Question 1.1 A nurse practitioner employed in the emergency
department admits a patient who has experienced severe frostbite to his hands
and toes after becoming lost on a ski trail. The NP recognizes that which of
the following phenomena has caused the tissue damage? (Points : 2)
Decreased blood
viscosity has resulted in interstitial bleeding.
Reactive
vasodilation has compromised perfusion.
Autonomic
nervous stimulation has resulted in injury.
Decreased blood
flow has induced hypoxia.
Question 2.2. A 6-year-old boy has been brought to the emergency
department by ambulance after his mother discovered that his heart rate was “so
fast I couldn’t even count it.” The child was determined to be in atrial
flutter and his mother is seeking an explanation from the health care team.
Which of the following points should underlie an explanation to the mother?
(Points : 2)
The child is
experiencing a reentry rhythm in his right atrium.
The resolution
of the problem is dependent on spontaneous recovery and is resistant to pacing
interventions.
The child is
likely to have a normal ECG apart from the rapid heart rate.
The boy’s atria
are experiencing abnormal sympathetic stimulation.
Question 3.3. A 14-year-old boy has been diagnosed with
infectious mononucleosis. Which of the following pathophysiological phenomena
is most responsible for his symptoms? (Points : 2)
The
Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
Viruses are
killing some of his B cells and becoming incorporated into the genomes of
others.
The EBV
inhibits the maturation of white cells within his peripheral lymph nodes.
The virus
responsible for mononucleosis inhibits the maturation of myeloblasts into
promyelocytes.
Question 4.4. A patient has suffered damage to his
pericardium following a motor vehicle accident. Which of the following
consequences should the nurse practitioner be most likely to rule out? (Points
: 2)
Impaired physical restraint of the left
ventricule
Increased
friction during the contraction/relaxation cycle
Reduced
protection from infectious organisms
Impaired
regulation of myocardial contraction
Question 5.5. Sputum samples from a patient with pneumonia
contain an infective agent that has a peptidoglycan cell wall, expresses
endotoxins, replicates readily in broth and on agar, grows in clusters, has
pili, and does not stain when exposed to crystal violet. This pneumonia is most
likely: (Points : 2)
Chlamydial
Viral
Mycoplasmal
Bacterial
Question 6.6. A nurse practitioner student is familiarizing
herself with the overnight admissions to an acute medical unit of a university
hospital. Which of the following patients would the student recognize as being
least likely to have a diagnosis of antiphospholipid syndrome in his or her
medical history? (Points : 2)
A 66-year-old
obese male with left-sided hemiplegia secondary to a cerebrovascular accident
A 90-year-old
female resident of a long-term care facility who has been experiencing
transient ischemic attacks
A 30-year-old
female with a diagnosis of left leg DVT and a pulmonary embolism
A 21-year-old
male with a diagnosis of cellulitis and suspected endocarditis secondary to
intravenous drug use
Question 7.7. A number of patients have presented to the
emergency department in the last 24 hours with complaints that are preliminarily
indicative of myocardial infarction. Which of the following patients is least
likely to have an ST-segment myocardial infarction (STEMI)?
(Points : 2)
A 70-year-old
woman who is complaining of shortness of breath and vague chest discomfort
A 66-year-old
man who has presented with fatigue, nausea and vomiting, and cool, moist skin
A 43-year-old
man who woke up with substernal pain that is radiating to his neck and jaw
A 71-year-old
man who has moist skin, fever, and chest pain that is excruciating when he
moves but relieved when at rest
Question 8.8. A 44-year-old female patient presents to the
emergency department with abnormal bleeding and abdominal pain that is later
attributed to gallbladder disease. Which of the following diagnoses would the
medical team be most justified in suspecting as a cause of the patient’s
bleeding? (Points : 2)
Calcium
deficiency
Vitamin K
deficiency
Hemophilia B
Idiopathic ITP
Question 9.9. A 60-year-old male patient with an acute viral
infection is receiving interferon therapy. The nurse practitioner is teaching
the family of the patient about the diverse actions of the treatment and the
ways that it differs from other anti-infective therapies. Which of the
following teaching points should the nurse practitioner exclude?
(Points : 2)
“Interferon can
help your father’s unaffected cells adjacent to his infected cells produce
antiviral proteins that limit the spread of the infection.”
“Interferon can
help limit the replication of the virus that’s affecting your father.”
“Interferon
helps your father’s body recognize infected cells more effectively.”
“Interferon can
bolster your father’s immune system by stimulating natural killer cells that
attack viruses.”
Question 10.10. A nurse practitioner employed in a
hospitalist notices that a patient is experiencing muscle atrophy following 2
weeks in traction after a motor vehicle accident. Which of the following
factors has most likely contributed to the atrophy of the patient’s muscle
cells? (Points : 2)
High levels of
insulin and IGF-1 in the patient’s blood during immobilization
Denervation of
the affected muscles during the time of traction
A reduction of
skeletal muscle use secondary to the traction treatment
Reduced oxygen
consumption and cellular function that ensures muscle cell survival
Question 11.11. A 16-year-old female has been brought to her
primary care nurse practitioner by her mother due to the girl’s persistent sore
throat and malaise. Which of the following facts revealed in the girl’s history
and examination would lead the nurse practitioner to rule out infectious
mononucleosis? (Points : 2)
The girl has a
temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
Her liver and
spleen are both enlarged.
Blood work
reveals an increased white blood cell count.
Chest
auscultation reveals crackles in her lower lung fields bilaterally.
Question 12.12. A nurse practitioner is providing care for
several patients on a medical unit of a hospital. In which of the following
patient situations would the nurse practitioner be most likely to rule out
hypertension as a contributing factor? (Points : 2)
A 61-year-old
man who has a heart valve infection and recurrent fever
An 81-year-old
woman who has had an ischemic stroke and has consequent one-sided weakness
A 44-year-old
man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old
woman with poorly controlled angina and consequent limited activity tolerance
Question 13.13. A group of researchers has identified that
the prevalence of two particular genetic disorders share a statistical
correlation. Which of the following statements best conveys the genetic
rationale for this situation? (Points : 2)
There is likely
a cause-and-effect relationship between the two genes responsible.
The chromosomes
containing each gene are likely closely situated.
The genes
causing each disorder are likely in the same section of the same chromosome.
The disorders
likely share the same locus.
Question 14.14. A 71-year-old woman is dependent on oxygen
therapy and bronchodilators due to her diagnosis of emphysema. Which of the
following processes would her care team be most justified in ruling out?
(Points : 2)
Decreased
elastic recoil due to alveolar damage
Decreased
residual lung volume due to impaired alveolar ventilation
Increased
anatomic dead space due to reduced tidal volume
Increased
alveolar dead space due to incorrect intrapleural pressure
Question 15.15. A researcher is involved in the production
of insulin through recombinant DNA technology. Which of the following
statements could the researcher best provide as a rationale for her work?
(Points : 2)
The gene
fragment responsible for insulin production can be isolated and reproduced.
Particular
bacteria are capable of insulin production.
It is possible
to reproduce the chromosome responsible for insulin production.
Recombination
of DNA base pairs can result in a gene that will produce insulin.
Question 16.16. Which of the following residents of a
long-term care facility is most likely to be exhibiting the signs and symptoms
of chronic obstructive pulmonary disease (COPD)? (Points : 2)
A 79-year-old
lifetime smoker who is complaining of shortness of breath and pain on deep
inspiration
An 81-year-old
smoker who has increased exercise intolerance, a fever, and increased white
blood cells
An 81-year-old
male who has a productive cough and recurrent respiratory infections
An 88-year-old
female who experiences acute shortness of breath and airway constriction when
exposed to tobacco smoke
Question 17.17. Which of the following patients on a medical
unit of a hospital is most likely to be experiencing health problems that may
be attributable to kidney disease? (Points : 2)
An 81-year-old
female patient with osteoporosis and anemia
A 77-year-old
patient with urinary retention due to benign prostatic hyperplasia (BPH)
A 55-year-old
woman with a recent stroke secondary to long-standing hypertension
A 60-year-old
man with a systemic fungal infection requiring intravenous antibiotics
Question 18.18. A 66-year-old obese man with a diagnosis of
ischemic heart disease has been diagnosed with heart failure that his care team
has characterized as attributable to systolic dysfunction. Which of the
following assessment findings is inconsistent with his diagnosis?
(Points : 2)
His resting
blood pressure is normally in the range of 150/90 and an echocardiogram
indicates his ejection fraction is 30%.
His
end-diastolic volume is higher than normal and his resting heart rate is
regular and 82 beats per minute.
He is presently
volume overloaded following several days of intravenous fluid replacement.
Ventricular
dilation and wall tension are significantly lower than normal.
Question 19.19. Which of the following phenomena is most
likely occurring during a child’s alveolar stage of lung development?
(Points : 2)
Terminal
alveolar sacs are developing and surfactant production is beginning.
A
single-capillary network exists and the lungs are capable of respiration.
The conducting
airways are formed, but respiration is not yet possible.
Primitive
alveoli are formed and the bronchi and bronchioles become much larger.
Question 20.20. A nurse practitioner has ordered the
measurement of a cardiac patient’s electrolyte levels as part of the patient’s
morning blood work. Which of the following statements best captures the
importance of potassium in the normal electrical function of the patient’s
heart? (Points : 2)
Potassium
catalyzes the metabolism of ATP, producing the gradient that results in
electrical stimulation.
Potassium is
central to establishing and maintaining the resting membrane potential of
cardiac muscle cells.
The
impermeability of cardiac cell membranes to potassium allows for action
potentials achieved by the flow of sodium ions.
The reciprocal
movement of one potassium ion for one sodium ion across the cell membrane
results in the production of an action potential.
Question 21.21. Which of the following patients who
presented to a walk-in medical clinic is most likely to be diagnosed with a
rhinosinusitis rather than a common cold?
(Points : 2)
A man
complaining of general fatigue, a headache, and facial pain with a temperature
of 100.9°F
A woman
presenting with malaise, lethargy, and copious nasal secretions
A man with a
dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F
A woman
complaining of generalized aches who has a hoarse voice and reddened, painful
upper airways
Question 22.22. A patient with poorly controlled diabetes
mellitus presents to the emergency department with suspected ketoacidosis.
Which of the following diagnostic results would be most likely to confirm this
diagnosis? (Points : 2)
Low O2 levels,
increased anion gap, base excess
High ammonia
levels, decreased anion gap, high potassium
Increased CO2,
increased anion gap, base deficit
Decreased CO2,
decreased anion gap
Question 23.23. A 3-year-old boy has developed croup
following a winter cold. His nurse practitioner would recognize that which of
the following causative microorganisms and treatments are most likely?
(Points : 2)
Respiratory
syncytial virus; treatment with intubation
Parainfluenza
virus; treatment with a mist tent and oxygen therapy
Haemophilus influenza;
treatment with appropriate antibiotics
Staphylococcus
aureus; treatment with bronchodilators and a mist tent
Question 24.24. A 66-year-old female patient has presented
to the emergency department because of several months of intermittently bloody
stools that has recently become worse. The woman has since been diagnosed with
a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory
drugs that she takes for her arthritis. The health care team would realize that
which of the following situations is most likely?(Points : 2)
The woman has
depleted blood volume due to her ongoing blood loss.
She will have
iron-deficiency anemia due to depletion of iron stores.
The patient
will be at risk for cardiovascular collapse or shock.
She will have
delayed reticulocyte release.
Question 25.25. A child possesses a trait that is the result
of the interaction of two different genes, neither of which could have produced
the trait independently. Which of the following explanations best captures the
genetic explanation for this?
(Points : 2)
The trait is an
expression of multiple alleles.
Epistasis has
dictated the phenotypic outcome.
The phenomenon
is an example of polygenic inheritance.
The outcome is
the result of the interaction between collaborative genes.
Question 26.26. Which target of both chemotherapy and
radiation treatment accounts for adverse as well as therapeutic effects?
(Points : 2)
Cell-surface
receptors
Circulating
hormone levels
Blood vessels
Rapidly
proliferating cells
Question 27.27. A patient who has a diagnosis of lung cancer
is scheduled to begin radiation treatment. The NP providing pretreatment
education is explaining some of the potential unwanted effects of the
treatment. Which of the following statements by the nurse is most accurate?
(Points : 2)
“Some patients
experience longer-term irritation of skin adjacent to the treatment site.”
“Sometimes you
might find that your blood takes longer to clot than normal.”
“The changes
that you might see are normally irreversible.”
“The unwanted
effects will be limited to the exposed portions of your skin.”
Question 28.28. A 77-year-old female with a diagnosis of
chronic obstructive pulmonary disease is experiencing impaired gas exchange and
CO2 retention, despite a rapid respiratory rate. Which of the following
phenomena would her care team most realistically anticipate? (Points : 2)
Arterial blood
gas sampling is likely to indicate a pH in the range of 7.45 to 7.55.
Her kidneys are
likely to reabsorb H+ and secrete HCO3–.
Her body may be
producing excess metabolic CO2.
Her kidneys
will adapt with an increase in plasma HCO3– and her pH will decrease.
Question 29.29. The nurse practitioner for a cardiology
practice is responsible for providing presurgical teaching for patients who are
about to undergo a coronary artery bypass graft. Which of the following
teaching points best conveys an aspect of the human circulatory system? (Points
: 2)
“Your blood
pressure varies widely between arteries and veins, and between pulmonary and
systemic circulation.”
“Only around
one quarter of your blood is in your heart at any given time.”
“Blood pressure
and blood volume roughly mimic one another at any given location in the
circulatory system.”
“Left-sided and
right-sided pumping action at each beat of the heart must equal each other to
ensure adequate blood distribution.”
Question 30.30. As part of his diagnostic workup, a
77-year-old man’s nurse practitioner has ordered blood work that includes
ferritin levels. The man is very interested in the details of his health care
and is unfamiliar with ferritin and its role. He asks his nurse practitioner to
explain the significance of it and the rationale for testing it. Which of the
following explanations by the nurse practitioner is most accurate? (Points : 2)
“Ferritin is
the activated and usable form of iron that your red blood cells can use to
transport oxygen.”
“Ferritin is a
stored form of iron that indirectly shows me whether you would benefit from
iron pills.”
“Ferritin is a
protein-iron complex that allows your red blood cells to make use of the iron
that you consume in your diet.”
“Ferritin is
the form of iron that is transported in your blood plasma to the red blood
cells that need it.”
Question 31.31. A nurse educator is orientating new nurses
to a renal unit of a hospital. Which of the following teaching points should
the nurse include as part of a review of normal glomerular function?
(Points : 2)
“Nephrons are
delicate structures that cannot endure the high pressure that exists in
capillary beds elsewhere in the body.”
“Glomerular
filtrate is very similar in composition to blood plasma found elsewhere in
circulation.”
“Dilation of
the afferent arteriole allows more blood into the nephron and increases the
glomerular filtration rate.”
“The glomerulus
is located between an arteriole and a venule that work together to regulate
blood flow.”
Question 32.32. A 77-year-old lifetime smoker has been
diagnosed with a tumor in his lung at the site of an old tubercle scarring
site, located in a peripheral area of his bronchiolar tissue. What is this
patient’s most likely diagnosis? (Points : 2)
Squamous cell
carcinoma
Small cell lung
cancer
Large cell
carcinoma
Adenocarcinoma
Question 33.33. A 51-year-old woman diagnosed with multiple
sclerosis (MS) five months prior is distressed that she has had several recent
episodes of urinary incontinence. She has asked her nurse practitioner why this
is the case. Which of the following statements best captures the facts that
would underlie the nurse’s response to the patient?
(Points : 2)
Neurologic
diseases like MS often result in flaccid bladder dysfunction.
She may be
unable to sense her bladder filling as a result of her MS.
Lesions of the
basal ganglia or extrapyramidal tract associated with MS inhibit detrusor
contraction.
Pathologic
reductions in bladder volume brought on by MS necessitate frequent micturition.
Question 34.34. Which of the following individuals are
displaying identified risk factors for the development of lower urinary tract
obstruction? (Points : 2)
A 32-year-old
woman who had a healthy delivery of her third child 4 months ago
A 68-year-old
man who has been diagnosed with benign prostatic hyperplasia (BPH)
A 55-year-old
man with diabetes who is receiving diuretic medications for the treatment of
hypertension
A 30-year-old
woman who has been diagnosed with gonorrhea
A 74-year-old
woman who has developed a lower bowel obstruction following several weeks of
chronic constipation
A 20-year-old
man who has spina bifida and consequent impaired mobility
Question 35.35. A 29-year-old construction worker got a
sliver under his fingernail four days ago. The affected finger is now reddened,
painful, swollen, and warm to the touch. Which of the following hematological
processes is most likely occurring in response to the infection?
(Points : 2)
Proliferation
of immature neutrophils
High
circulatory levels of myeloblasts
Increased
segmented neutrophil production
Phagocytosis by
myelocytes
Question 36.36. A 22-year-old female who adheres to a vegan
diet has been diagnosed with iron-deficiency anemia. Which of the following
components of her diagnostic blood work would be most likely to necessitate
further investigation? (Points : 2)
Decreased mean
corpuscular volume (MCV)
Decreased
hemoglobin and hematocrit
Microcytic,
hypochromic red cells
Decreased
erythropoietin levels
Question 37.37. A formerly normotensive woman, pregnant for
the first time, develops hypertension and headaches at 26 weeks’ gestation. Her
blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should
be ordered for her? (Points : 2)
Plasma
angiotensin I and II and renin
Urinary sodium
and potassium
Platelet count,
serum creatinine, and liver enzymes
Urinary
catecholamines and metabolites
Question 38.38. A nurse practitioner is providing prenatal
care and education for a first-time expectant mother, 22 weeks’ gestation, who
has a diagnosis of a sexually transmitted infection. Which of the following
statements by the expectant mother demonstrates an adequate understanding of
vertical disease transmission and congenital infections?
(Points : 2)
“Gonorrhea and
chlamydia pose the greatest risks of transmission from mother to child.”
“I know that my
baby will need observation for HIV signs and symptoms in the weeks following my
delivery.”
“My baby could
become infected either across the placenta or during the birth itself.”
“Prophylactic
immunization will reduce my baby’s chance of being born with an illness.”
Question 39.39. A 60-year-old man has been diagnosed with
renal calculi after repeated episodes of excruciating flank pain in recent
weeks. The man states, “I don’t know how this could happen to me, since I’m so
careful about eating a healthy diet.” What is the most appropriate response to
the man’s statement? (Points : 2)
“Your diet may
have played a part in this, but in fact genetics is likely primarily to blame.”
“What you eat
can influence your risk of stone formation, but many other factors like
hormones and your metabolism are involved.”
“You likely
don’t need to change your diet, but now that you have stones in one kidney,
you’re at very high risk of growing them in the other kidney.”
“Your diet
might be normally healthy, but high intake of normally beneficial minerals like
calcium and magnesium can lead to stones.”
Question 40.40. A 7-year-old boy is admitted to the hospital
with a suspected diagnosis of lead toxicity. Which of the following assessment
findings is most congruent with the patient’s diagnosis? (Points : 2)
Decreased deep
tendon reflexes
Hemoglobin 9.9
g/dL
Diffuse muscle
pain
White blood
cells (WBC) 11,000/mm3
Question 41.41. A pediatric unit will be receiving from a
rural medical outpost a patient transfer of an 8-day-old infant with a
suspected congenital renal disorder. Which of the following possibilities is
the care team most likely to be able to rule out early? (Points : 2)
One of the
infant’s kidneys may have failed to develop to a normal size.
The kidneys may
be misshapen and have cysts.
The upper or
lower poles of the two kidneys may be fused.
Renal cell
carcinoma may be present.
Question 42.42. A 31-year-old woman with a congenital heart
defect reports episodes of lightheadedness and syncope, with occasional
palpitations. A resting electrocardiogram reveals sinus bradycardia and she is
suspected of having sick sinus syndrome. Which of the following diagnostic
methods is the best choice to investigate the suspicion? (Points : 2)
Signal-averaged
ECG
Exercise stress
testing
Electrophysiologic study
Holter
monitoring
Question 43.43. As a result of dehydration, a patient’s
epithelial cells are producing insufficient amounts of mucus. Consequently, the
patient’s mucociliary blanket is compromised. Which of the following changes
would a care provider most reasonably anticipate as a direct result of this
change? (Points : 2)
Impaired
function of the patient’s cilia
Decreased
levels of oxygen saturation
Increased
amounts of bacteria in the lungs
Increased
carbon dioxide levels
Question 44.44. An 87-year-old male resident of an assisted
living facility has been consistently continent of urine until the last several
weeks. Which of the following actions by the care providers at the facility is
the most likely priority? (Points : 2)
Performing a
physical examination and history to determine the exact cause and character of
the incontinence
Providing
patient education focusing on the fact that occasional incontinence is a
normal, age-related change
Teaching the
resident about protective pads, collection devices, and medications that may be
effective
Showing the
resident the correct technique for exercises to improve bladder, sphincter, and
pelvic floor tone
Question 45.45. A patient who presented with shortness of
breath and difficulty climbing stairs has been diagnosed with pulmonary
fibrosis, a disease characterized by scarring of the alveoli. What would her
care team anticipate when observing her breathing? (Points : 2)
Rapid, deep
breaths
Wheezing
breaths
Short, shallow
breaths
Pursed-lip
breaths
