NP Exam 1 Review Questions with Accurate Answers

NP Exam 1 Review Questions with Accurate Answers A 43-year-old male recently underwent three months worth of lifestyle interventions but only had a moderate change in overall blood pressure readings at home. At today's visit, his blood pressure is consistent with his home readings, and is 138/85. The nurse practitioner knows that according to the AHA guidelines, we should begin initiating medications for a stage 1 hypertensive patient at what ASCVD cutoff point? 10% it is appropriate to initiate antihypertensives if their ASCVD risk score is 10% or greater. (Hint: can think of hyperTENsion to remember!) A middle-aged female presents to your clinic today. She has a history of smoking, hypertension, type II diabetes, and osteoporosis. She has been on lisinopril (Prinvil) 10 mg daily for the past five years and metformin (Glucophage) 500 mg twice daily. Upon your physical exam you notice asymmetric, non-pitting swelling around her upper lip which the patient states started yesterday night and is painless. She also reports diffuse abdominal pain and diarrhea. The rest of the physical exam was benign. Her fasting blood glucose is 130. Her vital signs are as follows: BP: 141/87 mmHg, HR: 92 bpm, RR: 12 breaths per minute, O2: 96% on room air. What is the most important thing for the nurse practitioner to do? Discontinue her lisinopril This patient is experiencing angioedema - ACE Inhibitor induced angioedema can occur anytime (days, weeks, or years after initiation). In addition to swelling of the lips, tongue, and face, visceral angioedema due to an ACE inhibitor can occur and cause symptoms including abdominal pain, diarrhea, and vomiting. She needs to immediately stop the lisinopril and it needs to be marked as an allergy. A patient calls the office complaining of a sudden onset of "cobweb like lines" moving in and out of her central vision in the right eye. She is not in any pain and is asking if she needs to come in and be seen. What should the nurse practitioner advise her to do? Refer to opthalmogogy immediately A group of new nurse practitioners are evaluating the strength of evidence of some new asthma guidelines. Which of the following would be at the bottom of the hierarchy of evidence? Editorial A 55-year-old male patient reports increasing issues with erectile dysfunction over the last six months. He is requesting to be placed on tadalafil (Cialis) for control of this condition. Which of the following is critical for the nurse practitioner to order prior to prescribing this medication? EKG You are performing an annual exam and pap smear on a 39-year-old woman who states she has never had a mammogram before. A close friend of hers was just diagnosed with breast cancer and she is wanting to know more about her risk and when she should begin screening. What in her history would be considered a risk factor for breast cancer? Her only child is a step daughter You recently diagnosed your patient with sciatica. You ask the patient to perform the squat and rise exam, and you found that there is a diminished knee jerk. Which of the following is the root cause of his sciatica based on this finding? L4 The squat and rise exam with a diminished knee jerk links to the L4 nerve. We can assess L5 with the heel walk and S1 with the toe walk. You are assessing a patient for acute abdominal pain. With the patient supine and right knee flexed, you perform inward rotation on the patient's hip. What maneuver is this and what are you assessing for? Obturator sign to assess for appendicitis Obturator- Is inward rOtation of the hip through full ROM and is a pOsitive sign w/ mOvement or flexion of the hip (I think of all the O's). Iliopsoas/psoas sign is performed by having patients raise their leg against resistance in a supine position, then while on their left side, extending the right leg from the hip ( When you do leg raises at the gym, your iliopsoas muscles are sore). Murphy's sign is elicited when deep palpation on the RUQ under the costal border produces pain during Midinspiratory arrest (I think M for Murphy's and M for Midinspiratory). An 85-year-old woman presents to the clinic today for a follow up x-ray. She states that she had x-rays completed 11 days after a fall at home but the imaging was negative at that time. Due to the nature of her fall, she was instructed to come in for an additional set of x-rays if the pain persisted. The nurse practitioner knows that if this patient has a fracture today, it is most likely which of the following? Scaphoid fracture Your 63-year-old male patient with vague abdominal pain has a triglyceride level of 899. Which of the following clinical signs would be most concerning given this lab value? Cullen's sign Patients with polycystic ovarian syndrome (PCOS) may develop all of the following except: Breast CA Upon a digital rectal examination, the nurse practitioner notes a warm and boggy prostate. This finding is consistent with which diagnosis? Prostatitis A 67-year-old male patient is currently being treated for benign prostatic hyperplasia. He is concerned that his finasteride (Proscar) is not adequately treating his symptoms. Which of the following questions is most important to ask this patient to do a further assessment? How long have you been taking this medication? A 33-year-old female is complaining of dysuria, flank pain and a fever. Her vital signs are as follows: BP: 112/76, HR: 76, RR: 18, 97% on room air, Temp: 101.6 F. The patient states she has had a urinary tract infection off and on over the past month and antibiotics never really helped. Upon your physical exam you elicit CVA tenderness. What is the best plan for this patient? Referral to the emergency room A 14-year-old male is complaining of scrotal pain. Which of the following descriptions would warrant immediate referral? The pain is unilateral and when you gently pinch the inner thigh, the testicle does not elevate An elderly patient who lives with his daughter is diagnosed with terminal cancer and asks you to not share the information with his daughter. Not sharing this information without the patient's consent upholds which ethical principle? Fidelity You are concerned that your diabetic patient may be developing chronic kidney disease. Which lab would be the best evaluation of the patient's kidney function? Glomerular Filtration Rate A 67-year-old female patient comes into the clinic today with a chief complaint of joint pain and stiffness. Which of the following symptoms would lead you to include osteoarthritis as a possible differential? Morning stiffness lasting 1 hour Which of the following is not a possible long-term complication of bulimia? Higher seizure threshold As a nurse practitioner, you want to educate your patient about the possible microvascular complications of diabetes that may occur. Which of the following is not one of these complications? Stroke You are concerned about prescribing an antidiabetic medication that may cause hypoglycemia because your patient has a history of falls. Which of the following medications would be most appropriate to prescribe? Metformin A middle-aged patient recently presented to the clinic with twitching of the upper lip and cheek in addition to new paresthesias noted in their fingertips and toes. The nurse practitioner would expect which of the following lab levels to be decreased when the labs result? Calcium A patient suffering from new palpitations and tremors has recently been diagnosed with hyperthyroidism. Upon assessment, the following EKG results are interpreted: an irregular QRS complex and absent P waves. Which of the following would be the most appropriate interpretation of this EKG? A FIB A patient messages you via the patient portal asking about what foods they need to avoid while taking their newly prescribed phenelzine (Nardil). Which of the following would you not include on the list of foods to avoid? Garbanzo beans After several months of increasing ankle swelling and a congested cough, a 63-year-old male patient is diagnosed with heart failure after his echocardiogram showed an ejection fraction of 38%. Today, he is presenting with a list of his current medications for medication reconciliation. Which medication would be appropriate to discontinue at today's visit? Diclofenac (Voltaren) A mother presents with her two young children, both of which have erythematous papules and burrows in-between their fingers. Which of the following would be the best treatment for this condition? Permethrin (NIX) A 39-year-old female patient was diagnosed with GERD today during her visit. She has no significant past medical history but is about to lose her insurance. What is the most appropriate medication to prescribe this patient today for her GERD? Nizatidine (Axid XR) A postmenopausal woman presents to the clinic with new onset vaginal bleeding. Which of the following is the nurse practitioner most concerned about? Endometrial cancer A 78-year-old patient with metastatic cancer is in your office to talk about potential hospice care. Which of the following would qualify this patient for such care? The patient needs help dressing, taking a shower, and making meals You are concerned that your patient may be developing chronic kidney disease. Which of the following is the least likely cause for this patient's possible CKD? Obesity You are concerned that your elderly patient may be at increased risk for falls. Which tool is most appropriate to use to further assess your patient's fall risk? TUG test Your middle-aged patient decides to begin lifestyle modifications such as diet and exercise to avoid the risk of going from pre-diabetic to being an actual diabetic. This is an example of which of the following? Health Belief Model All of the following are possible complications of long term steroid use except: Weight Loss You work in a rural clinic with many Medicare and Medicaid patients. One of your Medicare patients is asking which part of their plan covers their every other day dialysis appointments. How should you respond? Medicare Part B