What is the maximum half-life elimination of warfarin (Coumadin)?
8 hours
12 hours
16 hours
60 hours
Correct
Answer: D
Rationale: The half-life elimination of warfarin (Coumadin) is 20-60 hours. The onset of anticoagulant action for oral warfarin (Coumadin) is 24-72 hours. Warfarin acts by inhibiting the synthesis of vitamin K-dependent clotting factors, including Factors II, VII, IX, and X, and the anticoagulant proteins C and S.
A birth defect characterized by a hole in the septum that separates the two upper chambers of the heart is:
ventricular septal defect.
patent ductus arteriosus.
atrial septal defect.
tetralogy of Fallot.
Correct
Answer: C
Rationale: An atrial septal defect is a birth defect in which a hole exists in the septum dividing the upper chambers (atria) of the heart. The hole increases the amount of blood that flows through the lungs and over time, it may cause damage to the blood vessels in the lungs. Damage to the blood vessels in the lungs may cause problems in adulthood, such as high blood pressure in the lungs and heart failure. Other problems may include abnormal heartbeat, and increased risk of stroke.
A female patient has the following characteristics. Which one represents the greatest risk factor for development of type 2 diabetes?
BMI 25
LDL < 100 mg/dL
Mediterranean descent
Lack of regular healthcare
Correct
Answer: A
Rationale: A BMI of 25 or higher imparts an increased risk of type 2 diabetes. Mediterranean descent does not impart a specific risk factor for type 2 diabetes, but African-American, Asian-American, and Hispanic ethnicities have an increased risk.
A patient is started on a sulfonylurea (i.e., glyburide). The nurse practitioner informs the patient that sulfonylureas are likely to:
cause weight loss.
reduce microvascular events.
delay gastric emptying.
reduce the risk of hypoglycemic events.
Correct
Answer: B
Rationale: The advantages of sulfonylureas such as glyburide (DiaBeta) are that they are low cost, have a long use history, and cause a reduction in micro/macrovascular events. Disadvantages are they produce hypoglycemia and cause weight gain. Glucagon-like peptide (GLP-1) incretin mimetics cause weight loss and delay gastric emptying.
Which of the following is the best position for auscultating the heart for aortic insufficiency?
Lying supine and inhaling
Exhaling while standing
Turning to the left side and breathing deeply
Sitting up, leaning forward, and exhaling
Correct
Answer: D
Rationale: To better hear signs of aortic insufficiency by positioning the left ventricular outflow tract nearer to the chest wall, instruct the patient to sit upright, bend forward, and breathe out. Other positions such as standing, lying flat on the back, or rotating to the left side are ineffective for this purpose.
An NP is assessing an adult patient with an enlarged thyroid. When auscultating the thyroid, a bruit is noted. Which of the following conditions would most likely be associated with these findings?
Hashimoto thyroiditis
Infectious thyroiditis
Hyperthyroidism
Thyroid malignancy
Correct
Answer: C
Rationale: A systolic or continuous bruit auscultated with a stethoscope over an enlarged thyroid is most likely associated with hyperthyroidism caused by toxic multinodular goiter or Graves disease. Hashimoto thyroiditis, infectious thyroiditis, and thyroid malignancies do not typically present with a bruit.
An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is more indicative of a vitamin B12 deficiency?
Microcytosis
Macrocytosis
Leukocytosis
Thrombocytosis
Correct
Answer: B
Rationale: A vitamin B12 deficiency can produce an anemia called pernicious anemia. This is most commonly found in older adults and is characterized by macrocytosis. In other words, the red cells are larger than expected. Microcytosis may be seen in iron deficiency anemia or thalassemia. Leukocytosis refers to large numbers of white cells in the blood stream. Thrombocytosis refers to an increased number of platelets in the blood stream.
The type of hernia in which the hernial sac protrudes directly through the abdominal wall in the region of Hesselbach triangle is called a(n):
inguinal hernia.
umbilical hernia.
femoral hernia.
spigelian hernia.
Correct
Answer: A
Rationale: The type of hernia in which the hernial sac protrudes directly through the abdominal wall in the region of Hesselbach triangle is called an inguinal hernia. The inguinal triangle represents an area of potential weakness in the abdominal wall through which herniation can occur. Inguinal hernias may be direct, entering the inguinal canal, or indirect, in which the bowel enters the inguinal canal via the deep inguinal ring.
Cyanocobalamin (vitamin B12) is primarily stored in the:
fat tissue.
gastrointestinal tissue.
liver.
subcutaneous tissue.
Correct
Answer: C
Rationale: Absorbed cyanocobalamin (vitamin B12) is transported via specific B12 binding proteins, transcobalamin I and II, to the various tissues. The liver is the main organ for vitamin B12 storage.
Rationale: A patient with testicular torsion will have a negative cremasteric reflex and a high riding testis. There can also be profound testicular swelling and an acute onset of scrotal pain.
Prostate gland enlargement that narrows the urethral lumen and leads to increased prostatic smooth muscle tone is:
prostate cancer.
urethral stricture.
neurogenic bladder.
benign prostatic hyperplasia.
Correct
Answer: D
Rationale: Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland that narrows the urethral lumen and leads to increased prostatic smooth muscle tone. It develops primarily in the periurethral or transitional zone of the prostate. The pathogenesis of BPH is incompletely understood; older age and the presence of functioning Leydig cells of the testes are essential for its development. In men younger than 40 years who have low testosterone levels (and who are not treated with androgen), BPH is rare.
A 25-year-old pregnant woman has asymptomatic bacteriuria. The best treatment plan for this patient is to:
have her return if she becomes symptomatic.
administer gentamicin intramuscularly for one dose.
initiate cephalexin (Keflex) for 7 days.
prescribe trimethoprim/sulfamethoxazole (Bactrim) for 3 days.
Correct
Answer: C
Rationale: Without treatment, 30% to 40% of pregnant women with asymptomatic bacteriuria will develop a symptomatic urinary tract infection (UTI), including pyelonephritis. They are also more likely to deliver premature or low-birth-weight infants. The current recommendation is to administer a 3- to 7-day course of antimicrobial therapy to pregnant women with asymptomatic bacteriuria. The safest choices of treatment are amoxicillin (Moxatag), cefuroxime (Zinacef), cephalexin (Keflex) and nitrofurantoin (Macrobid). Macrobid should be avoided in the first trimester if possible. Ciprofloxacin (Cipro), levofloxacin (Levaquin) and trimethoprim/sulfamethoxazole (Bactrim) should only be prescribed if the benefits outweigh the risks, since safety has not been established in pregnancy. Aminoglycosides (i.e., gentamicin) should be avoided during pregnancy.
A patient you are caring for in your clinic has Medicare Part B. What does this mean?
The federal government will pay for his visit to your clinic today.
His medicare benefit covers outpatient services.
He will have a copay for his visit today.
His prescriptions will be partly paid for today.
Correct
Answer: B
Rationale: Part B pays the examiner (NP, PA, MD, etc.). Part B of Medicare pays for outpatient care, ambulatory surgery services, X-rays, durable medical equipment, laboratory, and home health. Part B is an option that Medicare recipients can pay for with a monthly option. This charge is based on income. Since there is an initial copay, the federal government's insurance plan may NOT pay for his visit to your clinic today.
An Infection of the tracheobronchial tree that causes reversible bronchial inflammation is:
upper respiratory disease.
bronchitis.
tuberculosis.
pneumonia.
Correct
Answer: B
Rationale: Bronchitis develops when mucous membranes in the tracheobronchial tree become hyperemic and edematous. This increases bronchial secretions and causes destruction of epithelium-impaired mucociliary activity. In most cases, the infection has a nonbacterial cause. Viral illness is frequently associated with this lower respiratory tract disease.
Glucocorticoids are indicated for the treatment of:
acute bronchitis.
asthma exacerbations.
lupus.
dry cough.
Correct
Answer: B
Rationale: Glucocorticoids are indicated for the treatment of exacerbations of asthma and COPD because of their anti-inflammatory activity. Mineralocorticoids are indicated for the treatment of adrenal hyperplasia, Addison's disease and may be useful in some cases of hypotension.
The most common fungal pathogen associated with otitis externa is:
Histoplasma.
Aspergillus.
Cryptococcus.
Pneumocystis.
Correct
Answer: B
Rationale: Aspergillus is a common fungal pathogen in patients who have otitis externa. Otitis externa may result from overtreatment with topical antibiotics or may arise due to moisture trapped in the external ear canal. Like other fungal pathogens, Aspergillus grows well in a warm, dark, moist environment. Candida and other organisms have also been isolated in otitis externa.
An NP is assessing an adolescent who presents with nausea and vomiting. On physical examination, the patient has constricted pupils, bradycardia, hypotension, and decreased bowel sounds. These findings are most likely consistent with which of the following conditions?
Opioid intoxication
Hypoglycemia secondary to diabetes
Stimulant intoxication
Ethanol intoxication
Correct
Answer: A
Rationale: Clinical manifestations of opioid toxicity include miosis, respiratory depression, central nervous system (CNS) depression, nausea, vomiting, hypotension, bradycardia, and decreased bowel sounds. Hypoglycemia typically presents with tachycardia, diaphoresis, tremor, hunger, pallor, headache, and confusion which may progress to loss of consciousness. Stimulant intoxication typically presents with tachycardia, hypertension, fever, anxiety, hallucinations, and paranoia. While ethanol intoxication may cause similar signs and symptoms of CNS depression, it does not cause miosis or a change in bowel sounds.
An NP is assessing an adult patient who has had burning retrosternal discomfort and a dry cough for the past two weeks. On exam, the patient is afebrile, has a respiratory rate of 16, and has no adventitious breath sounds. Which of the following diagnoses should be included in the NP's list of differential diagnoses?
Acute bronchitis
Asthma
Bronchiectasis
Pneumonia
Correct
Answer: A
Rationale: Acute bronchitis is a commonly viral illness that presents burning retrosternal discomfort and a dry cough. Asthma occurs in response to a trigger and is characterized by episodic wheezing, shortness of breath, and cough. The initial cough is dry and non-productive but may become productive over time. Bronchiectasis produces a chronic cough with copious and foul-smelling sputum that may be blood-tinged or bloody. On examination, pneumonia often presents with fever, tachypnea, rales, and a productive cough with mucoid or purulent sputum.
An adult patient presents to the clinic with iron deficiency anemia. Which of the following is the most likely risk factor for this condition?
Age <40 years
Celiac disease
Diet low in calcium
Hyperthyroidism
Correct
Answer: B
Rationale: Risk factors for iron deficiency anemia include celiac disease, age >65, frequent blood donations, bariatric surgery, heavy menstruation, pregnancy, and chronic kidney disease. Patients with celiac disease have decreased supplemental iron absorption. Adolescents, infants, and toddlers are also at higher risk for iron deficiency anemia. Foods high in calcium may impair iron absorption. Hyperthyroidism more commonly causes normochromic, normocytic anemia, and serum ferritin may be increased, not decreased, as it is with iron deficiency anemia.