Exam
NURS 6531 Midterm Exam (2 Versions, 200 Q & A ) / NURS6531N Midterm Exam (Year-2019/2020, 100 Q & A in Each Version, Verified and 100% Correct Answers)
NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University

Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest)

Question 1
A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?

Question 2
Which type of lung cancer has the poorest prognosis?

Question 3
Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:

Question 4
An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:

Question 5
A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:

Question 6
Marvin has sudden eye redness that occurred after a strenuous coughing episode. You diagnose a subconjunctival hemorrhage. Your next step is to:
Question 7
Which of the following is not a goal of treatment for the patient with cystic fibrosis?
Question 8
The most common cancer found on the auricle is:
Question 9
Which of the following color changes in a pigmented lesion suggests malignant transformation?
Question 10
Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?

Question 11
The Centorcriteria for diagnosis of Group A B-hemolytic streptococcus includes which of the following?

Question 12
When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?

Question 13
Mark has just been given a diagnosis of congestive heart failure. Which of his medications should be discontinued?


Question 14
Which of the following patient characteristics are associated with chronic bronchitis?

Question 15
Treatment of acute vertigo includes:

Question 16
 A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:

Question 17
A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?

Question 18
Diagnosis of Crohn’s disease is made considering signs, symptoms and:

Question 19
Which of the following is a predisposing condition for furunculosis?

Question 20
Expected spirometry readings when the patient has chronic emphysema include:

Question 21
A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?

Question 22
 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:

Question 23
Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?

Question 24
An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to:

Question 25
A middle-aged male presents to urgent care complaining of fever, dysphagia, and shortness of breath. The nurse practitioner notes the patient leaning forward in a tripod position and drooling. The clinical presentation of this patient suggests:
Question 26
Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:

Question 27

The differential diagnosis for a patient complaining of a sore throat includes which of the following?

Question 28
Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?

Question 29
The American Cancer Society recommends a flexible sigmoidoscopy for colorectal cancer screening in persons at average risk every:
Question 30
Jennifer, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to:

Question 31
A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?

Question 32
A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:

Question 33
John, age 33, has a total cholesterol level of 188 mg/dL. How often should he be screened for hypercholesterolemia?

Question 34
A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:
Question 35
Your patient Jerry has gout. What do you suggest?


Question 36
Your well-nourished 75-year-old patient has come into the office for a physical exam and states that she recently had two nosebleeds. She does not take any anticoagulants, and you have ruled out any coagulopathies. The most likely cause of these nosebleeds is:

Question 37
A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:

Question 38

 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:

Question 39
Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?


Question 40
A 55 year old patient has a work-up for hypertension and is noted to have elevated BUN and creatinine. Which of the following should the nurse practitioner suspect?		

Question 41
Which of the following is not a symptom of irritable bowel syndrome?

Question 42

Impetigo and folliculitis are usually successfully treated with:

Question 43
Which of the following is not a risk factor for coronary arterial insufficiency?

Question 44
The most appropriate treatment for a child with mild croup is:

Question 45
John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?

Question 46
Appropriate therapy for peptic ulcer disease (PUD) is:

Question 47

An AST that is more than twice the level of ALT is suggestive of:

Question 48
A 45 year old with diabetes has had itching and burning lesions between her toes for 2 months. Scrapings of the lesions confirm the diagnosis tineapedis. What is the best initial treatment option for this patient? 


Question 49
An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? 

Question 50
Sandra has celiac disease. You place her on which diet?

Question 51
Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:

Question 52
Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?

Question 53
A very active elderly patient has a documented diagnosis of arteriosclerosis obliterans. Common expected lower extremity physical exam findings include:

Question 54

Which of the following is a secondary cause of hyperlipidemia?
Question 55

Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?

Question 56
An employee picnic menu includes grilled hamburgers, potato salad, and homemade ice cream sundaes. Within an hour after the meal, several children and parents begin to have nausea, vomiting and stomach cramps. None of those affected have fever. What is the most likely etiologic agent?

Question 57
The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?

Question 58
A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?

Question 59
Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?

Question 60
A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:

Question 61
 A patient presents to the office with a blood pressure 142/80. This patient is classified as having:

Question 62
Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?

Question 63
A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:

Question 64
A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?

Question 65
Which choice below is least effective for alleviating symptoms of the common cold?

Question 66
 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:
Question 67
A patient reports to the nurse practitioner that he was diagnosed with hepatitis B a year ago and has not seen a health care provider since then. What information should this patient be given?

Question 68

The most common correlate(s) with chronic bronchitis and emphysema is(are):
Question 69
If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:

Question 70
Treatment of H.pylori includes which of the following?

Question 71
Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?



Question 72
What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?

Question 73

Which of the following best describes hypertrophic cardiomyopathy?

Question 74
Amaurosisfugax is described as a:


Question 75

The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: 
Question 76

Which of the following heart murmurs warrants the greatest concern?

Question 77
A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect:

Question 78
Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 170/89. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure? 
Question 79
Of the following, the patient who should be referred for periodic colonoscopy is the patient with:

Question 80

Dana has ischemic arterial ulcers. What is your first priority when counseling her?

Question 81
After thorough history, physical examination, and laboratory tests, a patient is diagnosed with irritable bowel syndrome (IBS). Which of the following initial treatment plans is currently considered most effective?

Question 82
Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

Question 83
What is the Gold standard for the diagnosis of asthma?

Question 84

An 8 year old presents to the health clinic with history of acute onset severe sore throat and respiratory distress with stridor in the last 2 hours. The child’s history is positive for fever and pharyngitis for 2 days. What is the most likely diagnosis?

Question 85
The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:

Question 86
Which intervention listed below is safe for long term use by an adult with constipation?

Question 87
The nurse practitioner is reviewing a patient’s lab report who completed the hepatitis B series 3 months ago. Which of the following lab results would you expect to see in this patient? 


Question 88

Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?

Question 89
A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?

Question 90
A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:

Question 91
A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:
Question 92
A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?

Question 93
Which of the following can result from chronic inflammation of a meibomian gland?

Question 94
A 15 year old male presents with abdominal pain that began in the peri-umbilical area then localized to the right lower quadrant (RLQ). He complains of anorexia, and low grade fever. A complete blood count (CBC) reveals moderate leukocytosis. What is the most likely diagnosis?


Question 95
Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?

Question 96
A false-positive result with the fecal occult blood test can result from:

Question 97
 A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:
Question 98
Risk factors for acute arterial insufficiency include which of the following?





Question 99
A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:

Question 100

Which of the following are classic features of ulcerative colitis?

NURS 6531 Midterm Exam / NURS6531 Midterm Exam (Latest): Walden University

Walden NURS 6531 Midterm Exam / Walden NURS6531 Midterm Exam (Latest)


•	Question 1
											
	
	When completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?			
		
	 
Yes
	No
			
•	Question 2

	
	The most common cancer found on the auricle is:			
		
	Actinic keratosis
	 
Basal cell carcinoma
	Squamous cell carcinoma
	Acral-lentiginous melanoma
			
•	Question 3

	
	Which of the following medication classes should be avoided in patients with acute or chronic bronchitis because it will contribute to ventilation-perfusion mismatch in the patient?			
		
	Xanthines
	 
Antihistimines
	Steroids
	Anticholinergics
			

•	Question 4

	
	A 47 year old male patient presents to the clinic with a single episode of a moderate amount of bright red rectal bleeding. On examination, external hemorrhoids are noted. How should the nurse practitioner proceed?			
		
	Instruct the patient on measures to prevent hemorrhoids such as bowel habits and diet. 
	Order a topical hemorrhoid cream along with a stool softener.
	 
Refer the patient for a barium enema and sigmoidoscopy.
 
	Refer the patient for a surgical hemorrhoidectomy.
			
•	Question 5

	
	Which of the following patient characteristics are associated with chronic bronchitis?			
		
	 
Overweight, cyanosis, and normal or slightly increased respiratory rate
 
	Underweight, pink skin, and increased respiratory rate
 
	Overweight, pink skin, and normal or slightly increased respiratory rate
 
	Normal weight, cyanosis, and greatly increased respiratory rate
			
•	Question 6

	
	 A 65-year-old female with a past medical history of hypertension, hyperlipidemia, and polymyalgia rheumatica presents to urgent care with new onset left lower quadrant pain. Her current medications include omeprazole 20 milligrams po daily, lisinopril 20 milligrams po daily, simvastatin 20 milligrams po daily, and prednisone 12 milligrams po daily. The nurse practitioner suspects acute diverticulitis and possibly an abscess. The most appropriate diagnostic test for this patient at this time is:			
		
	CBCdiff
 
	Erythrocyte sedimentation rate
 
	Abdominal ultrasound
 
	 
CT scan
			
•	Question 7

	
	A patient reports “something flew in my eye” about an hour ago while he was splitting logs. If there were a foreign body in his eye, the nurse practitioner would expect to find all except:			
		
	 
Purulent drainage
 
	Tearing
 
	Photophobia
 
	A positive fluorescein stain
			
•	Question 8

	
	A 21 year old college student presents to the student health center with copious, markedly purulent discharge from her left eye. The nurse practitioner student should suspect:			
		
	Viral conjunctivitis
 
	Common pink eye
 
	 
Gonococcal conjunctivitis
 
	Allergic conjunctivitis
			
•	Question 9

	
	 A 35 year old man presents with radicular pain followed by the appearance of grouped vesicles consisting of about 15 lesions across 3 different thoracic dermatomes. He complains of pain, burning, and itching. The nurse practitioner should suspect:			
		
	A common case of shingles and prescribe an analgesic and an antiviral agent
 
	A complicated case of shingles and prescribe acyclovir, an analgesic, and a topical cortisone cream
 
	 
Herpes zoster and consider that this patient may be immunocompromised
 
	A recurrence of chickenpox and treat the patient’s symptoms
			
•	Question 10

	
	Which type of lung cancer has the poorest prognosis?			
		
	Adenocarcinoma
 
	Epidermoid carcinoma
 
	 
Small cell carcinoma
 
	Large cell carcinoma
			
•	Question 11

	
	 An 83-year-old female presents to the office complaining of diarrhea for several days. She explains she has even had fecal incontinence one time. She describes loose stools 3–4 times a day for several weeks and denies fever, chills, pain, recent antibiotic use. The history suggests that the patient has:			
		
	Acute diarrhea
 
	 
Chronic diarrhea
 
	Irritable bowel
 
	Functional bowel disease
			
•	Question 12

	
	Margaret, age 32, comes into the office with painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?			
		
	An allergic reaction
 
	Relapsing polychondritis
 
	Lymphocytoma cutis
 
	 
Systemic lupus erythematosus
			
•	Question 13

	
	Antibiotic administration has been demonstrated to be of little benefit to the treatment of which of the following disease processes?			
		
	Chronic sinusitis
	 
Acute bronchitis
 
	Bacterial pneumonia
 
	Acute exacerbation of chronic bronchitis
			
•	Question 14

	
	Lisa, age 49, has daily symptoms of asthma. She uses her inhaled short-acting beta-2 agonist daily. Her exacerbations affect her activities and they occur at least twice weekly and may last for days. She is affected more than once weekly during the night with an exacerbation. Which category of asthma severity is Lisa in?			
		
	Mild intermittent
 
	Mild persistent
 
	 
Moderate persistent
			
•	Question 15

	
	Which of the following is the most appropriate therapeutic regimen for an adult patient with no known allergies diagnosed with group A B-hemolytic strep?			
		
	 
Penicillin V 500 milligrams PO every 8 hours for 10 days
 
	Ampicillin 250 milligrams PO twice a day for 10 days
 
	Clarithromycin 500 milligrams po daily for 7 days
	None of the above
			
•	Question 16

	
	A cashier complains of dull ache and pressure sensation in her lower legs. It is relieved by leg elevation. She occasionally has edema in her lower legs at the end of the day. What is the most likely cause of these problems?			
		
	Congestive heart failure
 
	 
Varicose veins
	Deep vein thrombosis
	Arterial insufficiency
			
•	Question 17

	
	Which statement below is correct about pertussis?			
		
	 
It is also called whooping cough
 
	It begins with symptoms like strep throat
 
	It lasts about 3 weeks
 
	It occurs most commonly in toddlers and young children
			
•	Question 18

	
	Which of the following is the most important diagnosis to rule out in the adult patient with acute bronchitis?			
		
	 
Pneumonia
 
	Asthma
 
	Sinusitis
 
	Pertussis
			
•	Question 19

	
	A 70 year old patient presents with left lower quadrant (LLQ) abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms, which correctly describes the suspected condition?			
		
	Diverticulosis
 
	Diverticula
	 
Diverticulitis
 
	Diverticulum
			
•	Question 20

	
	Sylvia, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?			
		
	Varicella
	 
Herpes zoster
	Syphilis
	Rubella
			
•	Question 21

	
	A 33-year-old female is admitted with acute pancreatitis. The nurse practitioner knows that the most common cause of pancreatitis is:			
		
	Alcohol
 
	 
Gallstones
 
	Medications
 
	Pregnancy
			
•	Question 22

	
	When a patient presents with symptoms of acute gallbladder disease, what is the appropriate nurse practitioner action?			
		
	Order abdominal x-rays
 
	 
Order an abdominal ultrasound
 
	Refer the patient to a surgeon for evaluation
 
	Prescribe pain medication
			
•	Question 23

	
	A false-positive result with the fecal occult blood test can result from:			
		
	ingestion of large amounts of vitamin C
 
	 
a high dietary intake of rare cooked beef
 
	a colonic neoplasm that is not bleeding
 
	stool that has been stored before testing
			
•	Question 24

	
	 A 76-year-old male complains of weight loss, nausea, vomiting, abdominal cramping and pain. Physical findings include an abdominal mass and stool positive for occult blood. The nurse practitioner pain suspects a tumor in the small intestine. The best diagnostic test for this patient is:			
		
	Colonoscopy
 
	 
Small bowel follow-through
 
	Barium enema
 
	CT abdomen
			
•	Question 25

	
	A patient presents to urgent care complaining of dyspnea, fatigue, and lower extremity edema. The echocardiogram reveals and ejection fraction of 38%. The nurse practitioner knows that these findings are consistent with:			
		
	Mitral regurgitation
 
	 
Systolic heart failure
 
	Cardiac myxoma
 
	Diastolic heart failure
			
•	Question 26

	
	Maxine, Age 76, has just been given a diagnosis of pneumonia. Which of the following is an indication that she should be hospitalized?			
		
	 
Multilobar involvement on chest x-ray with the inability to take oral medications
 
	Alert and oriented, slightly high but stable vital signs, and no one to take care of her at home
 
	Sputum and gram positive organisms
 
	A complete blood count showing leukocytosis
			
•	Question 27

	
	A 55 year old man is diagnosed with basal cell carcinoma. The nurse practitioner correctly tells him:			
		
	“It is the most common cause of death in patients with skin cancer.”
 
	 
“It can be cured with surgical excision or radiation therapy.”
 
	“It is a slow growing skin cancer that rarely undergoes malignant changes.”
 
	“It can be cured using 5-flurouracil cream twice daily for 2 to 4 weeks.”
			
•	Question 28

	
	Expected spirometry readings when the patient has chronic emphysema include:			
		
	Decreased residual volume (RV)
 
	Increased vital capacity (VC)
 
	Increased forced expiratory volume (FEV-1)
 
	 
Increased total lung capacity (TLC)
			
•	Question 29

	
	 An 80-year-old male admits to difficulty swallowing during the review of systems. The nurse practitioner recognizes the differential diagnosis for this patient’s dysphagia is:			
		
	Esophageal cancer
 
	Chest pain
 
	GERD
 
	 
A and C
 
	All of the above
			
•	Question 30

	
	A 40 year old female with history of frequent sun exposure presents with a multicolored lesion on her back. It has irregular borders and is about 11mm in diameter. What should the nurse practitioner suspect?			
		
	Squamous cell carcinoma
 
	 
Malignant melanoma
 
	A common nevus
 
	Basal cell carcinoma
			
•	Question 31

	
	Which of the following is not a goal of treatment for the patient with cystic fibrosis?			
		
	Prevent intestinal obstruction
 
	Provide adequate nutrition
 
	Promote clearance of secretions
 
	 
Replace water-soluble vitamins
			
•	Question 32

	
	The nurse practitioner is performing a physical exam on a middle-aged African-American man. Which of the following areas is a common site for melanomas in African-Americans and other dark-skinned individuals?			
		
	Scalp
 
	Nails
 
	Feet
 
	 
B and C
 
	All of the above
			
•	Question 33

	
	An adult presents with tinea corporis. Which item below is a risk factor for its development?			
		
	 
Topical steroid use
 
	Topical antibiotic use
 
	A recent laceration 
 
	Cold climates
			
•	Question 34

	
	A patient has experienced nausea and vomiting, headache, malaise, low grade fever, abdominal cramps, and watery diarrhea for 72 hours. His white count is elevated with a shift to the left. He is requesting medication for diarrhea. What is the most appropriate response?			
		
	Prescribe loperamide (Immodium) or atropine-diphenoxylate (Lomotil) and a clear liquid diet for 24 hours. 
 
	 
Prescribe a broad-spectrum antibiotic such as ciprofloxacin (Cipro), and symptom management.
 
	Offer an anti-emetic medication such as ondansetron (Zofran) and provide oral fluid and electrolyte replacement instruction.
 
	Order stool cultures.
			
•	Question 35

	
	Janine, age 29, has numerous transient lesions that come and go, and she is diagnosed with urticaria. What do you order?			
		
	Aspirin
	NSAIDs
	Opioids
	 
Antihistamines
			
•	Question 36

	
	 Of the following signs and symptoms of congestive heart failure (CHF), the earliest clinical manifestation is:			
		
	Peripheral edema
 
	 
Weight gain
 
	Shortness of breath
 
	Nocturnal dyspnea
			
•	Question 37

	
	A 16 year old male presents with mild sore throat, fever, fatigue, posterior cervical adenopathy, and palatine petechiae. Without a definitive diagnosis for this patient, what drug would be least appropriate to prescribe?			
		
	Ibuprofen
	Erythromycin
	 
Amoxicillin
	Acetaminophen
			
•	Question 38

	
	A 70 year old man who walks 2 miles every day complains of pain in his left calf when he is walking. The problem has gotten gradually worse and now he is unable to complete his 2 mile walk. What question asked during the history, if answered affirmatively, would suggest a diagnosis of arteriosclerosis obliterans?			
		
	“Are you wearing your usual shoes?” 
 
	“Do you also have chest pain when you have leg pain?”
 
	 
“Is your leg pain relieved by rest?”
 
	“Do you ever have the same pain in the other leg?”
			
•	Question 39

	
	Which of the following statements about malignant melanomas is true?			
		
	They usually occur in older adult males
	The patient has no family history of melanoma
	They are common in blacks
	 
The prognosis is directly related to the thickness of the lesion
			
•	Question 40

	
	Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles that do not clear with coughing, and peripheral edema. What do you suspect?			
		
	Asthma
	Nocturnal allergies
 
	Valvular disease
 
	 
Heart failure
			
•	Question 41

	
	Which antibiotic would be the most effective in treating community acquired pneumonia (CAP) in a young adult without any comorbid conditions? 			
		
	Erythromycin
 
	 
Clarithromycin (Biaxin)
 
	Doxycycline (Vibramycin)
 
	Penicillin
			
•	Question 42

	
	Which of the following dermatologic vehicles are the most effective in absorbing moisture and decreasing friction?			
		
	 
Powders
 
	Gels
 
	Creams
 
	Lotion
			
•	Question 43

	
	A 70 year old patient presents with a slightly raised, scaly, erythematous patch on her forehead. She admits to having been a “sun worshiper.” The nurse practitioner suspects actinic keratosis. This lesion is a precursor to:			
		
	 
Squamous cell carcinoma
 
	Basal cell carcinoma
 
	Malignant melanoma
 
	Acne vulgaris
			
•	Question 44

	
	An elderly patient is being seen in the clinic for complaint of “weak spells” relieved by sitting or lying down. How should the nurse practitioner proceed with the physical examination? 			
		
	Assist the patient to a standing position and take her blood pressure. 
 
	Assess the patient’s cranial nerves. 
 
	 
Compare the patient’s blood pressure lying first, then sitting, and then standing. 
 
	Compare the amplitude of the patient’s radial and pedal pulses.
			
•	Question 45

	
	What oral medication might be used to treat chronic cholethiasis in a patient who is a poor candidate for surgery?			
		
	 
 Ursodiol
 
	 Ibuprofen
 
	Prednisone
 
	 Surgery is the only answer
			
•	Question 46

	
	A 46-year-old female with a past medical history of diabetes presents with a swollen, erythematous right auricle and is diagnosed with malignant otitis externa. The nurse practitioner knows that the most likely causative organism for this patient’s problem is:			
		
	Staphylococcus aureus
 
	Group A beta hemolytic streptococcus
 
	Haemophilus influenza
 
	 
Pseudomonas aeruginosa
			
•	Question 47

	
	Which of the following is not a symptom of irritable bowel syndrome?			
		
	Painful diarrhea
	Painful constipation
	Cramping and abdominal pain
	 
Weight loss
			
•	Question 48

	
	A patient comes in complaining of 1 week of pain in the posterior neck with difficulty turning the head to the right. What additional history is needed?			
		
	 
Any recent trauma
	Difficulty swallowing
	 Stiffness in the right shoulder
	Change in sleeping habits
			
•	Question 49

	
	Marvin, age 56, is a smoker with diabetes. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis?			
		
	ACE Inhibitor
 
	 
Beta Blocker
 
	Calcium channel blocker
 
	Diuretic
			
•	Question 50

	
	The differential diagnosis for a patient complaining of a sore throat includes which of the following?			
		
	Gonococcal infection
 
	Thrush
 
	Leukoplakia
 
	B only
 
	 
A, B, and C
			
•	Question 51

	
	A patient presents to the primary care provider complaining of a rash on his right forehead that started yesterday and is burning and painful. The physical exam reveals an erythematous, maculopapular rash that extends over the patient’s right eye to his upper right forehead. Based on the history and examination, the most likely cause of this patient’s symptoms is:			
		
	Rhus dermatitis
 
	 
Ophthalmic zoster
 
	Chemosis
 
	Optic neuritis
			
•	Question 52

	
	Before initiating an HMG CoA-reductase inhibitor for hyperlipidemia, the nurse practitioner orders liver function studies. The patient’s aminotransferase (ALT) is elevated. What laboratory test(s) should be ordered?			
		
	 
Serologic markers for hepatitis
 
	Serum bilirubin
 
	Serum cholesterol with HDL and LDL
 
	A liver biopsy
			
•	Question 53

	
	A patient with elevated lipids has been started on lovastatin. After 3 weeks of therapy, he calls to report generalized muscle aches. The nurse practitioner should suspect:			
		
	A drug interaction
	Hepatic dysfunction
 
	Hypersensitivity to lovastatin
	 
Rhabdomyolysis
			
•	Question 54

	
	Treatment of acute vertigo includes:			
		
	 
Bedrest and an antihistamine
 
	Fluids and a decongestant
 
	A sedative and decongestant
 
	Rest and a low sodium diet
			
•	Question 55

	
	Treatment of H.pylori includes which of the following?			
		
	Proton pump inhibitor
 
	Antibiotic therapy
 
	Bismuth subsalicylate
 
	A and B
 
	 
A, B, and C
			
•	Question 56

	
	Carl, age 78, is brought to the office by his son, who states that his father has been unable to see clearly since last night. Carl reports that his vision is “like looking through a veil.” He also sees floaters and flashing lights but is not having any pain. What do you suspect?			
		
	Cataracts
 
	Glaucoma
 
	 
Retinal detachment
 
	Iritis
			
•	Question 57

	
	In order to decrease deaths from lung cancer:			
		
	All smokers should be screened annually
 
	All patients should be screened annually
 
	Only high risk patients should be screened routinely
 
	 
Patients should be counseled to quit smoking
			
•	Question 58

	
	John, age 33, has a total cholesterol level of 188 mgdL. How often should he be screened for hypercholesterolemia?			
		
	 
 Every 5 years
 
	Every 2 years
 
	 Every year
 
	Whenever blood work is done
			
•	Question 59

	
	Mort is hypertensive. Which of the following factors influenced your choice of using an alpha blocker as the antihypertensive medication?			
		
	Mort is black
 
	Mort also has congestive heart failure
 
	 
 Mort has benign prostatic hyperplasia
 
	 Mort has frequent migraine headaches
			
•	Question 60

	
	John, age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?			
		
	Actinic keratosis
	Eczema
	 
Psoriasis
	Seborrheic dermatitis
			
•	Question 61

	
	Harriet, a 79-year-old woman, comes to your office every 3 months for follow up on her hypertension. Her medications include one baby aspirin daily, Lisinopril 5mg daily, and Calcium 1500 mg daily. At today’s visit. Her blood pressure is 17089. According to JNC VIII guidelines, what should you do next to control Harriet’s blood pressure?			
		
	Increase her Lisinopril to 20mg daily 
 
	 
Add a thiazide diuretic to the Lisinopril 5mg daily
 
	Discontinue the Lisinopril and start a combination of ACE Inhibitor and calcium channel blocker
 
	Discontinue the Lisinopril and start a diuretic
			
•	Question 62

	
	An active 65-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes into the office you discover that he has 10 remaining teeth in poor repair. Your recommendation would be to:			
		
	defer any further dental work until his valve replacement is completed
	instruct him to have dental extraction done cautiously, having no more than 2 teeth per visit removed.
	 
suggest he consult with his oral surgeon about having all the teeth removed at once and receiving appropriate antibiotic prophylaxis
	coordinate with his cardiac and oral surgeons to have the tooth extractions and valve replacement done at the same time to reduce the risk of anesthetic complications.
			
•	Question 63

	
	Appropriate therapy for peptic ulcer disease (PUD) is:			
		
	Primarily by eradication of infection
 
	 
Based on etiology
 
	Aimed at diminishing prostaglandin synthesis
 
	Dependent on cessation of NSAID use
			
•	Question 64

	
	Shirley, age 58, has been a diabetic for 7 years. Her blood pressure is normal. Other than her diabetes medications, what would you prescribe today during her routine office visit?			
		
	A calcium channel blocker
 
	A beta blocker
 
	 
An ACE Inhibitor
 
	No hypertension medication 
			
•	Question 65

	
	Medicare is a federal program administered by the Centers for Medicare and Medicaid Services (CMS). The CMS has developed guidelines for Evaluation and Management coding, which all providers are expected to follow when coding patient visits for reimbursement. Which of the following is an important consideration regarding billing practices?			
		
	It is important to “undercode” so that one does not get charged with Medicare fraud
	The practice of “overcoding” is essential in this age of decreasing reimbursements
	 
Failing to bill for billable services will lead to unnecessarily low revenues
	Time spent with the patient is a very important determinant of billing
			
•	Question 66

	
	A 2 year old presents with a white pupillary reflex. What is the most likely cause of this finding?			
		
	Viral conjunctivitis
	Glaucoma
	Corneal abrasion
	 
Retinoblastoma
			
•	Question 67

	
	Harvey has had Meniere’s disease for several years. He has some hearing loss but now has persistent vertigo. What treatment might be instituted to relieve the vertigo?			
		
	Pharmacological therapy
 
	A labyrinthectomy
 
	 
A vestibular neurectomy
 
	Wearing an earplug in the ear with the most hearing loss
			
•	Question 68

	
	Which of the following is not a risk factor for coronary arterial insufficiency?			
		
	Hyperhomocysteinemia
 
	Smoking
 
	Genetic factors
 
	 
Alcohol ingestion
			
•	Question 69

	
	An 18-year-old female presents to the urgent care center complaining of severe pruritus in both eyes that started 2 days ago. Associated symptoms include a headache and fatigue. On examination, the nurse practitioner notes some clear discharge from both eyes and some erythema of the eyelids and surrounding skin. Which of the following is the most likely cause of this patient’s symptoms?			
		
	 
Allergic conjunctivitis
 
	Bacterial conjunctivitis
 
	Gonococcal conjunctivitis
 
	Viral conjunctivitis
			
•	Question 70

	
	A 20 year old is diagnosed with mild persistent asthma. What drug combination would be most effective in keeping him symptom-free?			
		
	A long-acting bronchodilator
	An inhaled corticosteroid and cromolyn
 
	Theophylline and a short acting bronchodilator
 
	 
A bronchodilator PRN and an inhaled corticosteroid
			
•	Question 71

	
	Acute rheumatic fever is an inflammatory disease which can follow infection with:			
		
	 
Group A Streptococcus
 
	Staphlococcus areus
 
	Β-hemolytic Streptococcus
 
	Streptococcus pyogenes
			
•	Question 72

	
	A 60 year old male diabetic patient presents with redness, tenderness, and edema of the left lateral aspect of his face. His left eyelid is grossly edematous. He reports history of a toothache in the past week which “is better.” His temperature is 100°F and pulse is 102 bpm. The most appropriate initial action is to:			
		
	Start an oral antibiotic, refer the patient to a dentist immediately, and follow up within 3 days
 
	Order mandibular x-rays and question the patient about physical abuse
 
	Start an oral antibiotic, mouth swishes with an oral anti-infective, and an analgesic
 
	 
Initiate a parenteral antibiotic and consider hospital admission
			
•	Question 73

	
	If a patient presents with a deep aching, red eye and there is no discharge, you should suspect:			
		
	 
Iritis
 
	Allergic conjunctivitis
 
	Viral conjunctivitis
	Bacterial conjunctivitis
			
•	Question 74

	
	The National Cholesterol Education Program’s Adult Treatment Panel III recommends that the goal for low density lipoproteins in high risk patients be less than:			
		
	160 mgdL
 
	130 mgdL
 
	 
100 mgdL
 
	70 mgdL
			
•	Question 75

	
	 A patient presents with classic symptoms of gastroesophageal reflux disease (GERD). He is instructed on life style modifications and drug therapy for 8 weeks. Three months later he returns, reporting that he was “fine” as long as he took the medication. The most appropriate next step is:			
		
	Referral for surgical intervention such as a partial or complete fundoplication
 
	Dependent upon how sever the practitioner believes the condition
 
	To repeat the 8 week course of drug therapy while continuing lifestyle modifications
 
	 
Investigation with endoscopy, manometry, andor pH testing
			
•	Question 76

	
	Group A β-hemolytic streptococcal (GABHS) pharyngitis is most common in which age group?			
		
	Under 3 years of age
 
	Preschool children
 
	 
6 to 12 years of age
 
	Adolescents
			
•	Question 77

	
	The most appropriate treatment for a child with mild croup is:			
		
	A bronchodilator
 
	An antibiotic
 
	A decongestant 
 
	 
A cool mist vaporizer
			
•	Question 78

	
	A child complains that his “throat hurts” with swallowing. His voice is very “throaty” and he is hyperextending his neck to talk. Examination reveals asymmetrical swelling of his tonsils. His uvula is deviated to the left. What is the most likely diagnosis?			
		
	 
Peritonsillar abscess
 
	Thyroiditis
 
	Mononucleosis
 
	Epiglottitis
			
•	Question 79

	
	Salmeterol (Servent) is prescribed for a patient with asthma. What is the most important teaching point about this medication?			
		
	 
It is not effective during an acute asthma attack.
 
	It may take 2 to 3 days to begin working. 
 
	This drug works within 10 minutes. 
 
	This drug may be used by patients 6 years and older.
			
•	Question 80

	
	Which intervention listed below is safe for long term use by an adult with constipation?			
		
	 
Bulk-forming agents
 
	Stool softeners
 
	Laxatives
 
	Osmotic agents
			
•	Question 81

	
	A 40 year old presents with a hordeolum. The nurse practitioner teaches the patient to:			
		
	 
Apply a topical antibiotic and warm compresses. 
 
	Apply cool compresses and avoid touching the hordeolum. 
 
	Use an oral antibiotic and eye flushes. 
 
	Apply light palpation to facilitate drainage.
			
•	Question 82

	
	Sarah has allergic rhinitis and is currently being bothered by nasal congestion. Which of the following meds ordered for allergic rhinitis would be most appropriate?			
		
	An antihistamine intranasal spray
	 
A decongestant nasal spray
 
	Ipratropium
 
	Omalizumab
			
•	Question 83

	
	What is the Gold standard for the diagnosis of asthma?			
		
	Patient’s perception of clogged airways
 
	Validated quality-of-life questionnaires
	 Bronchoscopy
 
	 
Spirometry
			
•	Question 84

	
	A patient complains of “an aggravating cough for the past 6 weeks.” There is no physiological cause for the cough. Which medication is most likely causing the cough?			
		
	Methyldopa
 
	 
Enalapril 
 
	Amlodipine
 
	Hydrochlorothiazide
			
•	Question 85

	
	Stacy, age 27, states that she has painless, white, slightly raised patches in her mouth. They are probably caused by:			
		
	Herpes simplex
 
	Aphthous ulcers
 
	 
Candidiasis
 
	Oral cancer
			
•	Question 86

	
	Risk factors for acute otitis media (AOM) include all of the following except:			
		
	Household cigarette smoke
 
	Group daycare attendance
 
	Sibling history of acute otitis media
 
	 
African-American ethnicity
 
			
•	Question 87

	
	Which of the following can result from chronic inflammation of a meibomian gland?			
		
	 
A chalazion
 
	Uveitis
 
	Keratitis
 
	A pterygium
			
•	Question 88

	
	What conditions must be met for you to bill “incident to” the physician, receiving 100% reimbursement from Medicare?			
		
	You must initiate the plan of care for the patient
	 
The physician must be on-site and engaged in patient care
	You must be employed as an independent contractor
	You must be the main health care provider who sees the patient
			
•	Question 89

	
	Of the following choices, the least likely cause of cough is:			
		
	Asthma
 
	Gastroesophageal reflux
 
	 
Acute pharyngitis
	Allergic rhinitis
			
•	Question 90

	
	The most common correlate(s) with chronic bronchitis and emphysema is(are):			
		
	Familial and genetic factors
 
	 
Cigarette smoking
 
	Air pollution
 
	Occupational environment
			
•	Question 91

	
	Which choice below is least effective for alleviating symptoms of the common cold?			
		
	 
Antihistamines
	Oral decongestants
	Topical decongestants
	Antipyretics
			
•	Question 92

	
	When teaching a patient with hypertension about restricting sodium, you would include which of the following instructions?			
		
	Diets with markedly reduced intakes of sodium may be associated with other beneficial effects beyond blood pressure control 
 
	Sodium restriction can cause serious adverse effects
 
	A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable
 
	 
Seventy-five of sodium intake is derived from processed foods
			
•	Question 93

	
	Which of the following heart murmurs warrants the greatest concern?			
		
	Systolic murmur
 
	Venous hum murmur
 
	 
Diastolic murmur
 
	Flow murmur
			
•	Question 94

	
	A patient presents with an inflamed upper eyelid margin. The conjunctiva is red and there is particulate matter along the upper eyelid. The patient complains of a sensation that “there is something in my eye.” What is the diagnosis and how should it be treated?			
		
	Hordeolum; treat with a topical antibiotic and warm compress
 
	Conjunctivitis; treat with topical antibiotic and warm compresses
 
	 
Blepharitis; treat with warm compresses and gentle debridement with a cotton swab
 
	Chalazion; refer to an ophthalmologist for incision and drainage
			
•	Question 95

	
	A 57-year-old male presents to urgent care complaining of substernal chest discomfort for the past hour. The EKG reveals ST elevations in Leads II, III, and AVF. The nurse practitioner is aware that these changes are consistent with which myocardial infarction territory?			
		
	 
Inferior wall
 
	Anterior wall
 
	Apical wall
 
	Lateral wall
			
•	Question 96

	
	The nurse practitioner observes a tympanic membrane that is opaque, has decreased mobility, and is without bulging or inflammation. The least likely diagnosis for this patient is: 
 			
		
	 
Acute otitis media (AOM)
 
	Otitis media with effusion
 
	Mucoid otitis media
 
	Serous otitis media
			
•	Question 97

	
	Alan, age 54, notices a bulge in his midline every time he rises from bed in the morning. You tell him it is a ventral hernia, also known as:			
		
	inguinal hernia
	 
epigastric hernia
 
	umbilical hernia
 
	incisional hernia 
			
•	Question 98

	
	A 58-year-old man is diagnosed with Barrett’s esophagus after an endoscopy. He has no known allergies. Which of the following medications is MOST appropriate to treat this patient’s disorder?			
		
	 
Omeprazole
 
	Ranitidine
 
	An antacid
 
	None of the above
			
•	Question 99

	
	Larry, age 66, is a smoker with hyperlipidemia and hypertension. He is 6 months post-MI. To prevent reinfarction, the most important behavior change that he can make is to:			
		
	 
Quit smoking
 
	Maintain aggressive hypertension therapy
 
	Stick to a low-fat, low-sodium diet
 
	Continue with his exercise program
			
•	Question 100

	
	Risk factors for acute arterial insufficiency include which of the following?			
		
	Recent myocardial infarction
 
	Atrial fibrillation
 
	Atherosclerosis
 
	 
All of the above
			
•	Question 101

	
	Impetigo and folliculitis are usually successfully treated with:			
		
	Systemic antibiotics
 
	 
Topical antibiotics
 
	Topical steroid creams
 
	Cleansing and debridement