Question 1: Which of the following symptoms is common with acute otitis media?
Bulging tympanic membrane
Bright light reflex of tympanic membrane
Increased tympanic membrane mobility
All of the above

Question 2. The cytochrome p system involves enzymes that are generally:
Inhibited by drugs
Induced by drugs
Inhibited or induced by drugs
Associated with decreased liver perfusion

Question 3. In AR disorders, carriers have:
Two mutated genes; one from each parent that cause disease
A mutation on a sex chromosome that causes a disease
A single gene mutation that causes the disease
One copy of a gene mutation but not the disease

Question 4. A 56-year-old male complains of anorexia, changes in bowel habits, extreme fatigue, and unintentional weight loss. At times he is constipated and other times he has episodes of diarrhea. His physical examination is unremarkable. It is important for the clinician to recognize the importance of:
CBC with differential
Stool culture and sensitivity
Abdominal X-ray
Colonoscopy

Question 5. Which of the following findings should trigger an urgent referral to a cardiologist or neurologist?
History of bright flash of light followed by significantly blurred vision
History of transient and painless monocular loss of vision
History of monocular severe eye pain, blurred vision, and ciliary flush
All of the above

Question 6. In examination of the nose, the clinician observes gray, pale mucous membranes with clear, serous discharge. This is most likely indicative of:
Bacterial sinusitis
Allergic rhinitis
Drug abuse
Skull fracture

Question 7. An 82-year-old female presents to the emergency department with epigastric pain and weakness. She admits to having dark, tarry stools for the last few days. She reports a long history of pain due to osteoarthritis. She self-medicates daily with ibuprofen, naprosyn, and aspirin for joint pain. On physical examination, she has orthostatic hypotension and pallor. Fecal occult blood test is positive. A likely etiology of the patient's problem is:
Mallory-Weiss tear
Esophageal varices
Gastric ulcer
Colon cancer

Question 8. Your patient is a 78-year-old female with a smoking history of 120-pack years. She complains of hoarseness that has developed over the last few months. It is important to exclude the possibility of:
Thrush
Laryngeal cancer
Carotidynia
Thyroiditis

Question 9. Your patient has been using chewing tobacco for 10 years. On physical examination, you observe a white ulceration surrounded by erythematous base on the side of his tongue. The clinician should recognize that very often this is:
Malignant melanoma
Squamous cell carcinoma
Aphthous ulceration
Behcet's syndrome

Question 10. The best way to diagnose structural heart disease/dysfunction non-invasively is:
Chest X-ray
EKG
Echocardiogram
Heart catheterization

Question 11. (*There are multiple questions on this exam related to this scenario. Be sure to read the whole way through to the question.) Mr.Keenan is a 42-year-old man with a mild history of GERD and a remote history of an appendectomy, presenting with an acute onset of significant right upper-quadrant abdominal pain and vomiting. His pain began after a large meal, was unrelieved by a proton-pump inhibitor, was unlike his previous episodes of heartburn, but upon questioning, reports milder, prodromal episodes of similar post-prandial pain. His pain seems to radiate to his back. Despite a family history of cardiac disease, he reports no classic anginal signs or chest pain. He furthermore denies respiratory or pleuritic signs and denies fever, night sweats, and unintended weight loss. Finally, there are no dermatologic signs, nor genitourinary symptoms.
Of the following lab studies, which would provide little help in determining your differential diagnosis?
Abdominal plain films
Liver function tests
Amylase/lipase
Urinalysis

Question 12. The pathophysiological hallmark of ACD is:
Depleted iron stores
Impaired ability to use iron stores
Chronic unable bleeding
Reduced intestinal absorption of iron

Question 13. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner.Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?
Pulmonary edema
Heart failure
Pulmonary embolism
Pneumonia

Question 14. A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
50 x 2-pack years
100-pack years
50-year, 2-pack history
100-pack history

Question 15. An 86-year-old patient who wears a hearing aid complains of poor hearing in the affected ear. In addition to possible hearing aid malfunction, this condition is often due to:
Acoustic neuroma
Cerumen impaction
Otitis media
Ménière's disease

Question 16. Which symptom is more characteristic of Non-Cardiac chest pain?
Pain often radiates to the neck, jaw, epigastrium, shoulder, or arm
Pain tends to occur with movement, stretching or palpation
Pain usually lasts less than 10 minutes and is relieved by nitroglycerine
Pain is aggravated by exertion or stress

Question 17. Aortic regurgitation requires medical treatment for early signs of CHF with:
Beta blockers
ACE inhibitors
Surgery
Hospitalization

Question 18. In examining the mouth of an older adult with a history of smoking, the nurse practitioner finds a suspicious oral lesion. The patient has been referred for a biopsy to be sent for pathology. Which is the most common oral precancerous lesion?
Fictional keratosis
Keratoacanthoma
Lichen planus
Leukoplakia

Question 19. Iron Deficiency Anemia (IDA) is classified as a microcytic, hypochromic anemia. This classification refers to which of the following laboratory data?
Hemoglobin and Hematocrit
Mean Corpuscular Volume (MCV) and Mean Corpuscular Hemoglobin (MCH)
Serum ferritin and Serum iron
Total iron binding capacity and transferrin saturation

Question 20. A key symptom of ischemic heart disease is chest pain. However, angina equivalents may include exertional dyspnea. Angina equivalents are important because:
Women with ischemic heart disease many times do not present with chest pain
Some patients may have no symptoms or atypical symptoms; diagnosis may only be made at the time of an actual myocardial infarction
Elderly patients have the most severe symptoms
A & B only

Question 21. An older patient reports burning pain after ingestion of many foods and large meals. What assessment would assist the nurse practitioner in making a diagnosis of GERD?
Identification of a fluid wave
Positive Murphy's sign
Palpable spleen
Midepigastric pain that is not reproducible with palpation

Question 22. When interpreting laboratory data, you would expect to see the following in a patient with Anemia of Chronic Disease (ACD):
Hemoglobin <12 g/dl, MCV decreased, MCH decreased
Hemoglobin >12 g/dl, MCV increased, MCH increased
Hemoglobin <12 g/dl, MCV normal, MCH normal
Hemoglobin >12 g/dl, MCV decreased, MCH increased

Question 23. Symptoms in the initial human immunodeficiency virus (HIV) infection include all of the following except:
Sore throat
Fever
Weight loss
Headache

Question 24. Epistaxis can be a symptom of:
Over-anticoagulation
Hematologic malignancy
Cocaine abuse
All of the above

Question 25. In a patient presenting with suspected recurrence of diverticulitis, abdominal pain usually presents where in the abdomen?
Left upper quadrant
Right upper quadrant
Left lower quadrant
Right lower quadrant

Question 26. Jeff, 48 years old, presents to the clinic complaining of fleeting chest pain, fatigue, palpitations, lightheadedness, and shortness of breath. The pain comes and goes and is not associated with activity or exertion. Food does not exacerbate or relieve the pain. The pain is usually located under the left nipple. Jeff is concerned because his father has cardiac disease and underwent a CABG at age 65. The ANP examines Jeff and hears a mid-systolic click at the 4th ICS mid-clavicular area. The ANP knows that this is a hallmark sign of:
Angina
Pericarditis
Mitral valve prolapse
Congestive heart failure

Question 27. The first assessment to complete related to the eyes is:
Eye lids
Visual acuity
Extraocular movements
Peripheral vision

Question 28. Rheumatic heart disease is a complication that can arise from which type of infection?
Epstein-Barr virus
Diphtheria
Group A beta hemolytic streptococcus
Streptococcus pneumoniae

Question 29. A 22-year-old female comes to your office with complaints of right lower quadrant abdominal pain, which has been worsening over the last 24 hours. On examination of the abdomen, there is a palpable mass and rebound tenderness over the right lower quadrant. The clinician should recognize the importance of:
Digital rectal examination
Endoscopy
Pelvic examination
Urinalysis

Question 30. Patients that have atopic disorders are mediated by the production of Immunoglobulin E (IgE) will have histamine stimulated as an immediate phase response. This release of histamine results in which of the following?
Sinus pain, increased vascular permeability, and bronchodilation
Bronchospasm, vascular permeability, and vasodilatation
Contraction of smooth muscle, decreased vascular permeability, and vasoconstriction
Vasodilatation, bronchodilation, and increased vascular permeability

Question 31. Which of the following is the most common cause of heartburn-type epigastric pain?
Decreased lower esophageal sphincter tone
Helicobacter pylori infection of stomach
Esophageal spasm
Peptic ulcer disease

Question 32. Which of the following statements is true concerning anti-arrhythmic drugs?
Amiodarone is the only one not associated with increased mortality and it has a very favorable side effect profile.
Both long-acting and short-acting calcium channel blockers are associated with an increased risk of cardiovascular morbidity and mortality.
Most anti-arrhythmics have a low toxic/therapeutic ratio and some are exceedingly toxic.
Anti-arrhythmic therapy should be initiated in the hospital for all patients.

Question 33. During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with:
Pneumonia
Pleuritis
Pneumothorax
A and B

Question 34. Which of the following would be considered a "red flag" that requires more investigation in a patient assessment?
Colon cancer in family member at age 70
Breast cancer in family member at age 75
Myocardial infarction in family member at age 35
All of the above

Question 35. Which of the following clinical reasoning tools is defined as evidence-based resource based on mathematical modeling to express the likelihood of a condition in select situations, settings, and/or patients?
Clinical practice guideline
Clinical decision rule
Clinical algorithm
Clinical recommendation

Question 36. Your patient complains of a feeling of heaviness in the lower legs daily. You note varicosities, edema, and dusky color of both ankles and feet. Which of the following is the most likely cause for these symptoms?
Femoral vein thrombosis
Femoral artery thrombus
Venous insufficiency
Musculoskeletal injury

Question 37. What is the most common valvular heart disease in the older adult?
Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis

Question 38. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:
Pneumothorax
Pleural effusion
Pneumonia
Pulmonary embolism

Question 39. A nurse practitioner reports that your patient's abdominal X-ray demonstrates multiple air-fluid levels in the bowel. This is a diagnostic finding found in:
Appendicitis
Cholecystitis
Bowel Obstruction
Diverticulitis

Question 40. According to the Genetic Information Nondiscrimination Act (GINA):
Nurse Practitioners (NPs) should keep all genetic information of patients confidential
NPs must obtain informed consent prior to genetic testing of all patients
Employers cannot inquire about an employee's genetic information
All of the above