In which of the following situations is parental consent usually needed prior to treatment? 

A. A 16-year-old requesting information about contraception. 

B. A 17-year-old who wants help with smoking cessation. 

C.A 16-year-old requesting treatment for acne vulgaris. 

D. An 18-year-old who requests treatment for a sexually transmitted infection.

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The legal authority of a nurse practitioner’s scope of practice is defined by:

A. The organization that grants NP certification. 

B. The NP’s employer. 

C. The law of the state where the NP practices.    

D. Federal law.

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The nurse practitioner is seeing a 24-year-old man in follow-up visit.  Three weeks ago, he was diagnosed with allergic rhinitis,  reporting that, “ for years, every spring when the pollen count is high, I get a runny, stuffy nose, and itchy throat”.  He started on a regimen of daily use of an intranasal corticosteroid as a controller medication with PRN use of an oral second-generation antihistamine for more severe symptoms. Which statement indicates that the patient understands his medication instructions from the initial visit?

A.“I take my antihistamine every day and am saving the nasal spray for really bad pollen days.”

B. “I use my antihistamine every day and my prescribed nasal spray only when I have a really bad runny or stuffy nose.”

C. "I use my prescribed nasal spray as advised every day, but I notice I haven’t had to use the antihistamine for a week.”  

D."I can use either the antihistamine pills or the nasal spray since both work the same way.” 

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A 34-year-old woman presents with uncomplicated UTI. Her last menstrual period ended approximately 5 days ago and has a history of bilateral tubal ligation approximately 5 years ago. She is otherwise healthy, has not received a systemic antimicrobial in the past year, denies drug allergies, and is not taking any medications. Per local antibiogram,  E. coli resistance rate to TMP/SMX is about 25%. Which of the following is the best choice for her therapy? 

A. Prescribe a course of 3-day oral trimethoprim-sulfamethoxazole
B. Order a single dose of IM ceftriaxone
C. Prescribe a 5-day course of oral nitrofurantoin
D. Advise that a 1-week course of oral ciprofloxacin therapy is needed

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In evaluating a 66-year-old man with dilated cardiomyopathy and heart failure, the NP notes a grade 3/6 medium-pitched blowing systolic murmur that radiates to the axillae. What do these findings most likely represent?

A.Innocent murmur

B. Mitral stenosis

C. Aortic regurgitation

D. Mitral regurgitation

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In treating a 26-year-old man with panic disorder who is otherwise healthy, you consider prescribing:

A. Bupropion.

B. Alprazolam.

C. Citalopram

D. Risperidone

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Which of the following is a most often noted in a 65-year-old woman with osteoarthritis?

A. Anemia of chronic disease is often noted. 

B. Usually presents as a systemic polyarthritis.

C. Constitutional signs and symptoms, including fatigue and unintended weight loss are reported 

D. Typically impacts weight-bearing joints, particularly in early disease

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A 55-year-old woman with recently diagnosed hypertension was started on a standard dose of or a thiazide diuretic daily 6 weeks ago. Today her blood pressure is 128/78 mm Hg and the patient is feeling well, and clinical exam fails to reveal abnormal heart sounds or hypertensive retinopathy.  The appropriate action at this time would be to?

A. Consider switching her HTN medication to a calcium channel blocker

B. Continue on her current medication regimen 

C. Add an ACEI to enhance HTN control

D. Advise patient she needs to take her HBP for at least 1 more month prior to evaluating its effectiveness

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A  45-year-old woman with no chronic health problems presents a 6-month history increasing fatigue despite adequate opportunity for rest , worsening dry skin and increased menstrual flow volume. In analyzing the laboratory data below, which is most consistent with the diagnosis of hypothyroidism? 

A. TSH <0.15 mIU/L (0.4–4.0 mIU/L), free T4=79 pmol/L (10–27 pmol/L)

B. TSH=8.9 mIU/L (0.4–4.0 mIU/L), free T4=15 pmol/L (10–27 pmol/L)

C. TSH=1.9 mIU/L (0.4–4.0 mIU/L), free T4=22 pmol/L (10–27 pmol/L)

D. TSH=64 mIU/L (0.4–4.0 mIU/L), free T4=3 pmol/L (10–27 pmol/L)

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Saundra is a 72-year-old with hypertension who is on an appropriate dose of an ACE inhibitor with adherence. Today’s BP= 152/96 and is without HTN-related complaint.  Physical exam is unremarkable.She has a history of well-controlled asthma and is using ICS/LABA therapy.  Due to osteoarthritis, she reports, “I get up slowly. Sometimes I do not get the bathroom on time and I lose my urine control.” Which of the following represents the next best step in Saundra’s HTN therapy? 

A.Advise that her BP is in an acceptable range

B. Thiazide diuretic therapy should be initiated

C. Add a CCB to her current therapy

D. A beta blocker represents the optimal additional therapy

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