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801. Anticipated age-related changes that can result in less drug effect include: A. Loss of beta-2 receptor sites. B. Lower gastrointestinal (GI) pH. C. Increased renin-angiotensin production. D. Increased GI motility.

802. A 79-year-old patient with chronic hypertension comes to your practice with complaints of dizziness and feeling like the inside of his head is spinning. He adds that these symptoms began about a week after being diagnosed with and prescribed medication for congestive heart failure 2 months prior. Which of the following is the best first line treatment choice to prescribe for this patient's condition?. A. Enalapril. B. Atenolol. C. Hydralazine. D. Furosemide.

803. All of the following are consistent with normal age-related vision changes except: A. Need for increased illumination. B. Increasing sensitivity to glare. C. Washing out of colors. D. gradual loss of peripheral vision.

804. Factors that contribute to stress incontinence include: A. Detrusor overactivity. B. Pelvic floor weakness. C. Urethral stricture. D. Urinary tract infection (UTI).

805. Which of the following is a true statement with regard to disease presentation in older adults?. A. Normal age-related changes do not alter the way an illness presents. B. Diseases in the elderly are usually more difficult to treat because they present at later stages. C. A mild decline in memory and information processing is not a normal age-related change. D. Diseases usually present at earlier stages due to impaired compensatory systems.

806. A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight loss of 15 pounds. The NP caring for this patient should: A. Obtain a baseline liver function test (LFT) before starting the drug. B. Write the initial prescription at the lowest possible dose. C. Encourage the patient to consume a diet high in fat and protein. D. Counsel the patient to take the drug with food to enhance absorption.

807. You see a 28-years old man who is having an anaphylactic reaction following a bee sting and is experiencing trouble breathing. Your initial response is to administer: A. Oral antihistamine. B. Injectable epinephrine. C. Supplemental oxygen.

808. The primary care NP sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough. The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day. Other family members have similar symptoms. The infant has had two sets of immunizations at 2 and 4 months of age. The NP should: A. administer the 6-month immunizations at this visit today. B. Schedule an appointment in 2 weeks for 6- month immunizations. C. Administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks. D. Withhold all immunizations until the infant's temperature returns to normal and the cough is gone.

809. Which of the following should not receive vaccination against influenza?. A. A 4-month-old infant who was born at 32 weeks of gestation. B. A 28-year-old woman who is breastfeeding a 2-week-old. C. A 24-year-old woman who is 8 weeks pregnant. D. A 19-year-old with a history of hive-form reaction to eating eggs.

810. Risk factors for ABRS include all of the following except: A. Viral infection. B. Allergies. C. Tobacco use. D. Recent history of epistaxis.

811. Appropriate oral antimicrobial therapy for otitis externa with an accompanying facial cellulitis suitable for outpatient therapy includes a course of an oral: A. Macrolide. B. Cephalosporin. C. Fluoroquinolone. D. Penicillin.

812. What are the most common causes of dry eyes?. A. Decreased tear production. B. Increased tear evaporation. C. Imbalance in tear composition. D. Laser eye surgery. E. All are corrects.

813. An 18-year-old man has no primary tetanus immunization series documented. Which of the following represents the immunization needed?. A. Tetanus, diphtheria, and acellular pertussis (Tdap) vaccine now with a dose of Td vaccine in 1 and 6 months. B. Tetanus IG now and two doses of tetanus- diphtheria (Td) vaccine 1 month apart. C. Three doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine 2 months apart. D. Td vaccine as a single dose.

814. Which of the following is an example of a primary prevention activity in a 76-year-old woman with osteoporosis?. A. Ensuring adequate illumination in the home. B. Bisphosphonate therapy. C. Calcium supplementation. D. Use of a back brace.

815. Tinnitus is a Perception of abnormal hearing or head noises, and its prevalence increases with age. A. True. B. False.

816. Risk factor for primary open-angle glaucoma includes all the following, except: A. African ancestry. B. Type 2 diabetes mellitus. C. Advanced age. D. Blue eye color.

817. Which of the following is the best treatment option for cellulitis when risk of infection with a methicillin-resistant pathogen is considered low?. A. Dicloxacillin. B. Amoxicillin. C. Metronidazole. D. Trimethoprim-sulfamethoxazole.

818. Oral antifungal treatment options for onychomycosis include all of the following except: A. Itraconazole. B. Fluconazole. C. Metronidazole. D. Terbinafine.

819. A 78-year-old resident of a long-term care facility complains of generalized itchiness at night that disturbs her sleep. Her examination is consistent with scabies. Which of the following do you expect to find on examination?. A. Excoriated papules on the interdigital area. B. Annular lesions over the buttocks. C. Vesicular lesions in a linear pattern. D. Honey-colored crusted lesions that began as vesicles.

820. For which of the following patients should an NP order varicella antibody titer?. A. A healthcare worker who reports having had varicella as a child. B. A 14-year-old with an uncertain immunization history. C. A 22-year-old woman who received two varicella immunizations 6 weeks apart. D. A 72-year-old with shingles.

821. Which of the following is most appropriate for the treatment of moderate-to-severe allergic rhinitis and conjunctivitis when symptoms are not controlled with current therapy?. A. Short course of oral corticosteroids. B. A single dose of a long-acting parental or IM corticosteroids. C. A daily dose of oral first-generation antihistamine. D. Immediate initiation of allergy immunotherapy.

822. Two 2-year-olds are playing in a sandbox. They are both scooping and pouring sand, occasionally glancing over at each other but not interacting. How would the nurse practitioner best characterize this type of play?. A. This behavior is abnormal, as by now they should want to play together. B. This behavior demonstrates parallel play, which is common in this age group. C. These children are participating in associative play, which is not expected in this age group. D. This is active play and is typical in this age group.

823. A 38-year-old woman comes to you and has multiple small joints involved with pain, swelling, and stiffness. Which of the following is the most likely explanation?. A. Rheumatoid Arthritis. B. Gout. C. Trauma. D. Septic arthritis.

824. While assessing a patient during a physical, you find a small, elevated area on her lower back. The area is a firm lesion of approximately 1.5 cm; it feels smooth to the touch, is not filled with fluid, and does not appear to extend below the epidermis. This morphology best describes which type of lesion?. A. Wheal. B. Tumor. C. Cyst. D. Nodule.

825. Kasey, age 7 months, is brought to the clinic by her concerned parents. They have been talking to other parents in their parenting group and need reassurance that Kasey is keeping up developmentally. As you observe Kasey, you notice that she responds to her name, consistently babbles, crawls around on the floor, and is able to pick up objects. Which of the following additional milestones would also be expected in a child her age?. A. Supports weight on feet. B. Holds head steady. C. Equal coordination of hands. D. Plays independently.

826. During auscultation of a newborn, a grade IV murmur is heard with a holosystolic thrill at the left lower sternal border. You suspect a congenital heart defect and order an x-ray. What findings would be most consistent with a suspected diagnosis of ventricular septal defect?. A. A normal chest x-ray. B. Cardiomegaly with rib notching. C. Boot-shaped heart. D. Cardiomegaly with increased pulmonary vascular markings.

827. A parent wants to know when the best time is to give the medication being prescribed for attention deficit hyperactivity disorder. Your instructions are based on your knowledge that the earliest onset of action after the ingestion of methylphenidate in children is usually: A. 15 minutes. B. 30 minutes. C. 45 minutes. D. 90 minutes.