AANP AGPCNP PSI Test 1 & 2 Questions & Answers

AANP AGPCNP PSI Test 1 & 2 Questions & Answers An 88-year-old presents with right-side weakness after being unable to rise unassisted following a fall to the bathroom floor. History includes aphasia and noncompliance with hypertension medication regimen. What is the most likely diagnosis? Left-sided or right-sided CVA? LEFT-SIDED CVA Which of the following signs/symtpoms are often associated with headahces due to intracranial tumor? 1) pain worse laying down, focal neurological signs 2) Hyperflexia, personality change 3) acute onset: hours to days 4) pupillary constriction; stupor 1) pain worse laying down, focal neurological signs Which of the following pharmacotherapeutics would be most important to administer to a patient who has a corneal abrasion? 1) Timolol 2) Gentamicin ophthalmic 3) Cromolyn optha 4) Olopatadine 2) Gentamicin ophthalmic (Genoptic) A 25-year-old presents with the chief complaint of decreased mobility and pain of the right shoulder exacerbated by movement. The patient reports that he participated in extensive house painting 24 hours prior to the onset of pain. He denies any trauma. Passive ROM is intact. No redness or ecchymosis is present. What is the next step to be taken in order to make a diagnosis? 1) Xray of shoulder 2) Palpate structures around the shoulder. 3) MRI of shoulder 4) EMG 2) palpate structures A 16-year-old female in the first month of taking Ortho-Novum 7/7/7 complains of midcycle spotting. She has not missed any doses and uses no other medication. Which of the following is appropriate? 1) Changing to Ortho-Novum 1/35 2) Discontinue use 3) Providing reassurance 4) Double dose-for two days 3) provide reassurance According to the Report of the U.S. Preventive Services Task Force, which of the following is NOT a current recommendation guideline for preventive care in elderly female patients? 1) Mammogram and clinical breast exams 2) Fecal Occult blood test and/or sig 3) Rubella serology or vaccination history 4) Pnuemo and influenza vaccines 3) Rubella serology or vaccination history 87 y/o NH patient is drowsy and barely responsive. Temp 95, BP: 110/70, Pulse 60, R 10. The best action is to: 1) initiate passive warming 2) apply a rebreather 3) Perform fluid replacement 4) initiate active warming 1) initiate passive rewarming A patient is referred with DM, HTN and CAD. He is on insulin and a beta blocker. How would you educate this patient on recognizing the signs and symptoms of hypoglycemia? 1) Edema 2) Tachycardia 3) palpitations 4) sweating 4) sweating A 65-year-old overweight patient is diagnosed with plantar fasciitis. Initial therapy of NSAIDs, stretching, ice, and rest has proven ineffective after 3 weeks. The best follow-up plan of care would be to: 1) stop NSAID, apply a heel cup and encourage exercise and wt loss. 2) continue NSAID, apply an arch support and encourage wt loss and exercise 3) continue NSAID, xray and add a short-leg night splint 4) COntinue NSAID, xray and add a metatarsal bar 2) continue NSAID, apply an arch support and encourage wt loss and exercise Fundoscopic exam of Hypertensive patient. 1) nicking of arteriols and viens, and small retinol hemorrages 2) drusen bodies and pale retina 3) pale macula and swollen disk margins 4) microaneurysms and optic disc cupping 1) nicking of arteriols and viens, and small retinol hemorrages Which of the following is a common presenting feature of hyperthyroidism in the elderly? 1) elevated TSH 2) Thyroid enlargement 3) atrial fibrillation 4) abnormal T3 suppression 3) atrial fibrillation A 35-year-old lawn maintenance worker presents reporting "something in my eye" since the previous day. The eye was rinsed with over-the-counter eyewash, without relief. The patient denies visual disturbances or drainage. In formulating a plan of care, the nurse practitioner would FIRST: 1) send to ophthalmologists 2) florescreen staining 3) test visual field 4) prescribe eyedrops 3) test visual field A 72-year-old patient presents with dry, itchy eyes. During the course of the physical examination, the nurse practitioner notes the presence of a gray band of opacity in the cornea that encircles the iris. The band is 1.0-1.5 mm wide. This finding is most consistent with a diagnosis of a/an: 1. corneal abrasion 2. arcus senilis 3. corneal ulcer 4. herpetic infection of the eye 2) arcus senilis A 26-year-old presents with reports of anorexia, fatigue, weight loss, malaise, fever, night sweats, and a cough that has been present for 4 weeks. The diagnostic study to perform first would be: 1) xray 2) pulmonary function test 3) bronchoscopy 4) H & H 1) xray (tb-night sweats) A 44-year-old female is complaining of frequent anxiety attacks with chest discomfort and fatigue. On physical examination, her lungs are clear bilaterally. There are a midsystolic click and a grade II/VI systolic murmur at the apex. Further evaluation would include which of the following? 1) EKG, flat plate of the abdomen, lipid profile 2) Echocardiogram, Doppler, EKG 3) Labs and benzo's 4) EEG, Anxiety Scale, and electrolytes 2) Echocardiogram, Doppler, EKG A healthy 84 y/o would like to start an exercise program, what would you do before this takes place? 1) physical exam 2) EKG 3) knee xrays 4) PT Stress test 1) Physical Exam 29 y/o has uncomplicated Chlamydia infection will exhibit: 1) green penile discharge 2) uticartia 3) unremarkable symtpoms 4) penile ulcer 3) unremarkable symptoms 37 has suspected PE. c/o anxiety and cough, CXR normal, the next test should be: 1) spirometry 2) MRI 3) COntract venogra[hy 4) helical CT pulmonary angiograph 4) helical CT pulmonary angiography. A 12-lead EKG shows an undulating baseline with no visible P waves and an irregularly irregular R-R interval. This arrhythmia is: 1) atrial flutter 2) atrial fibrillation 3) second degree heart block 4) Wolff-White Syndrome 2) atrial fibrillation After a 3-week camping trip, a 17-year-old is seen for a target lesion with central clearing, located in the inguinal area. The patient has had a severe headache, malaise, fatigue, and generalized musculoskeletal pain for several days. Pharmacologic management of this condition includes: 1) Bactrim 2) azithromycin 3) doxycycline (Doryx). 4) metronidazole 3) doxycycline (Doryx). Rocky Mountain spotted fever (Lyme disease-test with WEstern Blot) According to the American Diabetes Association, the newest standard for determining the presence of diabetes mellitus based on fasting plasma sugar level is a value equal to or greater than: 1) 110 mg/dL. 2) 126 mg/dL. 3) 135 4) whatever 2) 126 mg/dl In the elderly, one pathophysiologic mechanism of isolated systolic hypertension involves: 1) decreased cardiac output. 2) loss of vascular tissue elasticity. 3) hyperactive baroreceptors 2) loss of vascular tissue elasticity A 58-year-old female presents with shoulder and pelvic girdle pain for the past 6 months. She reports recent unintentional weight loss. On physical examination, there is pain on ROM, with no weakness noted. Laboratory studies show a low hemoglobin and an elevated sedimentation rate. Which of the following is the most likely diagnosis? 1) Polymyalgia rheumatica 2) polymyositis 3) osteoarthritis 4) Fibromyalgia 1) polymyalgia rheumatica An 85-year-old male relates that on the way to his annual physical examination, he suffered a sudden loss of vision in his right eye characterized by "a bunch of lights" and a feeling that "a curtain came down." All of the following would be included in the differential diagnosis EXCEPT: 1) opthalmolic migraine 2) retinal detachment. 3) diabetic retinopathy. 4) TIA 3) diabetic retinopathy A patient with diabetes mellitus who is on NPH and regular insulin split-dosing presents with complaints of early morning rise in fingerstick blood glucose. A review of self blood glucose monitoring reveals increased morning levels. After an increase in the evening insulin dose, the problem worsens. This is most likely an example of: 1) insulin resistance 2) the Somogyi effect. 3) needing more insulin in the mornings 4) Need to increase insulin at night 2) Somogyi effect In a healthy elder, which of the following TRADITIONALLY defines a positive urine culture? 1) ≥100,000 colonies/mL of a single organism 2) ≥10,000 colonies/mL of a single organism 3) ≥100,000 colonies/mL of a two or more organisms ≥100,000 colonies/mL of a single organism A 55-year-old patient exhibits a verified serum calcium level of 13 mg/dL [normal = 8.9-10.2 mg/dL]. The next step in determining the presence of pathology is to order a: 1) BUN and serum creatinine. 2) 24 hour urine 3) parathyroid hormone level. 4) thyroid panel 3) parathyroid hormone level An 88-year-old female presents with a 3-day history of vertigo. The patient has a past medical history of hypertension controlled with metoprolol, 50 mg daily. She reports that the presenting symptoms are constant, severe, and accompanied by nausea and vomiting. She denies experiencing diplopia, slurring of speech, chest pain, dyspnea, or diaphoresis. She exhibits mild anxiety and reluctance to change position or turn the head. BP = 126/76; P = 78; R = 16/min; and T = 98.2°F (36.8°C). HEENT examination reveals 17 beats of horizontal nystagmus on right lateral gaze; the nystagmus stops after several repetitions of the maneuver. Funduscopic, cardiac, pulmonary, abdominal, and neurologic examination results are normal. The most likely diagnosis is: 1) acoustic neuroma 2) vestibular neuritis. 3) vertibailar insufficiency 4) TIA 2) vestibular neuritis When initiating thyroid hormone replacement in the older adult, care must be taken to evaluate the patient's: 1) coronary status. 2) weight 3) renal function 4) mental state 1) coronary status Which of the following would be most appropriate to perform in the initial evaluation of a patient with symptoms of acute prostatitis? 1) Prostate-specific antigen (PSA) 2) Urinalysis and urine culture 3) Scrotal massage and urine sample 4) CBC with diff 2) urinalysis and urine culture Which of the following wet-mount results confirms a preliminary diagnosis of bacterial vaginosis? 1) Organisms about the size of white blood cells with undulating flagellum, occasional lactobacillus, many white blood cells 2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells 3) Squamous epithelial cells with stippling appearance and indistinct borders, many lactobacillus rods, few white blood cells 2) Squamous epithelial cells with stippling appearance and indistinct borders, no lactobacillus rods, many white blood cells Which of the following physical findings would best alert a nurse practitioner to the probability of a herniated lumbar disc? 1) Positive Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 90° 2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° 3) Negative Patrick's sign, decreased thoracolumbar ROM, positive straight-leg raise at 80° 2) Decreased thoracolumbar ROM, positive crossed straight-leg raise, positive straight-leg raise at 30° An 87-year-old obese female presents with complaints of calf pain in her right leg. The patient reports that the pain is increased with ambulation and has been increasing over the past 24 to 48 hours. The patient denies the following: any recent injury to the leg, smoking, or recent surgery. To assess this patient's symptoms, you would initially assess: 1) calf circumference and perform Doppler studies. 2) popliteal pulses and Doppler studies 3) Femoral pulses and skin temperature 4) Patrick's signs and popliteal pulses 1) calf circumference and perform Doppler studies What type of exercise would you recommend for a 74-year-old patient with hypertension and degenerative joint disease (DJD)? 1) Stationary bike 2) Aqua exercises 3) aerobic walking 2) Aqua exercises Trigeminal neuralgia 1) electric shock like unilateral pain 2) jaw pain extending to the neck 3) Bilateral burning pain 1) electric shock like unilateral pain A manifestation of autonomic neuropathy in a 70-year-old patient with diabetes mellitus is: 1) tremors. 2) orthostatic hypotension. 3) hypertension 4) color blindness 2) orthostatic hypotension The most common fluid and electrolyte imbalance in patients over 65 years of age is: 1) hypokalemia 2) due to dehydration. 3) Hypercalcemia 4) due to fluid overload 2) due to dehydration Office spirometry performed with an albuterol nebulizer treatment can confirm a diagnosis of asthma because it indicates: 1) a patient has pulmonary fibrosis 2) chronic carbon dioxide retension 3) if a patient has reversible airway obstruction. 3) if a patient has reversible airway obstruction. To assess ability to reason abstractly, you would ask the patient to: 1) the meaning of a common proverb 2) ask what they would do if there was a fire in the house 3) count backwards by 7's 1) the meaning of a common proverb A 66-year-old patient presents with bilateral otitis media with effusion and white patches in the mouth that do not rub off when wiped with a 4 × 4. The patient should be evaluated for: 1) lichen planus 2) HIV infection. 3) lymphoma 4) Candida lingua 2) HIV infection (hairy luekaplakia-immune) A 70-year-old patient presents with complaints of vague epigastric pain occurring at night, causing early morning awakening, and decreased appetite with early satiety. Significant history includes recent use of ibuprofen for headaches. Rectal examination was negative. While awaiting the results of ordered diagnostic tests, the practitioner should recommend all of the following EXCEPT: 1) starting H2 blockers. 2) taking off from work until the work-up is complete. 3) Reporting nausea/vomiting 4) Discontinue NSAIDS 2) taking off work until the work-up is complete A 32-year-old patient reports a 6-month history of intermittent symmetrical swelling of the wrists and daily morning stiffness lasting 1 hour or more in and around other joints. What is the most likely diagnosis? 1) Rheumatoid arthritis 2) Osteoarthritis 3) Gouty arthritis 1) Rheumatoid arthritis An 18-year-old college student presents for an athletic physical. When asked about current medications, she mentions she takes "some herb" she bought at the health food store for migraines and menstrual cramps. Which of the following herbal remedies has been commonly used for these conditions? 1) Echinacea 2) St. JOhn's Wort 3) ginko biloba 4) Feverfew 4) Feverfew The most common bacterial agents responsible for pneumonia in older adults residing in the community are: 1) Streptococcus pneumoniae and Haemophilus influenzae. 2) staphylococcus aureas and Haemophilus influenzae. 3) Psuedomonas aeruginosa and Klebsiella pneumonae 4) Legionnaires and streptococcus pneumoniae 1) Streptococcus pneumoniae and Haemophilus influenzae. Which cranial nerves test the oculomotor eye movement and strabismus? 1) CN I III, IV 2) CV III, IV and VI 3) CN III, V, VII 2) CV III, IV and VI The management of COPD in the elderly is best guided by: 1) pulse oximetry 2) arterial blood gases 3) radiographic images 4) symptomology 4) symptomology Which of the following is the most serious outcome of Barrett's esophagus? 1) Esophageal adenocarcinoma 2) esophageal varices 3) GERD 4) Stricture 1) Esophageal adenocarcinoma Which of the following is most important in enhancing a nurse practitioner's clinical assessment when promoting health behaviors in young adults? 1) Personality 2) Include the parents with the pateint 3) Taking developmental stages into consideration 4) Provide a chart of growth physical changes 3) Taking developmental stages into consideration Pulmonary status findings of increased total lung capacity and residual volume in a 74-year-old patient are indicative of: 1) emphysema. 2) COPD 3) chronic bronchitis 4) Asthma 1) emphysema A 65-year-old patient with hypertension and associated angina requests a flu vaccine. The patient had a pneumococcal vaccine 10 years ago. The most appropriate plan of care would include: 1) influenza vaccine, 0.5 mL IM, 2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. 3) pneumococcal vaccine, 0.5 mL IM. 2) influenza vaccine, 0.5 mL IM, and pneumococcal vaccine, 0.5 mL IM. An 87-year-old patient is being treated for major depression with a selective serotonin reuptake inhibitor. Which of the following would have the greatest probability of remaining in the serum long after being discontinued? 1) Celexa 2) Prozac 3) Paxil 4) Zoloft 2) Fluoxetine (Prozac) Age-related macular degeneration leads to which of the following? 1) Loss of central vision 2) Loss of peripheral vision 3) hemianopsia bilateral 1) loss of central vision The approved therapeutic International Normalized Ratio (INR) for a patient on warfarin (Coumadin) therapy for atrial fibrillation is: 1) 1.0-2.0 2) 2.0-3.0 3) 2.5-3.5 2) 2.0-3.0 A 57-year-old patient presents for a physical examination. The patient has been in good health, takes no medications, has a family history of hypertension and heart disease, denies alcohol use, and has never smoked. The patient's last tetanus booster was 9 years ago. Which of the following vaccines is indicated at this time? 1) TD 2) Influenza 3) PNA 4) Hep B 2) Influenza A patient with a diagnosis of diverticulosis presents with localized left lower quadrant discomfort, a palpable mass, mild leukocytosis, and T = 100° (37.8°C). The patient does not appear toxic and can tolerate fluids. An appropriate plan should include: 1) NPO, BARIUM enema 2) low fiber diet and referral to GI 3) clear liquids and oral antibiotics. 4) admit to hospital 3) clear liquids and oral antibiotics. A frail elder who is on total bed rest suddenly develops urinary and fecal incontinence. This condition is frequently an indication of: 1) dementia. 2) fecal impaction. 3) cholecystitis. 4) parkinsons. 2) fecal impaction. A 65-year-old female with diabetes mellitus presents for a routine follow up. BP is 142/88, Hgb A1c is 8.4%, fasting blood glucose is 160 mg/dL, and microalbumin is 60 mg/L (normal 30 mg/L). In addition to changing the diabetes medications, the nurse practitioner would also ensure that the patient is taking: 1) nifedipine 12.5mg daily 2) Amlodipine 10mg daily 3) benazepril, 10 mg daily. 4) atenolol 25mg BID 3) benazepril, 10 mg daily. A 67-year-old patient with type 2 diabetes mellitus, congestive heart failure (CHF), and mild coronary artery disease is currently taking digoxin, 0.25 mg daily; hydrochlorothiazide, 25 mg daily; glipizide, 10 mg daily; and atorvastatin (Lipitor), 20 mg h.s. Which of the following is an accurate statement regarding this regimen? 1) Glipizide will deplete potassium stores 2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. 3) atorvastatin will worsen the diabetes 2) The hydrochlorothiazide will predispose the patient to digoxin toxicity. An 18-year-old patient presents with complaints of maxillary facial pain and yellow nasal discharge for 14 days. What is the appropriate initial pharmacologic intervention? 1) Amoxicillin 2) Diphenhydramine 3) Doxycycline 4) erythromycin 1) Amoxicillin Therapy for temporal arteritis would include: 1) Tylenol with codiene 2) ibuprofen 800mg TID 3) prednisone, 60 mg daily PO and re-evaluate in 1 month. 3) prednisone, 60 mg daily PO and re-evaluate in 1 month. In addressing suspected domestic violence in an adult relationship, it is appropriate to: 1) just do a physical assessment, not social 2) make an assessment of battering. 3) avoid making a battering assessment, it is legal 2) make an assessment of battering. Over the past 6 months, a nurse practitioner has been treating a 62-year-old construction worker for chronic/recurrent right biceps tendonitis. He has had good and bad days, but seems to respond well to NSAIDs and muscle relaxants. Today he returns to the clinic after feeling a "snapping" sensation in his right upper arm while lifting a cinder block. To aid in diagnosis, the nurse practitioner would evaluate: 1) Right shoulder ROM, and strength 2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. 3) radial pulses and right biceps tendon 4) right supination/pronation 2) for the presence of right upper arm bulge ("Popeye muscle") and biceps strength. Which of the following accurately describes the phenomenon of isolated systolic hypertension, as opposed to isolated diastolic or combined systolic/diastolic hypertension, in the elderly? 1) Considered a significant risk factor for MI or stroke 2) demonstrated to be related to smoking 3) Occurs primarily in men 4) Not considered to be a major risk 1) Considered a significant risk factor for MI or stroke An 87-year-old long-term care facility resident was hospitalized for an abdominal surgery procedure, and the incision has become infected with methicillin-resistant Staphylococcus aureus (MRSA). The hospital is planning to return the patient to the same facility, which has no private rooms. According to CDC guidelines, the alternative placement would be to: 1) inform the hospital that the patient will have to go to another facility. 2) have the patient share a room with a resident who also has MRSA. 3) have the patient share a room with a resident who has VRSA. 4) Delay discharge until the wound is clear 2) have the patient share a room with a resident who also has MRSA. Which of the following laboratory tests are most widely accepted as indicators of the progression of HIV infection? 1) CD4 count and viral load 2) CD4 and Western Blot 3) CD4 and ELISA 4) WBC count and viral load 1) CD4 count and viral load Which class of antihypertensive agents has been associated with acute renal failure, and is absolutely CONTRAINDICATED in patients with bilateral renal artery stenosis? 1) Thiazide diuretics 2) Angiotensin-converting enzyme (ACE) inhibitors 3) Calcium channel blockers 4) Potassium sparing diuretics 2) Angiotensin-converting enzyme (ACE) inhibitors In geriatric patients, the polyvalent pneumococcal vaccine: 1) prevents or lessens the severity of 60%-70% of pneumococcal infections. 2) has no affect on immunocompromised patients 3) prevents pneumonia 100% of the time 1) prevents or lessens the severity of 60%-70% of pneumococcal infections A 39-year-old patient was diagnosed with acute bronchitis in the emergency department and treated with acetaminophen, dextromethorphan, and metaproterenol (Alupent). The patient's history reveals a smoking habit of 1 pack per day. He now presents to your office with a fever of 101.2°F (39.4°C) and a cough productive of thick, yellow-green, foul-smelling sputum. You would encourage smoking cessation and prescribe: 1) a penicillin antibiotic 2) a macrolide antibiotic. 3) theophylline 4) inhalors 2) macrolide antibiotic A 68-year-old female presents with a 3-week history of itching that increases in intensity at night. Red papules with scale crusts are noted on the axilla, groin, and interdigital webs of the hands. The most likely diagnosis is: 1) xerosis 2) herpes zoster 3) eczema 4) scabies. 4) scabies A 68-year-old male with Parkinson's disease was placed on haloperidol (Haldol), 1 mg PO t.i.d. after presenting in the emergency department with visual and auditory hallucinations. On a visit to the office 2 days later for follow-up, the immediate course of action should be to: 1) decrease the dose of haloperidol. 2) prescribe a more potent neroleptic 3) discontinue the haloperidol. 4) add SSRI 3) discontinue the halperidol A 70-year-old farmer was hit in the eye with a tree branch. The first step in the assessment of a possible corneal abrasion is to: 1) check for pupillary reaction. 2) measure visual acuity. 3) irrigate the eye 4) perform a fundoscopic exam 2) check for visual acuity Which of the following is considered the most important factor in understanding and predicting an individual's health across the life span? 1) Psychological profile 2) Body habitus 3) Family history 4) diet history 3) family history A 68-year-old patient with a recent diagnosis of mild transient ischemic attack has been placed on aspirin, 325 mg PO daily with food. The patient develops an aspirin allergy. You would discontinue aspirin and: 1) change to clopidogrel (Plavix). 2) change to valproic acid 3) refer for endoarectomy 4) change to bulibital 1) change to clopidorel An 85-year-old female presents with a 2-hour history of diminished vision and severe pain in the right eye, plus nausea and vomiting. Visual acuity is decreased, the left pupil reacts to light, the right pupil does not react to light, and the conjunctiva is injected. The nurse practitioner would: 1) immediately refer to an ophthalmologist. 2) administer steroids 3) complete a comprehensive eye vision test 4) administer pilotarpine eye drops 1) immediately refer to an ophthalmologist. (acute angle closure glaucoma) Which of the following statements about preventive health care for the elderly is incorrect? 1) Elderly people usually have adequate insurance coverage. 2) CALORIC needs are reduced in the elderly 3) femoral fractures are caused by uncoordinated muscle action than by the impact of the fall 4) Exercise EB to reduce mortality from CAD 1) Elderly people usually have adequate insurance coverage. 1. An older adult presents with severe abdominal pain. The husband reports that earlier in the afternoon, the patient's abdominal hernia had been firm and bulged out 4 inches (10.2 cm). The patient had him press on the hernia and immediately felt burning pain throughout the abdomen. Which of the following is the nurse practitioners' NEXT action? 1. Abdominal CT scan 2. Complete blood count with differential 3. Abdominal ultrasound 4. Referral to the ED 4. Referral to the ED 2. A young adult female who is 34 weeks pregnant presents with the complaint of urinary frequency every 1 to 2 hours. The patient has no fever and denies back pain. A urine dipstick test is positive for leukocyte esterase and nitrites. Microscopic analysis reveals 15-20 WBCs/hpf and a few bacteria. The BEST choice for treatment of this patient's urinary tract infection would be: 1. trimethoprim-sulfamethoxazole (Bactrim), 160 mg/800 mg twice daily for 3 days. 2. cephalexin (Keflex), 500 mg four times daily for 7 days. 3. ciprofloxacin (Cipro), 500 mg twice daily for 7 days. 4. erythromycin, 250 mg three times daily for 5 days. 2. cephalexin (Keflex), 500 mg four times daily for 7 days. 3. An adult male presents with new-onset pain and tenderness in the low back and pain in the right great toe after a weekend of golf. He denies experiencing numbness and tingling. Which of the following would the nurse practitioner expect to find an investigation of this patient's low back pain? 1. Exacerbation of extremity symptoms with straight-leg raising 2. Loss of bowel and bladder function 3. Increased ankle jerk on evaluation of deep tendon reflexes 4. Increased lumbar lordosis 1. Exacerbation of extremity symptoms with straight-leg raising 4. A true statement about essential tremors is that they: 1. often begin with "pill-rolling" of one hand and may affect the legs, feet, and toes. 2. are often barely visible, rapid tremors. 3. are a characteristic of Parkinson's disease. 4. are slow tremors that are absent or minimal at rest and usually involve the hands. 4. are slow tremors that are absent or minimal at rest and usually involve the hands. 5. Which opioid medication is the MOST potent? 1. Codeine 2. Morphine 3. Oxycodone 4. Hydromorphone 4. Hydromorphone 6. Which symptom documented in a menstrual diary is diagnostic of PMS? 1. Irritability 2. Decreased libido 3. Menstrual cramps 4. Dyspareunia 1. Irritability 7. Which of the following is the medication of choice for monotherapy of an older adult with hypertension and no related comorbid conditions? 1.Alpha-blocker 2.Vasodilator 3.Thiazide diuretic 4.Beta-blocker 3.Thiazide diuretic 8. An elderly, obese female presents for evaluation of a painful rash, first noticed 2 weeks ago, located under both breasts. The rash is visible as an area of confluent, beefy-red, excoriated lesions with smaller satellite lesions extending beyond the borders of the main lesions. The KOH prep reveals pseudohyphae. The nurse practitioner would recommend a/an: 1. course of oral steroids and air drying of skin after showers. 2. topical antifungal and order a fasting blood glucose. 3. oral antibiotic and order a hemoglobin A1c. 4. high-potency topical corticosteroid and use of dry dressings. 2. topical antifungal and order a fasting blood glucose. 9. An older adult female complains of problems with urination. She reports that whenever she feels the need to urinate, she is unable to "make it to the bathroom in time," and wets herself. Which type of incontinence is MOST likely? 1. Urge 2. Overflow 3. Transient 4. Stress 1. Urge 10. A young adult female presents with painful swelling of the right cheek anterior to the TMJ. The diagnosis is sialadenitis. In addition to antibiotics, treatment for this patient should include: 1. hot soaks and lemon drops. 2. alternating heat and cold. 3. cold compresses and massage. 4. hot soaks and mucolytics. 1. hot soaks and lemon drops. 11. Initial therapy for older adult patients with arthritic joints is: 1. naproxen, 1000 mg twice daily. 2. ibuprofen, 600 mg four times daily. 3. glucosamine, 750 mg twice daily. 4. acetaminophen, 1000 mg four times daily. 4. acetaminophen, 1000 mg four times daily. 12. Which of the following is an example of gross negligence? 1. Prescription of a drug that causes a fatal allergic reaction 2. Misdiagnosis of appendicitis, resulting in peritonitis and a prolonged hospital stay 3. Refusal to return the emergency phone call of a patient who has chest pain evolving into an MI 4. Failure to diagnose a problem at an unrelated routine visit 3. Refusal to return the emergency phone call of a patient who has chest pain evolving into an MI 13. What is the correct order of pharmacokinetics of drugs in the body? 1. absorption, distribution, metabolism, excretion 2. distribution, absorption, metabolism, excretion 3. absorption, metabolism, distribution, excretion 4. metabolism, distribution, absorption, excretion 1. absorption, distribution, metabolism, excretion 14. An older adult female is brought in by her daughter, who has been visiting her. The daughter reports that her mother seems confused and anxious, and is moving oddly as if she is stiff. The daughter has brought along the mother's medications. She is taking hydrochlorothiazide, levothyroxine (Synthroid), sertraline (Zoloft), baby aspirin, a multivitamin, and St. John's wort. Which condition would the nurse practitioner MOST urgently suspect? 1. Alzheimer's disease 2. Serotonin syndrome 3. Vascular dementia 4. Aspirin toxicity 2. Serotonin syndrome 15. An adolescent male presents with marked itching in the inguinal region but not on the scrotum. Examination shows a peripherally-spreading, sharply-demarcated, centrally-clearing, erythematous lesion. The MOST likely diagnosis is: 1. poor hygiene. 2. tinea versicolor. 3. pediculosis pubis. 4. tinea cruris. 4. tinea cruris.