APEA MAJOR EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026

APEA MAJOR EXAM QUESTIONS ANSWERED CORRECTLY LATEST UPDATE 2026 Which one of the following is an ethical infraction when using electronic medical records? - Answers Copying and pasting outdated notes Practice authority for advanced practice registered nurses (APRNs) is granted by: - Answers each state's board of nursing Which answer is true about full practice authority for nurse practitioners? - Answers Full practice authority is the authorization of nurse practitioners to evaluate patients; diagnose, order and interpret diagnostic tests; and to initiate and manage treatments—including prescribing medications—without required physical collaboration or supervision. Which of the following scenarios reflects "incident to" billing for Medicare-covered services? - Answers An NP bills 100% of the allowable Medicare fee schedule for follow-up care The scope of practice for nurse practitioners is determined by: - Answers the state government Medicare Part B covers - Answers physician services, outpatient services, and durable medical equipment Select the statement that best describes the role of a women's health nurse practitioner (WHNP) - Answers The role of the WHNP is to assess, diagnose, and treat the healthcare needs of women throughout their lifespan Statistical significance is represented by the P value. Which statement about P value is correct? - Answers When counseling a patient diagnosed with generalized anxiety disorder (GAD) or panic disorder, lifestyle modifications to decrease symptoms should include - Answers exercising vigorously for 20 minutes three times a week Which of the following is used to evaluate suspected obstructive sleep apnea (OSA) in patients who present with a sleep disorder? - Answers Polysomnography Why is it often challenging to differentiate between the diagnosis of major depressive disorder (MDD) and bipolar disorder? - Answers Patients with bipolar disorder often present for treatment during their low mood Which statement about grief/bereavement and major depressive disorder (MDD) is correct? - Answers Depression cannot be distinguished from grief/bereavement for at least 1 year after a loss The first-line drug class for the treatment of patients with generalized anxiety disorder (GAD) is - Answers selective serotonin reuptake inhibitors (SSRIs) Which of the following tools is considered the validated screening tool for identifying generalized anxiety disorder (GAD)? - Answers Generalized Anxiety Disorder questionnaire When initiating pharmacologic treatment for depression, what is the recommended interval for monitoring therapeutic effects? - Answers Every 2-4 weeks until therapeutic dose is reached According to DSM-5 criteria, what core symptoms must be present to diagnosis major depressive disorder (MDD)? - Answers Anhedonia Because of the high prevalence of postpartum depression, screening is recommended for all women in the perinatal period. The evidence-based tool recommended for outpatient perinatal and postpartum depression screening is the: - Answers Edinburgh scale The highly sensitive and specific assessment tool that should be used in primary care to evaluate patients suspected of alcohol use disorder (AUD) is: - Answers AUDIT Which one of the following physical attributes is most common in patients who have obstructive sleep apnea? - Answers Enlarged neck circumference The medication approved by the U.S. Food and Drug Administration (FDA) for use in the treatment of patients diagnosed with opioid use disorder (OUD) is: - Answers buprenorphine When prescribing zolpidem for patients diagnosed with insomnia, it is important to stress that the potentially serious side effect of this medication is - Answers amnesia Which of the following is an accepted instrument for initial general depression screening in the outpatient setting? - Answers Patient Health Questionnaire-2 (PHQ-2) When considering primary treatment goals for chronic insomnia, the priorities should include: - Answers improving symptoms of insomnia-related daytime impairment Which of the following is the best choice for treating community-acquired pneumonia (CAP) in an outpatient with no antibiotic use in the prior 3 months? - Answers Azithromycin monotherapy Expiratory airway restriction is a distinct characteristic of: - Answers chronic obstructive pulmonary disease (COPD). The tool used to confirm a suspected diagnosis of chronic obstructive pulmonary disease (COPD) is: - Answers spirometry. Differential diagnoses for the common cold would NOT include: - Answers varicella. When evaluating a patient's asthma symptom control over the prior 4 weeks, which of the following should be documented? - Answers Frequency of nighttime awakening due to asthma symptoms The CURB-65 criteria (confusion, urea, respiratory rate, blood pressure, age 65 or older) is a decision making tool used in the treatment of pneumonia when determining whether: - Answers inpatient management is advisable. Which one of the following has been proven effective in symptom management for the common cold? - Answers Acetaminophen When evaluating a patient who reports variable expiratory airflow restriction triggered by exercise, allergens, or irritant exposure, the differential diagnosis list should include: - Answers asthma. For patients diagnosed with bronchitis, which drug class is associated with improvement in cough without wheezing? - Answers Expectorants Which of the following statements about the use of codeine-based cough suppressants in viral upper respiratory illness is correct? - Answers Codeine-based cough suppressants are not recommended due to their potential to induce respiratory depression. While evaluating a patient with cough, the NP notes egophony over the middle lobe of the right lung. This finding raises concern for: - Answers a pulmonary consolidation. When considering a diagnosis of acute bacterial respiratory illness, the MOST concerning sign is: - Answers worsening symptoms with fever. When initiating treatment for mild asthma according to guidelines from the Global Initiative for Asthma (GINA), the first step is to prescribe a: - Answers low-dose inhaled corticosteroid (ICS) and formoterol preparation. Which one of the following raises concern for worsening asthma? - Answers Any number of nighttime symptoms A combination of breathing through pursed lips, use of accessory chest muscles, and increased anteroposterior chest diameter is characteristic of what disease process? - Answers Chronic obstructive pulmonary disease (COPD) Which one of the following is expected between asthma exacerbations? - Answers An absence of symptoms A patient asks about the optimal gestational age to perform first trimester screening. She wants to maximize Trisomy 21 detection and decrease the possibility of false-positive results. Based on her goal, when should a cell-free DNA test be performed? - Answers At 11 weeks' gestation A patient presents for an initial obstetric physical and reports a family history of autism. Which of the following would be most appropriate to include in her prenatal screening? - Answers Fragile X syndrome (FMR1 gene) A multiparous pregnant woman at 36 weeks' gestation complains about having only one or two bowel movements each week. She has been eating fresh vegetables and drinking at least 64 ounces of water daily. Her provider recommends a bulk-forming laxative. What is the correct way to explain how it works? - Answers It absorbs water and expands and increases moisture in the stool, making it easier to pass. Which category of medication is associated with the highest risk for fetal growth restriction (FGR)? - Answers Antiepileptic drugs A 25-year-old primigravida woman presents for an initial prenatal exam. Based on her last menstrual period (LMP), her calculated estimated gestational age (EGA) is 12 weeks. Based on her estimated gestational age, the fundus should be palpable: - Answers just above her pubic bone. During an initial obstetric physical exam, which finding would be considered normal for the cardiovascular portion of the examination? - Answers An S3 gallop When talking with a pregnant patient about hormonal effects she may be experiencing, what system is most likely to be noticeably slowed in response to her pregnancy progesterone levels? - Answers Bowel evacuation At what point would a woman exposed to congenital cytomegalovirus (CMV) have an increased risk of infant infection? - Answers During periconception or the first trimester A pregnant patient in her second trimester has noticed more heartburn and flatulence. The WHNP explains that these symptoms are most likely the result of: - Answers decreased gastric acidity. A pregnant patient in her second trimester has noticed contractions each afternoon. What would raise suspicions for preterm labor? - Answers Cervical dilation and/or effacement A pregnant patient has group B Streptococcus bacteriuria, at a level 105 CFU/mL. In the absence of an allergy, what intrapartum prophylaxis should be administered? - Answers Penicillin G IV every 4 hours When evaluating a pregnant woman's complete blood count, which laboratory value would indicate iron deficiency anemia? - Answers Decreased serum ferritin level A pregnant woman with a history of well-controlled hypertension is taking an angiotensin-converting-enzyme (ACE) inhibitor. What recommendation should the WHNP share with her? - Answers "Continuing this medication is not recommended. We need to discuss medication options." A patient in the third trimester comments, "I'm constipated all the time!" The appropriate intervention for relief would be: - Answers an increase in fiber intake. A uterine fundal height at the umbilicus most likely connotes a: - Answers 20-week gestation. A pregnant woman infected with human immunodeficiency virus (HIV) is already taking antiretroviral (ARV) therapy when she begins prenatal care. What fetal surveillance is indicated for her in the second trimester? - Answers Fetal anatomy ultrasound When a pregnant woman is visibly acutely ill, which differential should be considered because it is the most common cause of fatal nonobstetric infection in pregnant women? - Answers Pneumonia The U.S. Preventive Service Task Force recommends that all women seeking obstetric care be screened for alcohol use in the first trimester of pregnancy. Which tool is the most universally reliable for this purpose? - Answers TACE A patient has a reactive enzyme immunoassay (EIA) test and a reactive reflex rapid plasma reagin (RPR) test. She states that she recently experienced a rash, which resolved without treatment. She has no other symptoms. What stage of syphilis does this most likely represent? - Answers Early latent When speaking with a patient who is late in her third trimester, the best explanation for aching swollen leg veins would be: - Answers increased pressure on blood vessels from the enlarging uterus. For a midtrimester pregnant woman with a urinary tract infection, which one of the antibiotic choices would be appropriate? - Answers Fosfomycin Which finding has a higher correlation with fetal growth restriction (FGR) identified before 32 weeks' gestation compared to identification at 32 weeks' gestation or later? - Answers Gestational hypertension After explaining the diagnosis of severe iron deficiency anemia to a pregnant woman, what statement conveys that she understands the importance of treatment? - Answers "My baby could be small for gestational age (SGA) if my iron level is not adequate." Based on recommendations from the Centers for Disease Control and Prevention (CDC), which of the following women should be tested for HIV? - Answers All pregnant women Pregnant women with bipolar disorder who elect to discontinue their mood stabilizer medication while pregnant should be informed that the risk of new episodes is highest in which trimester? - Answers The first When should Rho(D) immune globulin (RhoGAM) be administered to an RhD-negative woman with no RH antibodies? - Answers After an uncomplicated delivery of an RhD-positive infant What is the current recommendation for influenza vaccination in pregnant women? - Answers All pregnant women should receive the inactivated influenza vaccine as soon as it is available. A 30-year-old G1 P0 woman presents for a routine prenatal exam at 26 weeks' gestation. Her pregnancy has been uncomplicated. Which screening test should the WHNP order and discuss with her at this time? - Answers 50-g 1-hour glucose test A 31-year-old woman presents for a routine gynecologic exam and mentions that she and her husband are contemplating pregnancy. What is the best advice to offer this couple? - Answers "Begin taking a folic acid supplement now." A low-risk pregnant patient's rubella titer shows that she does not have immunity. She will require postpartal vaccination. What is an important point for her to understand? - Answers The rubella immunization is contraindicated in a patient with a previous severe allergic reaction to it. At her routine 36-week obstetric appointment, a pregnant woman's fetal heart rate is above the umbilicus and she reports feeling kicks low in her abdomen. An ultrasound confirms breech presentation. In accordance with guidelines from the American College of Obstetricians and Gynecologists, what intervention would help correct the problem? - Answers External cephalic version A pregnant patient presents for an acute visit with complaints of fever, myalgias and nonproductive cough for the past 2 days. Because it is flu season, and based on the clinical evaluation, the WHNP treats the patient presumptively for influenza. What treatment will the WHNP prescribe? - Answers Oseltamivir 75 mg BID for 5 days Which lifestyle factors can cause a generalized increase in hemoglobin and hematocrit levels and should be considered when interpreting lab results in pregnant women? - Answers Living at a high altitude and tobacco use A woman who is 30 weeks pregnant presents to the clinic because she believes she is experiencing contractions. The most appropriate intervention at this time would be to perform a: - Answers fetal fibronectin test. During a normal uncomplicated pregnancy, what are the expected findings of a thyroid exam? - Answers A euthyroid state When assessing the fetus of a pregnant woman who is receiving treatment for syphilis infection, what is the best method of evaluation? - Answers Fetal sonogram A 22-year-old woman with a 24-week intrauterine pregnancy based on her last menstrual period has a fundal height of 20 cm. Fetal movement and fetal heart tones are present. Which of the following should be the next step in her care? - Answers Order an ultrasound study When teaching a pregnant woman about the suppressive antiviral therapy she is starting for herpes simplex virus (HSV) infection, which of the following is true? - Answers Suppressive antiviral decreases the rate of HSV transmission to susceptible heterosexual partners. What is the proper time frame for rubella vaccination in a pregnant patient with seronegative titers? - Answers After delivery A 29-year-old woman with essential hypertension schedules an office visit after a positive home pregnancy test. Her blood pressure is well controlled on lisinopril. Routine laboratory testing produces no unusual findings, and her physical exam is unremarkable. The pregnancy was not planned and she wants to know whether she should adjust her medication. How should the WHNP proceed? - Answers Start a daily prenatal vitamin and substitute labetalol for lisinopril. What does the Centers for Disease Control and Prevention (CDC) recommend as a preferred treatment for primary, secondary or early latent syphilis in pregnancy? - Answers Two-dose regimen of benzathine penicillin G As a singleton pregnancy progresses, how does the disproportionate increase in plasma volume and erythrocyte mass affect laboratory results? - Answers Decreased hematocrit levels When a pregnant woman reports leg cramps, what would be the most appropriate recommendation for symptom relief? - Answers Stand and dorsiflex the affected foot toward the knee Which of the following scenarios describes a true Rh incompatibility? - Answers The first pregnancy of an Rh(-) mother will not affect the fetus. A multiparous patient is in clinic for a routine obstetric appointment. Her fundal height is 27 cm from the symphysis pubis. Fetal heart tones are 136 beats per minute. She had no complications during previous pregnancies, and she reports none in her current one. A previous ultrasound performed at 20 weeks' gestation showed a singleton pregnancy. The most likely estimated gestational age is: - Answers 28 weeks. A patient in the third trimester has noticed that she becomes short of breath with activity levels that were comfortable for her prior to pregnancy. This symptom may be consistent with: - Answers the uterine fundal position pushing the diaphragm upward. What is the appropriate window to screen for gestational diabetes in a pregnant woman who is at average risk? - Answers Between weeks 25 and 28 of pregnancy A patient at 32 weeks' gestation has no history of herpes simplex virus (HSV). Her husband has a history of recurrent genital herpes, so she presents for counseling about reducing genital HSV transmission risk for the remainder of her pregnancy. What recommendation should the WHNP make to this patient? - Answers Abstain from vaginal intercourse with your husband for the remainder of the pregnancy. How does the National Institute on Alcohol Abuse and Alcoholism (NIAAA) define binge drinking in women? - Answers Four or more drinks in 2 hours In a 41-year-old multiparous pregnant woman, which one of the following is the most common risk? - Answers Multiple gestation pregnancy A pregnant patient's rubella titer shows that she is not immune and will need to be vaccinated postpartally. She is considered at low risk. What is an important consideration for this patient to understand? - Answers Pregnancy should be avoided for 4 weeks after immunization. During a prenatal visit, a patient tells the WHNP that the first day of her last menstrual period was Feb. 8. Based on Naegele's rule, when is the estimated date of delivery (EDD)? - Answers Nov. 15 For a pregnant patient with constipation, what would be appropriate lifestyle modifications to help with symptoms? - Answers Drinking plenty of fluids, eating 25 grams of fiber daily, and exercising regularly When using ultrasonography to estimate gestational age in pregnancy, it is important to understand that: - Answers the crown-rump length is a more accurate indicator of gestational age than the mean gestational sac diameter. During a prenatal visit, a patient tells the WHNP that the first day of her last menstrual period was Dec. 26. Based on Naegele's rule, when is the patient's estimated date of delivery (EDD)? - Answers Oct. 2 After the first outbreak, lesions associated with genital herpes simplex virus (HSV) typically heal: - Answers within 1 to 3 weeks. According to the evidence, what tool can be used to reduce risk for a pregnant woman with a singleton pregnancy who previously had a spontaneous preterm singleton delivery? - Answers Vaginal progesterone On her obstetric history form, a woman notes that the first day of her last menstrual period (LMP) was June 12. Her menstrual cycles had been regularly timed and consistent in length and duration. Based on Naegele's rule, her estimated date of delivery (EDD) is: - Answers March 19. Which part of a woman's history is a risk factor that warrants syphilis testing at 28 weeks' gestation and again at delivery? - Answers Living in a community with high rates of syphilis infection In which of the following situations would screening for bacterial vaginosis (BV) be most useful? - Answers A pregnant woman with malodorous discharge Which routine screening laboratory findings should prompt the WHNP to test for hemoglobinopathies? - Answers Anemia and normal iron studies Fetal growth restriction diagnosed before 32 weeks' gestation is commonly associated with: - Answers chromosomal abnormality. As a normal pregnancy progresses, a woman's cardiovascular system adjusts with an increase in cardiac output. In the first half of pregnancy, what is the major cause of the increased cardiac output? - Answers Increased stroke volume A patient presents after a positive pregnancy test. She does not recall the first day of her last menstrual period. Which of the following fundal heights is most consistent with a pregnancy less than 12 weeks' gestation? - Answers Uterine fundal height in the pelvis Normal physiologic respiratory changes in pregnancy include: - Answers an increase in tidal volume. When treating a pregnant women with a bacterial upper respiratory infection, what is the first-line antibiotic treatment? - Answers Amoxicillin-clavulanate A pregnant woman at 30 weeks' gestation has iron deficiency anemia. Which therapy should first be considered for her? - Answers Increased oral iron A multiparous woman is in clinic for her routine 28-week appointment. What vaccine does the American College of Obstetricians and Gynecologists (ACOG) recommend that all pregnant women receive between 27 and 36 weeks' gestation? - Answers Tetanus, diphtheria and pertussis (Tdap) A pregnant woman in her second trimester asks whether she should be immunized against influenza. What is the best response? - Answers "All women who are pregnant during influenza season should receive an inactivated influenza vaccine as soon as it is available." When indicated for maternal herpes simplex virus (HSV), acyclovir use in pregnancy is generally: - Answers recommended at 36 weeks' gestation for virus suppression. For a diagnosis of osteoporosis to be considered, the T-score should be: - Answers less than or equal to -2.5 of the femur. What is the current recommendation for screening nonpregnant asymptomatic women for bacteriuria? - Answers No routine screening in nonpregnant adult women When discussing weight loss with a patient, which dietary intervention should be recommended? - Answers Daily caloric reduction of 500-750 calories below estimated energy needs When evaluating a patient who has been diagnosed with osteoporosis, the recommended laboratory study that would assist in assessing for secondary causes is: - Answers 25-hydroxyvitamin D. Which of the following is a recommended annual screening in the management of diabetes mellitus (DM): - Answers random urine albumin-to-creatinine ratio. A patient presents with symptoms suggestive of diabetes mellitus (DM). Diagnostic criteria associated with DM include: - Answers symptoms of hyperglycemia and a random plasma glucose 200 mg/dL. The U.S. Preventive Services Task Force (USPSTF) recommends screening all women of reproductive age for intimate partner violence (IPV). Which of the following would be an appropriate approach to IPV screening? - Answers Initiate a conversation by saying: "Many people experience problems that can affect their health, so I ask all my patients their home life." Low-dose computerized tomography (LDCT) of the chest is used to screen for: - Answers lung cancer. A 25-year-old woman presents for a wellness exam. She asks if she can receive the human papillomavirus (HPV) vaccine. The most appropriate response would be: - Answers "Yes, the human papillomavirus (HPV) vaccine is indicated for patients up to age 45 years." A 50-year-old woman presents with a 10-year cardiovascular risk of at least 10%. Which recommendation would be appropriate to lower her risk? - Answers 81 mg aspirin daily The nurse practitioner is reviewing the Pap test result for a 29-year-old woman with a low-grade squamous intraepithelial lesion (LSIL) and a human papillomavirus (HPV) screening result positive for HPV-18. History shows that her previous Pap test results have all been normal. The most appropriate intervention would be to: - Answers perform a colposcopy. Which body mass index (BMI) range would classify a patient as being overweight? - Answers 25.0 to 29.9 kg/m2 Women who have systemic lupus erythematosus (SLE) with positive antiphospholipid antibodies are at higher risk of vascular ischemia. Because of this, the preferred method of contraception is: - Answers a copper intrauterine device (IUD). In which clinical scenario would obtaining an autoimmune antibody level (ANA) be most beneficial? - Answers When clinical findings correlate with positive autoimmune antibodies A physical finding of glossitis in a patient who presents with fatigue may be associated with: - Answers anemia. Fetal neural tube defects may develop during pregnancy in women with: - Answers folic acid deficiency. During a digital pressure exam by the NP, the patient reports tenderness over multiple soft tissue pressure points. These findings are most consistent with: - Answers fibromyalgia. When prescribing iron supplementation to a patient diagnosed with iron deficiency anemia (IDA), the patient should be informed about the possible side effect of: - Answers constipation. Sickle cell anemia is often overlooked in adults because screening is routinely completed: - Answers during the newborn period. When evaluating a patient for iron deficiency anemia (IDA), which of the following lab results would be diagnostic? - Answers Decreased serum ferritin For most patients diagnosed with rheumatoid arthritis, the nonbiologic disease-modifying antirheumatic drug (DMARD) that is considered first-line treatment is: - Answers methotrexate. Pallor observed in the palpebral conjunctivae is a physical assessment finding MOST often associated with: - Answers anemia. A malar rash across the nose and cheeks is a clinical finding most consistent with: - Answers systemic lupus erythematosus (SLE). What guidance could best help a patient reduce cutaneous manifestations of systemic lupus erythematosus (SLE)? - Answers Recommend applying a broad-spectrum sunscreen daily A presentation of long-term symmetrical polyarthritic joint changes in the hands, feet, and wrists is consistent with: - Answers rheumatoid arthritis. Which of the following is an important consideration when providing pregnancy counseling to a patient who has systemic lupus erythematosus (SLE)? - Answers Pregnancy should be planned when systemic lupus erythematosus (SLE) is under good control with medications that are not fetotoxic. Anemia may be associated with long-term use of: - Answers metformin. Which of the following best describes the differentiation between chronic and acute prostatitis? - Answers Chronic prostatitis produces symptoms for more than 3 of the preceding 6 months. Assessment for erectile dysfunction should include which of the following? - Answers A vascular exam including femoral and lower extremity pulses A 32-year-old man presents for an infertility workup. During the physical exam, the NP notes a cluster of veins on the left testicle. This is significant because: - Answers varicocele is associated with low sperm count and motility. The most likely differential for a man who presents with tenesmus, rectal burning, and discharge would be: - Answers Neisseria gonorrhoeae infection. Contraindications to testosterone therapy include: - Answers prostate cancer. What of the following is considered acceptable for patient-applied treatment for condyloma acuminatum? - Answers Podofilox 0.5% Which of the following is the recommended screening test for human papillomavirus (HPV) infection in men? - Answers No HPV screening test for men is available. In patients who present with symptoms suggestive of epididymitis, the exclusion of which differential diagnosis is time sensitive and critical? - Answers Testicular torsion Acute prostatitis is usually diagnosed: - Answers based on symptoms only. According to the Centers for Disease Control and Prevention (CDC), first-line treatment for N. gonorrhea infection when Chlamydia trachomatis has been excluded is: - Answers ceftriaxone one dose IM based on weight. Ken, age 45, just learned that his sister tested positive for the BRCA 2 genetic mutation. Ken's mother died of breast cancer, and his maternal aunt died of ovarian cancer. If Ken is also BRCA 2-positive, what is his cancer risk outlook? - Answers Ken is at higher risk of prostate cancer. While examining a 30-year-old man with complaints of groin pain, the NP notes induration and inflammation in the posterior portion of the testes. This area is tender to palpation. What is the anatomic area of concern? - Answers The epididymis An 18-year-old man presents with sudden unilateral scrotal pain. On exam, the NP notes a high-riding left testicle. Elevating the testicle appears to significantly reduce the pain. What is the appropriate working diagnosis? - Answers Testicular torsion The diagnosis of infertility in men is based on: - Answers patient history, physical exam findings, and semen analysis. When screening for prostate cancer, which of the following is a significant finding? - Answers A prostate-specific antigen (PSA) that is trending upward. Which symptom is the most common in a man with Chlamydia trachomatis (CT) infection? - Answers Meatal discharge Which statement is correct about screening for syphilis? - Answers Patients who did not use barrier methods during sexual activity with a new partner within the last 6 months should be screened for syphilis. The initial evaluation of a complaint of erectile dysfunction should include: - Answers a complete history and physical examination, plus appropriate laboratory studies. Initial evaluation of infertility in men consists of: - Answers semen analysis. An important question to ask when evaluating a patient who presents with symptoms of benign prostatic hyperplasia (BPH) is: - Answers Are you experiencing lower urinary tract symptoms (LUTS)? When evaluating a man with varicocele presentation, what would prompt a urology referral? - Answers New onset of varicocele in an adult The most common presentation of testicular cancer includes which of the following symptoms? - Answers Painless testicular mass A 45-year-old Black man presents for a wellness visit. He asks when he should start his personal screening for prostate cancer with a prostate-specific antigen (PSA) test. What would be the best evidence-based answer? - Answers Along with discussion of risks and benefits of screening, we should begin your screening for prostate cancer now, at age 45. Cryptorchism is considered a key risk factor for: - Answers infertility. When discussing the proper use of lubricants with condoms, which one the following statements by the NP would be correct? - Answers Water- or silicone-based lubricants are recommended for latex condoms. Which statement would be correct in patient education for the management of HPV-associated anogenital warts (condyloma acuminatum)? - Answers Watchful waiting is appropriate because lesions may resolve spontaneously. Hydrocele can be differentiated from other scrotal abnormalities by: - Answers scrotal ultrasound. Expedited partner therapy (EPT) is primarily used: - Answers because it reduces reinfection rates of chlamydia and gonorrhea. Which category of medications may be responsible for drug-induced erectile dysfunction? - Answers Opioids A patient with diabetes is concerned about developing erectile dysfunction. Which of the following would be appropriate advice by the NP? - Answers Reduce modifiable cardiac risk factors. During the examination of a 30-year-old man with complaints of groin pain, the NP notes that his cremasteric reflex is absent. Which conclusion can be made based on this finding? - Answers An absent cremasteric reflex is not normal and should be correlated with other findings. Chronic prostatitis requires prolonged antibiotic treatment because: - Answers the prostate gland has poor uptake of medications. After shared decision making, a 32-year-old man decides he would like to receive the human papillomavirus (HPV) vaccine. He asks how many doses he will require. The NP responds: - Answers Three According to the Centers for Disease Control and Prevention (CDC), clinicians should consider initiating pre-exposure prophylaxis (PrEP) in patients with substance abuse disorder when: - Answers the patient is in a serodiscordant sexual relationship. On evaluation, the NP notes a solid nonilluminating and nontender testicular mass. What should the NP tell the patient? - Answers This is concerning. We will need to further evaluate with a computerized tomography (CT) scan. Which class of medication presents a concern for secondary erectile dysfunction? - Answers Antihypertensives A 35-year-old man presents with an asymptomatic "rash" behind his scrotum. It extends to the rectal area. During the physical exam, the NP notes several soft, flesh-colored, pedunculated cauliflower-type lesions. This most likely describes: - Answers condyloma acuminatum. According to the Centers for Disease Control and Prevention (CDC), the first-line treatment for patients who test positive for Chlamydia trachomatis and negative for Neisseria gonorrhea is: - Answers azithromycin 1 g in a single dose. When gathering the history of a patient who presents with erectile dysfunction (ED), the NP learns he does not experience nocturnal erections. What might this indicate? - Answers His erectile dysfunction may be due to organic causes. Diagnosis of testicular torsion is confirmed by: - Answers color-flow Doppler ultrasound. A syphilis chancre is best described as: - Answers a papule that evolves into a painless shallow, hard ulceration with a yellow base. Testicular torsion distinguishes itself from epididymitis in that: - Answers it can be distinguished by the absence of the cremasteric reflex. The preferred method of testing for Chlamydia trachomatis in men is: - Answers Nucleic acid amplification test (NAAT). Gentle palpation of the prostate elicits pain and swelling when which condition is present? - Answers Acute prostatitis Which class of medications may cause urinary retention in men with benign prostatic hypertrophy (BPH)? - Answers Decongestants Which drug class is used to treat erectile dysfunction? - Answers PDE-5 inhibitors The most common presentation of Neisseria gonorrhoeae (GC) urethritis in men includes: - Answers mucopurulent urethral discharge. Suggested actions to optimize fertility in men include: - Answers cautious use of lubricants that may alter sperm motility. Which of the following best describes a normal prostate gland? - Answers Rubbery, approximately 3 cm in width, with a palpable medial sulcus Which of the following is characteristic of the patient population with the highest incidence of human immunodeficiency virus (HIV) infection? - Answers Anal receptive intercourse When counseling a man receiving treatment for Neisseria gonorrhea (GC) or Chlamydia trachomatis infection, which statement by the NP would be beneficial in reducing infection risk? - Answers As long as you complete your prescribed treatment, a test of cure is not necessary. Which patient history finding raises suspicion for gonococcal proctitis? - Answers Unprotected anal receptive intercourse Which of the following medication types may cause low sperm count and thus should be part of the history questions asked of a man who presents for infertility workup? - Answers Testosterone replacement A 28-year-old man presents for evaluation of a primary outbreak of anogenital warts. He asks what he can do to decrease the likelihood of transmitting HPV infection to other sexual partners. The most appropriate answer by the NP is: - Answers "The best way to reduce the likelihood of spreading human papillomavirus is the consistent and correct use of condoms." A 19-year-old man presents with painful lesions on the shaft of his penis. During the physical exam, the NP notes several clusters of erythematous vesicular lesions. What is the appropriate working diagnosis? - Answers Herpes simplex virus What is the reported first-year pregnancy rate in couples who use condoms in a "typical" manner (i.e., incorrectly or inconsistently)? - Answers 15-18% Gonorrhea should be considered in the differentials for a man who presents with: - Answers purulent urethral discharge. The prevention of erectile dysfunction (ED) includes modifiable risk factors such as: - Answers avoidance of marijuana and alcohol. The objective of treatment for primary cryptorchidism is: - Answers reducing testicular cancer risk. When counseling men who are interested in vasectomy, the following message should be included: - Answers The goal of vasectomy is permanent sterilization. When initiating sildenafil (Viagra) therapy for erectile dysfunction, the following administration information is important for the NP to provide: - Answers This medication will only cause an erection if you are sexually aroused. Which of the following is the first-line treatment for syphilis? - Answers Penicillin G Which of the following migraine triggers are the most common? - Answers Delayed or missed meals, weather changes, sleep disturbances According to guidelines for the treatment of tension-type headache (TTH), first-line therapy is: - Answers acetaminophen. Which objective finding would be specific to unconsciousness caused by generalized seizure activity? - Answers Urinary incontinence Which of the following would be considered a risk factor for provoked (acute symptomatic) seizures? - Answers Alcohol use In which of the following situations would immediate neuroimaging be appropriate? - Answers A patient reports the abrupt onset of a high-intensity headache. Which of the following symptoms suggests the possibility of secondary headache and warrants further diagnostic testing? - Answers Fever A patient presents with an initial unprovoked seizure and is concerned that it may recur. The best response by the NP would be: - Answers "The risk of subsequent unprovoked seizures is greatest within 2 years after the first seizure." Positional headaches are most often associated with: - Answers intracranial hypertension or hypotension. Which of the following is a primary distinction between syncope and generalized seizure activity? - Answers In syncope, brief motor jerking occurs for approximately 2 seconds. Which physical signs or symptoms differentiate a cluster headache from a migraine or tension-type headache? - Answers Reddened, watering eye on the affected side In the treatment of migraine headache, it is important to caution patients against overuse of acetaminophen, triptans and nonsteroidal anti-inflammatories because: - Answers they can cause medication overuse headaches. Which of the following statements is correct about antiepileptic drug (AED) therapy? - Answers Routine monitoring of AED drug levels is not recommended. Which one of the following medications would be the best choice for a patient diagnosed with coexisting chronic migraine headaches and anxiety or depression? - Answers Venlafaxine (Effexor) Which of the following abnormal features of headache should raise a concern for stroke? - Answers Neurologic symptoms A patient began taking a monophasic oral contraceptive pill (OCP) 5 months ago. She reported midcycle breakthrough bleeding after 2 months, but the WHNP asked her to wait one or two more cycles before changing to a different OCP. What is the likely reason for this patient's midcycle spotting? - Answers The dose of estrogen in the current OCP is too low to stabilize the endometrium. Which of the following is the appropriate action when a patient states that she is a victim of intimate partner violence (IPV)? - Answers Assess the immediate danger to the woman and any children in the home. Develop an emergency plan with the patient. The initial physical examination of an adolescent girl with complaints of heavy menses would NOT include: - Answers a complete pelvic exam. The WHNP evaluates a postmenopausal woman for an ovarian mass. The results of the pelvic ultrasound are abnormal, and the patient's cancer antigen 25 (CA-125) level is elevated. What would be the next step for definitive diagnosis? - Answers Surgical referral In girls, what is the usual sequence of physical changes in puberty? - Answers Thelarche, pubarche, menarche The WHNP performs a bimanual pelvic examination as part of a routine gynecologic exam. The examination identifies an adnexal mass. Which of the following is the appropriate study for further evaluation? - Answers Transvaginal ultrasound A 14-year-old girl reports painful menses. The patient's mother states that the adolescent typically experiences low back pain and cramping 1 day prior to menses and during the first 3 days of menses. How should the WHNP evaluate for dysmenorrhea? - Answers Perform a complete history and physical examination A patient presents to discuss bone density testing results that identified osteopenia. Which of the following medication classes might place this patient at additional risk for osteoporosis? - Answers Aromatase inhibitors A 30-year-old woman is planning to conceive in the next few years. What information should this patient receive about fertility rates in her age group? - Answers Fecundity starts to decrease at age 32. What is the preferred initial diagnostic test in the evaluation of an adnexal mass? - Answers Ultrasound of the pelvis A 14-year-old girl who experiences painful menses has agreed to take nonsteroidal anti-inflammatory drugs (NSAIDs) to help manage her symptoms. To achieve the best relief of pain, how should the WHNP instruct the patient to take the medication? - Answers Start taking the NSAID on the first day of menses. If you typically experience severe symptoms, start taking the NSAID the day before menses begins. A mother is concerned that her 14-year-old daughter has not experienced menarche. Which of the following would guide the WHNP's response? - Answers Thelarche Irregular menstrual cycles during adolescence are typically due to: - Answers anovulation. When discussing lifestyle modifications to decrease osteoporosis risk, which action may be helpful? - Answers Increased physical activity At the initial reproductive health visit, the clinician's goal is to: - Answers provide information on reproductive health and healthy relationships, and to discuss these issues with the patient. A patient returns for follow-up after a vaginal ultrasound showed ovarian cyst rupture. She has been seen in the past for pelvic pain. Her history contains no other diagnostic findings. What would be the best way to help prevent future ovarian cyst development? - Answers Oral contraceptives Per the Centers for Disease Control and Prevention (CDC), how often should sexually active women be screened for sexually transmitted infections? - Answers Annually A 56-year-old patient takes bioidentical hormones to manage vasomotor symptoms of menopause. She asks the WHNP what other options are available. The patient has been amenorrheic for 2 years and has not had any surgeries. She does not smoke cigarettes. A complete health history identifies no health risk factors. Which of the following choices should the WHNP recommend to decrease the patient's vasomotor symptoms? - Answers Transdermal estradiol/norethindrone acetate 0.05/0.14 mg patch twice weekly During a visit for an initial reproductive health exam, it is important to address gender and sexuality in an open and unbiased way. Which of the following statements or questions would foster a trusting relationship? - Answers Hello, I am Dr. Smith. I use the pronouns she and her. What pronouns do you prefer? As part of an annual adolescent health survey, which tool assists the provider in covering important areas of sexual and reproductive health? - Answers The HEEADSSS survey Which statement is correct about breast examination technique? - Answers During a breast examination, the woman should be in the supine position with her ipsilateral arm extended above her head. Which of the following would raise suspicion for breast cancer? - Answers Asymmetric breast nodularity Which of the following definitions accurately describes infertility? - Answers In a woman older than