Which headache sign does not warrant an immediate investigation? Question options: aggravated or relieved by change of position precipitated by Valsalva maneuver new onset after age 50 relieved with use of common analgesics Question 2 1 / 1 point During a migraine, what happens to the cerebral arteries? Question options: they dilate they constrict they vibrate they pulsate Question 3 1 / 1 point You are evaluating a 15 year old patient for bipolar disorder. His parents tell you that he has severe mood swings, is easily distracted, and constantly corrects his teachers. You would have a high suspicion for bipolar if which symptom was present? Question options: he is forgetful he sleeps less than 4 hours nightly he does not complete tasks he blurts out answers in class inappropriately Question 4 1 / 1 point Which risk factor is not associated with breast cancer? Question options: use of hormone replacement therapy personal or family history of breast cancer postmenopausal obesity low socioeconomic status Question 5 1 / 1 point A 26 year old woman with bulimia is likely to be: Question options: of average weight not concerned with weight very underweight very overweight Question 6 1 / 1 point What medication is used to relieve acute wheezing in a patient with asthma? Question options: oral corticosteroid short acting beta agonist long acting beta agonist inhaled corticosteroid Question 7 1 / 1 point You are evaluating an 80 year old patient for recent episodes of incontinence and confusion. His family states that this is unusual for him and he has become increasingly forgetful over the past two weeks. Which medication might be responsible for this? Question options: Coumadin (warfarin) Vitamin B-12 Tagamet (cimetidine) Altace (ramipril) Question 8 1 / 1 point What suggests hyperandrogenism in an adolescent female? Question options: polycystic ovaries high pitched voice obesity hirsutism Question 9 1 / 1 point Which is a synovial joint? Question options: skull vertebral bodies of the spine shoulder pubic symphysis of the pelvis Question 10 1 / 1 point A 67 year old woman with atrial fibrillation and an ejection fraction of 48% is on digoxin and has had normal digoxin levels of 0.8- 2 ng/dL for the past 9 months. Today, the level is 0.4 ng/dL. What could account for this change? Question options: regular use of an antacid increased exercise weight loss decreased creatinine clearance Question 11 0 / 1 point Which medication is contraindicated in a child with acute sinusitis? Question options: nasal steroids decongestants expectorants antihistamines Question 12 1 / 1 point Which best describes the lower extremity calf pain associated with peripheral artery disease? Question options: electric shock pulsating pain sharp, stabbing pain dull aching or cramping Question 13 1 / 1 point Jugular venous distention accompanied by chest pain is associated with: Question options: hypertension asthma pneumonia heart failure Question 14 1 / 1 point Which immunization protects against a virus that is transmitted through blood and body fluids and can lead to chronic liver disease? Question options: Hepatitis C Typhoid fever vaccine Hepatitis A Hepatitis B Question 15 1 / 1 point A pediatric patient has areas of scaling on the scalp with round patches of hair loss. What is the likely diagnosis? Question options: alopecia areata trichotillomania tinea capitis seborrheic dermatitis Question 16 1 / 1 point Your 70 year old patient complains of a sore mouth that prevents her from eating. On exam you note a beefy red, glossy smooth tongue. What do you suspect? Question options: cheilosis, a serious disease of the mouth and oropharynx secondary hypothyroidism pernicious anemia due to insufficient intrinsic factor a neurological disorder such as Parkinson’s disease Question 17 1 / 1 point A 62 year old male presents with leg pain and occasional numbness that is worse with ambulation and improved with lumbar flexion. What is the likely diagnosis? Question options: ankylosing spondylitis cauda equina syndrome bursitis spinal stenosis Question 18 1 / 1 point Which is not a typical symptom of late stage HIV? Question options: lymphadenopathy of more than 3 months persistent vomiting night sweats persistent, unexplained fatigue Question 19 1 / 1 point A pregnant patient presents for her 16 week prenatal visit. Her blood pressure had reduced from 118/79 to 109/68. What hemodynamic change is responsible for this? Question options: decrease in cardiac output decrease in systemic vascular resistance decrease in stroke volume decrease in preload Question 20 1 / 1 point Your 62 year old patient has been taking Griseofulvin 500 mg po BID for 3 weeks to treat tinea capitis and has only had marginal improvement. What is your next step? Question options: have the patient shave his head and warn him that hair regrowth will be slow continue the current therapy for 6-8 weeks Add 2.5% selenium sulfide shampoo twice weekly to the regimen prescribe a short course or oral steroids Question 21 1 / 1 point Rapid HIV testing would be most appropriate for a patient with complaints of: Question options: painful urination, dyspareunia, and penile or vaginal discharge painful bowel movements, anal itching, and abnormal menstrual bleeding or painful and swollen testicles painful urination, lower abdominal pain, and dyspareunia fever, headache, and lymphadenopathy Question 22 1 / 1 point What is a frequent side effect of SSRIs? Question options: sexual dysfunction delayed response time of 2-3 weeks anorexia depression Question 23 1 / 1 point You might suspect small bowel obstruction in a patient who complains of: Question options: hematemesis and bloody stool nausea and diarrhea vomiting and pain indigestion and anorexia Question 24 1 / 1 point What finding would be suggestive of osteosarcoma in a pediatric patient? Question options: pathologic fracture pain in the affected bone repeat fracture apophyseal avulsion Question 25 1 / 1 point What clinical manifestation suggests primary syphilis? Question options: no symptoms a single painless genital lesion rash marked by red or reddish-brown penny sized lesions on the palms and soles poor muscle coordination Question 26 1 / 1 point What medication is used first line for a patient with benign positional vertigo? Question options: pseudoephedrine hydrochlorothiazide promethazine meclizine Question 27 1 / 1 point Which symptom is most associated with testicular torsion? Question options: testicular swelling penile warts erectile dysfunction testicular pain Question 28 1 / 1 point A clinical breast exam should include palpation at the tail of Spence. Where is this located? Question options: laterally across the anterior axillary fold lower inner quadrant lower outer quadrant upper inner quadrant Question 29 1 / 1 point Which area does not drain to the right lymph duct? Question options: the right leg the right arm the right side of the head the right upper thorax Question 30 1 / 1 point Which presentation is most suspicious for penile cancer? Question options: a group of small, scattered vesicles a chancre a nontender, indurated penile nodule papules with a variety of shapes Question 31 1 / 1 point What is important to consider before prescribing metronidazole for giardiasis? Question options: whether the patient drinks alcohol whether the patient is at least 18 years of age presence of a sulfa allergy past medical history of peptic ulcer disease Question 32 1 / 1 point In which condition would the use of triptans for migraine headaches be contraindicated? Question options: kidney stones hypertension osteoarthritis vertigo Question 33 1 / 1 point Which is a true statement about varicose veins? Question options: They are usually diagnosed on clinical presentation. They are not affected by pregnancy. They are due to congenital valve deformities. They are more symptomatic during ovulation. Question 34 1 / 1 point When measuring the fundal height of a pregnant woman at 32 weeks, which measurement would prompt the nurse practitioner to suspect fetal growth restriction? Question options: 29 cm 30 cm 31 cm 32 cm Question 35 1 / 1 point What is the term for excess fluid that accumulates in the pleural cavity between the visceral and parietal spaces? Question options: pericardial effusion pleural effusion chylothorax pleural empyema Question 36 1 / 1 point Which pathogen is associated with common UTIs? Question options: Streptococcus Klebsiella Proteus mirabalis E coli Question 37 1 / 1 point Which medication inhibits blood coagulation by selectively blocking the active site of factor X-a? Question options: Coumadin (warfarin) Pradaxa (dabigatran) Lovenox (enoxaparin) Eliquis (apixaban) Question 38 0 / 1 point Which is a contraindication for menopausal estrogen replacement therapy in a 55 year old woman? Question options: history of phlebitis family history of lung cancer prior breast or uterine carcinoma current or past migraine headaches Question 39 1 / 1 point During abdominal exam, which sound over the bulging area of the abdomen would indicate ascitic fluid? Question options: tympany dullness hyperresonance normal resonance Question 40 1 / 1 point What is a typical finding in a patient with a meniscal tear? Question options: fixed patellar subluxation positive McMurray’s test audible click at the joint line positive anterior drawer test Question 41 1 / 1 point What is the most common presenting symptom of a woman with trichomoniasis? Question options: vaginal discharge painless, ulcerated vulvar lesion with vaginal discharge dyspareunia and abdominal pain fever, papules, and vaginal discharge with burning Question 42 1 / 1 point What is the single dose treatment for chlamydia? Question options: Rocephin (ceftriaxone) 250 mg IM Zithromax (azithromycin) 1 g po Vibramycin (doxycycline) 200 mg po Flagyl (metronidazole) 2 g po Question 43 1 / 1 point What is the mechanism of action of prostaglandin E1 in a patient with transposition of the great arteries? Question options: to prevent cyanotic episodes by trapping blood in the lower extremities to produce vasodilation and adequate oxygen saturation to maintain patency of the great arteries to maintain equal pressure in the ventricles Question 44 1 / 1 point How do 5-alpha reductase inhibitors work to reduce the symptoms of BPH? Question options: relax smooth muscle in the bladder neck decrease the size of the prostate relax smooth muscle in the prostate capsule increase blood flow to the prostate Question 45 1 / 1 point Which condition is best treated by using alpha adrenergic antagonists? Question options: renal insufficiency urge incontinence functional incontinence overflow incontinence Question 46 0 / 1 point What should not be prescribed for migraine prophylaxis in a 42 year old woman? Question options: verapamil (Verelan) amitriptyline (Elavil) metoprolol (Lopressor) sumatriptan (Imitrex) Question 47 1 / 1 point How would a 60 year old man typically describe prostate pain? Question options: Located in the glans penis Located in the suprapubic area Located in the perineum Located in the lower back Question 48 1 / 1 point What is the most common characteristic among patients with migraine headache? Question options: initial onset after age 35 weakness family history focal deficits Question 49 1 / 1 point Which patient would be at highest risk for contracting TB? Question options: A nursing home resident A low income immigrant A person who smoke 2 packs per day Someone who had recent contact with an infected patient Question 50 1 / 1 point Which is not a location of pain associated with kidney and ureter disorders? Question options: suprapubic abdominal flank back Question 51 1 / 1 point Which medication is appropriate for a woman with bladder sphincter dysfunction and stress incontinence? Question options: Minipress (prazosin) Urecholine (bethanechol) Urispas (flavoxate) pseudoephedrine Question 52 1 / 1 point Which condition is associated with chronic, bloody diarrhea? Question options: celiac disease irritable bowel syndrome Hepatitis A Crohn’s disease Question 53 1 / 1 point Which medication is indicated for patients with Generalized Anxiety Disorder (GAD)? Question options: Citalopram (Celexa) Imipramine (Tofranil) Buspirone (Buspar) Bupropion (Wellbutrin) Question 54 1 / 1 point At what point in pregnancy should Rh negative women receive Rhogam (Rho D immune globulin)? Question options: 6 weeks 35 weeks 28 weeks 12 weeks Question 55 1 / 1 point Which is common among patients with psoriasis? Question options: pruritis, positive Auspitz sign, and pitted nails pruritis, pitted nails, and satellite lesions dermatomal rash and satellite lesions pitted nails and plaques Question 56 1 / 1 point What historical finding may predispose a patient to testicular cancer? Question options: epididymitis inguinal hernia testicular torsion cryptorchidism Question 57 1 / 1 point What would you advise for a patient taking an oral glucocorticoid? Question options: take it in an empty stomach crush it in applesauce chew it prior to a high fat meal take it with food Question 58 1 / 1 point A child with enuresis should be treated with nasal desmopressin (DDAVP) for which symptom? Question options: daytime incontinence urinary pain secondary enuresis nocturnal enuresis Question 59 0 / 1 point Which medication is not contraindicated in a patient with sulfa allergy? Question options: celecoxib (Celebrex) sumatriptan (Imitrex) glimepride (Amaryl) silver sulfadiazine (Silvadene) Question 60 1 / 1 point What is likely to be elevated in a woman with polycystic ovarian syndrome? Question options: renin estrogen insulin progesterone Question 61 1 / 1 point Which medication should not be prescribed during an acute gout flare? Question options: Colchicine Steroids NSAIDs Allopurinol Question 62 1 / 1 point A Hispanic woman at 26 weeks of pregnancy tells you that she has been eating ice. What should the NP do? Question options: check the patient for diabetes encourage her to eat more at mealtimes tell her this is a dangerous cultural practice check the patient for anemia Question 63 1 / 1 point A 40 year old female patient has breasts with a soft texture, but uneven contour bilaterally. What is the most likely diagnosis? Question options: malignancy normal finding fibroadenoma cystic breasts Question 64 1 / 1 point What test of renal function is the best measure of renal insufficiency? Question options: 24 hour creatinine clearance serum creatinine serum uric acid BUN Question 65 1 / 1 point You are seeing a 63 year old male who has decreased chest expansion, symmetric thorax with moderate kyphosis, and bilateral diaphragm distention of 2 cm. What is the most likely diagnosis? Question options: pleural effusion COPD rib fracture pneumothorax Question 66 1 / 1 point Which cranial nerves are assessed when assessing bilateral eye movement? Question options: II, III, IV III, IV, and VI III, IV, VII II, IV, VI Question 67 1 / 1 point What pathological finding is noted in asthma? Question options: hypertrophy of smooth muscle necrosis of small airways absence of goblet cells absence of ciliary regeneration Question 68 1 / 1 point Which type of incontinence is most likely in a patient with Alzheimer’s disease who cannot reach the toilet in time? Question options: Urge Stress Overflow Functional Question 69 1 / 1 point Using GTPAL nomenclature, how would you document a patient currently pregnant with a history of an uncomplicated term vaginal delivery, preterm delivery of liveborn twins, and an 8 week elective abortion? Question options: G4 T1 P1 A1 L3 G3 T1 P1 A1 L3 G4 T1 P2 A1 L3 G5 T1 P2 A2 L2 Question 70 1 / 1 point The right lymphatic ducts drain into what part of the circulatory system? Question options: arteriovenous venous capillary bed arterial Question 71 1 / 1 point What is the most likely presenting symptom in a pediatric patient with croup? Question options: nocturnal symptoms shortness of breath A barking cough sudden onset of symptoms Question 72 1 / 1 point Which medication targets postprandial glucose by blocking its transport across the intestine into the bloodstream? Question options: acarbose (Precose) glipizide (Glucotrol) metformin (Glucophage) rosiglitazone (Avandia) Question 73 1 / 1 point Which type of insulin will help to reduce nocturnal hypoglycemia? Question options: NPH regular immediate-acting long-acting Question 74 1 / 1 point What symptoms in a college student living in a dorm would be suspicious for atypical community acquired pneumonia? Question options: temp of 102, dyspnea, and diminished lung sounds on auscultation low grade fever, malaise, and crackles audible throughout the lung fields temp of 101.2, sore throat, and diminished lung sounds on auscultation low grade fever, malaise, and clear lung fields on auscultation Question 75 1 / 1 point How would you describe the lesions of condyloma accuminata in a male patient? Question options: a chancre a red, nontender, enlarging nodule with induration a group of small, scattered vesicles multiple papular lesions with a verrucous appearance