The NP is seeing a 35 year-old well woman for a health promotion and physical exam woman. She has not complaints, is a nonsmoker, a light social drinker with 1-2 glasses of wine per month, and exercises about 30 mins 5 days a week. Her BMI is 22 and vital signs are unremarkable with BP= 110/70. Which of the following is an anticipated finding on her funduscopic exam?

A. Retinal arteries wider than veins
B. Arteriovenous nicking
C. Physiologic cup-to-optic disc ratio of less than 0.5 
D. Blurred optic disc margins

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A healthy 1 year old, accompanied by his mother, is in for a well child visit. He is due to receive routine immunizations for a child his age. His mother mentions that she is about 6 weeks pregnant and read that, “I know he should get the chickenpox and German measles vaccines today. Since I am pregnant, is this safe?” The NP considers the following:

A. Neither vaccine contain live virus and both can be given today.

B. Both vaccines contain live virus that the child will not shed, and he can receive these immunizations today.

C. The vaccines contain live virus and should be delayed until the mom is out of the first trimester of pregnancy.

D. Due to the mother’s pregnancy, these vaccines should be delayed until after she gives birth.

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A 78 year-old woman with well-controlled hypertension and dyslipidemia presents with a chief complaint of a many month history of pain, described as achiness, and stiffness in the joints both hands, particularly towards the end of the day. A part-time seamstress, she reports this discomfort is worse on work days.  She denies redness or heat in the affected regions and has no systemic complaints. Physical exam reveals Heberden and Bouchard nodes bilaterally. These findings are most consistent with a diagnosis of:

A. Rheumatoid arthritis
B. Systemic lupus erythematosus 
C. Osteoporosis
D. Osteoarthritis

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A 67-year-old man who is diagnosed with acute bacterial prostatitis presents with a chief complaint of a one-week history of constant perineal pain, arthralgia, irritative voiding symptoms, and intermittent fever. Which of the following is most consistent with anticipated findings on prostatic digital rectal exam (DRE) with this condition?

A. An enlarged prostate with obliterated median sulcus
B. A prostatic exam that reveals multiple firm, non tender nodular lesions
C. A tender, boggy prostate
D. A firm, non tender prostate

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Which of the following is most likely to be reported as part of the HPI in a woman presenting with bacterial vaginosis?

A. A 19-year-old woman with a 3-day history of vaginal and perineal itch, clumping white vaginal discharge that has a slight “musty” odor.

B. A 24-year-old woman with a 1-week history of mild perineal irritation, thin, grey-green vaginal discharge with a strong “fishy” odor.

C. A 68 year-old with chief complaint of vaginal irritation, discomfort on vaginal sexual activity, and denies unusual vaginal discharge or odor.

D. A 28 year-old woman with 10-day history of copious purulent yellow vaginal discharge without unusual odor, perineal irritation and mild dysuria.

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A 67-year-old man has been recently diagnosed with HTN, dyslipidemia and T2DM. As part of his medication treatment plan, he agrees to start statin therapy. The NP appreciates that which of the following laboratory tests should be conducted about 4-12 weeks after starting statin therapy?

A. AST and ALT
B. CK and potassium
C. Lipid profile
D. CBC with WBC differential and platelet count

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A 65-year-old woman has hypertension, dyslipidemia, type 2 diabetes, a 50 pack-year history of cigarette smoking, currently smoking ½ PPD,  and stage 3B chronic kidney disease (CKD)  (GFR = 37 mL/min/1.73 m2). She is not currently taking any dyslipidemia therapy and her LDL= 140 mg/dL. Which of the following represents the most appropriate pharmacologic intervention for treatment of dyslipidemia?

A. Owing to her age and comorbidity, no further intervention is required.

B. Moderate-intensity statin therapy is the preferred treatment option.

C. Niacin should be prescribed.

D. The use of ezetimibe (Zetia®) will likely be sufficient to achieve dyslipidemia control.

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Leonardo is a healthy 4- month-old who was born at 40-weeks gestation is in the office for a well child visit. His parents voice no concerns and state, “He is a very happy baby who loves to eat and is a good sleeper.” Which of the following is an anticipated normative developmental finding on an infant of this age?

A. Sitting without support  
B. Minimal to no Moro reflex noted
C. Rolling over tummy to back
D. Smiles when smiled to

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A 28-year-old woman G2P1LC1AB0, currently 22-weeks pregnant, presents with a 3-day history of urinary frequency and dysuria.  She is in no acute distress, without fever or vaginal discharge, reports “The baby is really moving around a lot” and denies GI symptoms. Fundal height is consistent with gestational age and FHT= 140 BPM and regular. UA dip in office is positive for leukocyte esterase and nitrites, yielding a working diagnosis of lower UTI.   Which of the following antimicrobials is preferred for the treatment of a UTI during pregnancy?

A. Doxycycline

B. Levofloxacin

C. Cephalexin

D. Azithromycin

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Robert has recently graduated from a NP program. During a job interview for an organization that has clinical sites in multiple states, he is asked questions about NP practice issues. Which of the following is accurate?

A.   Once I am nationally certified, I am also licensed to practice as an NP.

B. Once I am a certified NP and licensed to practice in one state, I will be able to practice in every state.

C. From state to state, NP practice acts are largely standardized.

D. NPs must obtain state-level prescriptive authority as well as a federal Drug Enforcement Agency (DEA) registration number in order to prescribe controlled substance.

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