Question

Question 1. 1. Which of the following best describes the pain associated with osteoarthritis? (Points : 2)
Constant, burning, and throbbing with an acute onset
Dull and primarily affected by eposure to cold and barometric pressure
Begins upon arising and after prolonged weight bearing and/or use of the joint
Begins in the morning and limits continued ambulation

Question 2. 2. Your 63-year-old Caucasian woman with polymyalgia rheumatica (PMR) will begin treatment with corticosteroids until the condition has resolved. You look over her records and it has been 2 years since her last physical eamination and any laboratory or diagnostic tests as she relocated and had not yet identified a health-care provider. In prioritizing your management plan, your first orders should include: (Points : 2)
Recommending she increase her dietary intake of Calcium and Vitamin D
Ordering once a year bisphosphonate and a proton pump inhibitor
Participate in a fall prevention program
Dual-energy -ray (DEA) scan and updating immunizations

Question 3. 3. In providing health teaching related to dietary restrictions, the nurse practitioner should advise a patient with gout to avoid which of the following dietary items: (Points : 2)
Green leafy vegetables
Beer, sausage, fried seafood
Sugar
Gluten and bread items

Question 4. 4. A 33-year-old female reports general malaise, fatigue, stiffness, and pain in multiple joints of the body. There is no history of systemic disease and no history of trauma. On physical eamination, the patient has no swelling or decreased range of motion in any of the joints.She indicates specific points on the neck and shoulders  that are particularly affected. She complains of tenderness upon palpation of the neck, both shoulders, hips, and medial regions of the knees. The clinician should include the following disorder in the list of potential diagnoses: (Points : 2)
Osteoarthritis
Rheumatoid arthritis
Fibromyalgia
Polymyalgia rheumatica

Question 5. 5. A 46-year-old female complains of fatigue, general malaise, and pain and swelling in her hands that has gradually worsened over the last few weeks. She reports that pain, stiffness, and swelling of her hands are most severe in the morning. On physical eamination, you note swelling of the metacarpophalangeal joints bilaterally. These are common signs of: (Points : 2)
Osteoarthritis
Rheumatoid arthritis
Scleroderma
Sarcoidosis

Question 6. 6. Which of the following statements about osteoarthritis is true? (Points : 2)
It affects primarily weight-bearing joints
It is a systemic inflammatory illness
The metacarpal phalangeal joints are commonly involved
Prolonged morning stiffness is common

Question 7. 7. The most appropriate first-line treatment for an acute gout flare is (assuming no kidney disease or elevated bleeding risk): (Points : 2)
Indomethacin 50 mg thrice daily for 2 days; then 25 mg thrice daily for 3 days
Doycycline 100 mg twice daily for 5 days
Prednisolone 35 mg four times a day for 5 days
Ice therapy

Question 8. 8. A 34-year-old female presents with fever, general malaise, fatigue, arthralgias and rash for the last 2 weeks. On physical eamination, you note facial erythema across the nose and cheeks. Serum diagnostic tests reveal positive antinuclear antibodies, anti-DNA antibodies, elevated C-reactive protein and erythrocyte sedimentation rate. The clinician should include the following disorder in the list of potential problems: (Points : 2)
Fibromyalgia
Sarcoidosis
Systemic lupus erythematosus
Rheumatoid arthritis

Question 9. 9. Your 66-year-old male patient has recently started treatment for metabolic syndrome and is currently taking the following medications: an ACE inhibitor and beta blocker for treatment of hypertension. He is also taking a statin medication, simvastatin for hyperlipidemia, and a biguanide, metformin, for type 2 diabetes. The patient complains of myalgias of the legs bilaterally and blood work shows elevated serum creatine kinase. Which of the medications can cause such a side effect? (Points : 2)
Beta blocker
ACE inhibitor
Statin medication
Metformin

Question 10. 10. A 20-year-old male construction worker is eperiencing new onset of knee pain. He complains of right knee pain when kneeling, squatting, or walking up and down stairs. On physical eamination, there is swelling and crepitus of the right knee and obvious pain with resisted range of motion of the knee. He is unable to squat due to pain. Which of the following disorders should be considered in the differential diagnosis? (Points : 2)
Joint infection
Chondromalacia patella
Prepatellar bursitis
All of the above

Question 11. 11. A 17-year-old male complains of severe right knee pain. He was playing football when he heard a “pop” at the moment of being tackled and his knee “gave away” from under him. On physical eamination, there is right knee swelling and decreased range of motion. There is a positive anterior drawer sign. These findings indicate: (Points : 2)
Knee ligament injury
Osgood-Schlatter disease
Prepatellar bursitis
Chondromalacia patella

Question 12. 12. A 55-year-old patient complains of lower back pain due to heavy lifting at work yesterday. He reports weakness of the left leg and paresthesias in the left foot. On physical eamination, the patient has diminished ability to dorsifle the left ankle. Which of the following symptoms should prompt the clinician to make immediate referral to a neurosurgeon? (Points : 2)
Straight leg raising sign
Lumbar herniated disc on -ray
Loss of left sided patellar refle
Urinary incontinence

Question 13. 13. Your patient is a 43-year-old female golfer who complains of arm pain. On physical eamination, there is point tenderness on the elbow and pain when the patient is asked to fle the wrist against the clinician’s resistance. These are typical signs of: (Points : 2)
Carpal tunnel syndrome
Osteoarthritis of the wrist
Epicondylitis
Cervical osteoarthritis

Question 14. 14. Which of the following describes the pathology of De Quervain’s tenosynovitis? (Points : 2)
Irritation of a tendon located on the radial side of the wrist, near the thumb
Impingement of the median nerve, causing pain in the palm and fingers
Fluid-filled cyst that typically develops adjacent to a tendon sheath in the wrist
Ulnar nerve compression at the olecranon process

Question 15. 15. What is the most common cause of hip pain in older adults? (Points : 2)
Osteoporosis
Osteoarthritis
Trauma due to fall
Trochanteric bursitis

Question 16. 16. A 43-year-old female was in a bicycling accident and complains of severe pain of the right foot. The patient limps into the emergency room. On physical eamination, there is no point tenderness over the medial or lateral ankle malleolus. There is no foot tenderness ecept at the base of the fifth metatarsal bone. According to the Ottawa foot rules, should an -ray of the feet be ordered? (Points : 2)
Yes, there is tenderness over the fifth metatarsal
No, there is not tenderness over the navicular bone
Yes, the patient cannot bear weight on the foot
A and C

Question 17. 17. 38-year-old Asian male, Mr. Chen, with past medical history significant for prehypertension who has recently taken up softball presents with three to five weeks of shoulder pain when throwing overhead. Ice minimally alleviates pain. Medications: Naproen minimally alleviates shoulder pain. Allergies: Penicillin-associated rash. Family history: Brother has rheumatoid arthritis.

Which of the following musculoskeletal causes of shoulder pain would merit urgent diagnosis and management? (Points : 2)
Adhesive capsulitis
Septic subacromial bursitis
Impingement of the supraspinatus tendon
Calcific tendinopathy

Question 18. 18. If Mr. Chen had restricted passive as well as active ROM of the shoulder, what problems involving the shoulder might you consider? (Points : 2)
Adhesive capsulitis
Rotator cuff tear
Tendinopathy of the long head of the biceps
Rotator cuff impingment

Question 19. 19. What is the essential dynamic stabilizer of the shoulder joint? (Points : 2)
Labrum
Rotator muscle group
Glenohumeral ligaments
Teres major muscle

Question 20. 20. Given Mr. Chen’s repetitive overhead activities, some injury to his rotator cuff muscle group is most likely. Of the following eam findings, which one would not support the diagnosis of rotator cuff tendinopathy? (Points : 2)
Positive Apley’s Scratch test
Weakness and pain with empty can testing
Limited active ROM
Inability to raise arm above his head

Question 1.
1. Your patient has been using chewing tobacco for 10 years. On physical eamination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is: (Points : 2)
Malignant melanoma
Squamous cell carcinoma
Aphthous ulceration
Behcet’s syndrome

Question 2.
2. Which of the following would be considered a “red flag” that requires more investigation in a patient assessment? (Points : 2)
Colon cancer in family member at age 70
Breast cancer in family member at age 75
Myocardial infarction in family member at age 35
All of the above

Question 3.
3. The pathophysiological hallmark of ACD is: (Points : 2)
Depleted iron stores
Impaired ability to use iron stores
Chronic uncorrectable bleeding
Reduced intestinal absorption of iron

Question 4.
4. It is important to not dilate the eye if ____ is suspected. (Points : 2)
Cataract
Macular degeneration
Acute closed-angle glaucoma
Chronic open-angle glaucoma

Question 5.
5. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as: (Points : 2)
50 2-pack years
100-pack years
50-year, 2-pack history
100-pack history

Question 6.
6. When teaching a group of older adults regarding prevention of gastroesophageal reflu disease symptoms, the nurse practitioner will include which of the following instructions? (Points : 2)
Raise the head of the bed with pillows at night and chew peppermints when symptoms of heartburn begins.
Raise the head of the bed on blocks and take the proton pump inhibitor medication at bedtime.
Sit up for an hour after taking any medication and restrict fluid intake.
Avoid food intolerances, raise head of bed on blocks, and take a proton pump inhibitor before a meal.

Question 7.
7. A 56-year-old male complains of anoreia, changes in bowel habits, etreme fatigue, and unintentional weight loss. At times he is constipated  and other times he has episodes of diarrhea. His physical eamination is unremarkable. It is important for the clinician to recognize the importance of: (Points : 2)
CBC with differential
Stool culture and sensitivity
Abdominal -ray
Colonoscopy

Question 8.
8. Dan G., a 65-year-old man, presents to your primary care office for the evaluation of chest pain and left-sided shoulder pain. Pain begins after strenuous activity, including walking. Pain is characterized as dull, aching; 8/10 during activity, otherwise 0/10. Began a few months ago,
intermittent, aggravated by eercise, and relieved by rest. Has occasional nausea. Pain is retrosternal, radiating to left shoulder, definitely affects quality of life by limiting activity. Pain is worse today; did not go away after he stopped walking. BP 120/80. Pulse 72 and regular. Normal  heart sounds, S1 and S2, no murmurs. Which of the following differential diagnoses would be most likely? (Points : 2)
Musculoskeletal chest wall syndrome with radiation
Esophageal motor disorder with radiation
Acute cholecystitis with cholelithiasis
Coronary artery disease with angina pectoris

Question 9.
9. A common auscultatory finding in advanced CHF is: (Points : 2)
Systolic ejection murmur
S3 gallop rhythm
Friction rub
Bradycardia

Question 10.
10. Which of the following symptoms is common with acute otitis media? (Points : 2)
Bulging tympanic membrane
Bright light refle of tympanic membrane
Increased tympanic membrane mobility
All of the above

Question 11.
11. Rheumatic heart disease is a complication that can arise from which type of infection? (Points : 2)
Epstein-Barr virus
Diphtheria
Group A beta hemolytic streptococcus
Streptococcus pneumoniae

Question 12.
12. In eamining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion? (Points : 2)
Fictional keratosis
Keratoacanthoma
Lichen planus
Leukoplakia

Question 13.
13. Jenny is a 24 year old graduate student that presents to the clinic today with complaints of fever, midsternal chest pain and generalized fatigue for the past two days. She denies any cough or sputum production. She states that when she takes Ibuprofen and rest that the chest
pain does seem to ease off. Upon eamination the patient presents looking very ill. She is leaning forward and states that this is the most comfortable position for her. Temp is 102. BP= 100/70. Heart rate is 120/min and regular. Upon auscultation a friction rub is audible. Her lung
sounds are clear. With these presenting symptoms your initial diagnosis would be: (Points : 2)
Mitral Valve Prolapse
Referred Pain from Cholecystitis
Pericarditis
Pulmonary Embolus

Question 14.
14. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist? (Points : 2)
History of bright flash of light followed by significantly blurred vision
History of transient and painless monocular loss of vision
History of monocular severe eye pain, blurred vision, and ciliary flush
All of the above

Question 15.
15. Helicobacter pylori is implicated as a causative agent in the development of duodenal or gastric ulcers. What teaching should the nurse practitioner plan for a patient who has a positive Helicobacter pylori test? (Points : 2)
It is highly contagious and a mask should be worn at home.
Treatment regimen is multiple lifetime medications.
Treatment regimen is multiple medications taken daily for a few weeks.
Treatment regimen is complicated and is not indicated unless the patient is symptomatic.

Question 16.
16. The best evidence rating drugs to consider in a post myocardial infarction patient include: (Points : 2)
ASA, ACE/ARB, beta-blocker, aldosterone blockade
ACE, ARB, Calcium channel blocker, ASA
Long-acting nitrates, warfarin, ACE, and ARB
ASA, clopidogrel, nitrates

Question 17.
17. The most common cause of eye redness is: (Points : 2)
Conjunctivitis
Acute glaucoma
Head trauma
Corneal abrasion

Question 18.
18. A specific eam used to evaluate the gall bladder is: (Points : 2)
Psoas sign
Obturator sign
Cullens sign
Murphy’s sign

Question 19.
19. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry  stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and
aspirin for joint pain. On physical eamination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient’s problem is: (Points : 2)
Mallory-Weiss tear
Esophageal varices
Gastric ulcer
Colon cancer

Question 20.
20. Which of the following is not a contributing factor to the development of esophagitis in older adults? (Points : 2)
Increased gastric emptying time
Regular ingestion of NSAIDs
Decreased salivation
Fungal infections such as Candida

Question 21.
21. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process? (Points : 2)
Seasonal allergies
Acute bronchitis
Bronchial asthma
Chronic bronchitis

Question 22.
22. A 59-year-old patient with history of alcohol abuse comes to your office because of ‘throwing up blood”. On physical eamination, you note ascites and caput medusa. A likely cause for the hematemesis is: (Points : 2)
Peptic ulcer disease
Barrett’s esophagus
Esophageal varices
Pancreatitis

Question 23.
23. Which disease process typically causes episodic right upper quadrant pain, epigastric pain or chest pain that can last 4-6 hours or less,  often radiates to the back (classically under the right shoulder blade) and is often accompanied by nausea or vomiting and often follows a
heavy, fatty meal. (Points : 2)
Acute pancreatitis
Duodenal ulcer
Biliary colic
Cholecystitis

Question 24.
24. Mr. A presents to your office complaining of chest pain, mid-sternal and radiating to his back. He was mowing his lawn. He reports the pain lasting for about 8 minutes and went away after sitting down. What is his most likely diagnosis based on his presenting symptoms? (Points : 2)
Acute MI
GERD
Pneumonia
Angina

Question 25.
25. In addition to the complete blood count (CBC) with differential, which of the following laboratory tests is considered to be most useful in diagnosing ACD and IDA? (Points : 2)
Serum iron
Total iron binding capacity
Transferrin saturation
Serum ferritin

Question 26.
26. If it has been determined a patient has esophageal reflu, you should tell them: (Points : 2)
They probably have a hiatal hernia causing reflu
They probably need surgery
They should avoid all fruit juices
Smoking, alcohol, and caffeine can aggravate their problem

Question 27.
27. Which of the following imaging studies should be considered if a pulmonary malignancy is suspected? (Points : 2)
Computed tomography (CT) scan
Chest -ray with PA, lateral, and lordotic views
Ultrasound
Positron emission tomography (PET) scan

Question 28.
28. 2. (*There are multiple questions on this eam related to the following scenario. Be sure to read the whole way through to the question.)
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor,
was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore
denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.

When all lab work is returned within normal limits, what is the most practical imaging study to order, considering cost, availability, and sensitivity? (Points : 2)  
Abdominal upright and flat plate -ray
Abdominal MRI
Abdominal CT scan with contrast
Abdominal ultrasound

Question 29.
29. Emphysematous changes in the lungs produce the following characteristic in COPD patients? (Points : 2)
Asymmetric chest epansion
Increased lateral diameter
Increased anterior-posterior diameter
Pectus ecavatum

Question 30.
30. (*There are multiple questions on this eam related to the following scenario. Be sure to read the whole way through to the question.)
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor,
was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore
denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor  genitourinary symptoms. The chosen imaging study reveals: “GB normal in size without wall-thickening, but with 5-6 stones with  shadowing. Common bile duct not dilated. Liver is homogenous and normal in size. Pancreas and kidneys are normal.” What is the most effective therapeutic/management option at this point? (Points : 2)
Trial of ursodiol
‘Watchful waiting’
Surgical consult
HIDA scan

Question 31.
31. A 26-year-old, non-smoker, male presented to your clinic with SOB with eertion. This could be due to: (Points : 2)
Eercise-induced cough
Bronchiectasis
Alpha-1 deficiency
Pericarditis

Question 32.
32. (*There are multiple questions on this eam related to this scenario. Be sure to read the whole way through to the question.)
Mr. Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor,
was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore
denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms. Of the following lab studies, which would provide little help in determining your differential diagnosis? (Points : 2)
Abdominal plain films
Liver function tests
Amylase/lipase
Urinalysis

Question 33.
33. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On eamination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of: (Points : 2)
Digital rectal eamination
Endoscopy
Pelvic eamination
Urinalysis

Question 34.
34. A nurse practitioner reports that your patient’s abdominal -ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in: (Points : 2)
Appendicitis
Cholecystitis
Bowel Obstruction
Diverticulitis

Question 35.
35. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to eclude the possibility of: (Points : 2)
Thrush
Laryngeal cancer
Carotidynia
Thyroiditis

Question 36.
36. Functional abilities are best assessed by: (Points : 2)
Self-report of function
Observed assessment of function
A comprehensive head-to-toe eamination
Family report of function

Question 37.
37. Essential parts of a health history include all of the following ecept: (Points : 2)
Chief complaint
History of the present illness
Current vital signs
All of the above are essential history components

Question 38.
38. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to: (Points : 2)
Acoustic neuroma
Cerumen impaction
Otitis media
Ménière’s disease

Question 39.
39. Upon assessment of respiratory ecursion, the clinician notes asymmetric epansion of the chest. One side epands greater than the other. This could be due to: (Points : 2)
Pneumothora
Pleural effusion
Pneumonia
Pulmonary embolism

Question 40.
40. When interpreting laboratory data, you would epect to see the following in a patient with Anemia of Chronic Disease (ACD): (Points : 2)
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased