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651. Accurate information should be provided to parents and children/adolescents if there is a disagreement about body piercing. True. False.

652. Federally funded managed care networks and community health centers must have interpreters accessible for clients with limited English proficiency. True. False.

653. If a child needs to take medications throughout the day at school, they should be consistent with the child's daily routine. True. False.

654. Children who experience difficulty adjusting to life in the U.S. can/may suffer acute and chronic physical and mental health concerns, especially if there is a recent history that includes trauma, loss, and refugee camp experiences. True. False.

655. Self-injurious behavior (SIB) is a coping strategy to relieve distress, anger, and stress. Because it indicates underlying distress, children/adolescents should receive assistance identifying these causes. There may be a history of physical, sexual, or emotional abuse. True. Fale.

656. Toddlers learn by doing and must experiment to familiarize themselves with their environment. Parents need to be present to provide safety for the learning child. True. False.

657. To build rapport with the child and parent, the FNP should begin by asking direct questions to the child, encouraging the child to share information about daily routines. True. False.

658. The NP is completing a health history with a woman who recently immigrated from Mexico and speaks little English; the NP speaks little Spanish. The woman’s husband is interpreting. Which approach is best?. A. Watch the patient’s non-verbal responses to questions carefully. B. Explain to both the importance of hearing the patient’s words and maintain eye contact with her. C. Ask the husband to answer all questions for her, especially in relation to her chief complaint. D. Maintain eye contact with the husband during the interview as he interprets.

659. Where can a potential employer go to find out if an FNP has been sued?. A. The FNP’s certifying agency. B. State Board of Nursing. C. Work Safety and Insurance Board. D. National Practitioner Data Bank.

660. In attempting to make a diagnosis, which factor will the FNP find most important in most situations?. A. Endoscopy. B. Imagine studies of the affected body system. C. History and physical exam. D. Urine and blood testing.

661. Which patient population in a large primary care clinic would be considered vulnerable subjects for a research study?. A. Seniors in a mall-walking exercise group. B. Patients with disorders affecting gait. C. Pediatric patients with chronic illness. D. Women patients with genital herpes.

662. The NP prescribes permethrin (Elimite) 5% cream for a patient with scabies and provides thorough directions for its use. What procedure shows that the patient has understood the directions?. A. Cream was applied on affected areas for 1 hour and washed off. B. Cream was placed carefully on lesions only not on any affected skin. C. Cream was applied to the affected areas and left for 2 days. D. Cream was applied from the neck down and left for 8 hours.

663. For which man is vigorous prostate massage absolutely contraindicated?. A. One with elevated PSA levels. B. One with known azoospermia. C. One with acute prostatitis. D. One with chronic prostatitis.

664. A teenager was diagnosed with mono. Which comment by the patient indicates that she has understood the instructions?. A. “I need to take antibiotics to cure mono.”. B. “The tiredness should go away in a week.”. C. “I can continue all my activities.”. D. “I am not able to play basketball.”.

665. A school principal with newly diagnosed Addison’s disease is provided with information about the course of the disease and treatment measures. What comment demonstrates that he has understood the basic information correctly?. A. “I can skip my meds on the days I am feeling well.”. B. “When I am under undue stress at work, I leave off the cortisol dose.”. C. “This condition is one that lasts a lifetime.”. D. “I need to reduce the level of salt in my diet.”.

666. Maddy is a 3-year-old girl diagnosed with both otitis media and bacterial conjunctivitis of undetermined cause. What treatment choice is best?. A. Bactrim suspension. B. Sulfacetamide sodium ophthalmic solution. C. Amoxicillin suspension and sulfacetamide sodium eye drops. D. Augmentin suspension.

667. A patient with active TB who is receiving rifampin and pyrazinamide has a threefold increase in liver enzymes. The NP should do which of the following?. A. Decrease the dose. B. Switch the medication. C. Stop the medication. D. Add INH.

668. Which of the following patients should not take diphenhydramine (Benadryl) at night for sleep?. A. A 23-year-old college student. B. A 35-year-old male who is stressed by his workload. C. A 70-year-old patient with glaucoma. D. A 37-year-old female with diarrhea.

669. Which of the following patients should not be placed on anticoagulation?. A. An individual with AF and an LVEF of less than 35%. B. A patient newly diagnosed with AF of an unknown duration in which the medical plan includes cardioversion. C. A patient who was successfully cardioverted from AF weeks ago. D. A 44-year-old woman with Factor V Leiden.

670. An NP who works with a number of patients with eating disorders is reviewing daily lab work on these patients. In which situation is immediate intervention warranted?. A. Male patient with TIBC 242 mcg/dL. B. Female patient with Hgb 12.2 gm and hematocrit 39%. C. Male patient with serum potassium of 3.5 mEq/L. D. Female patient with serum calcium level of 8.6 mg/dL.

671. A teen who was recently treated for leukemia has a temperature of 101°F. What is the standard of care in this case?. A. Give the influenza vaccine. B. Send the patient to the oncologist or ED. C. Drink cold liquids. D. Treat with acetaminophen for fever.

672. An FNP orders rubella vaccine for a postpartum woman and provides instructions. Which comment by the woman indicates that she has understood the information correctly?. A. “I should not kiss my 3and 5-year-olds for the next few days.”. B. “I should not get pregnant for at least 3 months.”. C. “It will not be safe for me to donate blood for at least 6 months.”. D. “I should give my baby formula for the next 2 days.”.

673. An NP is completing a chart review conducting research on the management of endometriosis by advanced practice nurses. Which finding in the chart suggests questionable management?. A. Levonorgestral intrauterine device to prevent ovulation. B. Danocrine 200 mg BID to suppress menses for 3 weeks, then 1 week off. C. GnRH agonist therapy for 6 months including Premarin 0.625 mg as add-back therapy. D. Combination birth control pills with no pill- free days for 6 months to atrophy implants.

674. Nurse practitioners at a public clinic provided an educational session on the new HPV vaccine, Gardasil, to a women’s group. Which statement by one of the participants indicates a need for more information?. A. “It reverses the virus after exposure and is advised for females aged 11 through 26.”. B. “The medicine prevents the types of HPV most likely to cause genital warts, pre- cancerous lesions, and cervical cancer.”. C. “The side effects are red and tender injection site, fever, and headache.”. D. “There are three doses given in the muscle of the arm or thigh over a 6-month period.”.

675. What is the standard of care needed for a 14- year-old girl with scoliosis and a degree of curvature of 10 degrees?. A. Use a back brace to prevent further progression of the curvature. B. No active treatment is necessary; monitor the patient during well checks. C. Prescribe physical therapy. D. Refer the patient to orthopedics.

676. In a patient with ß-thalassemia minor, which of the following actions is considered standard of care?. A. Education about “healthy” nutrition. B. Prophylactic potassium V penicillin. C. Administration of iron. D. Administration of erythropoietin.

677. Your community NP group is participating in a table-top simulation of a bioterror event. The exercise involves making triage decisions by using the military system: immediate, delayed, minimal, and expectant when a large mall is hit by three consecutive car bombs and thousands of holiday shoppers are inside. Which victim of such a disaster would receive triage as immediate treatment?. A. A woman who appears to be having a panic attack at the side of her dead husband. B. A 17-year-old boy with an obvious fractured left arm, bruises, and minor lacerations. C. A pregnant woman whose only injury appears to be a pneumothorax. D. A middle-aged policeman who has burns over 90% of his body.

678. An FNP is serving as a preceptor for an NP student and is evaluating her performance with a 6-year-old boy with suspected epiglottitis. Which action, if not the first action taken, would justify a “needs improvement” grade?. A. Problem-oriented history and physical exams are conducted. B. The child is eased into a sitting position for the exam. C. Emergency equipment is brought directly outside the exam room door. D. Blood is drawn for a stat CBC and differential test.

679. You are an NP in a large public clinic where many patients with STIs and vulvovaginitis are treated. Because of a concern that appropriates follow-up of treatment of male sexual partners is being addressed and appropriately documented, a chart audit is planned. For which diagnosis will this review appropriately evaluate the concern?. A. Cytologic vaginitis. B. Vulvovaginal candidiasis. C. Bacterial vaginosis. D. Trichomonas.

680. The NP has provided instructions to a prenatal patient on precautions to prevent exposure to toxoplasmosis. Which patient statement requires further discussion?. A. “I will avoid eggs and cheese.”. B. “I will wash vegetables thoroughly.”. C. “I will wear gloves while working in the vegetable garden.”. D. “I won’t empty cat litter.”.

681. An experienced NP is working as a clinical preceptor with a student NP. What treatment approach the student poses for a child with a diagnosis of amblyopia should definitely be questioned?. A. Patching the good eye to force increased use of the affected eye. B. Watchful waiting and revisit in 4 months. C. Referral appointment to ophthalmology clinic for evaluation for eye surgery. D. Use of ophthalmic drops with analgesic properties.

682. The NP is caring for an elderly woman with herpes zoster and overhears a comment the patient makes about the cause of her condition. Which one is accurate?. A. “I had chickenpox as a child; my immune system is weak, and the virus got reactivated.”. B. “I ate some steak tartare—that raw stuff—I think it caused this rash.”. C. “I should have used better hand washing, so I wouldn’t have been exposed to this bacterium.”. D. “I suppose I got the infection from my grandson, who has just had German measles.”.

683. Which of the following is not true about hepatitis B virus?. A. Perinatally infected infants are likely to become carriers. B. It can survive for more than 1 week on fomites. C. It is the most common form of hepatitis in the world. D. Contaminated water and shellfish are the major sources.

684. In consultation with a dermatologist, the FNP prescribes tretinoin (Retin-A) for a patient’s acne and provides instructions for use. What comment by the patient indicates understanding?. A. “I should wear gloves when applying this medicine to my face.”. B. “This medicine should make a dramatic impact in the first week.”. C. “Since the drug causes sun sensitivity, I’ll need to use sunscreen faithfully.”. D. “To supplement this drug, I should continue to use the benzoyl peroxide.”.

685. Which comment from a person with herpes simplex indicates a need for additional teaching?. A. “Exposure to a sunlamp or sunshine may make my cold sores worse.”. B. “This antiviral will cure my herpes.”. C. “I need to inform my sexual partner about my herpes.”. D. “If I get a tingling sensation around my mouth, I should start the antiviral medicine.”.

686. A man who has sustained an injury on the job has been assigned a case manager in workplace safety. The FNP should not expect that professional provider to: A. Collaborate with the FNP to develop a return-to-work plan. B. Decide on optimal treatment measures and timeline based on the FNP’s assessment and plan of care. C. Advocate for the patient throughout the recovery process. D. Evaluate and monitor your patient’s progress to recovery and return to work.

687. 92.An adult male present with a 3-day history of dysuria and penile discharge. Gram stains of the discharge reveal gram-negative cocci. Given this finding, the patient should be treated for: A. Syphilis. B. Urea plasma. C. Gonorrhea. D. E. coli.

688. When performing an annual gynecologic exam, the FNP notes bruising on both the patient’s upper arms in the distinct pattern of fingers. When the FNP mentions the bruises, the woman responds, “Clumsy me! I fell over my son’s tricycle—it’s nothing.” Which comment by the FNP is most appropriate?. A. “Was this really the accident you describe?”. B. “I am concerned about you, and I don’t think you are being truthful here.”. C. “The bruises seem to be in the shape of someone’s hands.”. D. “I believe someone grabbed you tightly by your upper arms.”.

689. On the third day of treatment with trimethoprim/sulfamethoxazole (Bactrim DS), which she has been taking BID, a patient develops a rash and notifies the FNP. Which treatment plan is appropriate?. A. Switch to another antibiotic sensitive to the causative organism. B. Discontinue the antibiotic and substitute Pyridium. C. Order Benadryl and encourage continuation of Bactrim DS. D. Continue the medication but cut the daily dose in half.

690. A teenage girl accompanied by her mother is seeking treatment for acne. She has both pustules and comedones. What management plan is consistent with those findings?. A. Dietary education, hygiene education, and benzoyl peroxide BID. B. Pregnancy test, benzoyl peroxide BID, and tetracycline 500 mg BID. C. Accutane with liver enzymes monitored every 3 months. D. Tetracycline 500 mg BID based on results of CBC.

691. An elderly woman with known heart disease is newly diagnosed with hypothyroidism. TSH T4). What treatment approach is most appropriate?. A. Order 100 mg of propylthiouracil daily. Plan to increase it every 2 weeks. B. Order 100 mg levothyroxine (Synthroid) daily. Plan to increase it every 4 to 6 weeks. C. Order 150 mg propylthiouracil daily. Plan to increase it in 4 to 6 weeks. D. Order 25 mg of levothyroxine (Synthroid) daily. Plan to increase it in 4 to 6 weeks.

692. The FNPs in a large clinic decide they want to portray their clinical site as being particularly supportive of women experiencing intimate partner abuse. They believe this environment will encourage disclosure. Which aspect of the plan is least appropriate to meeting this goal?. A. Placing information about shelters, hotlines, safety plans, and exit strategies in female- only bathrooms in plain brown wrappers. B. Wearing large lapel pins that read “Men Who Hit Don’t Deserve Women!”. C. Putting posters on the clinic walls that reflect this as a “safe space for those in unsafe relationships.”. D. Beginning to do universal screening for violence for all female patients.

693. An FNP is working with a 16-year-old girl with an eating disorder. Outcomes of care have not been consistently positive. Which criterion does not justify hospitalization at this time?. A. She has refused all food for the past 24 hours. B. Her weight gain during outpatient treatment is 2 lbs less than goal. C. Today’s weight is >25% below normal. D. She persists in suicidal ideation.

694. A 47-year-old executive, who is a long-term patient and has been followed for routine care and occasional minor illnesses for several years, presents today with complaints of impotence. He mentions that he awakens with an erect penis in the morning but is unable to achieve erection when he wants to make love to his wife. What plan is appropriate?. A. Refer him immediately to a urologist. B. Order a penile tumescence study. C. Prescribe Viagra. D. Conclude that there is no organic cause for the problem and discuss counseling.

695. What drug below is not an appropriate choice for treating tinea versicolor?. A. Nizoral shampoo. B. Oral Nizoral. C. Selsun shampoo. D. Cortisone cream.

696. A patient with a long-standing history of diabetes mellitus is experiencing severe painful peripheral neuropathy. Which treatment is most appropriate?. A. Gabapentin (Neurontin). B. Ice packs. C. Acetaminophen with codeine. D. Warm saline soaks.

697. Which of the following patients seen for vertigo is least in need of immediate evaluation?. A. The symptoms are new, and the patient also has visual disturbances. B. The vertigo was just reported and occurs only when the patient looks up or turns his head. C. The problem has a new onset and is associated with severe headaches. D. The vertigo is of recent onset and the patient is experiencing numbness.

698. The FNP diagnoses Fifth disease in a 6-year- old whose mother accompanied him to the clinic. The woman is 24 weeks pregnant. What anticipatory guidance is appropriate for the mother?. A. “I am going to arrange for you to see a perinatologist about immediate intrauterine exchange transfusion.”. B. “Because you’ve been exposed to this condition, your fetus faces a risk of congenital deafness.”. C. “You are too far along for an abortion, so you need to be prepared for this baby to have mental retardation.”. D. “Exposure does not cause birth defects or mental retardation, even if the fetus gets exposed.”.

699. What antibiotic choice is most appropriate for a male patient with chronic prostatitis?. A. Ciprofloxacin. B. Sulfonamide. C. Tetracycline. D. Trimethoprim.

700. Which skin lesion necessitates immediate intervention?. A. Black-brown mole on thigh that is 5 mm, symmetrical, and unchanged over many years. B. New 3 mm brown mole with irregular border that itches. C. Multiple flat moles scattered along the upper back that are brown with smooth round edges. D. Waxy papule of 2 cm diameter that appears “stuck on” the face.