51. Question: Janet is a 30-year-old woman who has been recently with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equine compression. Which of the following is a sign or symptom of cauda equine compression?
52. Question: A 34 year old patient was treated for a urinary tract infection (UTI) and has not responded to antibiotic therapy. Which of the following actions should be taken next?
53. Question: Blood in urine and frequency
54. Question: A patient is diagnosed with gastroesophageal reflux disease (GERD), and his endoscopic report reveals the presence of Barretts epithelium. Which of the following information should the clinician include in the explanation of the pathology
55. Question: Ian age 62 presents with a wide diffuse area of erythematous skin on his left lower leg that is warm and tender to palpation. There is some edema involved. You suspect
56. Question: A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram (ECG) changes should the clinician expect as a manifestation of the disease?
57. Question: As diabetic retinopathy progress, the presence of “cotton wool” spots can be detected Cotton Wool spots refers to
58. Question: Which of the following dietary information should be given to a patient with gastroesophageal reflux disease (GERD)
59. Question:Which of the following types of cellulitis is a streptococcal infection of the superficial layers of the skin which does not involve the subcutaneous layers?
60. Question: The clinician has instructed Sam, a 25-year-old patient with low back strain, to use NSAIDs to manage his symptom of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs to manage his pain?
61. Question: Mark has necrotizing fasciitis of his left lower extremity. Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria?
62. Question: The most common precancerous skin lesion found in Caucasians is
63. Question: The patient is seen complaining of “leaking urine when I sneeze” Which of the following action actions should the clinician take first?
64. Question: John is a 16 year old boy who presents to the emergency room after hurting his knee in a football game. He described twisting his knee and then being unable to extend it completely. John tells the clinician that he heard a pop when the injury occurred and has been experiencing localized pain. The clinician suspects a meniscal tear. Which test would be most appropriate to assess for the presence of a meniscal tear?
65. Question: A 27 years old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tracy infection(UTI) What are some additional symptoms consistent with a diagnosis of lower UTI?
66. Question: The patient is seen complaining of leaking urine when I sneeze ‘Which of the following actions should the clinician take first?
67. Question: Which obstructive lung diseases is classified as reversible?
68. Question: Which of the following are risk factors associated with obesity?
69. Question: The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following should the clinician order on the initial visit?
70. Question: The most common offending agents for medication- induced resting tremor are
71. Question: The patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication?
72. Question: The pt presents with costovertebral angle (CVA) tenderness and a sveral day history of high fever and chills and dysuria. Which of the following diagnosis is most likely given the above information?
73. Question: After 6 months of synthroid therapy, the clinician should expect which of the following in the repeated thyroid studies?
74. Question: Which of the following pt are at risk for developing urinary tract cancer?
75. Question: The pt has acute pancreatitis with 7 of the diagnostic criteria from Ranson’s Criteria in order to plan care, the clinician understands that this criteria score has which of the following meanings?
    

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NR 511 Week 8 Final Exam – Practice Questions

1. Question: Matthew, age 52, is a chef who just severed 2 of his fingers with a meat cutter. You would recommend that he:
2. Question: The valgus stress test, varus stress test, Lachman test, and thumb sign are all considered standard tests to check the integrity of the ligaments of the knee. Which test would the nurse practitioner choose to assess the anterior cruciate ligament (ACL), which is the most commonly involved structure in severe knee injury?
3. Question: Lillian, age 70, was told that she has osteoporosis. When she asks you what this is, you respond that osteoporosis:
4. Question: Mike, age 42, a golf pro, has had chronic back pain for many years. His workup reveals that it is not the result of a degenerative disk problem. His back “goes out” about twice per year, and he is out of work for about a week each time. Which of the following should the nurse practitioner advise him to do?
5. Question: Janine, age 69, has class III rheumatoid arthritis. According to the American Rheumatism Association, which of the following describes her ability to function?
6. Question: For an adult patient with a knee injury, the nurse practitioner orders a nonsteroidal anti-inflammatory drug (NSAID) to be taken on a routine basis for the next 2 weeks. Patient teaching should include which of the following?
7. Question: Sean, a factory line worker, has osteoarthritis (OA) of the right hand. According to the American College of Rheumatology (ACR), the guidelines for pharmacologic treatment include:
8. Question: Margaret, age 55, presents to you for evaluation of left hand and wrist pain and swelling after a slip and fall on the ice yesterday. On examination, you note tenderness at her “anatomical snuffbox.” You know this probably indicates a(n):
9. Question: Jim, age 22, a stock boy, has an acute episode of low back pain. The nurse practitioner orders a nonsteroidal anti-inflammatory drug (NSAID) and should educate him in which of the following?
10. Question: Jessie, age 49, states she thinks she has rheumatoid arthritis. Before any diagnostic tests are ordered, the nurse practitioner completes a physical examination and makes a diagnosis of osteoarthritis rather than rheumatoid arthritis. Which clinical manifestation ruled out rheumatoid arthritis?
11. Question: Greg, age 26, runs marathons and frequently complains of painful contractions of his calf muscles after running. You attribute this to:
12. Question: The nurse practitioner is considering a diagnosis of calcium pyrophosphate deposition disease (CPPD), or pseudogout, in a 72-year-old man who presents with complaints of pain and stiffness in his wrists and knees. The most useful diagnostic tests to assist in confirming this diagnosis would be:
13. Question: Ethan, age 10, jumped off a 2-foot wall, twisting his foot and ankle upon landing. His ankle x-ray demonstrates a fracture of the distal tibia, over the articular surface, through the epiphysis and physis (growth plate). Based on the Salter-Harris classification of growth plate injuries, you know this is a:
14. Question: In assessing a patient, you place the tips of your first 2 fingers in front of each ear and ask the patient to open and close his mouth. Then you drop your fingers into the depressed area over the joint and assess for smooth motion of the mandible. With this action, you are checking for:
15. Question: Sandra, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. The nurse practitioner’s next step is to:
16. Question: Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to whether he should apply heat or cold. What should the nurse practitioner tell him?
17. Question: Daniel, age 45, is of Northern European ancestry and has a dysfunctional and disfiguring condition affecting the palmar tissue under the skin of the distal palm and fourth and fifth fingers. What do you suspect?
18. Question: Paul has a malignant fibrosarcoma of the femur. He recently had surgery and is now on radiation therapy. You want to order a test to determine the extent of the tumor invasion of the surrounding tissues and the response of the bone tumor to the radiation. Which of the following tests should you order?
19. Question: Lois, age 52, who has just been given a diagnosis of sarcoidosis, has joint symptoms, including arthralgias and arthritis. Your next plan of action would be to:
20. Question: The nurse practitioner (NP) is assessing Maya, a 69-year-old Asian woman, for the first time. When trying to differentiate between scoliosis and kyphosis, the NP recalls that kyphosis involves:
21. Question: Marsha, age 34, presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia than of chronic fatigue syndrome?
22. Question: Upon assessment, the nurse practitioner notes unilateral back pain of acute onset that increases when standing and bending. A straight leg raise test is negative. The most likely diagnosis is:
23. Question: A 55-year-old patient presents with complaints of paresthesias in the lower lateral arm, thumb, and middle finger. The nerve roots most commonly related to these symptoms are C6 and C7. The most likely diagnosis would be:
24. Question: Christian, age 22, is a carpenter who is right hand dominant. He comes to the clinic for follow-up from the emergency department, where he was seen for right forearm pain. He states he was diagnosed with right forearm tendinitis and wants the provider to explain this diagnosis to him. Patient teaching should explain that he has inflammation of one or more tendons, which are:
25. Question: Steve, age 32, fell off a roof while shingling it. He is complaining of pain in his left hip and leg area. Other than an x-ray, what would make you suspect a fractured pelvis?
26. Question: Beth, age 49, comes in with low back pain. An x-ray of the lumbosacral spine is within normal limits. Which of the following diagnoses do you explore further?
27. Question: Joyce, age 87, broke her wrist after falling off a curb. She just had a plaster cast applied to her wrist. In instructing Joyce and her family on allowing the cast to dry properly, tell them to:
28. Question: When teaching Alice, age 77, to use a cane because of osteoarthritis of her left knee, an important point to stress is:
29. Question: You are caring for a patient who has a history of psoriasis and is now showing signs of joint involvement. Seropositivity provides a definitive diagnosis of psoriatic arthritis (PsA). The initial treatment choice for management of the patient is:
30. Question: Hilda, age 73, presents with a complaint of low back pain. Red flags in her history of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus suggest the possibility of which of the following serious underlying conditions as the cause of her low back pain?
31. Question: A nurse practitioner is driving home from work and stops at the scene of a motorcycle accident that must have just occurred, as there are no rescue vehicles present. The driver is lying unconscious at the side of the road with an obvious open fracture of his femur. Which of the following actions should take priority?
32. Question: Mr. McKinsey, age 69, was recently given a diagnosis of degenerative joint disease. Which assessment should the nurse practitioner use to check for effusion of the patient’s knee?
33. Question: Sam, age 50, presents with Paget disease that has been stable for several years. Recently, his serum alkaline phosphatase level has been steadily rising. The nurse practitioner determines that it is time to start him on pharmacologic management. Which of the following should she initially prescribe?
34. Question: James, age 17, has been complaining of a painful knob below his right knee that has prevented him from actively participating in sports. He has recently been given a diagnosis of Osgood-Schlatter disease and asks you about his treatment options. The nurse practitioner should tell him that the initial treatment is:
35. Question: The nurse practitioner (NP) suspects a herniated disk in a 72-year-old patient. The NP elevates the patient’s affected leg when she is in the supine position, and it elicits back and sciatic nerve pain, which indicates a positive test. This is known as which test or sign?
36. Question: Jill, age 49, has recently begun a rigorous weightlifting regimen. She presents to the primary care office with a shoulder dislocation. Which of the following clinical manifestations leads the nurse practitioner to suspect an anterior shoulder dislocation over a posterior dislocation?
37. Question: Karen, who is postmenopausal, is taking 1200 mg of calcium daily but does not understand why she also needs to take vitamin D. You tell her that:
38. Question: Sigrid, age 48, appears with a 3-month history of heat intolerance, increased sweating, palpitations, tachycardia, nervousness, irritability, fatigue, and muscle weakness. Which test would you order first? 
39. Question: Eunice, age 32, has type 2 diabetes. She said she heard she should take an aspirin a day after she reaches menopause for its cardioprotective action. She does not have coronary artery disease, but her father does. How do you respond? 
40. Question: Marie, age 50, has type 1 diabetes and checks her blood glucose level several times every day. Her blood glucose level ranges from 250 to 280 mg/dL in the morning and is usually about 140 at lunch, about 120 at dinner, and about 100 at bedtime. In the morning, she takes 30 units of neutral protamine Hagedorn (NPH) insulin and 4 units of regular insulin, and before dinner she takes 18 units of NPH insulin and 4 units of regular insulin. Although she has had her insulin dose adjusted several times in the past month, it has had no effect on her high morning blood glucose level. What is your next course of action? 
41. Question: Which class of antihypertensive agents may be problematic for clients with diabetes? 
42. Question: Marty has pheochromocytoma. You instruct him to: 
43. Question: Jeffrey, age 17, has gynecomastia. You should also assess him for: 
44. Question: Jeremiah, age 72, has gout and is obese. When teaching him about diet, which of the following do you tell him? 
45. Question: An elderly client presents with atrial fibrillation. Which of the following lab tests is important in forming the diagnosis? 
46. Question: Martin, age 62, has acute nontransient abdominal pain that grows steadily worse in the epigastric area and radiates straight through to the back. The pain has lasted for days. He is also complaining of nausea, vomiting, sweating, weakness, and pallor. Physical examination reveals abdominal tenderness and distention and a low-grade fever. What do you suspect? 
47. Question: Leah, age 70, has had diabetes for many years. When teaching her about foot care, you want to stress: 
48. Question: Betty, age 40, has had type 1 diabetes for 20 years and takes a combination of neutral protamine Hagedorn (NPH) and regular insulin every day. She comes to the office because she has developed a severe upper respiratory infection with chills, fever, and production of yellow sputum. Because of her acute infection, you know that Betty is likely to require: 
49. Question: A client with hyperthyroidism presents with a complaint of a “gritty” feeling in her eyes. Over the past week, her visual acuity has diminished, and her ability to see colors has changed. She also has a feeling of pressure behind her eyes. The next step for the nurse practitioner is to: 
50. Question: Morton has type 2 diabetes. His treatment, which includes diet, exercise, and 3 oral antidiabetic agents at maximum dose, is insufficient to achieve acceptable glycemic control. Your next course of action is to: 
51. Question: Jay has had diabetes for 10 years. He recently had a physical and was told he has some evidence of nephropathy. What is the first manifestation of this condition? 
52. Question: Sadie, age 40, has just been given a diagnosis of Graves disease. She has recently lost 25 lb, has palpitations, is very irritable, feels very warm, and has a noticeable bulge on her neck. The most likely cause of her increased thyroid function is: 
53. Question: A patient presents to your primary care office with abnormal lab results. On physical exam, you tap the patient’s facial nerve around the zygomatic arch, just anterior to the earlobe. This describes which of the following tests and is associated with which of the following lab abnormalities? 
54. Question:Which of the following conditions is a common pathological cause of hirsutism? 
55. Question: What is the primary pathological irregularity associated with diabetes mellitus type 1? 
56. Question: Which of the following is not a risk factor for diabetes mellitus type 2? 
57. Question: A 55-year-old Asian male presents with a history of severe left great toe pain. He states he cannot even touch the toe with a sheet without it causing pain. He denies trauma but states he cannot ambulate without pain. He admits to drinking alcohol but not to excess. On physical exam, he has normal vital signs, and you note erythema of the great toe at the interphalangeal (IP) joint. Which of the following is the gold standard for diagnosis of this problem? 
58. Question: What is the medication of choice for an initial acute attack of gout? 
59. Question: The process of aging results in: 
60. Question: A client with newly diagnosed diabetes who has a glycated hemoglobin (HbA_1c) of 7.5 is started on therapeutic lifestyle changes (TLCs) and medical nutrition therapy (MNT). Which oral antidiabetic agent is recommended as monotherapy? 
61. Question: Reynolds is on the antithyroid drug (ATD) methimazole (Tapazole), so you make it a point to check his: 
62. Question: After an oral cholecystogram, Sam complains of burning on urination. This is because of: 
63. Question: Ben, a client with type 1 diabetes, is hospitalized with an admitting diagnosis of diabetic ketoacidosis (DKA). Which of the following signs and symptoms would be consistent with this condition? 
64. Question: Your client with diabetes asks you about insulin glargine (Lantus). You tell her that: 
65. Question: Jennifer has diabetes mellitus (DM) and is injecting 30 units of Novolin 70/30 with breakfast and 18 units at bedtime. She is complaining that she woke up once in the middle of the night with palpitations and sweating. Based on this information, what do you recommend? 
66. Question: Dan, age 45, is obese and has type 2 diabetes. He has been having trouble getting his glycohemoglobin under control. He has heard that exenatide (Byetta) causes weight loss and wants to try it. What do you tell him? 
67. Question: You suspect that Sharon has hypoparathyroidism because, in addition to her other signs and symptoms, she has: 
68. Question: Morris has had type 1 diabetes for 10 years. Several recent urinalysis reports have shown microalbuminuria. Your next step would be to: 
69. Question: Jason, age 14, appears with tender discoid breast tissue enlargement (2-3 cm in diameter) beneath the areolae. Your next action would be to: 
70. Question: What is the most common cause of gynecomastia? 
71. Question: QuWhat is the most common cause of Cushing disease? 
72. Question: Which of the following statements about metformin is untrue? 
73. Question: Which of the following body mass index (BMI) values defines class 1 obesity? 
74. Question: Joan has severe asthma and has been on high doses of oral corticosteroids for 2 years. She has been reading some home remedy books and stops all of her medications. What condition may she develop? 
75. Question: The most common cause of hyperthyroidism is: 
76. Question: Steve, age 42, has never been hypertensive but appears today in the office with a blood pressure of 162/100 mm Hg. He also complains of “attacks” of headache, perspiration, and palpitations, with frequent bouts of nausea, pain, weakness, dyspnea, and visual disturbances. He has lost 10 lb over the past 2 months and seems very anxious today. Your next action would be to: 
77. Question: Jenny, age 46, has hypertension that has been controlled with hydrochlorothiazide 50 mg every day for the past 3 years. She is 5 ft 8 in tall and weighs 220 lb. Her fasting blood sugar (FBS) is 300 mg/dL, serum cholesterol level is 250 mg/dL, serum potassium level is 3.4 mEq, and she has 4+ glucosuria. Your next course of action would be to: 
78. Question: Juanita, age 23, complains of palpitations that started a few weeks ago; they occur 2 to 4 times a day and last 5 to 10 minutes. She feels nervous and is having trouble sleeping. Her stools have been frequent (1-3 per day) and loose. She is taking levothyroxine 150 µg daily. Her labs indicate free thyroxine (T₄) 2.28 and thyroid-stimulating hormone (TSH) 0.022. She has a history of Graves disease and had radioactive iodine (RAI) treatment a few months ago. She has been on thyroid replacement for 2 months. Based on these data, you decide to: 
79. Question: A low thyroid-stimulating hormone (TSH) can lead to: 
80. Question: Sara, age 40, has diabetes and is now experiencing anhidrosis on the hands and feet, increased sweating on the face and trunk, dysphagia, anorexia, and heartburn. Which complication of diabetes do you suspect? 
81. Question: Mary, age 72, has been taking insulin for several years. She just called you because she realized that yesterday she put her short-acting insulin in the long-acting insulin box and vice versa. She just took 22 units of regular insulin when she was supposed to take only 5 units. She says that she tried to do a fingerstick to test her glucose level but was unable to obtain any blood. She states that she feels fine. What do you tell her to do first? 
82. Question: A client with diabetes on a sulfonylurea and metformin with a glycated hemoglobin (HbA_1c) of 6.5% is complaining of episodes of low blood sugar. Which of the following changes would be the most appropriate? 
83. Question: Mindy is scheduled to have an oral glucose tolerance test (OGTT). She is instructed to discontinue many of her medications for 3 days before the test. Which one is it safe to continue taking? 
84. Question: Sandra, age 28, has secondary obesity. Which of the following may have caused this? 
85. Question: Which of the following statements about hypothyroidism is not true? 
86. Question: To reduce the incidence of flares, foods high in what amino acid need to be limited in the diets of patients with gout? 
87. Question: Marsha, age 24, is preparing for radioactive iodine therapy for her Graves disease. Which test must she undergo first? 
88. Question: When teaching Marcy how to use her new insulin pump, you tell her that she needs to monitor her blood glucose level: 
89. Question: The major risk factor for thyroid cancer is: 
90. Question: The American Diabetes Association (ADA) recommends which of the following quarterly blood tests be performed on all clients with diabetes? 
91. Question: Mason, age 52, has diabetes mellitus (DM) and is overweight. You now find that he is hypertensive. How should you treat his hypertension? 
92. Question: Tamika, who has diabetes, states that she heard fiber is especially good to include in her diet. How do you respond? 
93. Question: Mark has type 1 diabetes and has mild hyperglycemia. What effect does physical activity (exercise) have on his blood glucose level? 
94. Question: When you inspect the integumentary system of clients with endocrine disorders, a finding of coarse hair may be an indicator of: 
95. Question: Which is the only curative treatment option for primary hyperparathyroidism (PHPT)? 
96. Question: A patient presents to your primary care office complaining of polydipsia, polyuria, and polyphagia. Which of the following diagnoses would not be in your differential diagnosis? 
97. Question: A 35-year-old female presents to your primary care office for review of her laboratory results. Her physical exam shows a blood pressure (BP) of 140/90, pulse (P) of 105, oxygen saturation of 97%, and temperature of 98.6°F. She has complaints of palpitations, weight loss, hair loss, and anxiety. Her labs are all normal except for a low thyroid-stimulating hormone (TSH) and an elevated thyroxine (T₄). What would your next course of treatment be? 
98. Question: A 35-year-old male presents to your office complaining of fatigue, weight loss, nausea, and abdominal pain. On physical exam, you notice he has orthostatic hypotension and hyperpigmented skin. You do a morning cortisol level, which is low. The plasma adrenocorticotropic hormone (ACTH) is elevated. How would you treat this patient? 
99. Question: Which of the following statements about diabetes mellitus is untrue? 
100. Question: Which of the following would not confirm a diagnosis of diabetes? 
101. Question: Which of the following would not be ordered on a regular basis to evaluate diabetic patients for end organ damage associated with diabetes? 
102. Question: Harriet, age 62, has type 1 diabetes that is well controlled by insulin. Recently, she has been having marital difficulties that have left her emotionally upset. As a result of this stress, it is possible that she will: 
103. Question: Lynne has Cushing syndrome. You would expect her to have or develop: 
104. Question: Joy has gout. In teaching her about her disease, which food do you tell her is allowed in the diet? 

Urgent Care Questions

1. Question: What lifestyle choice increases the risk of upper respiratory infection? 
2. Question: A 65-year-old female presents to your urgent care center complaining of a cough. She has a past medical history of myocardial infarction, hypertension, hyperlipidemia, and diabetes. She states she had this cough last year and received a Z-Pak, and it made her feel better, so she is requesting one now. Her vital signs are as follows: pulse (P) 85, blood pressure (BP) 140/90, oxygen saturation 95% on room air, temperature 99.0°F. Upon further questioning, her cough has been going on for 3 weeks and is nonproductive. She also notes some shortness of breath, mostly with periods of ambulation. She denies chest pain. She notes that recently her feet and legs have become more swollen. You do not have access to an x-ray at your facility. What is the most concerning cause of the patient’s cough that would be in your differential diagnosis? 
3. Question: A 15-year-old female presents to your urgent care center complaining of a sore throat for 3 days. Her vital signs are as follows: temperature 102.1°F, pulse (P) 70, blood pressure (BP) 130/85, oxygen saturation 97%. The patient denies cough. On physical exam, she has pearly white exudates on the tonsils, erythema of the throat, and palpable anterior cervical chain lymphadenopathy. What is the recommended treatment? 
4. Question: A 10-year-old female presents to your urgent care center with her mother complaining of ear pain. The patient spends most of her summer at the local swim club. She notes right ear pain. She has no fever. She awoke today with green drainage on her pillow. On physical exam, the patient has pain with palpation of the affected ear, and you cannot visualize the tympanic membrane. What is the most likely diagnosis? 
5. Question: An 18-year-old high school cross country runner presents to your office complaining of foot pain for 2 weeks. The patient runs 3 to 6 miles per day. He states it feels better when he runs on the track as opposed to the road. On physical exam, he is tender to palpation over his fifth metatarsal head, but there is no ecchymosis, erythema, or edema of the foot. X-ray of his foot is negative for fracture. What is the best diagnostic study to order for further evaluation of his complaint? 
6. Question: A patient presents to your primary care clinic with diarrhea. What about the diarrhea would be concerning for a parasitic infection? 
7. Question: A 50-year-old female diabetic patient presents to your urgent care center complaining of chest discomfort. Which of the following symptoms would lead you to believe her chest pain is related to gastroesophageal reflux rather than a cardiac etiology? 
8. Question: The ABCDEs of skin cancer can help you diagnose a cancerous skin lesion. Which of the following definitions does not accurately describe the corresponding letter of the acronym? 
9. Question: A patient presents to your primary care office for a blood pressure check. You have recently started them on an antihypertensive medication. However, on physical exam, the patient continues to have an elevated blood pressure. Which of the following symptoms would not be concerning for a hypertensive crisis? 
10. Question: Which of the following headache descriptions does not match the accompanying diagnosis? 
11. Question: In which of the following scenarios is antibiotic treatment necessary following an injury to the skin? 
12. Question: A 20-year-old female presents to your urgent care clinic complaining of a cat bite. The patient recently adopted a cat. She was playing with the cat yesterday when the cat bit her on the arm. What antibiotic should be prescribed to prevent infection? 
13. Question: Which of the following patients needs a computed tomography (CT) scan of the head following a minor head trauma? 
14. Question: Following a sprain/strain injury, the PRICE acronym is helpful in treating a patient’s symptoms. Which of the following does not correspond to the PRICE acronym? 
15. Question: According to the Glasgow Coma Scale (GCS), what is the number assigned to someone with a normal level of consciousness? 
16. Question: What bacterium causes Rocky Mountain spotted fever? 
17. Question: A patient presents to the emergency department by ambulance directly from football practice. The patient is tachycardic, tachypneic, and hypotensive. Their skin is hot and dry, and their core body temperature is 104°F. What is this patient’s diagnosis? 
18. Question: The remodeling of a scar can take how long? 
19. Question: How soon after a facial laceration should sutures be removed? 
20. Question: A patient on which of the following medications is at risk of sun poisoning? 
21. Question: A 5-year-old male presents to your urgent care clinic with his mother. The patient was sent home from school for eye redness. He has bilateral erythema of his conjunctivae and watery drainage. He complains of pruritus of both eyes. The patient also has clear drainage from his nose and a sore throat. On physical exam of his throat, you notice erythema of his tonsils but no exudates. What is the most likely cause of the patient’s symptoms? 
22. Question: A 70-year-old female presents to your emergency department complaining of right hip pain. She cannot ambulate. She had a fall in the bathroom of her house and had to be picked up by the emergency medical technicians (EMTs) her husband called. She complains of groin pain. What would you expect to see on physical exam? 
23. Question: A 20-year-old male presents to your urgent care center complaining of headaches for 2 weeks. The patient’s headaches are intermittent but severe and last 15 to 30 minutes. He has had 3 to 4 severe headaches in the last 2 weeks. He denies a past medical history and has had no recent trauma. The patient’s physical exam shows right-sided rhinorrhea, conjunctivitis, and facial swelling. What is the likely cause of the patient’s symptoms? 
24. Question: Which of the following is not associated with panic disorder? 
25. Question: A 20-year-old female presents to your urgent care clinic complaining of a cat bite. The patient recently adopted a cat. She was playing with the cat yesterday when the cat bit her on the arm. What antibiotic should be prescribed to prevent infection? 
26. Question: A patient presents to your urgent care office complaining of lightheadedness, dizziness, and problems concentrating following a motor vehicle accident 7 days ago. Originally, these complaints were more severe, but they have slowly decreased in intensity. What is the patient’s diagnosis? 
27. Question: When a patient is diagnosed with an epidermal hematoma, which artery is ruptured in the brain? 
28. Question: Ingestion of which of the following objects always requires surgical or endoscopic removal? 
29. Question: If a patient has palsy of cranial nerve (CN) XI, what would they not be able to do? 
30. Question: You are examining a patient in the emergency department following a closed head injury and you notice their pupils do not constrict when bright light is shone into them. To what cranial nerve would this suggest damage? 
31. Question: A patient presents to the emergency department. You are concerned they have taken too many aspirin. What would you expect to see on an arterial blood gas? 
32. Question: Following a diagnosis of heat stroke, the goal is to decrease the patient’s temperature to what number in the first hour? 
33. Question: Hypothermia is defined as a core body temperature less than? 
34. Question: Which joint of the hand is most susceptible to a “fight bite”? 
35. Question: A patient arrives via ambulance with a friend. The patient is not responsive. The friend states the patient was walking across an intersection when a car struck him. The patient was unresponsive for a moment and then got up from the ground and began talking to his friend. He then started to become more confused and eventually became unresponsive. What type of brain injury does the patient have? 
36. Question: You are examining a patient in the intensive care unit (ICU) after a motor vehicle accident. The patient is intubated but responds to painful stimuli. What score would you give them on the motor portion of the Glasgow Coma Scale (GCS)? 
37. Question: You are examining a patient in the intensive care unit (ICU) after a motor vehicle accident. The patient is intubated but opens his eyes in response to verbal commands. What score would you give him on the eye-opening portion of the Glasgow Coma Scale? 
38. Question: Which of the following patients would not be a candidate for outpatient treatment of influenza? 
39. Question: A 70-year-old man presents to your urgent care clinic complaining of a cough. He states he has had the cough for 6 weeks. The cough is dry and nonproductive. He denies fevers, chills, and weight loss. The patient admits to a 50-year history of smoking 1 pack per day. His pulse oximetry is 93% on room air. His chest x-ray shows enlarged lung fields. What would you recommend as the next step in his care? 
40. Question: Which of the following is not a risk factor for the development of sinusitis? 
41. Question: What is the most common cause of a urinary tract infection? 
42. Question: A patient presents to your urgent care center for evaluation following a motor vehicle accident. On physical exam, the patient seems lethargic and has thin, clear nasal drainage. You also note bruising around the eyes and mastoid process. What injury did the patient sustain in the car accident? 
43. Question: A 25-year-old construction worker comes into the emergency department after a third-story fall at his construction site. The patient’s main complaint is bilateral heel pain. The patient’s x-rays confirm bilateral calcaneal fractures. Based on the patient’s mechanism of injury, what other part of the body should you x-ray? 
44. Question: As a general rule, when treating hypothermia, at what rate do you want to warm the patient’s temperature?  

GENDER-RELATED PROBLEMS

1. Question: A male patient presents to the clinic for evaluation of infertility. Subjectively, the patient complains of pain and fullness of the testes and states, “My testicles feel like a bag of worms.” On physical examination, the nurse practitioner notes tortuous veins posterior to and above the testes that extend up into the external inguinal ring. Based on the preceding assessment, the nurse practitioner refers the patient to surgery for a diagnosis of: 
2. Question: Bill, age 43, appears with a tender, ulcerated, exudative, papular lesion on his penis. It has an erythematous halo, surrounding edema, and friable base. The nurse practitioner should suspect: 
3. Question: Milton, a 72-year-old unmarried, sexually active white man, presents to your clinic with complaints of hesitancy, urgency, and occasional uncontrolled dribbling. Although the nurse practitioner suspects benign prostatic hyperplasia, what else should the differential diagnosis include? 
4. Question: Herb, a 47-year-old with diabetes, is complaining of a rash on his penis. Before examining him, you suspect that he may have: 
5. Question: Roger, a healthy 68-year-old man, comes in to see you with a complaint of sudden episodes of an urgent need to void. He has had several episodes of moderate amounts of unintentional urine loss during these times. Other than these episodes, he is voiding in amounts “normal” for him, with no leakage when he coughs or sneezes. The practitioner’s initial diagnosis is which type of incontinence? 
6. Question: Josh and Martha have 5 children and do not want any more. Josh said he heard about a no-scalpel vasectomy (NSV) and asks the nurse practitioner how it works. What would be the best response? 
7. Question: Harry, age 60, has benign prostatic hyperplasia and complains of some incontinence. The nurse practitioner’s first step in diagnosing overflow incontinence would be to order a: 
8. Question: Michael complains of a urinary tract infection (UTI). Which of the following is a risk factor for UTIs in men? 
9. Question: Mikey had an undescended testicle at birth, and at age 2 it remains in the inguinal region. His mother is afraid of surgery and asks for your advice. How do you respond? 
10. Question: Reiter syndrome is a complication of: 
11. Question: Lynne, age 43, comes to your office in tears, stating that last night she had unprotected sex and forgot to take her birth control pill. She wants to know about the “morning-after pill.” You tell her: 
12. Question: A 17-year-old female patient requests to start medroxyprogesterone acetate (Depo-Provera) injections as her method of birth control. She discloses that she has had 4 sexual partners in the past year. Her last menstrual period was 12 days ago, and she had unprotected intercourse 3 days ago. The appropriate management for this patient would be to: 
13. Question: Marcia, age 59, presents with depression. According to the diagnostic criteria for major depressive disorder (MDD), which of the following must be present? 
14. Question: Julia, age 60, asks you about taking alendronate (Fosamax). What do you tell her about using this medication? 
15. Question: Sharon, age 37, states she has heard that douching effectively washes out sperm after intercourse and that she has been using this as a method of birth control. Which of the following statements about douching is true? 
16. Question: The Joneses are thinking about going for infertility counseling because they have been married for 5 years and have been unable to conceive. They ask you whether the man or the woman is usually the cause of infertility. What do you tell them about the etiology of infertility? 
17. Question: During a pelvic examination, you ask Mrs. Krane, age 54, to perform a Valsalva maneuver (ie, forcibly exhaling while keeping the mouth and nose closed). While doing this strain maneuver, a pouching is seen on the anterior wall of the vagina. This is indicative of: 
18. Question: A 26-year-old female comes to your office to discuss birth control options. Her history includes migraine headaches with aura while on combination oral contraceptives in the past. She does not want to become pregnant. Which of the following birth control options would be the best choice for her? 
19. Question: Laura, age 65, presents to the office complaining of vaginal bleeding for 12 days. She reports she has not had a menses since the age of 52 and that this bleeding looks much like her menses used to look. The initial workup for postmenopausal bleeding (PMB) should include: 
20. Question: Russo, age 59, is a postmenopausal woman who comes to your office complaining of vaginal dryness. She has been sexually active with a new partner and says that penetration is very painful. She has tried over-the-counter lubricants but has not found one that works. Her history is significant for hypertension only. After examination and wet prep, you diagnose her with atrophic vaginitis. The treatment for this condition includes: 
21. Question: Jeb, a 72-year-old male, is seen at your practice for follow-up of several episodes of orthostatic hypotension. After obtaining a review of systems and a digital rectal examination, it also appears that he has benign prostatic hyperplasia (BPH) with lower urinary tract symptoms. The nurse practitioner reviews his recent ultrasound evaluation, which reports a prostate volume of over 40 mL, and the results of the American Urological Association (AUA) symptom index for BPH, which shows his score to be 12. Based on the preceding information and the patient’s desire for noninvasive medical therapy, what management should he be offered? 
22. Question: A patient is being treated for erectile dysfunction. The patient is morbidly obese and is also being treated for cardiovascular disease and coagulopathy. Which of the following medications would be contraindicated? 
23. Question: Tommy, age 15, comes to the clinic in acute distress with “belly pain.” When obtaining his history, the nurse practitioner (NP) finds that he fell off his bike this morning and has vomited. Upon closer examination, the NP determines the belly pain to be left-sided groin pain or pain in his left testicle. He is afebrile and reports no dysuria. Which of the following diagnoses is most likely? 
24. Question: Morris, age 52, is in a new relationship and is not sure whether his erectile dysfunction is organic or is caused by stress about his performance. What simple test could you suggest to determine if he has the ability to have an erection? 
25. Question: You are performing a school physical examination on Damon, age 5. You are unable to retract his foreskin over the glans while inspecting his penis. This is referred to as: 
26. Question: Tim asks the nurse practitioner (NP) about returning to his normal sex life after surgery for benign prostatic hyperplasia. He should be told: 
27. Question: Jeff, age 20, presents to the college health clinic with complaints of difficulty passing his urine and a discharge from his penis. Upon further investigation, you note that the discharge is urethral in origin. The most common cause of these symptoms in the young adult male population is: 
28. Question: Bernard, age 59, presents to the emergency department with a diagnosis of priapism. Despite application of cold compresses and pain medications, relief is unsuccessful. What is the treatment of choice? 
29. Question: Jennifer, age 42, presents for her well-woman examination, and you notice “dimpling” on her left breast. Your differential diagnosis includes: 
30. Question: Sandra, age 63, says that her previous doctor never discussed why he took her off hormone replacement therapy (HRT) 3 years ago. Her last menstrual period was at age 49, and she started HRT that same year. You share with her some of the results of the Women’s Health Initiative (WHI). Which statement regarding the study is true? 
31. Question: Gerri, age 26, is thinking about getting pregnant in the near future, and she asks you what kind of vitamins she should be taking. You respond: 
32. Question: Which of the following terms describes the bluish or purplish discoloration of the vulva, vagina, and a portion of the cervix that occurs in pregnancy? 
33. Question: On physical exam, Judy has pubic hair that spreads over her mons pubis with a slight lateral spread. In addition, her breast development shows breast enlargement with secondary mound formation by the developing areolae. Which Tanner stage best describes Judy’s development? 
34. Question: A vaginal pH of 4.2 is an expected finding in: 
35. Question: Joy has been breastfeeding and has developed puerperal mastitis. You tell her: 
36. Question: A 27-year-old female presents to your office for a levonorgestrel-releasing intrauterine system (Mirena) insertion. She reports that her menses started 3 days ago and is normal. How soon after insertion will she be able to safely rely on the intrauterine device (IUD) for contraception? 
37. Question: Marsha, age 42, is having chronic abnormal uterine bleeding (AUB) and cannot take oral contraceptives (OCs) due to a history of a deep vein thrombosis (DVT). Management includes which medication? 
38. Question: Julia is nursing her 8-week-old baby and states that he is very irritable and sleeps poorly. What medication or substance do you ask her if she is taking or using? 
39. Question: There are many causes of amenorrhea. In ballet dancers and marathon runners, which anatomical structure is the probable cause? 
40. Question: A 63-year-old man presents to your office with hematuria, hesitancy, and dribbling. Digital rectal examination (DRE) reveals a smooth, moderately enlarged prostate. The client’s prostate-specific antigen (PSA) is 1.2. What is the most appropriate management strategy at this time? 
41. Question: Drew has erectile dysfunction and says that a friend told him about a method that uses a constricting ring around the base of the penis. What is he referring to? 
42. Question: John asks for a prescription for sildenafil (Viagra). He says that the only medication he takes is isosorbide mononitrate (Monoket) oral tablets and that he has diabetes that he controls with diet alone. What should the nurse practitioner tell him? 
43. Question: Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is: 
44. Question: The nurse practitioner is performing a rectal examination on James, age 46, for follow-up of melena. What would the provider expect his stool to look like if his condition has not resolved? 
45. Question: Susan, age 28, is 9 months pregnant and asks you about using umbilical cord blood after birth for newborn DNA identification. What do you tell her? 
46. Question: The best method to diagnose uterine polyps is a: 
47. Question: Samantha, age 19, has a diagnosis of a Chlamydia vaginal infection. You believe it is questionable whether she will fill the prescription you write or take it for 7 days as ordered. What do you do? 
48. Question: Which of the following ovarian tumors or cysts have the potential for malignancy? 
49. Question: Joanne, age 23, wants to use some form of birth control, but because she is getting married next year, she wants to be able to stop the birth control method after the wedding and have her fertility restored almost immediately. Which method do you recommend for her? 
50. Question: Thomas, age 69, comes to your office for the results of her dual-energy x-ray absorptiometry (DXA) scan. She reports that her mother had osteopenia before she died. The DXA scan results show a T score of -2.7 in the hip and -2.8 in the spine. You explain to her that her results show: 
51. Question: Susan, age 35, has been diagnosed with fibrocystic breast disease. Which of the following may exacerbate the condition? 
52. Question: Regular testicular self-exams have not been studied enough to show if they lower the risk of dying from testicular cancer. This is why the American Cancer Society and other agencies do not have a recommendation about regular testicular self-exams for all men. Still, some practitioners do recommend that all men examine their testicles monthly after reaching puberty. If you are teaching a patient how to do a testicular self-examination, which of the following do you tell him? 
53. Question: Max, age 70, is obese. He is complaining of a bulge in his groin that has been there for months. He states that it is not painful, but it is annoying. The practitioner notes that the origin of the swelling is above the inguinal ligament and directly behind and through the external ring. This finding is most indicative of a(n): 
54. Question: Jake, age 62, has a low International Prostate Symptom Score for lower urinary tract symptoms associated with his benign prostatic hyperplasia (BPH). The nurse practitioner should recommend: 
55. Question: A patient’s chief complaint is heaviness in the scrotum. The nurse practitioner notes swelling of the testes, along with warm scrotal skin. Which of the following diagnoses is most probable? 
56. Question: Sidney, age 72, presents to the clinic with complaints of a weak urine stream, hesitancy, and painful ejaculation. On digital rectal examination, you note that his prostate is boggy. The most common cause of his symptoms is: 
57. Question: You are referring a 73-year-old client for management of his prostate cancer with hormonal therapy. It is understood that goserelin acetate (Zoladex) acts as a method of androgen ablation by: 
58. Question: Cynthia says that her health care provider wants to do a colposcopy. She asks you what this is. You tell her that a colposcopy: 
59. Question: Which of the following statements do you use when instructing women about their fertile period (ie, when they are most likely to become pregnant)? 
60. Question: Mary, age 33, delivered a healthy baby boy 6 months ago by cesarean delivery. Her baby weighed 9 lb 6 oz. Her prenatal care was complicated by gestational diabetes mellitus (GDM). She did not need to take any medications. She asks you about the possibility of getting diabetes later in life. The correct response should be: 
61. Question: Darcy, age 57, is to undergo a core needle biopsy for a suspicious breast mass. This procedure includes: 
62. Question: Judi, age 24, has a seizure disorder. She would like to conceive within the next year. Her visit is for preconceptual counseling. What is the drug of choice for her during pregnancy? 
63. Question: Sarah, age 29, complains of premenstrual syndrome (PMS). She states she was told that changing her diet might help in managing some of the symptoms. What change in her diet do you recommend? 
64. Question: A 33-year-old woman complains of dyspareunia in the lower back during orgasm. The nurse practitioner should consider: 
65. Question: A 21-year-old woman comes to your office and reports a history of genital warts. In reference to the human papillomavirus (HPV) vaccination (ie, Gardasil, Gardasil 9, and Cervarix), she should be educated that: 
66. Question: Jennifer, age 27, is complaining of lower abdominal pain. After doing some laboratory studies, you find leukocytosis, an elevated erythrocyte sedimentation rate, and an elevated C-reactive protein level. Which of the following is the most appropriate diagnosis? 

HEMATOLOGICAL DISORDERS 

1. Question: Mindy, age 6, was recently discharged from the hospital after a sickle cell crisis. You are teaching her parents to be alert to the manifestations of splenic sequestration and tell them to be alert to: 
2. Question: Your client Mrs. Young, age 64, is here to see you because she has pain in her left breast. She reports no pain in her right breast and no noted lesions or masses on breast self-exam, which she performs monthly. You know that: 
3. Question: Jimmy, age 6 months, is newly diagnosed with sickle cell disease. His mother brings him to the clinic for a well-baby visit. Which of the following should you do on this visit? 
4. Question: Allie, age 5, is being treated with radiation for cancer. Her mother asks about the effect radiation will have on Allie’s future growth. Although she knows that a specialist will be handling Allie’s care, her mother asks for your opinion. How do you respond? 
5. Question: Your client Jeannie, age 64, comes to you complaining of tinnitus and lightheadedness without loss of consciousness. On physical exam, you note splenomegaly. To sort out your differential diagnosis, you order an alkaline phosphatase and vitamin B₁₂ level because you are ruling out a diagnosis of: 
6. Question: Julie’s brother has chronic lymphocytic leukemia (CLL). She overheard that he was in stage IV and asks what this means. According to the Rai classification system, stage IV is a stage: 
7. Question: You have a new client, Robert, age 67, who presents with generalized lymphadenopathy. You know that this is indicative of: 
8. Question: Your client Mr. Jones has Sjögren syndrome. Which treatment do you suggest? 
9. Question: Stu, age 49, has slightly reduced hemoglobin and hematocrit readings. What is your next action after you ask him about his diet? 
10. Question: Which hypersensitivity reaction results in a skin test that produces erythema and edema within 3 to 8 hours? 
11. Question: In which of the following circumstances is the reticulocyte count elevated? 
12. Question: Macrocytic normochromic anemias are caused by: 
13. Question: Which of the following cancers is associated with Epstein-Barr virus? 
14. Question: Lorie, age 29, appears with the following signs: pale conjunctivae and nail beds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? 
15. Question: Your client Jackson has decreased lymphocytes. You suspect: 
16. Question: Your client Shirley has an elevated mean corpuscular volume (MCV). What should you be considering in terms of diagnosis? 
17. Question: Samuel, age 5, is receiving radiation therapy for his acute lymphoblastic leukemia. This treatment puts him at increased risk of developing which type of cancer as a secondary malignancy when he becomes an adult? 
18. Question: Sam is being worked up for pancreatic cancer. He states the doctor wants to put a “scope” in and inject dye into his ducts. He wants to know more about this. What procedure is he referring to? 
19. Question: Which of the following is the most common cause of megaloblastic anemia? 
20. Question: Which of the following is not considered an AIDS-defining condition? 
21. Question: Julia asks how smoking increases the risk of folic acid deficiency. You respond that smoking: 
22. Question: Shelley has esophageal cancer and asks you if cigarettes and alcohol played a part in its development. How do you respond? 
23. Question: Sally has human immunodeficiency virus (HIV) and asks which method of birth control, other than abstinence, would be best for her. You suggest: 
24. Question: Which of the following white blood cell types are elevated in parasitic infections, hypersensitivity reactions, and autoimmune disorders? 
25. Question: Jill has just been given a diagnosis of human immunodeficiency virus (HIV) and has a normal initial Pap smear. When do the Centers for Disease Control and Prevention (CDC) guidelines state she should have a repeat Pap test? 
26. Question: You are examining Joseph, age 9 months, and note a palpable right supraclavicular lymph node. You know that this finding is suspicious for: 
27. Question: Marsha states that a relative is having a carcinoembryonic antigen (CEA) test done to detect some type of cancer. She wants to know what kind. You tell her a CEA is performed to detect: 
28. Question: Tina, age 2, had a complete blood count (CBC) drawn at her last visit. It indicates that she has a microcytic hypochromic anemia. What should you do now at this visit? 
29. Question: Jan is having biological therapy for her pancreatic cancer. What kind of treatment is this? 
30. Question: Which of the following conditions is an X-linked recessive disorder commonly seen in African American males? 
31. Question: Nancy recently had a mastectomy and refuses to look at the site. Her husband does all the dressing changes. When she comes in to the office for a postoperative checkup, what would you say to her? 
32. Question: Which of the following indicate that Jim, a 32-year-old client with AIDS, has oropharyngeal candidiasis? 
33. Question: Sara comes today with numerous petechiae on her arms. You know she is not taking warfarin (Coumadin). What other drugs do you ask her about? 
34. Question: Which of the following is the most common type of leukemia in the United States? 
35. Question: Which of the following tests is the most specific for diagnosing rheumatoid arthritis? 
36. Question: Jameson complains of unilateral blurry vision and partial blindness in the left eye. On physical examination, you find decreased peripheral vision on her left side. Funduscopic examination reveals cotton wool spots. Your most likely diagnosis is: 
37. Question: Robin has human immunodeficiency virus (HIV) and is having a problem with massive diarrhea. You suspect the cause is: 
38. Question: Jones, your client, has an elevated platelet count. You suspect: 
39. Question: When the donor and recipient of a transplant are identical twins, this is referred to as what type of transplant? 
40. Question: Despite successful primary prophylaxis, which infection remains a common AIDS-defining diagnosis? 
41. Question: Which of the following is a benign neoplasm? 
42. Question: Mandy’s 16-year-old daughter has hepatitis A. Which of the following statements made by Mandy indicates she understands the teaching you’ve just completed? 
43. Question: Barbara, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond? 
44. Question: Skip, age 4, is brought to the office by his mother. His symptoms are pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, and hepatosplenomegaly. You refer him to a specialist. Which of the following tests do you expect the specialist to perform to confirm a diagnosis? 
45. Question: Lorie, age 29, appears with the following signs: pale conjunctivae and nail beds, tachycardia, heart murmur, cheilosis, stomatitis, splenomegaly, koilonychia, and glossitis. What do you suspect? 
46. Question: Which is the best serum test for spotting an iron deficiency early, before it progresses to full-blown anemia? 
47. Question: Which of the following describes the pattern of inheritance that results in sickle cell anemia? 
48. Question: Sherri’s blood work returns with a decreased mean corpuscular volume (MCV) and a decreased mean corpuscular hemoglobin concentration (MCHC). What should you do next? 
49. Question: Maria, age 35, asks if being obese predisposes her to cancer. How do you respond? 
50. Question: Frank, a 66-year-old white male who is on diuretic therapy, presents with an elevated hematocrit. He also has splenomegaly on examination as well as subjective complaints of blurred vision, fatigue, headache, and tinnitus. You suspect: 
51. Question: Joan had a modified radical mastectomy with radiation therapy 10 years ago. She asks when she can have her blood pressure and needle sticks performed in the affected arm. How do you respond? 
52. Question: A 28-year-old female presents to your primary care office for an annual physical. She denies any complaints other than heavy menstrual bleeding, which is something she has experienced her whole life. On routine complete blood count (CBC) evaluation, her hemoglobin is 11.0. Other pertinent values include a decreased serum ferritin and elevated total iron-binding capacity (TIBC). Her mean corpuscular volume (MCV) is 75. Which of the following is the likely cause of her anemia? 
53. Question: A male patient presents to the emergency department complaining of severe knee pain. He admits to social alcohol use and a diet consisting of meat and fish. He states he has had no trauma to his knee but the pain has been getting worse for 4 days. He notes warmth and erythema of the knee as well as decreased range of motion. The patient’s x-ray is negative. You aspirate the patient’s knee, and the fluid that is aspirated is cloudy and thick. What would you see in the joint aspirate to make a diagnosis of gout? 
54. Question: A 30-year-old male nurse presents to the emergency department. He was stuck with a needle yesterday while working and found out today that the patient involved in the needle stick is human immunodeficiency virus (HIV) positive. What is the time window for starting postexposure prophylaxis to help prevent the transmission of HIV? 
55. Question: Caroline, 65, is homeless and has iron deficiency anemia. She smokes and drinks when she can and has a stomach ulcer. Which of the following is not one of her risk factors for iron deficiency anemia? 
56. Question: Which of the following diagnostic tests confirms the diagnosis of sideroblastic anemia? 
57. Question: A 15-year-old male presents to your office complaining of fatigue, shortness of breath, and joint pain for 2 weeks. The parent has blamed these symptoms on a “growth spurt.” On physical exam, you notice multiple areas of bruising. His throat is not erythematous, and no exudates are seen. He has palpable splenomegaly, and his rapid strep and mono tests are negative. Which of the following is the most likely diagnosis?