Prescriptive authority: When examining a pregnant patient, where should the fundal height be at 22 weeks? What intervention does the American College of Rheumatology recommend as first-line therapy ... for osteoarthritis? A 63-year-old male retired accountant complains of pain and stiffness in his feet and hands of several years duration. He reports that the pain and stiffness become worse with activity. On examination, he is noted to have Heberden's nodes but no other bony deformities. Which of the following is the most probable diagnosis? The family of a 78-year-old man moved him into an assisted living center because he can no longer be left at home alone. He is unable to toilet when asked to do so and he has had several episodes of incontinence. He has walked out of the facility twice and been unable to find his way back from 3 blocks away. On examination, he is pleasant but mildly confused. Which of his medications is LEAST likely contributing to his behavior? A patient with no significant medical history has varicose veins. She complains of "aching legs". The intervention that will provide the greatest relief for her complaint is to: Stress urinary incontinence is: Which commonly used herbal remedy is NOT associated with anxiety and/or depressive symptom relief? Upon ophthalmoscopic examination of a 78-year-old patient, the nurse practitioner observes dark spots against a red retina. What diagnosis is this finding most consistent with? A 72 year old female patient reports a 6 month history of progressively more swollen and painful distal interphalangeal (DIP) joints of one hand. There are no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis? The nurse practitioner is evaluating a 35-year-old female nurse. She has a history of hospitalization for hepatitis B infection 2 years ago. Her laboratory tests demonstrate positive HBsAg. The nurse practitioner would most likely diagnose: One exception to the recommendation to limit dietary fat intake is: The most effective primary prevention of skin cancer is to educate the public about: A patient has experienced nausea and vomiting, headache, malaise, low-grade fever, abdominal cramps, and diarrhea for 32 hours. The white count is slightly elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response? A child with Type 1 diabetes mellitus brings in a glucose diary indicating consistent morning hyperglycemia. How can the nurse practitioner differentiate the Somogyi effect from dawn phenomenon? Of the following signs and symptoms of heart failure (HF), the earliest clinical manifestation is: The mother of a 6-month-old infant asks about the use of an infant walker. The most appropriate response is to: A mother complains that her 3-month-old infant becomes constipated easily. She states she has been using her 4-year-old sibling's suppositories, but they make the baby "fussy" and have diarrhea stools. The nurse practitioner should recommend: A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that "there is something in my eye." What is the diagnosis and how should it be treated? . Initial treatment of a child presenting with a severe head injury is: Eligibility requirements for the ANP or FNP exam include all of the following EXCEPT: A 12-year-old presents with ear pain of 36 hours duration. The nurse practitioner diagnoses acute otitis media because the: An appropriate initial treatment for external genital warts caused by human papilloma virus (HPV) in a non-pregnant patient is: A 6-year-old presents with complaints of sore throat and fever for 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. There are no other remarkable findings. What is the most likely diagnosis? The daughter of a 75-year-old patient reports that her mother roams the house at night saying she cannot fall asleep. She has fallen twice. Of the following choices, which would be the most appropriate to treat her insomnia? Which antibiotic is demonstrated to be the most effective treatment for community acquired pneumonia (CAP) in young adults without any co-morbid conditions? All of the following are associated with erectile dysfunction (ED) EXCEPT: The nurse practitioner suspects migraine in a 6 year old male with a 2 month history of recurrent headache. What finding would support a diagnosis of migraine headache? A 49 year old man sees the nurse practitioner for evaluation of a 2 millimeter macular lesion on his back. The lesion is brown with regular borders. The most appropriate action for the nurse practitioner is to: A 45 year old with Type 1 diabetes mellitus has had itching and burning lesions between her toes for 6 months. Scrapings of the lesions confirm the diagnosis tinea pedis. What is the best treatment option for this patient? The nurse practitioner strongly suspects hyperthyroidism in a 62-year-old patient. Which of the following would NOT be an appropriate initial intervention? The most appropriate treatment for a child with mild croup is: A patient presents to the nurse practitioner with complaints of diarrhea and malaise which started at 2:00 am the morning of the visit. After history and examination, the nurse practitioner advises the patient that the problem should be self-limiting. If the diarrhea does not resolve, when should the nurse practitioner advise the patient to return? An obese 43-year-old has recurrent superficial fungal skin infections over the past 2 years. Today, she presents with intertriginous candida. Her skin is macerated from frequent rubbing and scratching. The plan of care for this patient should include: An obese hyperlipidemic patient, newly diagnosed with type 2 diabetes mellitus has fasting blood glucose values 180 to 250 mg/dL (10.1-14 mmol/L). What is the most appropriate initial treatment to consider? Which of the following set of symptoms should raise suspicion of a brain tumor? A 15-year-old high school student presents with a mild sore throat and low-grade fever that has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The nurse practitioner suspects mononucleosis. Which of the following is the LEAST appropriate intervention? A patient with shortness of breath has suspected heart failure. What evaluation would best help determine this? A 2-year-old female presents with a 3 day history of high fever, followed by abrupt resolution and development of a pink, maculopapular rash today. What pharmacological intervention(s) should the nurse practitioner consider? A middle-aged female complains of insomnia, night sweats, feeling intensely hot, emotional lability, extreme nervousness, and impatience. The LEAST likely cause of her symptoms is: An 8-year-old presents to the health clinic with history of acute onset severe sore throat and respiratory rate 34/minute in the last 30 minutes. The child's history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis is? All of the following are typical of toddlers EXCEPT: The nurse practitioner correctly teaches the patient with diabetes mellitus that if blood glucose is less than 100 mg/dL (5.6 mmol/L) prior to exercise, the patient should first consume 15 grams of carbohydrates, such as: A 17-year-old female presents with painful vesicular lesions on her vulva. Which of the following would be the most definitive diagnostic test? In the United States, occupational licensure is a responsibility of: A patient with a diagnosis of giardiasis is being treated with metronidazole (Flagyl®). What information would be important to obtain before prescribing this medication? An adolescent goes to Colorado for a ski trip. He is unaccustomed to the high altitude and very dry air. He develops nose bleeds and visits the nurse practitioner. What intervention is LEAST effective? Which of the following does NOT increase a woman's risk of developing cervical cancer? Advances in obstetric and neonatal care have: A patient presents with periorbital erythema and edema, fever, and nasal drainage. The nurse practitioner should: A 32-year-old female patient presents with fever, chills, right flank pain, right costovertebral angle tenderness, and hematuria. Her urinalysis is positive for leukocytes and red blood cells. The nurse practitioner diagnoses pyelonephritis. The most appropriate intervention is: A 16 year old sexually active student presents with complaints of a greenish-gray frothy vaginal discharge and vaginal itching. The nurse practitioner should suspect: Most hypertension in pre-adolescents and children is: The diagnosis of mitral valve prolapse can be confirmed by: Which laboratory abnormality may be observed in a patient who takes lisinopril? Which patient could be expected to have the highest systolic blood pressure? An 87 year old has history of symptomatic heart failure. He presents today with lower extremity edema and mild shortness of breath with exertion. In addition to a diuretic for volume overload, what other medication should he receive today? An elderly patient with hypertension and angina takes multiple medications. Which one of the following decreases the likelihood of his having angina? Which patient is most likely to have mitral valve prolapse? A 75 year-old patient with long-standing hypertension takes an ACE inhibitor and a thiazide diuretic daily. He has developed dyspnea on exertion and peripheral edema over the past several days. This probably indicates: The carotid arteries are auscultated for bruits because: A common, early finding in patients who have chronic aortic regurgitation (AR) is: Mrs. Jones is an 85 year old who has average blood pressures of 170/70. What agent would be a good starting medication to normalize her blood pressure? An elderly hypertensive patient has osteoporosis. Which antihypertensive agent would have the secondary effect of improving her osteoporosis? Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about one week? Warfarin therapy is greatly influenced by a patient's food and medication intake. Which group listed can potentially decrease INR in an outpatient who takes warfarin? A patient with newly diagnosed heart failure has started fosinopril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure? An 80 year-old female who is otherwise well, has a blood pressure of 176/80. How should she be managed pharmacologically? How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors? A patient will be screened for hyperlipidemia via a serum specimen. He should be told: Tables are used for determination of maximum blood pressure values for adolescents. How are blood pressure values established for adolescents? A nurse practitioner has not increased the dosage of an antihypertensive medication even though the patient's blood pressure has remained >140/90. This might be described A 28 year-old has a Grade 3 murmur. Which characteristic indicates a need for referral? In older adults, the three most common ailments are: Niacin is known to: A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI): An example of a premalignant lesion that develops on sun-damaged skin is: A patient is found to have koilonychia. What laboratory test would be prudent to perform? A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the infected area would likely demonstrate: Which of the following antibiotics may increase the likelihood of photosensitivity? The agent commonly used to treat patients with scabies is permethrin. How often is it applied to eradicate scabies? Most cases of atopic dermatitis exacerbation are treated with: A patient has used a high potency topical steroid cream for years to treat psoriasis exacerbations when they occur. She presents today and states that this cream "just doesn't work anymore." What word describes this? A 3 year-old female had a fever of 102 degrees F for 3 days. Today she woke up from a nap and is afebrile. She has a maculopapular rash. Which statement is true? A topical treatment for basal cell carcinoma is: A child with a sandpaper textured rash probably has: A 6 year-old patient with sore throat has coryza, hoarseness, and diarrhea. What is the likely etiology? A patient has been diagnosed with MRSA. She is sulfa allergic. Which medication could be used to treat her? Which of the following skin lesions in the elderly is a premalignant condition? Mr. Johnson is a 74 year old who presents with a pearly-domed nodular looking lesion on the back of the neck. It does not hurt or itch. What is a likely etiology? What advice should be given to a parent who has a child with Fifth Disease? Which of the following areas of the body has the greatest percutaneous absorption? A 68 year old female adult with pendulous breasts complains of "burning" under her right breast. The nurse practitioner observes a malodorous discharge with mild maceration under both breasts. What is this? A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive ELISA for Borrelia. The Western blot is positive. How should he be managed? A patient with a primary case of scabies was probably infected: A patient has a lower leg wound that appears infected. It is red, warm to touch and edematous. He had an acute onset of pain, symptoms, and low grade fever. What is this? The main difference between cellulitis and erysipelas is the: A 6 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? A 16 year-old has been diagnosed with Lyme disease. Which drug should be used to treat him? An adolescent athlete has injured his ankle playing basketball. He has right ankle pain, ecchymosis, significant edema, and he is unable to bear weight at the time of the clinical exam. Which diagnosis is least likely? An adolescent complains of knee pain. He is diagnosed with Osgood-Schlatter disease. What assessment finding is typical? A 75 year-old female, who knits daily, has a positive Finkelstein test. What is her likely diagnosis? If plantar fasciitis is suspected in a patient, how is this diagnosed? A 70 year old patient has had intermittent back pain for more than 3 years. In the last year, it is constant (pain scale is 2-3/10) and at times is sharp. She is not a surgical candidate. What class of medication would be a good choice for improvement of chronic pain in this patient? pain a patient experiences. A male patient takes HCTZ daily for hypertension. He developed severe pain in his great toe yesterday. He was diagnosed with gout today and started on a medication. Which medication listed below would be contraindicated at this time? The age at which a child can first walk backwards is: A 45 year-old male who is in good health presents with complaints of pain in his left heel. He states that the first few steps out of bed in the morning are extremely painful. He has no history of trauma. What is the likely etiology of his pain? A 70 year-old African American male complains of pain in his back and trunk. Cardiovascular disease is ruled out. He has a normocytic normochromic anemia with hypercalcemia. A likely diagnosis is: A young athlete is found to have a depression of the longitudinal arch of both feet. He complains of heel pain bilaterally. The rest of his foot is normal and he has continued with his activities. What could be recommended for his heel pain? Which of the following tests, if positive, is part of the criteria for systemic lupus erythematosus (SLE)? Bone mineral density screening in women over age 65 years is an example of: patient who is 73 years old was diagnosed with diabetes several years ago. His A1C has remained elevated on oral agents and a decision to use insulin has been made. What is the goal post prandial glucose for him? A 37 year-old overweight male is diagnosed today with Type II diabetes. His fasting glucose is 159 mg/dL. He is hyperlipidemic (LDL = 210 mg/dL) and hypertensive (146/102). What medications should be initiated today? A patient presents with consistently elevated blood glucose before his evening meal. What choice below represents an insulin change that would improve his evening glucose? Current regimen: AM: 22u intermediate-acting insulin, 12u short-acting insulin PM: 10u intermediate-acting insulin, 8u short-acting insulin What is the earliest detectable glycemic abnormality in a patient with Type 2 diabetes? Which laboratory abnormality very commonly accompanies hypothyroidism? A 55-year-old female patient with diabetes has these fasting lipid values: Total cholesterol 200 mg/dL HDL 45 mg/dL LDL levels of 120 mg/dL Triglyceride 309 mg/dL This patient's Hgb A1c was measured. It is 9.2%. What is the relationship between Hgb A1c and this patient's lipid values? A 45 year-old female patient has a screening TSH performed. Her TSH value is 13 mU/L. It was repeated in one week and found to be 15 mU/L. What explains this finding? A 65 year-old diabetic has been on oral anti-hyperglycemic agents and is still having poor glycemic control. His AM fasting glucoses range from 140s-160s. You decide to add insulin. He weighs 127 kilograms. What should the NP order as an initial starting dose? Which one is not a risk factor for the development of Type 2 diabetes? A 76 year-old patient has fasting glucose values of 151 mg/dL and 138 mg/dL on different days. This patient: A 55-year-old female patient with diabetes has these fasting lipid values: Total cholesterol 200 mg/dL HDL 45 mg/dL LDL levels of 120 mg/dL Triglyceride 309 mg/dL According to American Diabetes Association (ADA) which patient lipid value(s) meet(s) the goal for this patient? A 32 year-old patient is a newly diagnosed diabetic. She has developed a sinus infection. Her symptoms have persisted for 10 days. Six weeks ago she was treated with amoxicillin for an upper respiratory infection. It cleared without incident. What should be recommended today? A patient with mononucleosis would most likely have: What symptom triad is most commonly associated with infectious mononucleosis? How long should a 6 year old with acute otitis media be treated with an antibiotic? An 80 year-old is having difficulty hearing. When the nurse practitioner examines him, she is unable to visualize the tympanic membrane because of cerumen impaction. This produces what kind of hearing loss? The hearing loss associated with aging involves: What is the usual age for vision screening in young children? An elderly patient who has a red eye with tearing was diagnosed with conjunctivitis. What characteristics below indicate viral conjunctivitis? A patient diagnosed with Strept throat received a prescription for azithromycin. She has not improved in 48 hours. What course of action is acceptable? [Show More]
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