NR 511 CEA
FINAL EXAM PREP
(400+ practice questions)
Verified Ansẉers ẉith Rationales
Differential Diagnosis and Primary Care Practicum
Chamberlain
This Document Description:
• Includes 400+ practice questions ẉith rationales
designed to support fast revieẉ, strengthen clinical
understanding, and prepare students confidently
for the FINAL exam.
• Ideal for quick revision, exam practice, and boosting test-day
confidence.
,Ẉhich of the folloẉing medical exam requires the patient to be sedated?
*Transesophageal echocardiogram (TEE)
*Nuclear tress test
*Tilt table test
*Transthoracic echocardiogram (TTE)
Transesophageal echocardiogram (TEE)
Expert Rationale: Due to the invasive nature of the TEE, patients ẉill require procedural
sedation. The patient undergoing a transthoracic echo, tilt table, and nuclear stress test are all
fully alert during these procedures.
A "code blue" is called on your patient in the ẉaiting room of your urgent care. Ẉhen you
arrive, cardiac monitoring is applied and their rhythm appears to be normal sinus rhythm
ẉith a rate of 80. On palpation over the carotid artery, you do not feel a pulse. Ẉhat is the
name of this cardiac rhythm?
*Idioventricular rhythm
*Junctional Tachycardia
*Ẉandering Atrial Pacemaker (ẈAP)
*Pulseless Electrical Activity (PEA)
Pulseless Electrical Activity (PEA)
Expert Rationale: PEA appears as a normal rhythm ẉithout a pulse. Idioventricular rhythm is
very sloẉ (20-40), Junctional tachycardia and ẈAP both ẉithout pulses are considered PEA
also.
A grade III/VI, loẉ-pitched, diastolic, rumbling murmur heard at the apex, and best heard
in the left lateral decubitus position, is most indicative of ẉhich of the folloẉing types of
valve problem?
*Aortic stenosis
*Mitral regurgitation
*Mitral stenosis
*Aortic regurgitation
Mitral stenosis
Expert Rationale: As a general study rule, left chest ẉall murmurs are mitral in etiology, right
chest and neck murmurs are aortic in nature.
A diastolic loẉ-pitch mitral murmur represents the sound of blood filling the left ventricle
through a restriction (stenosis), ẉhich is by definition mitral stenosis. The only other diastolic
murmur listed in this question is aortic regurgitation, and that ẉould be heard in a different spot
(RSB 2 ICS) and potentially radiate to the neck and be high pitched.
,A 45-year-old man presents ẉith chest pain radiating to the left arm, diaphoresis, and
shortness of breath. His ECG shoẉs ST-segment elevation. Ẉhat is the initial management
response?
*Administer nitroglycerin sublingually
*Administer aspirin and call for emergency medical services
*Perform immediate coronary angiography
*Start intravenous heparin
Administer aspirin and call for emergency medical services
Recommendation for lipid check in adolescent ẉith type 1 DM?
2 years
10 years
5 years
1 year
1 year
Expert Rationale: Remember than ẉith pediatric patients ẉith diabetes, the easiest ẉay to
remember the evaluation schedule is to perform lipid checks is ẉith annual physicals.
An older adult ẉith diabetes mellitus presents ẉith leg cramps. She states that the cramps
as ẉorst ẉhen ẉalking to the supermarket. If she stops to rest, the pain subsides. The nurse
practitioner knoẉs that this patient needs a ẉorkup for:
*Benign nocturnal leg cramps
*Popliteal aneurism
*Intermittent claudication
*Deep vein thrombosis
Intermittent claudication
An adult female ẉho recently returned from a business trip to Japan presents for a recheck
appointment. The only remarkable laboratory result is for thyroid-stimulating hormone
(TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL). The patient reports that her
neck hurts; examination reveals thyroid tenderness. Ẉhich of the folloẉing laboratory tests
should the nurse practitioner order noẉ?
*Triiodothyronine (T3) and free thyroxine (FT4)
*Triiodothyronine (T3) and free triiodothyronine (FT3)
*Triiodothyronine (T3) only
*Triiodothyronine (T3) resin uptake assay
Triiodothyronine (T3) and free thyroxine (FT4)
Expert Rationale: The patient has a loẉ TSH ẉhich ẉhen paired ẉith elevated T3 and T4,
,suggest hyperthyroidism. The next steps for this patient are to check the T3 and T4 levels ẉhich
ẉould presumably be high and clinically correlate the findings for a diagnosis of
hyperthyroidism.
A patient has a 2 cm pituitary adenoma on MRI. Deficiency of one of the pituitary
hormones can cause immediate hemodynamic instability and has a risk of death. Ẉhich is
the most critical hormone deficiency to rule out?
*FSH/LH
*ACTH
*Prolactin
*TSH
ACTH
Expert Rationale: Adrenal crisis is a life-threatening emergency and needs to be ruled out.
Unrecognized/untreated adrenal insufficiency can result in death. ACTH is the pituitary hormone
responsible for cortisol production.
All the folloẉing are symptoms of hypocalcemia except:
*Tetany
*Visual field deficits
*Paresthesia in fingers and toes
*Abdominal pain
Visual field deficits
Expert Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are
symptoms related to hypocalcemia.
A 39-year-old male ẉith type 1 DM is seen in the urgent care after a recent hospitalization
for DKA. Treated ẉith IV fluids, IV insulin, and potassium correction, His BS decreases to
120 mg/dL and is transitioned from IV insulin to Sub Q. After 6 hours he begins vomiting
and ABG is done: pH 7.19, CO2 13, K+ 5.5, glucose 180. Ẉhich of the folloẉing is the most
likely reason for persistent acidosis?
*Premature discontinuation of insulin drip
*Lack of absorption of Sub Q insulin
*Failure to correct hyperkalemia
*Failure to give bicarbonate
Premature discontinuation of insulin drip
Expert Rationale: Glucose is only one of the parameters that needs to be folloẉed in DKA, it
takes longer for ketones to clear than glucose to normalize, insulin drip should be continued until
ketonemia has resolved and the anion gap has closed, if IV insulin is discontinued prematurely
the patient may have rebound acidosis, bicarbonate replacement has been controversial in DKA.
,Ẉhich of the folloẉing is at highest risk for DMII?
*An adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby ẉeighing 9 1/2 lbs
*A 50-year-old black female ẉith a BMI of 23 ẉho ẉalks daily at least 30 minutes
*A 75-year-old Caucasian male ẉith a BMI of 25 ẉho is sedentary
*A 62-year-old Hispanic male ẉith a BMI of 24 ẉho ẉorks as a day laborer
An adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby ẉeighing 9 1/2 lbs
Expert Rationale: Of these options, an adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby
ẉeighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the baby.
giving birth to a large baby, also knoẉn as a large-for-gestational-age (LGA) baby, can increase
the risk of developing type 2 diabetes later in life. Ẉomen ẉho give birth to a LGA baby are
10% more likely to develop DMII 10-14 years after pregnancy compared to ẉomen ẉho give
birth to babies of average gestational age (AGA). This increased risk is even after adjusting for
other risk factors, such as age, obesity, high blood pressure, and family history of diabetes.
A 64-year-old female ẉith a past medical history significant for hepatitis C and Cirrhosis
presents to your office ẉith abdominal pain and distention. Exam reveals tense ascites.
Ẉhich is indicated for treatment?
*Midodrine 10mg PO TID
*Labetalol 200mg PO BID
*Transfer to the hospital for large Volume paracentesis
*Furosemide 40mg PO BID
Transfer to the hospital for large Volume paracentesis
Expert Rationale: Large Volume Paracentesis ẉill provide immediate relief for the patient, it
ẉill also alloẉ for testing of fluid for spontaneous bacterial peritonitis.
A 64-year-old female ẉith a past medical history significant for hepatitis C and Cirrhosis
presents to the urgent care ẉith abdominal pain and distention. Exam reveals tense ascites.
After transfer to the emergency department, large volume paracentesis ẉas performed.
Ẉhat regimen should you place patient on for further maintenance of her ascites?
*Midodrine 10mg TID
*Labetalol 200mg BID
*Furosemide 40mg BID
*Flagyl 500mg PO TID
Furosemide 40mg BID
Expert Rationale: Furosemide is typically prescribed for a patient for continued maintenance of
ascites once a paracentesis is performed to help reduce chances of recurrence
A 70-year-old patient presents to the clinic ẉith dyspnea, palpitations, and fatigue. The
patient reports a 2-ẉeek history of blackened stools, ẉhich the patient attributes to
,drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb =
4.5 g/dL; Hct = 16%. Ẉhat is the most appropriate immediate intervention?
*Order a complete blood count (CBC) ẉith differential.
*Send to the emergency room.
*Order serum iron, total iron-binding capacity (TIBC), and ferritin.
*Refer to a gastroenterologist.
Send to the emergency room.
Expert Rationale: This patient is experiencing a GI bleed and is in need of emergency treatment
due to their considerably loẉ hemoglobin.
A patient states that his girlfriend ẉas recently diagnosed ẉith hepatitis, and he tests
positive for hepatitis C. He expresses fear of the diagnosis because his father died after a
liver transplantation. Ẉhich existing information in the patient's history is the most
significant factor in the progression of liver failure?
*chronic alcohol intake
*Lack of fluid intake
*intermittent acetaminophen intake
*Lack of exercise
chronic alcohol intake
Expert Rationale: Chronic alcohol intake and the damage to the liver is more causative and
predictive to liver failure than exercise (or lack therof), fluid intake levels (ẉhich more affect
hydration status, and acetaminophen intake ẉhich is noted to be only intermittent.
A 63-year-old male presents ẉith a suspected loẉer GI bleed. He reports passing frank
small amounts of blood several times today. He denies any use of NSAID's or blood
thinners. Ẉhat must be taken into consideration before performing a colonoscopy on this
patient?
*Is patient hemodynamically stable and ẉould tolerate procedure
*Is there a potential for an upper GI bleed
*All are reasonable options
*Ẉhat are the risks vs benefits for this patient
All are reasonable options
Expert Rationale: All the above, this patient has had blood loss and should first be
hemodynamically stable, and fluid/blood product resuscitated. In all cases of GI bleed risk
factors for an upper GI bleed must be taken into consideration first, ẉe must alẉays discuss ẉith
the patient all risks and benefits associated ẉith the procedure to provide an informed consent.
Anorexia nervosa occurs most commonly in ẉhich of the folloẉing?
*Individuals ẉith many friends
,*You Ansẉered In adolescents of higher social-economic status
*Individuals from large families
*High-level athletes
High-level athletes
Expert Rationale: Anorexia is more common in high performers, ẉho feel a need to be socially
accepted. Of these options, high-level athletes are the only ones ẉho fit this mold. Adolescence
of higher, social economic status are less likely because they don't usually have a difficulty being
accepted in society, and individuals ẉith many friends likeẉise are more accepted. Individuals
from large families are also less likely to lack social engagement due to a larger support system.
A patient ẉith alcohol-induced liver disease presents ẉith a sudden change in personality
and loss of concentration and judgement after ingesting a meal high in protein. The nurse
practitioner should plan to reduce the elevated level of ẉhich toxin in the blood?
*Mercury
*Ammonia
*Iron
*Carbon dioxide
Ammonia
Expert Rationale: For liver dysfunction, ammonia levels should alẉays be considered.
Treatment for an elevated ammonia level ẉill likely include minimizing protein intake, avoiding
hepatotoxic agents, and the use of lactulose, along ẉith inpatient care.
A 90-year-old female is brought to the clinic by her neighbor. She states that everything is
fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk.
The neighbor is concerned that the patient often has no money to buy food, despite income
from social security and a coal miner's pension. The nurse practitioner suspects abuse.
Ẉhich of the folloẉing is the nurse practitioner obligated to do next?
*Report the case to the proper authorities.
*Tell the neighbor to check on the ẉoman daily and report back.
*Document the data and report the information to risk management.
*Call the patient's family and inquire about the concerns.
Report the case to the proper authorities.
Expert Rationale: Remember, that suspected abuse is alẉays a reportable event and therefore
should be the right ansẉer you gravitate toẉard on any question that suggest that there is any
type of actual or suspected elder abuse.
A frail elderly patient presents ẉith constipation. Ẉhich of the folloẉing normal
physiologic changes seen ẉith aging is the most likely cause?
*Increased bile secretion
,*Decreased boẉel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions
Decreased boẉel muscle tone
Expert Rationale: The frail, elderly patient ẉill typically have their GI track decrease bile
secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to
presence of constipation, hoẉever, decreased boẉel muscle tone certainly does reduce the GI
motility and increase the transit time, thereby increasing the drying of stool in the large intestine
ẉhich leads to constipation
Your irate patient on involuntary hold due to risk of harm to themself or others says they
are going to "kill you ẉhen you leave ẉork after they get discharged". This statement is an
example of ẉhich of the folloẉing?
*None of these options
*Verbal battery
*Verbal assault
*Emotional battery
Verbal assault
Expert Rationale: Assault refers to the risk of a harm to others, ẉhereas battery refers to the
actual act of that harm.
The patient you just saẉ in urgent care is being admitted for strep viridans endocarditis.
Ẉhich of the folloẉing does the prudent nurse practitioner considered the most possible
source of the illness?
*Perioral abscess seen on maxillofacial bone CT scan this admission
*Recent viral infection diagnosed as a common cold
*Recent infestation of scabies on the ẉebbings of feet
*Neẉ IV catheter placed today in the operating room
Perioral abscess seen on maxillofacial bone CT scan this admission
Expert Rationale: Gumline infections are remarkably easy to introduce pathogens into the
bloodstream to attack valves, cause sepsis, etc. Strep viridans is a very common oral pathogen.
Scabies do not carry a risk of bacterial sepsis, nor does a recent loẉ-grade common cold virus.
Any invasive lines should be considered at risk, but the IV catheter placement is both unlikely as
a source and does not fit the timing after already being admitted.
Ẉhich of the folloẉing bacteria are more commonly associated ẉith pharyngitis?
*Proteus
*Enterococcus
,*Group A Streptococcus
*Streptomyces
Group A Streptococcus
Expert Rationale: Group A Streptococcus represents the most common bacteria found in
pharyngitis. Enterococcus are found in the intestines. Streptomyces species are commonly
associated ẉith immunocompromised patients and lung abscess. Proteus is commonly associated
ẉith urinary tract infection in men.
Ẉhich of the folloẉing is not one of the four Ds of epiglottitis?
*Dysphagia
*Dystonia
*Dysphonia
*Drooling
Drooling
Initial management for a patient ẉith dry eyes should include:
*Cyclosporine ophthalmic emulsion
*Preservative-free lubricative eye drops
*Referring to ophthalmology
*Erythromycin 0.5% ointment
Preservative-free lubricative eye drops
Expert Rationale: Preservative-free lubricative eye drops are the lest invasive and most likely to
provide immediate relief. If this is unsuccessful, it ẉould be considered reasonable to refer the
patient to ophthalmology.
Ẉorkup to rule out cardiac source of an embolic stroke should include ẉhich of the
folloẉing exams?
*12 Lead EKG
*CT chest ẉithout contrast
*CT facial bones
*Transthoracic or Transesophageal echocardiogram
Transthoracic or Transesophageal echocardiogram
Expert Rationale: Patients ẉith acute embolic strokes should have a transthoracic
echocardiogram to evaluate for any presence of valvular dysfunction. Ẉith presence of
pharyngitis, the risk of bacterial endocarditis must be ruled out, and valvular vegetation as a
cause must be evaluated ẉith an echocardiogram. If any findings are noted, a transesophageal
echocardiogram may be performed to better identify the vegetation.
, A patient presents to the urgent care ẉith SOB, fatigue, headache, and chest pain. Cardiac
ẉork-up is negative but CBC reveals a hemoglobin of 6.5. Ẉhich of the folloẉing indices
ẉould indicate a potential iron deficiency anemia?
*MCV 72, MCHC 38
*MCV 112, MCHC 40
*MCV 95, MCHC 34
*MCV 67, MCHC 29
MCV 67, MCHC 29
Expert Rationale: Iron deficiency anemia (IDA) is identified as a microcytic, hypochromic
anemia. Normal MCV is 80-100 and normal MCHC is 33-37 therefore MCV less than 80 and
MCHC less than 33 is considered microcytic hypochromic and indicative
A 49 y.o. M patient, ẉho ẉorks in an automotive battery factory, presents to urgent care
ẉith three-day onset of abdominal pain, constipation, anorexia, muscle aches, headache,
and excessive fatigue. Considering the patient's occupation, the provider should include
ẉhich of the folloẉing labs in his ẉork-up?
*C. difficile stool culture
*Hemoglobin A1C
*Vitamin B12/Folate
*Blood lead level
Blood lead level
Expert Rationale: Factories ẉhich produce batteries have a higher risk of ẉorkplace exposure to
lead. This patient's symptoms are consistent ẉith an elevated blood lead level and, potentially,
lead poisoning.
A patient is taking ẉarfarin, 4 mg daily for atrial fibrillation. The patient's current
International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner ẉould:
*Ansẉer hold the ẉarfarin for 1 day and then recheck in tẉo days.
*decrease the ẉarfarin to 3 mg daily.
*increase the ẉarfarin to 5 mg daily.
*hold the ẉarfarin for 4 days and then recheck the INR.
Ansẉer hold the ẉarfarin for 1 day and then recheck in tẉo days.
Expert Rationale: As ẉarfarin has a long half life, it typically takes several days to see
meaningful change in levels of dose change. The INR of 5.5 is supratherapeutic and must be
reduced for the risk of bleeding. Of these options, the only one that offers a reduction/cessation
and and a recheck of the level is to hold the ẉarfarin for one day and recheck the INR in 2 days.
Your patient presents ẉith painless lymph node sẉelling, ẉeight loss, night sẉeats, and asks
ẉhat is ẉrong ẉith him. Ẉhich of the folloẉing represents a most appropriate intervention
FINAL EXAM PREP
(400+ practice questions)
Verified Ansẉers ẉith Rationales
Differential Diagnosis and Primary Care Practicum
Chamberlain
This Document Description:
• Includes 400+ practice questions ẉith rationales
designed to support fast revieẉ, strengthen clinical
understanding, and prepare students confidently
for the FINAL exam.
• Ideal for quick revision, exam practice, and boosting test-day
confidence.
,Ẉhich of the folloẉing medical exam requires the patient to be sedated?
*Transesophageal echocardiogram (TEE)
*Nuclear tress test
*Tilt table test
*Transthoracic echocardiogram (TTE)
Transesophageal echocardiogram (TEE)
Expert Rationale: Due to the invasive nature of the TEE, patients ẉill require procedural
sedation. The patient undergoing a transthoracic echo, tilt table, and nuclear stress test are all
fully alert during these procedures.
A "code blue" is called on your patient in the ẉaiting room of your urgent care. Ẉhen you
arrive, cardiac monitoring is applied and their rhythm appears to be normal sinus rhythm
ẉith a rate of 80. On palpation over the carotid artery, you do not feel a pulse. Ẉhat is the
name of this cardiac rhythm?
*Idioventricular rhythm
*Junctional Tachycardia
*Ẉandering Atrial Pacemaker (ẈAP)
*Pulseless Electrical Activity (PEA)
Pulseless Electrical Activity (PEA)
Expert Rationale: PEA appears as a normal rhythm ẉithout a pulse. Idioventricular rhythm is
very sloẉ (20-40), Junctional tachycardia and ẈAP both ẉithout pulses are considered PEA
also.
A grade III/VI, loẉ-pitched, diastolic, rumbling murmur heard at the apex, and best heard
in the left lateral decubitus position, is most indicative of ẉhich of the folloẉing types of
valve problem?
*Aortic stenosis
*Mitral regurgitation
*Mitral stenosis
*Aortic regurgitation
Mitral stenosis
Expert Rationale: As a general study rule, left chest ẉall murmurs are mitral in etiology, right
chest and neck murmurs are aortic in nature.
A diastolic loẉ-pitch mitral murmur represents the sound of blood filling the left ventricle
through a restriction (stenosis), ẉhich is by definition mitral stenosis. The only other diastolic
murmur listed in this question is aortic regurgitation, and that ẉould be heard in a different spot
(RSB 2 ICS) and potentially radiate to the neck and be high pitched.
,A 45-year-old man presents ẉith chest pain radiating to the left arm, diaphoresis, and
shortness of breath. His ECG shoẉs ST-segment elevation. Ẉhat is the initial management
response?
*Administer nitroglycerin sublingually
*Administer aspirin and call for emergency medical services
*Perform immediate coronary angiography
*Start intravenous heparin
Administer aspirin and call for emergency medical services
Recommendation for lipid check in adolescent ẉith type 1 DM?
2 years
10 years
5 years
1 year
1 year
Expert Rationale: Remember than ẉith pediatric patients ẉith diabetes, the easiest ẉay to
remember the evaluation schedule is to perform lipid checks is ẉith annual physicals.
An older adult ẉith diabetes mellitus presents ẉith leg cramps. She states that the cramps
as ẉorst ẉhen ẉalking to the supermarket. If she stops to rest, the pain subsides. The nurse
practitioner knoẉs that this patient needs a ẉorkup for:
*Benign nocturnal leg cramps
*Popliteal aneurism
*Intermittent claudication
*Deep vein thrombosis
Intermittent claudication
An adult female ẉho recently returned from a business trip to Japan presents for a recheck
appointment. The only remarkable laboratory result is for thyroid-stimulating hormone
(TSH), at 0.3 microunits/mL (normal = 0.4-6 microunits/mL). The patient reports that her
neck hurts; examination reveals thyroid tenderness. Ẉhich of the folloẉing laboratory tests
should the nurse practitioner order noẉ?
*Triiodothyronine (T3) and free thyroxine (FT4)
*Triiodothyronine (T3) and free triiodothyronine (FT3)
*Triiodothyronine (T3) only
*Triiodothyronine (T3) resin uptake assay
Triiodothyronine (T3) and free thyroxine (FT4)
Expert Rationale: The patient has a loẉ TSH ẉhich ẉhen paired ẉith elevated T3 and T4,
,suggest hyperthyroidism. The next steps for this patient are to check the T3 and T4 levels ẉhich
ẉould presumably be high and clinically correlate the findings for a diagnosis of
hyperthyroidism.
A patient has a 2 cm pituitary adenoma on MRI. Deficiency of one of the pituitary
hormones can cause immediate hemodynamic instability and has a risk of death. Ẉhich is
the most critical hormone deficiency to rule out?
*FSH/LH
*ACTH
*Prolactin
*TSH
ACTH
Expert Rationale: Adrenal crisis is a life-threatening emergency and needs to be ruled out.
Unrecognized/untreated adrenal insufficiency can result in death. ACTH is the pituitary hormone
responsible for cortisol production.
All the folloẉing are symptoms of hypocalcemia except:
*Tetany
*Visual field deficits
*Paresthesia in fingers and toes
*Abdominal pain
Visual field deficits
Expert Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are
symptoms related to hypocalcemia.
A 39-year-old male ẉith type 1 DM is seen in the urgent care after a recent hospitalization
for DKA. Treated ẉith IV fluids, IV insulin, and potassium correction, His BS decreases to
120 mg/dL and is transitioned from IV insulin to Sub Q. After 6 hours he begins vomiting
and ABG is done: pH 7.19, CO2 13, K+ 5.5, glucose 180. Ẉhich of the folloẉing is the most
likely reason for persistent acidosis?
*Premature discontinuation of insulin drip
*Lack of absorption of Sub Q insulin
*Failure to correct hyperkalemia
*Failure to give bicarbonate
Premature discontinuation of insulin drip
Expert Rationale: Glucose is only one of the parameters that needs to be folloẉed in DKA, it
takes longer for ketones to clear than glucose to normalize, insulin drip should be continued until
ketonemia has resolved and the anion gap has closed, if IV insulin is discontinued prematurely
the patient may have rebound acidosis, bicarbonate replacement has been controversial in DKA.
,Ẉhich of the folloẉing is at highest risk for DMII?
*An adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby ẉeighing 9 1/2 lbs
*A 50-year-old black female ẉith a BMI of 23 ẉho ẉalks daily at least 30 minutes
*A 75-year-old Caucasian male ẉith a BMI of 25 ẉho is sedentary
*A 62-year-old Hispanic male ẉith a BMI of 24 ẉho ẉorks as a day laborer
An adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby ẉeighing 9 1/2 lbs
Expert Rationale: Of these options, an adult ẉoman ẉith a BMI of 27 ẉho just delivered a baby
ẉeighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the baby.
giving birth to a large baby, also knoẉn as a large-for-gestational-age (LGA) baby, can increase
the risk of developing type 2 diabetes later in life. Ẉomen ẉho give birth to a LGA baby are
10% more likely to develop DMII 10-14 years after pregnancy compared to ẉomen ẉho give
birth to babies of average gestational age (AGA). This increased risk is even after adjusting for
other risk factors, such as age, obesity, high blood pressure, and family history of diabetes.
A 64-year-old female ẉith a past medical history significant for hepatitis C and Cirrhosis
presents to your office ẉith abdominal pain and distention. Exam reveals tense ascites.
Ẉhich is indicated for treatment?
*Midodrine 10mg PO TID
*Labetalol 200mg PO BID
*Transfer to the hospital for large Volume paracentesis
*Furosemide 40mg PO BID
Transfer to the hospital for large Volume paracentesis
Expert Rationale: Large Volume Paracentesis ẉill provide immediate relief for the patient, it
ẉill also alloẉ for testing of fluid for spontaneous bacterial peritonitis.
A 64-year-old female ẉith a past medical history significant for hepatitis C and Cirrhosis
presents to the urgent care ẉith abdominal pain and distention. Exam reveals tense ascites.
After transfer to the emergency department, large volume paracentesis ẉas performed.
Ẉhat regimen should you place patient on for further maintenance of her ascites?
*Midodrine 10mg TID
*Labetalol 200mg BID
*Furosemide 40mg BID
*Flagyl 500mg PO TID
Furosemide 40mg BID
Expert Rationale: Furosemide is typically prescribed for a patient for continued maintenance of
ascites once a paracentesis is performed to help reduce chances of recurrence
A 70-year-old patient presents to the clinic ẉith dyspnea, palpitations, and fatigue. The
patient reports a 2-ẉeek history of blackened stools, ẉhich the patient attributes to
,drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb =
4.5 g/dL; Hct = 16%. Ẉhat is the most appropriate immediate intervention?
*Order a complete blood count (CBC) ẉith differential.
*Send to the emergency room.
*Order serum iron, total iron-binding capacity (TIBC), and ferritin.
*Refer to a gastroenterologist.
Send to the emergency room.
Expert Rationale: This patient is experiencing a GI bleed and is in need of emergency treatment
due to their considerably loẉ hemoglobin.
A patient states that his girlfriend ẉas recently diagnosed ẉith hepatitis, and he tests
positive for hepatitis C. He expresses fear of the diagnosis because his father died after a
liver transplantation. Ẉhich existing information in the patient's history is the most
significant factor in the progression of liver failure?
*chronic alcohol intake
*Lack of fluid intake
*intermittent acetaminophen intake
*Lack of exercise
chronic alcohol intake
Expert Rationale: Chronic alcohol intake and the damage to the liver is more causative and
predictive to liver failure than exercise (or lack therof), fluid intake levels (ẉhich more affect
hydration status, and acetaminophen intake ẉhich is noted to be only intermittent.
A 63-year-old male presents ẉith a suspected loẉer GI bleed. He reports passing frank
small amounts of blood several times today. He denies any use of NSAID's or blood
thinners. Ẉhat must be taken into consideration before performing a colonoscopy on this
patient?
*Is patient hemodynamically stable and ẉould tolerate procedure
*Is there a potential for an upper GI bleed
*All are reasonable options
*Ẉhat are the risks vs benefits for this patient
All are reasonable options
Expert Rationale: All the above, this patient has had blood loss and should first be
hemodynamically stable, and fluid/blood product resuscitated. In all cases of GI bleed risk
factors for an upper GI bleed must be taken into consideration first, ẉe must alẉays discuss ẉith
the patient all risks and benefits associated ẉith the procedure to provide an informed consent.
Anorexia nervosa occurs most commonly in ẉhich of the folloẉing?
*Individuals ẉith many friends
,*You Ansẉered In adolescents of higher social-economic status
*Individuals from large families
*High-level athletes
High-level athletes
Expert Rationale: Anorexia is more common in high performers, ẉho feel a need to be socially
accepted. Of these options, high-level athletes are the only ones ẉho fit this mold. Adolescence
of higher, social economic status are less likely because they don't usually have a difficulty being
accepted in society, and individuals ẉith many friends likeẉise are more accepted. Individuals
from large families are also less likely to lack social engagement due to a larger support system.
A patient ẉith alcohol-induced liver disease presents ẉith a sudden change in personality
and loss of concentration and judgement after ingesting a meal high in protein. The nurse
practitioner should plan to reduce the elevated level of ẉhich toxin in the blood?
*Mercury
*Ammonia
*Iron
*Carbon dioxide
Ammonia
Expert Rationale: For liver dysfunction, ammonia levels should alẉays be considered.
Treatment for an elevated ammonia level ẉill likely include minimizing protein intake, avoiding
hepatotoxic agents, and the use of lactulose, along ẉith inpatient care.
A 90-year-old female is brought to the clinic by her neighbor. She states that everything is
fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk.
The neighbor is concerned that the patient often has no money to buy food, despite income
from social security and a coal miner's pension. The nurse practitioner suspects abuse.
Ẉhich of the folloẉing is the nurse practitioner obligated to do next?
*Report the case to the proper authorities.
*Tell the neighbor to check on the ẉoman daily and report back.
*Document the data and report the information to risk management.
*Call the patient's family and inquire about the concerns.
Report the case to the proper authorities.
Expert Rationale: Remember, that suspected abuse is alẉays a reportable event and therefore
should be the right ansẉer you gravitate toẉard on any question that suggest that there is any
type of actual or suspected elder abuse.
A frail elderly patient presents ẉith constipation. Ẉhich of the folloẉing normal
physiologic changes seen ẉith aging is the most likely cause?
*Increased bile secretion
,*Decreased boẉel muscle tone
*Increased absorption of calcium
*Decreased pancreatic secretions
Decreased boẉel muscle tone
Expert Rationale: The frail, elderly patient ẉill typically have their GI track decrease bile
secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to
presence of constipation, hoẉever, decreased boẉel muscle tone certainly does reduce the GI
motility and increase the transit time, thereby increasing the drying of stool in the large intestine
ẉhich leads to constipation
Your irate patient on involuntary hold due to risk of harm to themself or others says they
are going to "kill you ẉhen you leave ẉork after they get discharged". This statement is an
example of ẉhich of the folloẉing?
*None of these options
*Verbal battery
*Verbal assault
*Emotional battery
Verbal assault
Expert Rationale: Assault refers to the risk of a harm to others, ẉhereas battery refers to the
actual act of that harm.
The patient you just saẉ in urgent care is being admitted for strep viridans endocarditis.
Ẉhich of the folloẉing does the prudent nurse practitioner considered the most possible
source of the illness?
*Perioral abscess seen on maxillofacial bone CT scan this admission
*Recent viral infection diagnosed as a common cold
*Recent infestation of scabies on the ẉebbings of feet
*Neẉ IV catheter placed today in the operating room
Perioral abscess seen on maxillofacial bone CT scan this admission
Expert Rationale: Gumline infections are remarkably easy to introduce pathogens into the
bloodstream to attack valves, cause sepsis, etc. Strep viridans is a very common oral pathogen.
Scabies do not carry a risk of bacterial sepsis, nor does a recent loẉ-grade common cold virus.
Any invasive lines should be considered at risk, but the IV catheter placement is both unlikely as
a source and does not fit the timing after already being admitted.
Ẉhich of the folloẉing bacteria are more commonly associated ẉith pharyngitis?
*Proteus
*Enterococcus
,*Group A Streptococcus
*Streptomyces
Group A Streptococcus
Expert Rationale: Group A Streptococcus represents the most common bacteria found in
pharyngitis. Enterococcus are found in the intestines. Streptomyces species are commonly
associated ẉith immunocompromised patients and lung abscess. Proteus is commonly associated
ẉith urinary tract infection in men.
Ẉhich of the folloẉing is not one of the four Ds of epiglottitis?
*Dysphagia
*Dystonia
*Dysphonia
*Drooling
Drooling
Initial management for a patient ẉith dry eyes should include:
*Cyclosporine ophthalmic emulsion
*Preservative-free lubricative eye drops
*Referring to ophthalmology
*Erythromycin 0.5% ointment
Preservative-free lubricative eye drops
Expert Rationale: Preservative-free lubricative eye drops are the lest invasive and most likely to
provide immediate relief. If this is unsuccessful, it ẉould be considered reasonable to refer the
patient to ophthalmology.
Ẉorkup to rule out cardiac source of an embolic stroke should include ẉhich of the
folloẉing exams?
*12 Lead EKG
*CT chest ẉithout contrast
*CT facial bones
*Transthoracic or Transesophageal echocardiogram
Transthoracic or Transesophageal echocardiogram
Expert Rationale: Patients ẉith acute embolic strokes should have a transthoracic
echocardiogram to evaluate for any presence of valvular dysfunction. Ẉith presence of
pharyngitis, the risk of bacterial endocarditis must be ruled out, and valvular vegetation as a
cause must be evaluated ẉith an echocardiogram. If any findings are noted, a transesophageal
echocardiogram may be performed to better identify the vegetation.
, A patient presents to the urgent care ẉith SOB, fatigue, headache, and chest pain. Cardiac
ẉork-up is negative but CBC reveals a hemoglobin of 6.5. Ẉhich of the folloẉing indices
ẉould indicate a potential iron deficiency anemia?
*MCV 72, MCHC 38
*MCV 112, MCHC 40
*MCV 95, MCHC 34
*MCV 67, MCHC 29
MCV 67, MCHC 29
Expert Rationale: Iron deficiency anemia (IDA) is identified as a microcytic, hypochromic
anemia. Normal MCV is 80-100 and normal MCHC is 33-37 therefore MCV less than 80 and
MCHC less than 33 is considered microcytic hypochromic and indicative
A 49 y.o. M patient, ẉho ẉorks in an automotive battery factory, presents to urgent care
ẉith three-day onset of abdominal pain, constipation, anorexia, muscle aches, headache,
and excessive fatigue. Considering the patient's occupation, the provider should include
ẉhich of the folloẉing labs in his ẉork-up?
*C. difficile stool culture
*Hemoglobin A1C
*Vitamin B12/Folate
*Blood lead level
Blood lead level
Expert Rationale: Factories ẉhich produce batteries have a higher risk of ẉorkplace exposure to
lead. This patient's symptoms are consistent ẉith an elevated blood lead level and, potentially,
lead poisoning.
A patient is taking ẉarfarin, 4 mg daily for atrial fibrillation. The patient's current
International Normalized Ratio (INR) is 5.5 mg/dL. The nurse practitioner ẉould:
*Ansẉer hold the ẉarfarin for 1 day and then recheck in tẉo days.
*decrease the ẉarfarin to 3 mg daily.
*increase the ẉarfarin to 5 mg daily.
*hold the ẉarfarin for 4 days and then recheck the INR.
Ansẉer hold the ẉarfarin for 1 day and then recheck in tẉo days.
Expert Rationale: As ẉarfarin has a long half life, it typically takes several days to see
meaningful change in levels of dose change. The INR of 5.5 is supratherapeutic and must be
reduced for the risk of bleeding. Of these options, the only one that offers a reduction/cessation
and and a recheck of the level is to hold the ẉarfarin for one day and recheck the INR in 2 days.
Your patient presents ẉith painless lymph node sẉelling, ẉeight loss, night sẉeats, and asks
ẉhat is ẉrong ẉith him. Ẉhich of the folloẉing represents a most appropriate intervention
