MIDTERM
EXAM
Question 1
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 2
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 3
Mark has just been given a diagnosis of congestive heart
failure. Which of his medications should be discontinued?
Question 4
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 5
Which of the following is the most important diagnosis to
rule out in the adult patient with acute bronchitis?
Question 6
Risk factors for acute arterial insufficiency include which
of the following?
Question 7
What is the Gold standard for the diagnosis of asthma?
Question 8
Which of the following dermatologic vehicles are the most
effective in absorbing moisture and decreasing friction?
Question 9
Amaurosis fugax is described as a:
Question 10
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 11
Which of the following patient characteristics are
associated with chronic bronchitis?
Question 12
In the initial evaluation of a patient with new onset
hypertension, the nurse practitioner should:
Question 13
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 14
A 2 year old presents with a white pupillary reflex. What is
the most likely cause of this finding?
Question 15
Expected spirometry readings when the patient has chronic
emphysema include:
Question 16
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 17
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 18
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 19
A patient presents with periorbital erythema and edema,
fever, and nasal drainage. The nurse practitioner should:
Question 20
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 21
Stacy, age 27, states that she has painless, white, slightly
raised patches in her mouth. They are probably caused by:
Question 22
Treatment of H.pylori includes which of the following?
Question 23
Janine, age 29, has numerous transient lesions that come and
go, and she is diagnosed with urticaria. What do you order?
Question 24
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?
Question 25
Your patient Jerry has gout. What do you suggest?
Question 26
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 27
Martha had a less than 7% value on her Schilling test. What
medication do you anticipate she might need?
Question 28
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 29
Which statement below is correct about pertussis?
Question 30
An AST that is more than twice the level of ALT is
suggestive of:
Question 31
Your 31-year-old patient, whose varicella rash just erupted
yesterday, asks you when she can go back to work. What do you tell her?
Question 32
Acute rheumatic fever is an inflammatory disease which can follow
infection with:
Question 33
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 34
Of the following, the patient who should be referred for
periodic colonoscopy is the patient with:
Question 35
Which type of lung cancer has the poorest prognosis?
Question 36
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 37
Treatment of acute vertigo includes:
Question 38
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?
Question 39
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 40
Of the following choices, the least likely cause of cough is:
Question 41
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 42
A 40 year old presents with a hordeolum. The nurse
practitioner teaches the patient to:
Question 43
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 44
The Centor criteria for diagnosis of Group A B-hemolytic
streptococcus includes which of the following?
Question 45
Group A ?-hemolytic streptococcal (GABHS) pharyngitis is
most common in which age group?
Question 46
Which of the following statements about malignant melanomas
is true?
Question 47
What conditions must be met for you to bill “incident to”
the physician, receiving 100% reimbursement from Medicare?
Question 48
Appropriate therapy for peptic ulcer disease (PUD) is:
Question 49
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 50
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?
Question 51
Risk factors for acute otitis media (AOM) include all of the
following except:
Question 52
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 53
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 54
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?
Question 55
The most common cancer found on the auricle is:
Question 56
A 58 year old complains of tightness in his chest while
cutting firewood. It disappears quickly if he stops chopping. He denies
shortness of breath, his total cholesterol level is less than 200 mg/dL, and he
is a non-smoker. What is the most appropriate action for the nurse practitioner
to take with this patient?
Question 57
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?
Question 58
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?
Question 59
Mort is hypertensive. Which of the following factors
influenced your choice of using an alpha blocker as the antihypertensive
medication?
Question 60
Management of a patient with hypertension and an abdominal
aortic aneurysm would include:
Question 61
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 62
Impetigo and folliculitis are usually successfully treated
with:
Question 63
Which of the following color changes in a pigmented lesion
suggests malignant transformation?
Question 64
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?
Question 65
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:
Question 66
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 67
When a patient presents with symptoms of acute gallbladder
disease, what is the appropriate nurse practitioner action?
Question 68
Sandra has celiac disease. You place her on which diet?
Question 69
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 70
A 12 year old patient is afebrile and complains of severe
left ear pain. On examination, the TM is gray and intact and there is a green
discharge in the external canal. What action by the nurse practitioner is most
appropriate?
Question 71
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 72
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?
Question 73
What oral medication might be used to treat chronic
cholethiasis in a patient who is a poor candidate for surgery?
Question 74
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 75
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 76
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 77
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 tinea pedis. What is the best initial treatment option for this
patient?
Question 78
Which of the following is not a risk factor for coronary
arterial insufficiency?
Question 79
A very active elderly patient has a documented diagnosis of
arteriosclerosis obliterans. Common expected lower extremity physical exam
findings include:
Question 80
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 81
John, age 33, has a total cholesterol level of 188 mg/dL.
How often should he be screened for hypercholesterolemia?
Question 82
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 83
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 84
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 85
Which intervention listed below is safe for long term use by
an adult with constipation?
Question 86
Which of the following is a secondary cause of
hyperlipidemia?
Question 87
What condition is associated with mucus production greater
than 3 months per year for at least 2 consecutive years?
Question 88
In order to decrease deaths from lung cancer:
Question 89
Marian, age 52, is obese. She complains of a rapid onset of
severe right upper quadrant abdominal cramping pain, nausea, and vomiting. Your
differential diagnosis might be:
Question 90
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 91
Salmeterol (Servent) is prescribed for a patient with
asthma. What is the most important teaching point about this medication?
Question 92
The differential diagnosis for a patient complaining of a
sore throat includes which of the following?
Question 93
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 94
Diagnosis of Crohn’s disease is made considering signs,
symptoms and:
Question 95
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 96
A false-positive result with the fecal occult blood test can
result from:
Question 97
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 98
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:
Question 99
Which antibiotic would be the most effective in treating
community acquired pneumonia (CAP) in a young adult without any comorbid
conditions?
Question 100
A 20 year old is diagnosed with mild persistent asthma. What
drug combination would be most effective in keeping him symptom-free?
