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Just need the correct answers to these final exam questions.

Question 4 Which patient would benefit most from screening for type 2 diabetes? A 30 year old female with unintended weight loss.
A 25 year old male with family history of type 1 diabetes
An obese female with recurrent vaginitis
A 50 year old hyperlipidemic male

Question 5 A 72 year old female patient reports a 6 month history of gradually progressive swollen and painful distal interphalangeal (DIP) joints of one hand. She has no systemic symptoms but the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), and rheumatoid factor (RF) are all minimally elevated. What is the most likely diagnosis?
Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Lupus Peripheral neuropathy

Question 6 A 32 year old male patient complains of urinary frequency and burning on urination for 3 days. Urinalysis reveals bacteriuria. He denies any past history of urinary tract infection. The initial treatment should be:
Trimethoprim-sulfamethoxazole for 3 days
Ciprofloxacin for 7-10 days
Trimethoprim-sulfamethoxazole for 14 days
Ciprofloxacin for 3 days

A thymectomy is usually recommended in the early treatment of which disease? Parkinsons disease
Multiple sclerosis
Myasthenia gravis
Huntingtons chorea

Question 8 The diagnosis of human papilloma virus (HPV) infection in males is usually made by:
Clinical appearance
Viral culture
Tzanck smear
KOH prep

Question 9 The most effective intervention(s) to prevent stroke is (are):
81 mg of aspirin daily
Carotid endarterectomy for patients with high-grade carotid lesions
Routine screening for carotid artery stenosis with auscultation for bruits
Smoking cessation and treatment of hypertension

Question 10 What is the most common cause of Cushings syndrome?
Excessive ACTH production
Administration of a glucocorticoid or ACTH
Pituitary adenoma or a non-pituitary ACTH-producing tumor
Autonomous cortisol production from adrenal tissue

Question 11 Diagnostic radiological studies are indicated for low back pain: Routinely after 3 weeks of low back pain symptoms.
To screen for spondylolithiasis in patients less than 20 years of age with 2 weeks of more of low back pain.
When there is a suspicion of a space-occupying lesion, fracture, cauda equina, or infection.
As a part of a pre-employment physical when heavy lifting is included in the job description.

Question 12 After treating a patient for Helicobacter pylori infection, what test do you order to see if it has been cured?
An enzyme-linked immunosorbent assay titer
A urea breath test
A rapid urease test
A repeat endoscopy

Question 13 Which appropriate test for the initial assessment of Alzheimers disease provides the performance ratings on 10 complex, higher order activities? MMSE CAGE questionnaire
FAQ Functional Activities Questionnaire
Holmes and Rahe social readjustment scale

Question 14 Major depression occurs most often in which of the following conditions?
A. Myocardial infarction
Parkinsons disease
Alzheimers disease

Question 15 Which of the following statements about multiple sclerosis (MS) is correct?
MS is a chronic, untreatable illness that is almost always fatal.
MS is a disease of steadily progressive and unrelenting neurologic deterioration. MS is a chronic, treatable illness with unknown cause and a variable course. Patients with MS who take active steps to improve their health have the best cure rate.

Question 16 Diagnostic evaluation of hypothyroidism reveals:
Elevated TSH and decreased T4
Decreased TSH and increased T4
Decreased TSH and decreased T3
Elevated TSH and increased T4

Question 17 Risk factors for prostate cancer include all of the following except: Family history
Benign prostatic hypertrophy
African American race

Question 18 What information should patients with diabetes and their families receive about hypoglycemia?
Hypoglycemia is a rare complication. Hypoglycemia requires professional medical treatment.
Hypoglycemia is serious, dangerous, and can be fatal if not treated quickly. Hypoglycemia occurs only as a result of insulin overdose.

Question 19 Which history is commonly found in a patient with glomerulonephritis?
Beta-hemolytic strep infection
Frequent urinary tract infections
Kidney stones

Question 20 Which of the following is characteristic of a manic episode?
weight loss of gain
insomnia or hypersomnia
diminished ability to think or concentrate
grandiose delusions

Question 21 Central obesity, moon face, and dorsocervical fat pad are associated with:
Metabolic syndrome
Unilateral pheochromocytoma
Cushings syndrome
None of the above

Question 22 Which of the following is the most common cause of low back pain? Lumbar disc disease
Spinal stenosis
Traumatic fracture

Question 23 A middle-aged female presents complaining of recent weight loss. The physical exam reveals an enlarged painless cervical lymph node. The differential diagnosis for this patients problem includes:
Infection Toxoplasmosis
All of the above
None of the above Question

24 An 81-year-old female is diagnosed with type 2 diabetes. When considering drug therapy for this patient, the nurse practitioner is most concerned with which of the following side effects?
Weight gain
Fracture risk
Weight loss

Question 25 A patient has HIV infection and is having a problem with massive diarrhea. You suspect the cause is:

Question 26 Which of the following is the most common causative organism of nongonococcal urethritis?
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma hominis
Trichonomas vaginalis

Question 27 The most common symptoms of transient ischemic attack (TIA) include:
Nausea, vomiting, syncope, incontinence, dizziness, and seizure.
Weakness in an extremity, abruptly slurred speech, or partial loss of vision, and sudden gait changes.
Headache and visual symptoms such as bright spots or sparkles crossing the visual field.
Gradual onset of ataxia, vertigo, generalized weakness, or lightheadedness
Question 28 What is the first symptom seen in the majority of patients with Parkinsons disease?
Rest tremor
Flexed posture

Question 29 A 21-year-old female presents to the office complaining of urinary frequency and urinary burning. The nurse practitioner suspects a urinary tract infection when the urinalysis reveals
14 red blood cells per high-powered field
Specific gravity 1.012
10- white blood cells per high-powered field

Question 30 A 26 year old female presents with elbow pain that is described as aching and burning. There is point tenderness along the lateral aspect of the elbow and painful passive flexion and extension. She reports she has been playing tennis almost daily for the past month. The most likely diagnosis is:
Radial tunnel syndrome
Ulnar collateral ligament sprain
Olecranon bursitis
Lateral epicondylitis

Question 31 Maria, age 17, was raped when she was 13 year old. She is now experiencing sleeping problems, flashbacks, and depression. What is your initial diagnosis?
Panic disorder
Post-traumatic stress disorder

Question 32 An elderly man is started on lisinopril and hydrochlorhiazide for hypertension. Three days later, he returns to the office complaining of left great toe pain. On exam, the nurse practitioner notes an edematous, erythematous tender left great toe. The likely precipitant of this patients pain is:
Tight shoes
Arthritis flare

Question 33 Which of the following is a contraindication for metformin therapy? Insulin therapy
Creatinine 1.5
None of the above

Question 34 A positive drawer sign supports a diagnosis of:
Cruciate ligament injury
Meniscal injury
Patellar ligament injury

Question 35 Steve, age 69, has gastroesophageal reflux disease (GERD). When teaching him how to reduce his lower esophageal sphincter pressure, which substances do you recommend that he avoid?

Question 36 A patient taking levothyroxine is being over-replaced. What condition is he at risk for?

Question 37 Diabetes screening recommendations for asymptomatic adults age 45 and over include which of the following:
2-hour 75 gram oral glucose tolerance test
C-peptide level
A and B
All of the above

Question 38 Dave, age 38, states that he thinks he has an ear infection because he just flew back from a business trip and feels unusual pressure in his ear. You diagnose barotrauma. What is your next action?
Prescribe systemic antibiotics
Prescribe antibiotic ear drops
Prescribe nasal steroids and oral decongestants
Refer him to an ear, nose, and throat specialist

Question 39 Josh, age 22, is a stock boy and has an acute episode of low back pain. You order and NSAID and tell him which of the following?
Maintain moderate bed rest for 3-4 days
Call the office for narcotics if there is no relief with the NSAID in 24-48 hours Begin lower back strengthening exercises depending on pain tolerance
Wear a Boston brace at night

Question 40 Risk factors for Addisons disease include which of the following? Tuberculosis
Autoimmune disease
All of the above

Question 41 Urine cultures should be obtained for which of the following patients? Suspected urinary tract infection in pregnancy
Febrile patients
Young men
All of the above

Question 42 Jennifer says that she has heard that caffeine can cause osteoporosis and asks you why. How do you respond?
Caffeine has not effect on osteoporosis.
A high caffeine intake has a diuretic effect that may cause calcium to be excreted more rapidly.
Caffeine affects bone metabolism by altering intestinal absorption of calcium and assimilation of calcium into the bone matrix.
Caffeine increase bone resorption.

Question 43 The diagnosis which must be considered in a patient who presents with a severe headache of sudden onset, with neck stiffness and fever, is:
Migraine headache
Subarachnoid hemorrhage

Question 44 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 45 The most commonly recommended method for prostate cancer screening in a 55 year old male is:
Digital rectal examination (DRE) plus prostate specific antigen (PSA)
Prostate specific antigen (PSA) alone
Transrectal ultrasound (TRUS) alone
Prostate specific antigen (PSA) and transrectal ultrasound (TRUS)

Question 46 The primary goals of treatment for patients with alcohol abuse disorder are:
Reduction in withdrawal symptoms and reduction in desire for alcohol Psychotherapeutic and pharmacological interventions to decrease desire for and effects of alcohol
Abstinence or reduction in use, relapse prevention, and rehabilitation
Marital satisfaction, improvement in family functioning, and reduction in psychiatric impairment

Question 47 You are assessing a patient after a sports injury to his right knee. You elicit a positive anterior/posterior drawer sign. This test indicates an injury to the: Lateral meniscus
Cruciate ligament
Medical meniscus
Collateral ligament

Question 48 Marsha presents with symptoms resembling both fibromyalgia and chronic fatigue syndrome, which have many similarities. Which of the following is more characteristic of fibromyalgia?
Musculoskeletal pain
Difficulty sleeping

Question 49 Differential diagnosis of proteinuria includes which of the following? Orthostatic proteinuria
Nephrotic syndrome
A and B

Question 50 A patient presenting for an annual physical exam has a BMI of 25 kg/m2 This patient would be classified as:
Normal weight

Question 51 Reed-Sternberg B lymphocytes are associated with which of the following disorders:
Aplastic anemia
Hodgkins lymphoma
Non Hodgkins lymphoma
Myelodysplastic syndromes

Question 53 A 77-year-old female presents to the office complaining a sudden swelling on her right elbow. She denies fever, chills, trauma, or pain. The physical exam reveals a non-tender area of swelling over the extensor surface over the right elbow with evidence of trauma or irritation. The nurse practitioner suspects: Arthritis
Ulnar neuritis
Septic arthritis
Olecranon bursitis

Question 54 Establishment of a definitive diagnosis of osteomyelitis requires:

A known causative injury such as a puncture wound, bite, or decubitus ulcer.

Biopsy of culture of the pathogen from blood or bone aspirate.

Visualization of purulent material draining into soft tissue. Lucent areas identified on plain x-ray.

Question 55 The most accurate measure of diabetes control is:
Avoidance of micro- and macro-vascular complications.
Insulin sensitivity.
Early morning glucose levels.

Question 56 A patient has been diagnosed with generalized anxiety disorder (GAD). Which of the following medications may be used to treat generalized anxiety disorder?
Alprazolam or diazepam
Venlafaxine or buspirone
Trazodone or sertraline
Venlafaxine or hydroxyzine pamoate

Question 57 The most common presentation of thyroid cancer is:
Generalized enlargement of the thyroid gland.
A solitary thyroid nodule.
A multinodular goiter.
Abnormal thyroid function tests.

Question 58 Which of the following accounts for half of the bladder tumors among men and one-third in women?
Cigarette smoke, both active and passive inhalation
Chemicals from plastic and rubber
Chronic use of phenacetin-containing analgesic agents
Working long hours and not voiding often

Question 59 You have a new patient that presents with generalized lymphadenopathy. You know that this is indicative of:
Sjogrens syndrome
Pancreatic cancer
Disseminated malignancy of the hematologic system
Cancer of the liver

Question 60 Sally, a computer programmer, has just been given a new diagnosis of carpal tunnel syndrome. Your next step is to:
Refer her to a hand surgeon
Take a more complete history
Try neutral position wrist splinting and oral NSAID
Order a nerve conduction study such as am electromyography

Question 61 Which drug category contains the drugs that are the first line Gold standard therapy for COPD?
Inhaled beta-2 agonist bronchodilators
Inhaled anticholinergic bronchodilators

Question 62 Potential causes of septic arthritis include which of the following? Lyme disease
Prosthetic joint infection
Reiters syndrome
A and B
All of the above

Question 63 The nurse practitioner diagnoses epididymitis in a 24 year old sexually active male patient. The drug of choice for treatment of this patient is: Oral ciprofloxacin (Cipro)
Oral doxycycline (Virbamycin) plus intramuscular ceftriaxone
Oral trimethoprim-sulfamethoxazole (Bactrim DS)
Intramuscular penicillin

Question 64 A patient has been taking fluoxetine (Prozac) since being diagnosed with major depression, first episode, 2 months ago. She reports considerable improvement in her symptoms and her intention to discontinue the medication. What should be the nurse practitioners recommendation?
Advise the patient to stop the antidepressant medication
Question the patient to determine if the self-assessment is correct before advising her to discontinue the medication
Recommend that the patient continue the antidepressant medication for at least 4 more months
Discuss with the patient the need to take the antidepressant medication indefinitely

Question 65 Your patient has an elevated mean cell volume (MCV). What should you be considering in terms of diagnosis?
Iron-deficiency anemia
Hemolytic anemia
Lead poisoning
Liver disease

Question 66 Which of the following medications increase the risk for metabolic syndrome?
Proton pump inhibitors
Protease inhibitors
A and C
All of the above

Question 67 The hallmark of neurofibromatosis (von Recklinghausens disease) present in almost 100% of patients is:
Acoustic neuroma
Astrocytoma of the retina
Distinctive osseous lesions
Caf_u lait spots

Question 68 The most commonly recommended pharmacological treatment regimen for low back pain (LBP) is:
Acetaminophen or an NSAID
A muscle relaxant as an adjunct to an NSAID
An oral corticosteroid and diazepam (Valium)
Colchicine and an opioid analgesic

Question 69 Legal authority for advanced practice nursing rests with:
The Health Care Financing Administration
Federal statutes
State laws and regulations
Certifying bodies

Question 70 Which of the following physical modalities recommended for treatment of rheumatoid arthritis provides the most effective long term pain relief?
Superficial and deep heat
Application of cold
Transcutaneous electrical nerve stimulation (TENS)

Question 71 A patient presents with dehydration, hypotension, and fever. Laboratory testing reveals hyponatremia, hyperkalemia, and hypoglycemia. These imbalances are corrected, but the patient returns 6 weeks later with the same symptoms of hyperpigmentation, weakness, anorexia, fatigue, and weight loss. What action(s) should the nurse practitioner take?

Obtain a thorough history and physical, and check serum cortisol and ACTH levels.

Obtain a diet history and check CBC and FBS.

Provide nutritional guidance and have the patient return in 1 month.

Consult home health for intravenous administration of fluids and electrolytes.

Question 72 Jack, age 55, comes to the office with a blood pressure of 144/98 mm Hg. He states that he did not know if it was ever elevated before. When you retake his blood pressure at the end of the exam, it remains at 144/98. What should your next action be?

Start him on an ACE Inhibitor
Start him on a diuretic
Have him monitor his blood pressure at home
Try nonpharmacological methods and have him monitor his blood pressure at home

Martin is complaining of erectile dysfunction. He also has a condition that has reduced arterial blood flow to his penis. The most common cause of this condition is:
Parkinsons disease
Multiple sclerosis
Diabetes mellitus

Question 74 Which of the following is not a risk factor associated with the development of syndrome X and type 2 diabetes mellitus?
Hypertriglyceridemia and low high-density lipoprotein (HDL)
Gestational diabetes and polycystic ovarian syndrome
Hispanic, African-American, Native-American, and Pacific Islander ethnicity Postprandial hypoglycemia

Question 75 A 28-year-old female presents to the office requesting testing for diagnosis of hereditary thrombophilia. Her father recently had a deep vein thrombosis and she is concerned about her risk factors. The nurse practitioner explains that:
The patient should start anticoagulant therapy immediately.
Hereditary thrombophilia does not always require anticoagulation therapy. Women of childbearing age cannot take anticoagulant therapy.
Genetic and risk management counseling are recommended.
B and D

Question 76 The 4 classic features of Parkinsons disease are:

Mask-like facies, dysarthria, excessive salivation, and dementia.

Tremor at rest, rigidity, bradykinesia, and postural disturbances.

Depression, cognitive impairment, constipation and shuffling gait.

Tremor with movement, cogwheeling, repetitive movement, and multi-system atrophy.

Question 77 Which of the following set of symptoms should raise suspicion of a brain tumor?
Recurrent, severe headaches that awaken the patient and are accompanied by visual disturbances.
Vague, dull headaches that are accompanied by a reported sense of impending doom.
Periorbital headaches occurring primarily in the evening and accompanied by pupillary dilation and photophobia.
Holocranial headaches present in the morning and accompanied by projective vomiting without nausea.

Question 78 The most common cause of elevated liver function tests is:
Biliary tract obstruction
Chronic alcohol abuse
A drug-induced injury

Question 79 The physiological explanation of syncope is:

Accelerated venous return and increased stroke volume resulting in deactivation of the parasympathetic nervous system.

A cycle of inappropriate vasodilation, bradycardia, and hypotension.

A sudden rise in blood pressure due to overly efficient vasoconstriction.

Emotional stress resulting in hypertension, tachycardia, and increased venous return.

Question 80 A 60 year old male patient with multiple health problems presents with a complaint of erectile dysfunction (ED). Of the following, which medication is most likely to be causing the problem?
Thiazide diuretic
Famotidine (Pepcid)

Question 81 The cardinal sign of infectious arthritis is:
Affected joint is painful at rest, with movement and weight bearing
Rapid onset that wakes the patient during the night
Long history of severe pain with associated joint swelling
None of the above

Question 82 A 75-year-old female is diagnosed with primary hyperparathyroidism and asks the nurse practitioner what the treatment for this disorder is. The nurse practitioner explains:
Primary hyperparathyroidism is treated with Vitamin D restriction
Primary hyperparathyroidism is treated with parathyroidectomy
Primary hyperparathyroidism is treated with daily magnesium
Primary hyperparathyroidism is treated with parenteral parathyroid hormone (PTH)

Question 83 Which of the following is not appropriate suppression therapy for chronic bacterial prostatitis?
Doxycycline 100 mg qd
Nitrofurantoin 100 mg qd
Bactrim DS qd
Erythromycin qd

Question 84 Who is at a higher risk for developing nephrolithiasis?
Jack, who exercises every day and drinks copious amounts of water
Mary, who watches her weight and eats a low-sodium diet
Harvey, a couch potato who drinks a lot of no-sodium soda
Bill, who runs every day and takes excessive amounts of vitamin C

Question 85 Potential side effects of levofloxacin include which of the following? Confusion
Achilles tendon rupture
All of the above

Question 86 A patient has just been diagnosed with Bells palsy. He is understandably upset and has questions about the prognosis. You response should be:
Although most of your symptoms will disappear, some will remain but can usually be camouflaged by altering your hairstyle or growing a beard

Unfortunately there is no cure but you have a mild case

The condition is self-limiting and most likely complete recovery will occur

With suppressive drug therapy you can minimize the symptoms

Question 87 A diabetic patient is taking low-dose enalapril for hypertension. A record of the patients blood pressure over 4 weeks ranges from 130 to 142 mmHg systolic and 75 to 85 mmHg diastolic. How should the nurse practitioner respond?

Change to a different class of antihypertensive medication to get better control.

Increase the dosage of the current BP medication.

Continue the current medication and dosage for 4 more weeks.

Add a beta-blocker to the current medication regimen.

Question 88 What diabetic complications result from hyperglycemia?
1. Retinopathy
2. Hypertension resistant to treatment
3. Peripheral neuropathy
4. Accelerated atherogenesis

Which of the following are correct:
1, 2, & 3
2, 3, & 4
1, 3, & 4
1, 2, & 4

Question 89 Diagnostic confirmation of acute leukemia is based on:
Bone marrow aspiration and biopsy
All of the above

Question 90 The best test to determine microalbuminuria to assist in the diagnosis of diabetic neuropathy:
A dipstick strip done during routine urinalysis in the office
A 24-hour urine collection
An early morning spot urine collection
A serum albumin test

Question 91 Which of the following antibiotics should not be prescribed for a pregnant woman in the 3rd trimester?

Question 92 Martin, a 58 year old male with diabetes, is at your office for his diabetes follow up. On examining his feet with monofilament, you discover that he has developed decreased sensation in both feet. There are no open areas or signs of infection on his feet. What health teaching should Martin receive today regarding the care if his feet?

Wash your feet with cold water daily See a podiatrist every 2 years, inspect your own feet monthly, and apply lotion to your feet daily

Go to a spa and have a pedicure monthly

See a podiatrist yearly; wash your feet daily with warm soapy water and towel dry between the toes; inspect your feet daily for lesions; apply lotion to dry areas

Question 93 The intervention known to be most effective in the treatment of severe depression, with or without psychosis, is:
Electroconvulsive therapy (ECT)
A selective serotonin reuptake inhibitor (SSRI)
A tricyclic antidepressant (TCA)

Question 94 The initial clinical sign of Dupuytrens contracture is:
Pain with ulnar deviation
Painless nodule on palmer fascia
Pain and numbness in the ring finger
Inability to passively extend finger

Question 95 Which of the following is the most common complication of the myelodysplastic syndromes?

Question 96 What information should a 42 year old patient with newly diagnosed diabetes receive about exercise?

Buy good walking shoes with support and a flexible sole.

Exercise at least 5 days per week.

Snack before exercise.

Do not exercise if your blood sugar is greater than 180 mg/dL

Question 97 What is the most commonly abused substance?

Question 98 Sam, age 67, is a diabetic with worsening renal function. He has frequent hypoglycemic episodes, which he believes means that his diabetes is getting better. How do you respond?

Youre right; it seems like your diabetes is improving. Because your kidneys are not functioning well, your insulin is not being metabolized and excreted as it should, so you need less of it.

You have watched your diet for all these years and as a result, your body is using less insulin.

I will have to change your oral hyperglycemic agents as it seems your body is making more insulin.

Question 99 A child with type 1 diabetes mellitus has experienced excessive hunger, weight gain and increasing hyperglycemia. The Somogyi effect is suspected. What steps should be taken to diagnose and treat this condition?

Decrease the evening insulin dose and check capillary blood glucose (CBG) at 2:00 am.

Instruct the childs parents on physical activities to help weight loss.

Increase the evening insulin dose and check CBG at 2:00 am.

Refer the child for instruction on a strict diabetic diet.

Question 100 At what age is screening most likely to detect scoliosis?
4 to 6 years
8 to 10 years
12 to 14 years
18 to 20 years

Question 101 The most reliable indicator(s) of neurological deficit when assessing a patient with acute low back pain is(are):
Patient report of bladder dysfunction, saddle anesthesia, and motor weakness of limbs.
History of significant trauma relative to the patients age.
Decreased reflexes, strength, and sensation in the lower extremities.
Patient report of pain with the crossed straight leg raise.

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