NSG 6440 APEA Sample Exam - 100 Q and A

NSG 6440 APEA Exam

1. A 44 year old obese female patient presents with abdominal pain. What is the most likely etiology if she is afebrile?

2. A 36 year old obese female presents with abdominal pain. If the most likely different diagnosis is cholecystitis, what is the diagnostic test of choice?

3. A 46 year old female with RLQ abdominal pain had suspected diverticulitis. What should be part of the initial workup? Choose all that apply.

4. What is the gold standard for treatment of patients who had GERD?

5. How many weeks should a patient be treated with a PPI?

6. A 56 year old male has relocated to your area from another state. You will be his primary care provider. He is past smoker, had elevated BMI and history of Barrett’s esophagus. He takes OTC PPIs and is asymptomatic. What should be part of his plan of care?

7. What choices may be associated with constipation? Select all that apply. Hemorrhoids, Anal fissure, Anorexia nervosa, Parkinson disease, Hypothyroidism, Irritable bowel syndrome, Diuretics

8. A 52 year old female states that after a BM the last 3 mornings, there have been pink drops of “blood” in the toilet water. She had a normal colonoscopy at age 50 and has no family history of CRC. What should be done first?

9. A 55 year old was diagnosed with Crohn’s Disease (CD) about 5 years ago. You are her PCP. Which findings today might be related to her CD? Select all that apply.

10. A 44 year old patient has elevated LFTs. ALT = 98 (normal = 11-23); AST = 78 (normal = 3-17). He states that he feels well. What are the 4 most common etiologies of elevated LFTs?

11. Which of the following could be the cause of an elevated alkaline phosphatase level?

12. A 35 year old woman tried to donate blood but was unable to due to a “low blood count”. Which lab test should the NP order today to evaluate this patient? CBC

14. A 35 year old female was diagnosed today with IDA. The NP has prescribed one daily ferrous sulfate to treat her. What labs should be ordered when she returns in 4 weeks for a clinic follow up?

15. A patient has been diagnosed with anemia of chronic disease. What might be part of the reason for this diagnosis? Select all that apply.

16. A malnourished 85 year old patient is in your exam room today. What symptoms might warrant a serum B12 level? Select all that apply.

17. A 45 year old patient has suspected B12 deficiency. What symptoms might reflect a B12 deficiency?

18. An 85 year old patient presents with complaints of intermittent burning lips and tongue. She is asymptomatic at the time of exam and had a normal appearing tongue. What action by the NP will elicit the most beneficial diagnostic information?

19. Which symptoms are associated with depression in older adults? Select all that apply.

20. If a patient has a positive screen for bipolar disorder, what 2 choices should be part of the NP’s initial plan of care?

21. What is the most effective approach for the management of moderate depression? Select all that apply.

22. A 35 year old female presents with moderate depression. She refuses to take a medication but is willing to try psychotherapy. What is an example of psychotherapy? Select all that apply.

23. A 40 year old female is diagnosed with a first episode of moderate depression. What medication would be a good initial choice for her?

24. A patient has taken 100 mg sertraline for the past 7 months. She abruptly stopped taking it 5 days ago. What symptoms today may be attributed to abrupt discontinuation of the SSRI? (Sertraline 50 – 200mg daily). Select all that apply. Chills, dizziness, fatigue, myalgias, dysphoria

25. What historical finding contraindicates the use of bupropion in a patient who has depressive disorder?

26. An 85 year old patient has been diagnosed with moderate depressive disorder. Which medication would be a good initial choice to treat her?

27. A 75 year old woman was diagnosed with depression and started on sertraline (usual dose 50-200mg daily). Which dosage would be a good starting dose? 25mg once daily

28. Which statements are true about depression in adolescents?

29. A patient has been diagnosed with generalized anxiety disorder (GAD). What medication might be helpful in relieved symptoms long term?

30. A patient has been diagnosed with generalized anxiety disorder (GAD). What medication might be helpful in relieving acute symptoms?

31. A 22 year old witnessed a brutal murder of her friend. She has been diagnosed with PTSD. Which medication could be tried initially to treat her? Select all that apply.

32. A 24 year old woman was diagnosed with depression by another provider 1 week ago. In the PCP office today, she reports episodes of racings thought and inability to sleep since starting escitalopram. She should be screened for:

33. Which antidepressant is most lethal if consumed in quantity?

34. A man who is being treated with sertraline for depression has complaints of erectile dysfunction. Which medication could be tried in lieu of sertraline? Bupropion (Wellbutrin)

35. A 70 year old female has daily complaints of fatigue and pain for the past few months. The nurse practitioner suspects depression. How should she be evaluated initially?

36. An older adult presents to your office today. She reports that while drinking morning coffee today, the left side of her face became numb, and the coffe she was drinking dripped down her face. After about 10-15 minutes, this resolved. She feels fine now and mental status is normal. The NP is assessing cerebellar function in this patient. Which neuro assessments will evaluate this patient’s cerebellar function?

37. What conditions can mimic a stroke? Select all that apply.

38. Which 3 characteristics may be found in a patient who presents with Bell’s palsy?

39. Triptans may be safely given to patients who (select all that apply):

40. A patient with vertigo has a positive result when the Dix-Hallpike maneuver is performed. This means:

41. A patient who has taken metformin for 5 years has diabetic neuropathy in his feet. The first step in treatment is:

42. A characteristic of medications used to treat Parkinson symptoms is one that:

43. A 54 year old man presents with a chief complaint of cough. What question is most important to ask?

44. A 34 year old male has been diagnosed with acute bronchitis. What is an indication for an antibiotic?

45. What is the gold standard for diagnosing community acquired pneumonia?

46. An older adult has suspected pneumonia. Which chest xray view(s) should be ordered for this ambulatory patient?

47. A middle aged adult in your exam room had undiagnosed COPD? Which findings support a diagnosis of COPD? (CLUES?) select all that apply.

48. Which choices may contribute to a COPD exacerbation or worsening of airway function? Select all that apply.

49. A patient with an asthma exacerbation/wheezing is in your office this morning. When is the NP most likely to hear wheezing?

50. Which of the following are indications for chest xray? Select al that apply. Cough with fever, shortness of breath, chest pain, chest with trauma, assessment of occult disease

51. Osteoporosis is a possible side effect of inhaled steroids. What other side effect(s) may be seen with chronic steroid use?

52. UTIs in older adults may present with all the following symptoms except? Select all that apply.

53. Which of the statements about pyelonephritis are true? Select all that apply. Pyelonephritis patient often become very sick quickly, WBC casts usually indicate pyelonephritis

54. What statements are true about kidney function/testing. Select all that apply. Renal function declines with age, especially after age 60, eGFR reflects kidney function, eGFR can be abnormal due to dehydration

55. Patient complains of fever and dark urine. Urine specimen is sent to lab. Urinalysis report indicates (-) on blood, nitrites, and leukos. RBC casts are present. How should the patient be managed?

56. An otherwise health 55 year old has been diagnosed with overactive bladder. What will help manager her symptoms? select all that apply.

57. What is a deep form of impetigo that causes erosions into the dermis?

58. Which antibiotic is preferred antibiotic prophylaxis for a cat bite?

59. A patient was bitten on the face by a dog and has a 4.5-cm gaping facial wound. How might this be managed? Select all that apply.

60. Which clinical features are common to tinea corporis? Select all that apply.

61. Fungal infections are expected to be more common in patients who:

are asplenia, have hepatitis C, have poorly managed DM

62. An antibiotic used first line to treat early Lyme disease and other tick borne infections is:

63. A 76 year old patient has vesicles and pain on his right forehead and eyebrow. His right eye is red and feels more comfortable with his lid closed. In addition to treating with an oral antiviral agent, how should this be managed?

64. What is a criterion for diagnosis of lupus?

65. A patient has had atopic dermatitis since childhood. What other disease is he likely to have?

66. A 36 year old male presents with silvery, scaly, pruritic rash. Which statement is NOT true?

67. Which vehicle is least appropriate to use to treat a steroid-responsive condition on thickened skin of the elbows and knees of an adult?

68. All of the organisms listed can produce pruritus. Which one is treated with oral agent?

69. A patient has scabies. Which asymptomatic contact listed bellow does not need to be treated for scabies?

70. Steroid selection should be based on: (select all that apply)

71. Mr. Boudreaux has suspected BPH. Which urinary symptoms would you expect him to report? Select all that apply.

72. If Mr. Boudreaux’s only symptom is urinary frequency, what else might be in your differential diagnosis? Select all that apply.

73. If Mr. Boudreaux’s findings/symptoms include microscopic hematuria and urinary frequency, what might be included in your differential diagnosis?

74. You have diagnosed Mr. Boudreaux with BPH. His daily symptoms include frequency, urgency and weakened urinary stream. What might help to manage his symptoms quickly?

75. Mrs. Boudreaux calls your office the day after Mr. Boudreaux’s visit and states that he is not taking the tamsulosin you prescribed. The most likely reason is:

76. Mr. Boudreaux is in your office for a 4-week follow up appointment. He has been taking the tamsulosin for almost 4 weeks. He is likely to report that:

77. A 50 year old patient presents with fever, chills, tenderness on DRE, and pelvic pain. What should be included in the differential diagnosis?

78. When are symptoms of groin hernias most evident? Select all that apply. After sitting for an extended period of time, with heavy lifting, after prolonged standing

79. In what position should a patient be examined to identify the presence of a hernia?

80. How is an inguinal hernia most commonly diagnosed?

81. Which of the following conditions could contribute to diastais recti? Select all that apply.

82. A 17 year old boy presents with a sensation of heaviness in his scrotum. On exam the NP palpates a small nodule on the left testable. How should the NP proceed?

83. A 19 year old patient is in your urgent care center with complain of scrotal pain 9/10. He has an absent cremasteric reflex. The NP’s differential diagnosis includes (select all that apply):

84. Which conditions make NSAID use for osteoarthritis riskier for patients? select all that apply.

85. What is the most common cause of lateral epicondylitis?

86. What common overuse syndrome produces dorsal thumb pain?

87. What 2 tests might be used to asses for carpal tunnel syndrome?

88. A patient with a recent history of breast cancer presents with sudden severe low back pain. What is likely etiology?

89. A patient with complaint of acute low back pain has a positive straight leg raise. When he is distracted, the straight leg raise improves. He is observed to move easily when getting dressed. These can be documented as:

90. Popping, locking, catching and “giving out” are common patient descriptions for a:

91. A 36 year old woman has a BMI of 30, family history of T2DM and hypothyroidism, takes no medications, normal LMP 2 weeks ago, BP: 135/82 mmHG, HR: 78 and rRR 16/min. What is the initial pharmacolocal intervention for a patient’s blood glucose?

92. A 36 year old woman has a BMI of 30, family history of T2DM and hypothyroidism, takes no medications, normal LMP 2 weeks ago, BP: 135/82 mmHG, HR: 78 and rRR 16/min. Prior to prescribing metformin, what labs should be checked? Select all that apply.

93. The NP has prescribed metformin 850mg of immediate release (IR) metformin BID. On day 3 of metformin, the patient calls the office stating that she is having “profound diarrhea”. How should this be mananged? Select all that apply.

94. On 2 week follow up, the patient is tolerating 850mg metformin IR once daily. What should be done with the metformin dose?

95. A 76 year old man had a BMI of 33, takes metformin, lisinopril, levothyroxine, Spiriva, albuterol, Flomax, pravastatin, vitamin D and metoprolol, BP:125/62 mmHg, HR:78, and RR: 14/min. What pharmacological intervention can be considered for his blood glucose?

96. An active 80 year old patient takes 24 units of basal insulin. What is her AM fasting glucose goal?

97. A 62 year old patient takes 36 units of basal insulin. The NP has added once daily meal time insulin. What is the most likely reason?

98. A 45 year old patient has subclinical hypothyroidism, TSH 6.2. What are the major risks of prescribing levothyroxine?

99. You have diagnosed a 26 y/o female with primary hypothyroidism. Her calculated replacement is 108 mcg daily. How much should she be given initially?

100. You have diagnosed a 76 y/o female with primary hypothyroidism. Her calculated replacement is 108 mcg daily. How much should she be given initially?

101. What is the most common cause of primary hypothyroidism? Autoimmunity