Exit Exam Residency FNP

4. Pregnant at 24 weeks gestation is seen by the APRN. The pregnant is concerned about receiving an influenza vaccination, which she read on the internet that is mercury poisoning. Which information supported by evidence-based findings should the APRN provide?. A. Mercury is a preservative found in multi- dose influenza vials. B. Mercury-free vaccinations are available that do not contain thimerosal. C. There is no scientific evidence of mercury problems in vaccine. D. Hand washing is as protective against influenza as the vaccine.

5. During an initial prenatal exam, the APRN notes that a client is positive for chlamydia, negative for PID, and has a thick mucoid discharge at the cervix. What management plan is indicated?. A. Initialize therapy with doxycycline Vibramycin). B. Treat the client and all sexual partners. C. Determine if the client is allergic to penicillin (Pen V). D. Treat pain associated with the symptoms.

7. A 47-years old fair skinned female patient is seeing the APRN for a well woman exam, The APRN noted several discrete, smooth-surfaced, dome, shaped, red papules on the patient's trunk and several light-brown smooth surfaced lesions on the patient's lower extremities. The patient denies recent changes in the color or shape of the lesions but admits to unprotected sun exposure, including blistering sunburns, during her youth. What is the mostly likely diagnoses for this patient lesions?. A. Malignant melanoma and basal cell carcinoma. B. Squamous cell carcinoma and dermatosis papulose nigra. C. Actinic keratosis and sebaceous hyperplasia. D. Cherry angiomas and solar lentigos.

8. A 19years old male college student presents with sprained ankle incurred while playing basketball, Which instructions should the APRN advise patient to implement after injury?. A. Use ice pack for 20 min then discontinue for 30 min and repeat for 24-48 hours. B. Alternate heat and cold packs, 20 mins each, for the first 24-48 hours. C. Apply heat for the first 12 hours, then ice packs after weight-bearing activities. D. Keep ice packs on ankle for the first 12 hours, then heat after weight-bearing activities.

23. A 45 years old male patient with known coronary artery disease presents with severe headache, elevated blood pressure of 180/95, and tachycardia of 120 beats/minute. Which class of medication should the APRN prescribe best for this client?. A. Calcium Channel Blocker (CCB). B. Beta Blocker. C. Diuretic. D. Angiotensin converting enzyme inhibitor (ACEI).

28. A first grade boy complains of a sudden onset of pain in his left eye. He was on the and says, "I got a dirt in my eye" How should the APRN check for a corneal abrasion?. A. Determine if the pupils are equal, round, and reactive to light. B. Using the otoscope, check for the presence of foreign bodies. C. Use an ophthalmoscope to check for presence of a red reflex. D. Applying fluorescein stain, examine the eye with a wood's lamp.

36. A woman at 20 weeks gestation has a positive urine screen for Group B Streptococus. What action should the APRN take?. A. Consult with obstetrician about hospitalized IV penicillin therapy. B. Implement the protocol for a 10 day course of antibiotics. C. Notify the pediatrician of the Group B streptococcal infection. D. Teach the client about signs and symptoms of preterm labor.

40. A sexually active adolescent client has symptoms of dysuria with urethral discharge. This urethritis is associated with a Chlamydia infection. What treatment should the APRN prescribe?. A. Penicillin G (Syphilis). B. Doxycycline (Chlamydia). C. Ceftriaxone (Gonorrhea). D. Spectinomycin (Gonorrhea).

45. An elderly patient who takes Coumadin (Warfarin) daily, request advice regarding a new prescription medication for join pain due to osteoarthritis. Which over the counter medication the APRN advise the patient to take?. A. Acetaminophen (Tylenol). B. Aspirin (Buffen). C. Ibuprofen (Motrin). D. Naproxen (Naprosyn).

46. A 17 years old male who has been taking Bactrim for sinusitis presents to the emergency Department with a temperature of 103 F, malaise and hemorrhagic bullae on his lips, mouth and most of his body. Which admitting diagnosis should the APRN make?. A. Erysipelas Cellulitis. B. Erythema Multiform Minor. C. Stevens Johnson Syndrome. D. Rocky Mountain Spotted Fever.

52. The APRN is conducting routine employee screening. A new employee ask how long it takes to get rid of marihuana in the body. The APRN should inform patient that recreational drugs such as marihuana, yield positive results for how long after used?. A. 1 month. B. 2 days. C. 24 hours. D. 2 weeks.

54. A patient presents with watery soft diarrhea after taking a prescribed antibiotic for one week, in a stool culture test which organism should be obtained by the APRN?. A. Helicobacter Pylori. B. Salmonella Sp. C. Clostridium Difficile. D. Staphylococcus aureus.

66. A 24 years old is seen the APRN because pernicious anemia. Which high folic acid foods should the APRN teach the client to eat?. A. Cottage cheese, skim milk, and yogurt. B. Brussels sprouts, lima beans, and potatoes. C. Carrots, salmon, and avocados. D. Cereals, nuts and green vegetables.

70. At a parenting class, a mother has concerns that her child does not seen to have any close friends. Which age do children begin to develop friendships?. A. Two years. B. Twelve mounts. C. Eighteen months. D. Three years.

75. A client at 39 weeks gestation comes to the clinic and tells the APRN that her bag of waters has ruptured. Which finding provides the best determination that the client's membranes are ruptured?. A. Contractions occurring 3 minutes apart. B. A positive Fern test. C. An elevated serum white count. D. Nitrazine paper that turns blue when placed in vagina.

78. A 25 years old nulligravida and her 27 years old spouse are seen the APRN because they have not been able to get pregnant for the last 2 years. The wife has regular menstruation every 30 days that last for 4 days. Which intervention should the APRN order next?. A. A semen analysis. B. A clomiphene challenge test. C. A follicle stimulant hormone level. D. A post coital test.

82. Julie, a 72-year-old female, comes to see you because of complaints of memory loss, extreme drowsiness, and dizziness. Which of the following drugs would most likely lead to these side effects?. A. Paromomycin. B. Furosemide. C. Phenytoin. D. Doxazosin.

94. The most common trigger for delirium is: A. alcohol withdrawal. B. fecal impaction. C. head trauma. D. acute infection.

95. Older adults are at greater risk of subdural hematoma, even with minor head trauma due to: A. lower bone density in the skull. B. relatively fragile blood vessels. C. decreased adipose tissue reserves. D. age-related reduction in circulating clotting factors.

105. Factors that contribute to stress incontinence include: A. detrusor overactivity. B. pelvic floor weakness. C. urethral stricture. D. urinary tract infection (UTI).

109. An effective method to prevent presbycusis is: A. avoid using cotton swabs in the ear canal. B. use of ear protection when exposed to loud noises. C. avoid using hearing aids for a prolonged period of time. D. regular cerumen removal.

121. This age-related change that results in near vision blurriness is a change in the senses sometimes reported by the older adult. A. Hyposmia. B. Presbycusis. C. Presbyopia. D. Age-related maculopathy. E. Chronic glaucoma.

123. A nurse practitioner (NP) is considering a possible drug regimen for an 80-year-old patient who reports being forgetful. To promote adherence to the regimen, the NP should: A. select drugs that can be given once or twice daily. B. provide detailed written instructions for each medication. C. order medications that can be given on an empty stomach. D. instruct the patient to take a lower dose if side effects occur.

148. Which of the following statements is most accurate regarding cellulitis?. A. Insect bites, abrasion, or other skin trauma can be the origin of cellulitis. B. Cellulitis most often occurs on the chest and abdomen. C. Necrosis is a common complication of cellulitis. D. Cellulitis often occurs spontaneously without any identifiable skin wound.

156. First-line treatment of impetigo with less than 5 lesions of 1-2 centimeters in diameter on the legs in a 9-year-old girl is: A. Topical Mupirocin. B. Topical neomycin. C. Oral cefixime. D. Oral doxycycline.

157. 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.

163. Which of the following women should have screening for cervical cancer?. A. A 21-year-old who has had one male sexual partner and consistent condom use. B. An 80-year-old with heart failure and a remote history of normal Pap test results. C. A 17-year-old with coitarche 3 years ago and four male sexual partners. D. An 18-year-old who has a history of genital warts.

166. An example of a primary prevention measure for a 78-year-old man with chronic obstructive pulmonary disease is: A. Conducting a home survey to minimize fall risk. B. Reviewing the use of prescribed medications. C. Checking FEV1 (force expired volume at 1 second) to FVC (forced vital capacity) ratio. D. Ordering fecal occult blood test (FOBT).

167. 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.

253. Of the following, which eye disorder is characterized by an abrupt or sudden onset with painful swelling on the lid margin?. A. Hordeolum. B. Strabismus. C. Conjunctivitis. D. Chalazion.

254. All of the following are viral causes of pharyngitis and tonsillitis except: A. Mumps virus. B. Respiratory syncytial virus. C. Influenza A and B. D. Epstein-Barr virus.

274. The most common findings of impetigo include all of the following choices: A. Pain. B. Pruritic rash. C. Honey-crusting lesions. D. Regional lymphadenopathy.

298. The FNP explains eye patching as a treatment strategy for a child with amblyopia related to strabismus. In a teach-back session, which comment made by the child's father necessitates immediate clarification?. A. "She can fit the patch directly over her eye or over the lens in her glasses.". B. "If the patch bothers her, she can take it off for up to an hour at a time.". C. "She will need to wear the patch consistently except for bath time and bedtime—2 hours total.". D. "The patch can be removed daily for 2 hours before bedtime.".

344. Which of the following best describes the expected physical exam findings in a patient with severe COPD?. A. Wheezing. B. Egophony. C. Decreased breath sounds. D. Rales.

363. Young adults may develop which kind of rash when they are infected with erythema infectiosum?. A. Skin around the neck is thickened and dark brown-black. B. Erythematous rash in a butterfly distribution on the face. C. 2 mm to 5 mm red macules on the trunk and proximal extremities. D. Reddened exanthema on hands and feet with distinct margins at wrist and ankle joints.

378. A patient has had a genital probe return with a positive Chlamydia but negative gonorrhea. The appropriate antibiotic treatment for this patient is: A. Suprax 500 mg 1 dose. B. Doxycycline 100 mg BID × 7 days. C. Rocephin 125 mg IM. D. Cipro 500 mg × 1 dose.

424. Which of the following elements in the history would make an elderly patient most susceptible to falling in the near future?. A. Taking two medications at a time. B. Routine activities. C. Walking 2 miles 3 times a week. D. Initiation of a new medication within past 2 weeks.

425. Which of the following historical factors in a patient with sickle cell disease typically is the presenting symptom of a patient in crisis?. A. Decreased hearing. B. Extremity pain. C. Nosebleeds. D. Menorrhagia.

539. The FNP explains eye patching as a treatment strategy for a seven-year-old child with amblyopia related to strabismus. In a teach-back session, which comment made by the child's father necessitates immediate clarification?. A. "She can fit the patch directly over her eye or the lens in her glasses.". B. “If the patch bothers her, she can take it off for up to an hour at a time.”. C. "She must wear the patch consistently except for bath time and bedtime—2 hours total.". D. “The patch can be removed daily for 2 hours before bedtime.”.

550. A two-year-old with sickle cell anemia (SCA) should receive which immunizations?. A. All routine childhood immunizations at an accelerated rate. B. All routine childhood immunizations at a decelerated rate. C. All routine childhood immunizations are at the usual time. D. Immunizations should be limited in this group.

743. A Child of 6 years old who has a diagnosis of pneumonia returns to the clinic after not responding to antibiotic treatment after 48 hours. The patient has a respiratory rate of 36 breaths/ minute. The FNP should do which of the following?. A. Consult with the physician about the hospitalization of the patient. B. Prescribe a metered-dose inhaler. C. Prescribe two oral antibiotics. D. Treat the symptoms because pneumonia is viral.

744. All of the following electrolyte disorders are commonly found in a person with chronic renal failure except: A. hypernatremia. B. hypercalcemia. C. hyperkalemia. D. hypophosphatemia.

746. Preeclampsia presentation is noted after the week of pregnancy. A. 10th. B. 15th. C. 20th. D. 25th.

750. Hirschsprung's disease is characterized by the following: A. Failure to pass meconium in the first 48 hours of life. B. Intermittent constipation in the first year of life. C. Inability to absorb carbohydrates. D. Chronic fecal incontinence.

752. The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis?. A. corticosteroids. B. Answer angiotensin II receptor antagonists. C. beta-adrenergic antagonists. D. cephalosporins.

756. Pregnant at 24 weeks gestation is seen by the APRN. The pregnant is concerned about receiving an influenza vaccination, which she read on the internet that is mercury poisoning. Which information supported by evidence-based findings should the APRN provide?. A. Mercury is a preservative found in multi-dose influenza vials. B. Mercury-free vaccinations are available that do not contain thimerosal. C. There is no scientific evidence of mercury problems in vaccine. D. Hand washing is as protective against influenza as the vaccine.

758. What pharmacological agent should the APRN prescribe to achieve the best results initially in the management of patients with erosive reflux esophagitis?. A. Barrier paste medications, such as sucralfate (Carafate). B. Proton pump inhibitors, such as omeprazole (Prilosec). C. The H2 antagonist, such as famotidine (Pepcid). D. Promotility agents, such cisapride (Propulsid).

777. Carlos is a 19-year-old Hispanic college student living in the United States (US); he is in Puerto Rico (PR) visiting his family. Before coming to P.R., he went camping with his friends. He comes into your office because he feels like he is getting a cold and he found a red spot shaped like a target on his left thigh. He has no medical conditions; he is not sexually active. What is the most probable diagnosis?. A. Lyme disease. B. Psoriatic arthritis. C. Gonococcal arthritis. D. Rocky Mountain fever.

783. Susan is 17 years old and comes to your office with a history of a mildly pruritic painful 3 cm round vesicular lesion on her right upper lip. The lesion has a small amount of serous fluid and Tzank smear is positive for giant multinucleated cells. This lesion is most likely caused by: A. Herpes virus. B. Allergic reaction. C. Streptococci. D. S. aureus.

790. Albert is a 68 year old African American diagnosed with Hypertension. Which type of medication is recommended to control his BP?. A. Calcium Channel Blockers (CCBs). B. Beta-blockers (BBs). C. Angiotensin II -receptor blockers (ARBs). D. Beta-blockers (BBs).

792. A 9 year old child with purulent rhinorrhea and nasal congestion for 14 days is diagnosed with acute sinusitis. Which of the following treatments is most recommended?. A. Antibiotic. B. Use of aerosol for 1 week. C. Systemic antihistamines. D. Saline wash.

793. A new patient who recently visited the woods in North Carolina complains of a new onset of fever and a red rash that started 2 days ago. The rash first appeared on the wrist and the ankles and included the palm of the hands. The patient reports that it is spreading toward his trunk. The patient's eyes are not injected and no enlarged nodes are palpated on his neck. There is no desquamation of the skin. Which of the following diagnosis is most likely?. A. Rocky Mountain spotted fever. B. Meningococcemia. C. Kawasaki disease. D. Fifth disease.

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.

879. Which of the following elements in the history would make an elderly patient most susceptible to falling in the near future?. A. Taking two medications at a time. B. Routine activities. C. Walking 2 miles 3 times a week. D. Initiation of a new medication within past 2 weeks.

880. When a patient complains of ear pain, the diagnoses of otitis media and otitis externa must be considered in the differential. In comparison with otitis media, otitis externa presents with: A. Fever. B. Erythematous, bulging tympanic membrane. C. Yellow-green nasal discharge. D. Pain with movement of the tragus.

882. Preferred treatment options for a pregnant woman in the second trimester with migraine include: A. sumatriptan. B. codeine. C. aspirin. D. acetaminophen.

885. Which of the following best describes the expected physical exam findings in a patient with severe COPD?. A. Wheezing. B. Egophony. C. Decreased breath sounds. D. Rales.

888. Mr. Raul 60 /o presents to you companied by his daughter with complaints of numbness to his legs, in obtaining a history from him his daughter states at times Mr. Raul has had personality changes, memory loss, and is not eating well at all (anorexia). As you examine this patient you detect peripheral numbness of his extremities. Which of the following deficiency is the cause?. A. Vitamin B6. B. Ferritin. C. Vitamin B12. D. Folic acid.

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.

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.

715.A patient with hypertension comes into the office complaining of a dry cough. Which of the following is the most likely cause of the cough?. A. Angiotension receptor blocker. B. HCTZ. C. ACE inhibitor. D. Beta blocker.

739. The APN is assessing a 7- years old girl with right ear pain due to cerumen impaction. The APN expects which results from tuning fork conduction test of the right ear?. A. Weber test cause lateralization of sound to the right ear. B. Rinne's air conduction test is heard longer on the right ear. C. Vibratory sensation of right mastoid prominence is prominent. D. Rinne's air conduction test heard best in to the left ear.

740. Recommended length of antimicrobial therapy for a pregnant woman with asymptomatic bacteruria is: A. 1 to 3 days. B. 3 to 7 days. C. 8 to 10 days. D. 2 weeks.

741. The APN is examining a child with suspected pyelonephritis. What symptoms are expected findings for this client?. A. Right lower quadrant pain, vomiting, and diarrhea. B. Tachycardia, rash, and bilateral flank pain. C. Fever, anorexia, and dysuria. D. Oliguria, amber-colored urine and constipation.

747. The components of HELLP syndrome include all of the following except: A. hepatic enzyme elevations. B. thrombocytosis. C. hemolysis. D. eclampsia.

749. A 70 years old male complains of blurring in his right eye without pain or erythema and tells the APRN that he feels like a dark veil is covering his eye. Which action should the APRN implement?. A. Schedule a dilated eye examination with his optometrist. B. Irrigate the affected eye with sterile normal saline. C. Prescribe antibiotic eye drops, four times a day for 7 days. D. Refer immediately for an ophthalmologist appointment.

751. During an initial prenatal exam, the APRN notes that a client is positive for chlamydia, negative for PID, and has a thick mucoid discharge at the cervix. What management plan is indicated?. A. Initialize therapy with doxycycline Vibramycin). B. Treat the client and all sexual partners. C. Determine if the client is allergic to penicillin (Pen V). D. Treat pain associated with the symptoms.

752. The use of which of the following medications can precipitate acute renal failure in a patient with bilateral renal artery stenosis?. A. corticosteroids. B. angiotensin II receptor antagonists. C. beta-adrenergic antagonists. D. cephalosporins.

754. A 19- years old male college student presents with sprained ankle incurred while playing basketball, Which instructions should the APRN advise patient to implement after injury?. A. Use ice pack for 20 min then discontinue for 30 min and repeat for 24-48 hours. B. Alternate heat and cold packs, 20 mins each, for the first 24-48 hours. C. Apply heat for the first 12 hours, then ice packs after weight-bearing activities. D. Keep ice packs on ankle for the first 12 hours, then heat after weight-bearing activities.

763. Mr. K comes in with complaints of: “A sudden onset of “tearing” chest pain that radiates to his shoulders, abdomen and back.” You immediately suspect: A. Aortic dissection. B. Myocardial infarction. C. Unstable angina. D. Pericarditis.

768. A 24 years old is seen the APRN because pernicious anemia. Which high folic acid foods should the APRN teach the client to eat?. A. Cottage cheese, skim milk, and yogurt. B. Brussels sprouts, lima beans, and potatoes. C. Carrots, salmon, and avocados. D. Cereals, nuts and green vegetables.

774. You are treating Mrs. X for primary Hypothyroidism with a replacement thyroid hormone. Her TSH results today are : 0.3 mIU/L (0.4-2.5 mIU/L); what should you do?. A. Reduce her hormone replacement medication dose. B. Order a pituitary scan for possible tumor. C. Order a thyroid scan for possible tumor. D. Increase her hormone replacement medication dose.

784. A mother reports that her toddler has developed a "runny nose on the side" the child has no fever, is eating well, and is playing actively. The APRN should provide which primary differential diagnosis?. A. Upper respiratory infection. B. Seasonal allergic rhinitis. C. A cold. D. Obstruction.

785. An 17 years old male who has been taking Bactrim for sinusitis presents to the emergency Department with a temperature of 103 F, malaise and hemorrhagic bullae on his lips, mouth and most of his body. Which admitting diagnosis should the APRN make?. A. Erysipelas Cellulitis. B. Erythema Multiform Minor. C. Stevens Johnson Syndrome. D. Rocky Mountain Spotted Fever.

788. Cullen and Turner sign are commonly associated with: A. Acute pancreatitis. B. Cholecystitis. C. Cirrhosis. D. Myocardial infarction.

796. A woman at 20 weeks gestation has a positive urine screen for Group B Streptococus. What action should the APRN take?. A. Consult with obstetrician about hospitalized IV penicillin therapy. B. Implement the protocol for a 10 day course of antibiotics. C. Notify the pediatrician of the Group B streptococcal infection. D. Teach the client about signs and symptoms of preterm labor.

725. A nurse practitioner (NP) is considering a possible drug regimen for an 80-year-old patient who reports being forgetful. To promote adherence to the regimen, the NP should: A. select drugs that can be given once or twice daily. B. provide detailed written instructions for each medication. C. order medications that can be given on an empty stomach. D. instruct the patient to take a lower dose if side effects occur.

804. Factors that contribute to stress incontinence include: A. detrusor overactivity. B. pelvic floor weakness. C. urethral stricture. D. urinary tract infection (UTI).

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. Correct! Injectable epinephrine. C. Supplemental oxygen.

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.

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.

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.

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 parenteral or IM corticosteroids. C. a daily dose of oral first-generation antihistamine. D. immediate initiation of allergy immunotherapy.

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.

829. How and where does the obturator sign present in pediatric patients with appendicitis?. A. Sharp pain in the right lower quadrant of the abdomen. B. Pain with internal rotation of the right hip. C. Pain with extension of the right hip. D. Tenderness one-third the distance from the anterior superior iliac spine to the umbilicus.

843. A 25-year-old woman presents in the 10th week of gestation requesting antenatal screening for Down syndrome. What advice should the NP give?. A. Because of her age, no specific testing is recommended. B. She should be referred for second-trimester ultrasound. C. Screening that combines nuchal translucency measurement and biochemical testing is available. D. She should be referred to a genetic counselor.

846. Which of the following therapeutic interventions best addresses the underlying pathophysiological mechanisms of GERD?. A. Antacids. B. Elevation of the head of the bed. C. Weight loss. D. Proton pump inhibitor.

864. Which of the following rashes is found in scarlet fever?. A. Rash evolving from pink macules to red papules and finally to petechiae. B. Rash is bright red and maculopapular, with a fine sandpaper- like texture. C. Petechial lesions distributed on the trunk and extremities. D. Annular erythematous rash with scaling on the leading edge.

866. Which of the following historical factors in a patient with sickle cell disease typically is the presenting symptom of a patient in crisis?. A. Decreased hearing. B. Extremity pain. C. Nosebleeds. D. Menorrhagia.

875. Which of the following examination findings is consistent with the diagnosis of Hirschsprung's disease?. A. Large fecal mass palpable in abdomen but no stool in rectal vault. B. Large amount of stool in rectal vault. C. Fluid wave of abdomen. D. Hepatosplenomegaly.

890- 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?. Rheumatoid Arthritis. Gout. Trauma. Septic arthritis.

891- An 18-year-old woman in whom a sexually transmitted disease (STD) was recently diagnosed asks the nurse not to tell her mother that she has an STD. Her mother asks the nurse what is causing her daughter’s vaginal discharge. The nurse should: Select one: Ignore the mother’s request for information. Tell the client’s mother that she has a urinary tract infection, to protect the client’s privacy and honor the mother’s request. Follow the principle of veracity and tell the mother the diagnosis. Respect the principle of confidentiality and support the client's request not to tell her mother the diagnosis.

892- Mr. Raul 60 y/o presents to you companied by his daughter with complaints of numbness to his legs, in obtaining a history from him his daughter states at times Mr. Raul has had personality changes, memory loss, and is not eating well at all (anorexia). As you examine this patient you detect peripheral numbness of his extremities. Which of the following deficiency is the cause?. Vitamin B6. Vitamin B12. Ferritin. Folic acid.

893- Your patient with hypertension comes in and insists that one of his new medications is causing him to cough. When looking at his list of medications, you think the cough must be from: Captopril (Capoten). Tadalafil (Cialis). Metropolol (Toprol XL). Clopidogredrel (Plavix).

895- Cullen and Turner sign are commonly associated with: Cholecystitis. Cirrhosis. Myocardial infarction. Acute pancreatitis.

The primary purpose of certification is to: Regulate nurse practitioners, clinical specialists, midwives and nurse anesthetists. Grant the provider permission to be paid by health insurances. Maintain quality documentation of nursing personnel. Verify that an individual has obtained advanced knowledge and has a special set of skills.

899-Albert is a 68 year old African American diagnosed with Hypertension. Which type of medication is recommended to control his BP? Select one: Statins. Angiotensin II -receptor blockers (ARBs). Beta-blockers (BBs). Calcium Channel Blockers (CCBs.

902. A patient presents with watery soft diarrhea after taking a prescribed antibiotic for one week, in a stool culture test which organism should be obtained by the APRN?. Helicobacter Pylori. Salmonella Sp. Clostridium Difficile. Staphylococcus aureus.

15. The APN is assessing a 7years old girl with right ear pain due to cerumen impaction. The APRN expects which results from tuning fork conduction test of the right ear?. A. Weber test cause lateralization of sound to the right ear. B. Rinne's air conduction test is heard longer on the right ear. C. Vibratory sensation of right mastoid prominence is prominent. D. Rinne's air conduction test heard best in to the left ear.

18. A 70 years old male complains of blurring in his right eye without pain or erythema and tells the APRN that he feels like a dark veil is covering his eye. Which action should the APRN implement?. A. Schedule a dilated eye examination with his optometrist. B. Irrigate the affected eye with sterile normal saline. C. Prescribe antibiotic eye drops, four times a day for 7 days. D. Refer immediately for an ophthalmologist appointment.

26. A mother reports that her toddler has developed a "runny nose on the side" the child has no fever, is eating well, and is playing actively. The APRN should provide which primary differential diagnosis?. A. Upper respiratory infection. B. Seasonal allergic rhinitis. C. A cold. D. Obstruction.

30. The APRN is examining a 6 months old infant for well baby check up. Which findings indicates that the fontanels are normal at this infant growth?. A. Anterior closed, posterior closed. B. Anterior open, posterior closed. C. Anterior open, posterior open. D. Anterior closed, posterior open.

32. For uncomplicated genital gonococcal infections, The CDC recommends which drug treatment regimen?. A. Azithromycin (Zithromax) 250 mg PO daily x 5 days. B. Doxycycline (Vibraycin) 100 mg PO BID x 14 days. C. Bactrim 160 mg x 3 weeks. D. Ceftriaxone 125 mg IM single dosis.

1. The APRN is examining an elderly female client and notices that she has a motor dysfunction in her hip region. Which procedure should the APRN consider to perform to further assess for hip dysfunction?. A. Abduct and internally rotate each hip while the client is supine. B. Have the client balance first on one foot and then the other. C. Flex the hip and knee while lying flat with other leg extended. D. Ask the patient to stand and bend over the examination table.

92. William, a 68-year-old, had been suffering from shingles and complained of extreme continual burning pain on his head and legs. He was given medication to treat the intense burning sensations but has now returned to the clinic with complaints of blurry vision and the inability to urinate or have a bowel movement. Which of the following drugs is most likely the cause of his latest complaints?. A. Phenytoin. B. Acyclovir. C. Ibuprofen. D. Amitriptyline.

118. An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the NP recommend for this patient?. A. Loratadine (Claritin). B. Hydroxyzine (Vistaril). C. Diphenhydramine (Benadryl). D. Chlorpheniramine maleate (Chlorphen 12).

120. Painless vision change that includes central vision distortion is an age-related change in the senses reported by the older adult. It is known as: A. Hyposmia. B. Presbycusis. C. Presbyopia. D. Age-related maculopathy. E. Chronic glaucoma.

130. First-line treatment for uncomplicated hordeolum is: A. Topical corticosteroid. B. Warm compresses to the affected area. C. Incision and drainage. D. oral antimicrobial therapy.

131. 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.

132. Physical examination findings in otitis externa include: A. Tympanic membrane immobility. B. Increased ear pain with tragus palpation. C. Tympanic membrane erythema. D. Tympanic membrane bullae.

134. Expected findings in Acute Otitis Media (AOM) include: A. Prominent bony landmarks. B. Tympanic membrane immobility. C. Itchiness and crackling in the affected ear. D. Submental lymphadenopathy.

139. When caring for a patient with angle-closure glaucoma, the most appropriate next action is: A. prompt referral to an ophthalmologist. B. to provide analgesia and repeat the evaluation when the patient is more comfortable. C. to instill a corticosteroid ophthalmic solution. D. To patch the eye and arrange for follow-up in 24 hours.

141. The Rinne test is able to test for and distinguish between conductive hearing loss (CHL) and sensorineural hearing loss (SNHL), while the Weber test assesses for the presence of CHL only. A. True. B. False.

142. A 19 year old woman presents with a complaint of bilaterally itchy, red eyes with tearing that occurs intermittently throughout the year and is often accompanied by a rope- like eye discharge and clear nasal discharge. This is most consistent with conjunctival inflammation caused by a(n): A. bacterium. B. virus. C. Allergen. D. injury.

144. The use of lindane (Kwell) to treat scabies is discouraged because of its potential for: A. Hepatotoxicity. B. Neurotoxicity. C. Nephrotoxicity. D. Pancreatitis.

146. A 58-year-old woman presents with a sudden left-sided headache that is most painful in her left eye. Her vision is blurred, and the left pupil is slightly dilated and poorly reactive. The left conjunctiva is markedly injected, and the eyeball is firm. The vision screen with the Snellen chart is 20/30 OD and 20/90 OS. The most likely diagnosis is: A. unilateral herpetic conjunctivitis. B. open-angle glaucoma. C. angle-closure glaucoma. D. Anterior uveitis.

120. 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.

154. 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.

173. Which of the following is usually viewed as the most cost-effective form of healthcare?. A. Primary prevention. B. Secondary prevention. C. Tertiary prevention. D. Cancer-reduction measures.

216. At what age does taking a blood pressure reading usually become a part of a child's physical examination?. A. At 2 years. B. At 3 years. C. At 4 years. D. At 5 years.

230. What is the average age by which toddlers achieve daytime control of bowel and bladder movements?. A. By 18 months of age. B. By 2 years of age. C. By 2.5 years of age. D. By 3 years of age.

249. Which of these factors is most likely to increase the risk of Down syndrome in infants?. A. Advanced maternal age. B. Intrauterine infection during the second trimester. C. Alcoholism during pregnancy. D. Smoking during pregnancy.

255. Which of the following conditions does not have a bacterial etiology?. A. Epiglottitis. B. Infectious mononucleosis. C. Acute otitis media. D. Conjunctivitis.

260. An infant presents to the clinic with an angry red diaper rash with satellite lesions. A potassium hydroxide preparation used to examine the lesion is negative. Your treatment would consist of which of these methods?. A. Hydrocortisone 1 % cream. B. Zinc oxide ointment. C. Acyclovir 5% cream. D. Nystatin 100,000 units/gram.

261. A 14-year-old patient presents to your clinic with complaints of stiff joints and pain that starts in her shoulders before traveling down her arms. She reports that, following a recent nature hike, she found a tick on her leg. Within a few days, a lesion that "looks like a bull's eye" had developed at the tick site. She also tells you that she has been experiencing severe headaches, and that her heart occasionally races like a drum." Which stage of the most likely diagnosis is the patient experiencing. A. Stage 1. B. Stage 2. C. Stage 3. D. Stage 4.

264. 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.

265. A 2-year-old is brought to your clinic presenting with red, irritated eyes. The mother says the symptoms manifested after they had visited a public swimming pool the day prior. Upon examination, you see no discharge. The child does not indicate any pain, only an itching sensation. You tell the mother that the condition is self-limiting, and you proceed with a normal saline flush on the patient's eyes. Which is the most likely diagnosis?. A. Bacterial conjunctivitis. B. Hordeolum. C. Chemical conjunctivitis. D. Viral conjunctivitis.

266. Which of the following is most likely to becaused by Chlamydia trachomatis?. A. Pharyngitis. B. Croup. C. Infectious mononucleosis. D. Epiglottitis.

120. You are teaching the parents of an 8-month- old infant with gastroesophageal reflux disease. Which of the following actions should you advise the parents to perform immediately after meals specifically to decrease reflux activity?. A. Position the infant in a semi-supine position. B. Assist the newborn to burp after meals. C. Elevate the newborn's head. D. Administer a histamine 2-receptor antagonist.

270. Which test can be used to diagnose either Hirschsprung's disease or intussusception?. A. Barium enema. B. Rectal biopsy. C. Ultrasound. D. Colon biopsy.

280. Vitamin deficiency resulting from malabsorption is most likely to present with: A. Vomiting. B. Chronic diarrhea. C. Fatigue. D. Thin stools.

281. A 6-month-old male is brought to your clinic with complaints of vomiting. His mother says that her son was fine, but then "he just got really irritable and started crying, and then just started throwing up green barf." The mother says that she noticed her son has not been as energetic as usual, and that there was "jelly- like poop" when changing his diaper. Based on these findings, which gastrointestinal disorder would you most likely suspect?. A. Gastroenteritis. B. Hirschsprung's disease. C. Pyloric stenosis. D. lntussusception.

282. How and where does the obturator sign present in pediatric patients with appendicitis?. A. Sharp pain in the right lower quadrant of the abdomen. B. Pain with internal rotation of the right hip. C. Pain with extension of the right hip. D. Tenderness one-third the distance from the anterior superior iliac spine to the umbilicus.

345. Which of the following objective findings is pathognomonic for infectious mononucleosis?. A. Throat erythematous, no exudate. B. Facial edema. C. Maculopapular rash. D. Lymphadenopathy.

361. Which of the following signs would indicate to the FNP that a patient might have an airway occlusion and needs assistance?. A. Holding throat with both hands. B. Coughing. C. Crying. D. Whispery, soft voice.

362. Expected objective findings in acute otitis media include: A. Submental lymphadenopathy. B. Prominent bony landmarks on tympanic membrane. C. Itchiness and cracking in the affected ear. D. Tympanic membrane immobility.

385. Which of the following therapeutic interventions best addresses the underlying pathophysiological mechanisms of GERD?. A. Antacids. B. Elevation of the head of the bed. C. Weight loss. D. Proton pump inhibitor.

392. When a patient complains of ear pain, the diagnoses of otitis media and otitis externa must be considered in the differential. In comparison with otitis media, otitis externa presents with: A. Fever. B. Erythematous, bulging tympanic membrane. C. Yellow-green nasal discharge. D. Pain with movement of the tragus.

405. Which of the following examination findings is consistent with the diagnosis of Hirschsprung's disease?. A. Large fecal mass palpable in abdomen but no stool in rectal vault. B. Large amount of stool in rectal vault. C. Fluid wave of abdomen. D. Hepatosplenomegaly.

422. Which of the following rashes is found in scarlet fever?. A. Rash evolving from pink macules to red papules and finally to petechiae. B. Rash is bright red and maculopapular, with a fine sandpaper-like texture. C. Petechial lesions distributed on the trunk and extremities. D. Annular erythematous rash with scaling on the leading edge.

430. Which findings in a 7 months old infant are most indicative of intussusception?. A. Normal bowel movement and high fever. B. Red jelly-like stools and projectile vomiting. C. Right upper quadrant olive shaped mass and profuse diarrhea. D. Right upper quadrant mass and episodes of severe crying.

120. Skin lesions associated with actinic keratosis can be described as: A. A slightly rough, pink or flesh-colored lesion in a sun-exposed area. B. A well-defined, slightly raised, red, scaly plaque in a skinfold. C. A blistering lesion along a dermatome. D. A crusting lesion along with flexor aspects of the fingers. All of the following patients received pneumococcal.

410. A 21-year-old patient comes in with fever, malaise, and fatigue. Which of the following is the most likely diagnosis for this patient?. A. Lymphoma. B. Mononucleosis. C. Chronic fatigue syndrome. D. Tuberculosis.

477. A patient was admitted who was just in an automobile accident. She is complaining of abdominal pain. Which of the following would indicate abdominal bleeding?. A. Kehr’s sign. B. Hamman’s sign. C. Battle’s sign. D. Cullen’s sign.

479. A teenage boy who has been receiving sulfonamide begins to exhibit a high fever and generalized rash and is brought in by his father. The NP notes that the boy has lesions on his mucous membranes and that the skin on the palms and soles is sloughing. Such findings raise the index of suspicion of what diagnosis?. A. Viral stomatitis. B. Stevens-Johnson syndrome. C. Urticaria. D. Atopic dermatitis.

120. In a patient diagnosed with Bell’s palsy, which of the following also must be considered in the differential diagnosis?. A. Pituitary tumor. B. Lyme disease. C. Migraine headache with aura. D. Trigeminal neuralgia.

547. A 3-year-old has been recently treated for an upper respiratory infection (URI), but drainage from the right nostril persists. What should the N.P. suspect?. A. Allergic rhinitis. B. Presence of a foreign body. C. Unresolved URI. D. Dental caries.

558. Hirschsprung's disease is characterized by the following: A. Intermittent constipation in the first year of life. B. inability to absorb carbohydrates. C. failure to pass meconium in the first 48 hours of life. D. chronic fecal incontinence.

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?.

739. The APN is assessing a 7- years old girl with right ear pain due to cerumen impaction. The APN expects which results from tuning fork conduction test of the right ear?. A. Correct! Weber test cause lateralization of sound to the right ear. B. Rinne's air conduction test is heard longer on the right ear. C. Vibratory sensation of right mastoid prominence is prominent. D. Rinne's air conduction test heard best in to the left ear.

747. The components of HELLP syndrome include all of the following except: A. hepatic enzyme elevations. B. thrombocytosis. C. hemolysis. D. eclampsia.

751. During an initial prenatal exam, the APRN notes that a client is positive for chlamydia, negative for PID, and has a thick mucoid discharge at the cervix. What management plan is indicated?. A. Initialize therapy with doxycycline Vibramycin). B. Treat the client and all sexual partners. C. Determine if the client is allergic to penicillin (Pen V). D. Treat pain associated with the symptoms.

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.

120. 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 parenteral or IM corticosteroids. C. a daily dose of oral first-generation antihistamine. D. immediate initiation of allergy immunotherapy.

725. 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.