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2025 CEA PREP FULL PRACTICE
EXAM ACTUAL QUESTIONS WITH
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The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA view shows a left lower chest area of consolidation adjacent to the left border of the heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view shows this lesion absent of the window posterior to the cardiac silhouette. Which is the most likely location of this area of focal consolidation? *Left upper lobe apex *Right middle lobe *Left upper lobe lingula *Left lower lobe - CORRECT ANSWER>>>>Left upper lobe lingula Ratonale: Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette is obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula. The inability to fully relax the myocardium during relaxation is a trademark of which of the following diagnoses? - CORRECT ANSWER>>>>Diastolic dysfunction Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and is common in patients with thickened hypertrophic myocardium. An otherwise healthy African American adult male has been diagnosed with hypertension. He has been restricting his salt intake, eating a DASH (Dietary Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is still elevated. Which is the BEST medication to prescribe him? - CORRECT ANSWER>>>>Calcium channel blocker Rationale: African American patients per JNC8 Hypertension Guidelines should be managed with a dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line management therapy for hypertension not at goal with DASH and lifestyle modifications. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which medical imaging is considered standard of care for serial surveillance? - CORRECT ANSWER>>>>CT angiography of the chest Rationale: CT angiography is considered the standard of care for measuring vascular luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at times, they are not able to provide multi-axis reconstruction needed to accurately measure the size. Transesophageal echo is not needed to accurately measure the aorta and requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation? - CORRECT ANSWER>>>>phenylephrine Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor activity. A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea. On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is the most likely diagnosis? - CORRECT ANSWER>>>>Congestive heart failure Rationale: Of the available options, the most accurate response is congestive heart failure as it is signifying both a right ventricular back up with jugular venous extension and crackles on lung assault, which are suggestive of left ventricular back up. it is possible the patient may have an acute myocardial infarction that precipitated this, however, a patient has not described that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate response of these available is congestive heart failure. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an ejection fraction of 40% who is also not on optimal medical therapy has been diagnosed with a myocardial infarction this admission and received emergent placement of a drug-eluting stent to the left anterior descending artery. As the medical home who will manage this patient after discharge, which medication strategy would you expect to be a priority in the patient's care? - CORRECT ANSWER>>>>Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35% Rationale: The patient should have a protective mechanism such as an implantable automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90 days for an AICD in this state, optimizing their medication regimen and repeating an echo in 2-3 months to re-evaluate for improvement in their EF is required by most insurance companies. A baseline echo is needed at discharge to provide a baseline for improvement vs their repeat echo in 2- 3 months. Dual anti-platelet therapy is required for 12 months minimum post-MI. A Holter monitor does not provide any conceivable benefit for this patient as presented. Which of the following people groups represent the least risk of cardiac disease? - CORRECT ANSWER>>>>Caucasians Rationale: Statistically African Americans, Native Hawaiians, and American Indians are at at increased risk of cardiac disease due to higher rates of hypertension, diabetes, and obesity than Caucasians. A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is now adequately controlled with medication. Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL =
- In addition to starting therapeutic lifestyle changes, the nurse practitioner should start the patient on: - CORRECT ANSWER>>>>a statin drug. Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD risk, but for a patient who is an active smoker with premature coronary disease history
Rationale: Of these options, an adult woman with a BMI of 27 who just delivered a baby weighing 9 1/2 lbs is the most likely due to their increased BMI and the large size of the baby. giving birth to a large baby, also known as a large-for-gestational-age (LGA) baby, can increase the risk of developing type 2 diabetes later in life. Women who give birth to a LGA baby are 10% more likely to develop DMII 10-14 years after pregnancy compared to women who give birth to babies of average gestational age (AGA). This increased risk is even after adjusting for other risk factors, such as age, obesity, high blood pressure, and family history of diabetes. A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine - CORRECT ANSWER>>>>25 mcg Rationale: The widely considered best practice for treatment of hypothyroidism in the elderly is to "go slow and start low". 25 mcg is the most appropriate low dose to start with of these options. It is possible that over time the dose will be increased until therapeutic levels are obtained, but the risk of over-dosing the patient outweighs the desire to quickly achieve this state. An adult female who recently returned for a recheck appointment. The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4- 6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now? - CORRECT ANSWER>>>>Triiodothyronine (T3) and free thyroxine (FT4) Rationale: Remember that a patient with low TSH is suspicious of hyperthyroidism with a corresponding finding of elevated T3/T4 and clinical symptoms of a goiter, tremulousness, anxiety, palpitations, weight loss, insomnia, diarrhea, etc. This patient is describing a sore neck as well, which is suggestive of Graves disease (hyperthyroid state). All the following are symptoms of hypocalcemia except: - CORRECT ANSWER>>>>Visual field deficits Rationale: Visual field deficits is a potential symptom of pituitary adenoma. All other are symptoms related to hypocalcemia. An adult patient diagnosed with type 2 diabetes mellitus presents for a recheck. The patient follows a carbohydrate counting diet and walks 30 minutes 5 times weekly. Current fasting blood glucose = 116 mg/dL [normal = less than 99 mg/dL] and A1c = 6.3% [normal = less than 7.0%]. In accordance with the American Diabetes Association, the nurse practitioner would recommend that the next follow-up appointment be scheduled for: - CORRECT ANSWER>>>>6 months. Rationale: Based off of the ADA recommendation, this patient should be evaluated in six months. They are actually showing good control and excellent compliance with diet and exercise management strategies. If there compliance was worse or they were not controlled with their A1c, this would likely be a three month follow up. Your patient has a diagnosis of Hashimoto's and is on Levothyroxine 75 mcg daily. Her recent TSH was elevated at 15 uU/mL. Your next best action is to: - CORRECT ANSWER>>>>Increase Levothyroxine to 100 mcg daily Rationale: When the TSH is elevated the patient needs more thyroid hormone. Once diagnosed with Hashimoto's there is no clinical need/benefit to repeating anti bodies.
A patient has a 3 cm pituitary mass noted on CT. What is your next step in evaluating the patient? - CORRECT ANSWER>>>>Screen for hormone deficiencies Rationale: Initial work up includes hormone testing. Cabergoline is the treatment for prolactinoma. Surgery consult is indicated when there are VF deficits and/or abutment/compression on optic nerves or chiasm or if adenoma is hyperfunctioning. Adenomas
1 cm with no VF deficit or abutment/compression of optic nerves or chiasm require a follow up MRI at 6 months. An adult female presents with a chief complaint of fatigue and weight gain. She states that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings would support this diagnosis? - CORRECT ANSWER>>>>Dry skin, bradycardia, and hypoactive deep tendon reflexes Rationale: Dry skin, bradycardia, and hypoactive deep tendon reflexes are all fairly classic signs of hypothyroidism. To further substantiate these concerns, the patient should have their TSH and T3 and Free T4 checked, and it is likely their TSH would be elevated, T3/T4 low. An older adult patient with new onset GERD, cough, heartburn. Initial tx - CORRECT ANSWER>>>>Antacid and lifestyle modification/weight loss Rationale: Before initiating a PPI or H2RA, it would always be wise to initiate diet/exercise and symptom management when present with an antacid. Loss of weight/dieting is most likely to deal with obesity as the most common underlying cause of GERD. A 59-year-old male presents with symptoms of abdominal pain, jaundice, and weight loss which he has not been trying to lose weight. What would be a malignancy associated with these symptoms? - CORRECT ANSWER>>>>Pancreatic cancer Raionale: Pancreatic cancer, the most typically presentation includes abdominal pain, jaundice, and weight loss. Although weight loss and abdominal pain may be present with adenocarcinoma it is unlikely to present with jaundice, and you're unlikely to have abdominal pain or jaundice with any esophageal malignancy. A 63-year-old male presents with a suspected lower GI bleed. He reports passing frank small amounts of blood several times today. He denies any use of NSAID's or blood thinners. What must be taken into consideration before performing a colonoscopy on this patient? - CORRECT ANSWER>>>>All are reasonable options Rationale: This patient has had blood loss and should first be hemodynamically stable, and fluid/blood product resuscitated. In all cases of GI bleed risk factors for an upper GI bleed must be taken into consideration first, we must always discuss with the patient all risks and benefits associated with the procedure to provide an informed consent. A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day. She also reports mild cramping. Which labs would be helpful in further workup of a diagnosis? - CORRECT ANSWER>>>>ESR, fecal occult, Stool culture Rationale: ESR, Fecal occult, and stool culture would be the biggest benefit to determine the potential cause of her symptoms.
Which is best performed to assess the risk for fall in an 88-year old adult? - CORRECT ANSWER>>>>Get up and go test Rationale: This question is asking you if you understand the different screening to available for Mobility and fall risk. The global screening assessment, PHQ-2 questionnaire, and clock drawing test have no clinical significance to mobility. The "get up and go" test is the only option that is a mobility test of these four. A frail elderly patient presents with constipation. Which of the following normal physiologic changes seen with aging is the most likely cause? - CORRECT ANSWER>>>>Decreased bowel muscle tone Rationale: The frail, elderly patient will typically have their GI track decrease bile secretion and decrease absorption of calcium. A decrease in pancreas secretions is not related to presence of constipation, however, decreased bowel muscle tone certainly does reduce the GI motility and increase the transit time, thereby increasing the drying of stool in the large intestine which leads to constipation An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice cream only. The family is concerned about the patient not getting enough nutrition. The NP: - CORRECT ANSWER>>>>explains loss of appetite is common at the end of life Rationale: Death is an uncomfortable topic, and must be handled tactfully. Factual re-orientation to the terminal state of a patient's condition may be appropriate when unrealistic expectations for their longevity have been voiced. The reasonable choice in this case is to describe the normalcy of what the patient is experiencing with their loss of appetite and their terminal state. Testing the patient for depression has really no clinical bearing on this particular time nor does prescribing methylphenidate. Ordering a UA and CBC would suggest a concern of a urinary tract infection, and that is not a likely scenario to describe the patient's existing condition. Support the patient as his advocate by helping the man enjoy the ice cream he requested. An elderly patient is being admitted to the skilled nursing facility and is being screened for the risk of falling. Which of the following information would trigger a complete falls assessment? - CORRECT ANSWER>>>>A history of two or more falls in the prior year Rationale: Of these options, the only two that have any clinical bearing on falls are a patient who has a demonstrated incident of two or more falls in a year and a patient who has a altered cognition, such as the patient who is living alone and has mild dementia. Of the two options, the clear winner is the patient who has already demonstrated to fall in the last year and they should certainly be a valuated more thoroughly with a complete fall assessment. The management of COPD in the elderly is best guided by: - CORRECT ANSWER>>>>symptomatology. Rationale: Symptomatology is what guides COPD management since the severity and frequency of symptoms will warrant changes and additions to medications as exacerbations present. Although very useful tool for chronic management and baseline status, spirometry does not typically dictate therapy, rather diagnose the disease state itself. Our blood gases may be used for clinically correlate severity during an exacerbation, and radiologic imaging may showcase severity of stable chronic finding such as somatic, lung tissue or bullae.
Which of the following is an example of implied consent? - CORRECT ANSWER>>>>The patient collapses while having a myocardial infarction in the hospital cafeteria. Bystanders witnessed the patient clutch his chest, say "my chest", then collapse. They start CPR and initiate the emergency care system to transport the patient for care in the emergency department. Rationale: Surgical consent is by definition "informed" when the risks and benefits are discussed as with the patients undergoing surgery and a chest tube, and 2 person emergency consent is described with the patient with altered mental status. The collapsed patient reflects a clear inability to care for oneself and care is being performed under the assumption of what is implied as what any reasonable person would want. Which of the following refers to the primary access point of medical care patients are encouraged to use to aid in providing continuity and reduction of cost per the Affordable Care Act? - CORRECT ANSWER>>>>The Medical Home Rationale: The medical home reduces cost by providing continuity of care, reducing overtesting, duplicate testing, and aids with longitudinal management of the patient. The other options all increase these cost-burdening elements and should be avoided unless care through the medical home is not a reasonable or appropriate option. A patient states they do not want to have any further medical care and wishes to leave against medical advice. Unknown to you, the healthcare tech then held their arm down to get an IV catheter placed against their will. The healthcare tech is at risk of being charged with which of the following: - CORRECT ANSWER>>>>Battery Rationale: Assault refers to the risk of a harm to others, whereas battery refers to the actual act of that harm. Which act formed in 1996 was created to protect patient health information from being disclosed without the patient's consent or knowledge? - CORRECT ANSWER>>>>Health Insurance Portability and Acountability Act (HIPAA) Rationale: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. FERPA was aimed at educational protections similar to HIPAA but for education. COBRA is for continuing insurance benefits after separation from employment. EMTALA is to guarantee provision of emergency treatment for stabilization or for those in active labor. An 87-year-old female has a history of ovarian cancer. She recently completed the tenth of 26 chemotherapy treatments. She informs the nurse practitioner that she plans to stop chemotherapy; she has lived a good life and is ready to die. She is alert and very active, and lives with her son. The family is determined that the patient will complete the chemotherapy. The nurse practitioner's most appropriate action is to: - CORRECT ANSWER>>>>support the patient's decision. Rationale: Good nursing practice supports advocacy at all times for the patient, even when the patient's family disagrees. Supporting their decision to self-direct their care is your primary obligation.
is the most appropriate next step in management? - CORRECT ANSWER>>>>Intranasal corticosteroids Which of the following best characterizes presbycusis in the older adult? - CORRECT ANSWER>>>>Bilateral high-frequency sensorineural hearing loss Your 24-year-old male patient has been admitted post-motor vehicle collision at a high rate of speed. A CT head is performed revealing a pyramidal fracture involving the lateral walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is this? - CORRECT ANSWER>>>>Le Fort II Rationale: Le Fort II fracture lines pass through the posterior alveolar ridge, lateral walls of maxillary sinuses, inferior orbital rim, and nasal bones Le Fort type I, the plane of injury is horizontal and typically results in a separation of the teeth from the upper face. The horizontal fracture line generally passes through the alveolar ridge which is the bony socket that holds the teeth, the lateral nose, and the inferior part of the maxillary sinus, one of the four nasal sinuses that resides near the nose. Le Fort type II presents with a pyramidal-shaped fracture. The upper teeth make up the base and the nasofrontal suture— a band of tissue connecting the frontal bone and the nasal bones—makes up the point or apex of the pyramidal fracture. The pyramidal plane of fracture can again occur through the alveolar ridge (an extension of the upper jaw) and maxillary sinuses, but typically also extends through the orbital rim (eye socket) and nasal bones. Le Fort type III, the plane of injury is transverse, or horizontal, similar to type I; however, in type III, injury typically begins at the nasofrontal area and extends across the orbital walls, zygomatic arch (cheek bone), and pterygoid plates. A type III Le Fort fracture is the most extensive as it can result in a complete dislocation of the midface from the base of the skull, known as a craniofacial dislocation. Which of the following is not a common symptom of Meniere's disease? - CORRECT ANSWER>>>>Photophobia Rationale: The classic triad of Meniere's disease is vertigo, tinnitus, and hearing loss. The medical term for nosebleed is which of the following? - CORRECT ANSWER>>>>Epistaxis Rationale: Epistaxis is the medical term for nosebleed. A 73 y.o. M presents to the ED with complaints of large output hematemesis since early this morning. He is a endorses chronic alcohol use and his PMH is positive for peptic ulcer. Which of the following symptoms indicate a potentially severe GI bleed and likely need for immediate PRBC transfusion? - CORRECT ANSWER>>>>Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities Rationale: Symptoms of severe blood loss include Orthostatic dizziness, confusion, angina, severe palpitations, and cold/clammy extremities. A 35-year-old man presents with recurrent episodes of severe pain in his back, chest, and extremities. He has a history of sickle cell disease. What is the most appropriate initial
management during a pain crisis? - CORRECT ANSWER>>>>Hospitalization for intravenous fluids and opioids Rationale: Patients experiencing acute sickle cell crisis should be transported to the hospital for IV hydration therapy and pain management. A 14-year-old with sickle cell anemia has recently experienced a sickle cell crisis and presents for a follow-up examination after a recent hospitalization. It is most important to continue monitoring growth, development, and: - CORRECT ANSWER>>>>hemoglobin levels. Rationale: Chronic monitoring for patients with sickle cell disease includes monitoring of hemoglobin and hematocrit. A patient with a known intrinsic factor autoantibody is at risk for developing which of the following conditions? - CORRECT ANSWER>>>>B12 deficiency and pernicious anemia Rationale: Causes of B12 deficiency include malabsorption and intrinsic factor deficiency. Intrinsic factor deficiency is a result of gastric resection or IF autoantibody. A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for management of pain due to pelvic fracture after motor vehicle collision. Admission labs show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection. What is the most appropriate level of intervention for his patient? - CORRECT ANSWER>>>>Observation until patient becomes symptomatic Rationale: Treatment of neutropenia in asymptomatic patients is observation. Overactivation of coagulation and fibrinolysis resulting in thrombosis and hemorrhage is a trademark of which of the following? - CORRECT ANSWER>>>>Disseminated intravascular coagulation Rationale: DIC is a systemic process that has potential to result in thrombosis and hemorrhage often due to overactivation of coagulation and fibrinolysis. A patient diagnosed with iron deficiency anemia requires iron supplementation. Which of the following treatments would likely be ineffective? - CORRECT ANSWER>>>>Ferrous sulfate 325 mg PO BID for a 43 y.o. F s/p gastric bypass 2 years ago Rationale: Patients who have undergone bariatric surgery have a permanent loss and/or alteration of gastric space and subsequent decrease in the production of HCL and/or enterocytes. This loss decreases the conversion/absorption of ferric iron (present in food) into the usable ferrous form. Any PO administration of either ferrous or ferric iron is less likely to be absorbed in adequate amounts after gastric bypass or other gastric procedures. All the following thrombocytopenic emergencies require immediate action except: - CORRECT ANSWER>>>>Scheduled surgical procedure with mild thrombocytopenia Rationale: Mild thrombocytopenia is not an emergency, but should involve evaluation by a hematologist or oncologist if no etiology is known prior to surgical stress. In which of the following patients is PRBC transfusion recommended? - CORRECT ANSWER>>>>73 y.o. M with acute GI bleed and Hgb 6.
underfilled. Off floor privileges would not be wise since the infection risk and pain requires close monitoring, fall risk, and analgesic requirements. A patient who has active herpes zoster is at risk of shedding which contagious virus? - CORRECT ANSWER>>>>Varicella zoster Rationale: Patients with herpes zoster (shingles) are at risk of transmitting varicella zoster (chicken pox) to those who have not yet had varicella or been vaccinated. Your patient presented yesterday to urgent care with symptoms of lower extremity weakness and then went home for observation with family. They have returned to urgent care and it now appears to be affecting the patient's abdomen in just the past few hours. What is your priority intervention? - CORRECT ANSWER>>>>Immediate transportation to the hospital and monitor for airway involvement (This patient appears to have ascending GB and is at risk of airway compromise based on the rapid succession of symptoms towards the airway.) Rationale: With Guillain-Barre syndrome as the leading diagnosis, there are two types (ascending and descending). Ascending, which is being described in this scenario, will require hospitalization as it is next likely to affect the thorax/lungs and may require airway management with an advanced airway to support if the patient's muscle loses neurologic control due to demyelination. Your patient has been noticing bilateral joint pain in the knees and feet for about 6 months and has been started on methotrexate. Which of the following diagnoses correlate to this treatment plan? - CORRECT ANSWER>>>>Rheumatoid arthritis Rationale: This is a classic diagnosis and treatment of RA. OA is the same as DJD, and PMR is typically located in the upper chest and shoulder girdle. A patient is newly diagnosed with multiple sclerosis. Treatment includes prednisone with physical therapy. The nurse practitioner advises the patient to begin disease-modifying therapy: - CORRECT ANSWER>>>>as soon as possible. Rationale: To limit disease progression, disease modifying therapy (DMARDs) should be initiated as soon as possible. This is also to limit the exposure and duration of steroid therapy as this does not treat the underlying cause and it may take some time for DMARD therapy to become fully therapeutic for the patient. Your patient is being treated with disease modifying anti-rheumatic drugs for a plaque-like skin condition located on the extensor surfaces of joints. Which condition is this likely describing? - CORRECT ANSWER>>>>Plaque psoriasis Rationale: Plaque psoriasis is trademarked by these findings. Eczema tends to be on the flexor surfaces and is not treated with DMARDs. Contact dermatitis is due to exposure to an irritant and is typically self-limiting without the use of DMARDs. What is the most likely diagnosis for an elderly patient with GI cancer who presents with skin pallor, conjunctival pallor, palpitations, and weakness? - CORRECT ANSWER>>>>Iron deficiency anemia
Rationale: Iron deficiency anemia due to GI cancer may present with symptoms such as fatigue, weakness, pale skin, shortness of breath, and dizziness. These symptoms occur because of reduced oxygen-carrying capacity in the blood due to low hemoglobin levels. An 18-year-old presents with acne. He notes that he washes his face with a mild skin cleanser 3 to 4 times daily, however the acne persists and has worsened. The nurse practitioner explains that: - CORRECT ANSWER>>>>frequent facial scrubs can worsen acne. Rationale: Over-washing the face can contribute to acne or exacerbate existing acne symptoms. Over-washing can irritate the skin, causing redness, inflammation, and sensitivity. This can worsen existing acne lesions and delay healing. What is the definitive treatment for uncomplicated skin abscess on the arm? - CORRECT ANSWER>>>>Incision and drainage Rationale: The definitive treatment for an uncomplicated skin abscess is to open and drain the contents. The body will then re-approximate by secondary intention once the contents has been evacuated. Gram negative coverage is not recommended for an area typically associated with gram-positive flora. Which of the following is a true statement about squamous cell carcinoma? - CORRECT ANSWER>>>>Squamous cell carcinoma is more likely to have metastasis than basal cell carcinoma Rationale: Squamous cell carcinoma is more common to have metastasis than basal cell carcinoma. Basal cell carcinoma is more common than squamous cell carcinoma. A frail elderly male with a history of sun exposure and rough, scaly, brownish lesions on the face, ears, and hands presents with a firm erythematous, ulcerated nodule on the dorsal surface of the hand. The most likely diagnosis is: - CORRECT ANSWER>>>>Squamous cell carcinoma Rationale: Squamous cell carcinoma (SCC) is a type of skin cancer that can also occur in other areas of the body, including the lining of the respiratory and digestive tracts. The symptoms of SCC can vary depending on the location of the cancer. SCC typically appears as a firm, red nodule or a flat sore with a scaly crust. It may also present as a rough, scaly patch that may bleed or crust over. A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal area. Which diagnostic procedure would confirm a diagnosis of pinworm infestation? - CORRECT ANSWER>>>>Examination of transparent tape sample from perianal skin Rationale: Scotch Tape Test (Cellophane Tape Test): This is a common diagnostic method where a piece of transparent adhesive tape (such as Scotch tape) is pressed against the perianal skin in the morning before bathing or using the toilet. The tape is then carefully placed on a glass slide or slide labeled with the patient's name and date of collection and submitted to a laboratory for examination under a microscope. The presence of pinworm eggs or occasionally adult worms clinging to the tape can confirm the diagnosis.
Rationale: Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid in the body. It inhibits the enzyme xanthine oxidase, which is involved in the metabolism of purines (substances that contribute to uric acid formation). Allopurinol is commonly used as a long-term maintenance therapy to prevent recurrent gout attacks and to reduce the risk of complications associated with chronic hyperuricemia, such as tophi (deposits of urate crystals in joints and other tissues). For primary prevention of osteoporosis in females, the US Preventative Task Force recommends bone density screening: - CORRECT ANSWER>>>>At least once after age 65 Rationale: Women at higher risk of osteoporosis, such as those with a family history, early menopause, or certain medical conditions, should discuss bone density screening (DEXA scan) with their healthcare provider. Your patient has presented with an acute GI bleed. In working up potential causes, which of the following scenarios is most probable as a reason for the bleed? - CORRECT ANSWER>>>>Four days of high dose of naproxen sodium for joint pain after a long hike Rationale: Acute high dose use of NSAID is a risk of developing a stomach ulcer and subsequent GI bleeding. Topical use of NSAID is not associated with systemic absorption over 1-2% and accordingly does not carry the prostaglandin inhibition risks to the gut lining. Use of prednisone does not predispose to bleeding, nor does acetaminophen use. A 25-year-old athlete presents with shoulder pain and difficulty with overhead activities. Physical examination suggests impingement syndrome. What is the most appropriate initial treatment? - CORRECT ANSWER>>>>Physical therapy focusing on rotator cuff strengthening Rationale: Exercises to improve shoulder strength and flexibility, focusing on the rotator cuff and scapular stabilizers is an important initial treatment. Physical therapy may include stretching and strengthening exercises, as well as techniques to improve shoulder mechanics. A 75-year-old presents with depression. The patient also has osteoarthritis of both knees that interferes with mobility. Which antidepressant may also benefit osteoarthritis? - CORRECT ANSWER>>>>Duloxetine (Cymbalta) Rationale: For individuals with both osteoarthritis and depression, duloxetine offers the advantage of addressing both conditions simultaneously, potentially improving overall quality of life. Its dual action can also be beneficial in managing chronic pain and associated emotional distress often experienced by patients with osteoarthritis. Which of the following treatments is most successful for patients with chronic fatigue syndrome?
- CORRECT ANSWER>>>>Graded exercise program Rationale: A graded exercise program (GEP) for chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a structured approach to physical activity aimed at gradually increasing exercise tolerance and improving overall function. Here are key components and considerations for implementing a GEP: Individualized Assessment: Before starting a GEP, it's crucial to conduct a thorough assessment of the individual's current physical capabilities, symptom severity, and any specific limitations or concerns related to CFS.
Goal Setting: Establish clear and realistic goals with the patient, focusing on improving function, reducing symptom severity, and enhancing quality of life rather than aiming for rapid fitness gains. Structured Program: Develop a structured exercise plan tailored to the individual's baseline fitness level and tolerance. The program typically involves incremental increases in exercise intensity, duration, or frequency over time. Pacing: Emphasize the importance of pacing activities to avoid overexertion and exacerbation of symptoms. Encourage regular breaks during activity and gradual progression based on symptom response. A 25-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis? - CORRECT ANSWER>>>>Cystitis Rationale: Symptoms of cystitis include frequent urges to urinate, which may be accompanied by pain or burning during urination. The urine may appear bloody or cloudy, and there can be discomfort or pressure in the lower abdomen or pelvic area. Additionally, individuals may feel generally unwell, fatigued, or experience a mild fever. Inability to reach the bathroom before urinating is a feature consistent with which of the following diagnoses? - CORRECT ANSWER>>>>urge-type incontinence Rationale: Urge-type incontinence, also known as overactive bladder (OAB) or urgency incontinence, is a condition characterized by a sudden and strong need to urinate, often followed by involuntary leakage of urine. This type of incontinence occurs when the bladder muscle (detrusor) contracts involuntarily, leading to urgency and sometimes an inability to reach the toilet in time. An older adult with diabetes mellitus, COPD, hypertension, and osteoarthritis develops chronic kidney disease. The most likely cause is: - CORRECT ANSWER>>>>Diabetes Rationale: Diabetes is a leading cause of kidney failure, medically known as end-stage renal disease (ESRD), and it is often referred to as diabetic nephropathy when discussing kidney damage specifically caused by diabetes. An older adult female presents with a 2-month history of incontinence. She specifically complains of an inability to make it to the bathroom without the loss of some urine most of the time, and denies incontinence due to laughing, coughing, or sneezing; she denies dysuria. Her medications include an angiotensin-converting enzyme (ACE) inhibitor. The initial plan of action for this patient would be: - CORRECT ANSWER>>>>Obtaining a urinalysis for pyuria, hematuria, and glucosuria Rationale: Obtaining a urinalysis for pyuria (pus in the urine), hematuria (blood in the urine), and glucosuria (glucose in the urine) is typically done to assess and diagnose various medical conditions affecting the urinary tract and overall health. A 50-year-old man presents for a routine check-up and expresses concerns about prostate health. What is the most appropriate screening recommendation for prostate cancer? - CORRECT ANSWER>>>>Prostate-specific antigen (PSA) test every year starting at age 50
Because of the frequency and debilitating nature of an adult patient's migraine headaches, the NP decides to place the patient on preventive therapy. Which medication would be most appropriate? - CORRECT ANSWER>>>>Propranolol Rationale: Beta blockers, such as propranolol and metoprolol, work by blocking beta-adrenergic receptors. This action leads to vasoconstriction (narrowing of blood vessels), which can help stabilize blood flow in the brain. Migraines are often associated with vasodilation of cranial blood vessels, and beta blockers counteract this effect, reducing the likelihood of migraine attacks triggered by vasodilation. An elderly woman has vascular dementia. In the past week she's become agitated, is making less sense when she talks, and is sleeping more. Vital signs are: BP=110/76, P=86 regular, R=12/min, T=97.9 degrees F (36.6 degrees C). What should the nurse practitioner do? - CORRECT ANSWER>>>>Assess for an infection Rationale: Due to the atypical and sometimes subtle presentation of infections in elderly individuals, healthcare providers need to maintain a high index of suspicion and conduct thorough assessments, including physical examination and appropriate diagnostic tests (such as blood cultures, urinalysis, chest X-ray, etc.), to promptly identify and treat infections in this vulnerable population. Your patient has a new diagnosis of Parkinson's disease and presents after one month of treatment to urgent care with acute hypotensive episode with a blood pressure of 90/44. Which medication is likely responsible for this? - CORRECT ANSWER>>>>Carbidopa/levodopa overdose Rationale: Use of dopamine promoters in overdose may cause acute decrease in blood pressure. Carbidopa/Levodopa (is a commonly used dopamine promoter. A 37-year-old woman with a history of chronic migraines presents with unilateral headache, photophobia, and nausea. She mentions that her headaches have been progressively worsening. What is the most appropriate next step in evaluation? - CORRECT ANSWER>>>>MRI of the brain Rationale: Unilateral head pain, especially if severe or persistent, may warrant imaging to rule out structural abnormalities such as brain tumors, vascular malformations, or cysts. These conditions can cause localized pain and may require specific management or intervention. During the MRI, detailed imaging of the brain's structures and tissues will be obtained, providing valuable information to assist healthcare providers in diagnosing the cause of unilateral head pain and guiding appropriate treatment decisions. An 88-year-old male presents with concerns about memory loss. He feels good, takes an aspirin daily, and has no chronic diseases. He lives alone, drives his own car, and manages his financial affairs. To evaluate his memory, which of the following tests should the nurse practitioner choose? - CORRECT ANSWER>>>>Mini-Cog Test Rationale: The Mini-Cog is quick to administer and has been shown to be effective in identifying individuals who may need further cognitive assessment. It can help healthcare providers initiate appropriate interventions or referrals to specialists for a more comprehensive evaluation if cognitive impairment is suspected.
Which of the following tools is most easily administered in the practice setting for assessing cognitive decline? - CORRECT ANSWER>>>>Clock drawing (mini cog) Rationale: Drawing a clock involves multiple cognitive domains, including visuospatial skills, executive function (planning and organization), attention, and memory. These cognitive abilities are often affected in conditions such as dementia and Alzheimer's disease, making clock drawing a useful screening tool. Which of the following drug classes are used to prevent migraine headaches? - CORRECT ANSWER>>>>Beta-blockers Rationale: Beta blockers are medications that are commonly used for preventing migraines due to several beneficial effects on the body's physiology. Here are some reasons why beta blockers are effective in migraine prevention: Vasodilation Control: Beta blockers help regulate blood vessel dilation and constriction, which can contribute to migraine attacks. By stabilizing blood vessels, beta blockers can reduce the likelihood of vasodilation that triggers migraines. Neurotransmitter Regulation: Beta blockers affect the action of neurotransmitters such as serotonin and norepinephrine, which play a role in pain sensation and migraine pathways in the brain. By modulating these neurotransmitters, beta blockers can help reduce migraine severity and frequency. Reduction of Triggers: Beta blockers can help mitigate triggers associated with migraines, such as stress, anxiety, and physical exertion. By lowering heart rate and blood pressure, they may also decrease the physiological responses that can precipitate migraines. Prophylactic Effect: Beta blockers are effective when used as a prophylactic (preventive) treatment, meaning they are taken regularly to reduce the frequency and intensity of migraine attacks over time. Evidence-Based Efficacy: Several beta blockers, including propranolol and metoprolol, have been extensively studied and shown to be effective in reducing migraine frequency and severity in clinical trials. Well-Tolerated: Beta blockers are generally well-tolerated by many individuals, with common side effects including fatigue, dizziness, and mild gastrointestinal symptoms. They are often preferred for migraine prevention due to their established efficacy and relatively low risk of serious adverse effects. Patients who have which of the following comorbidities should avoid ergot and triptan anti- migraine medications? - CORRECT ANSWER>>>>Coronary artery disease Rationale: Due to the vasoconstrictive nature of ergot and triptan drugs, patients with coronary artery disease should refrain from their use. Which of the following is a common initial symptom of Alzheimer's disease? - CORRECT ANSWER>>>>Decrease in short-term memory Rationale: Forgetting recently learned information or important dates and events. In the early stages, individuals may have difficulty recalling information that they previously knew well. Patients with altered mental state should be considered for all the following potential causes except which of the following? - CORRECT ANSWER>>>>Hypertriglyceridemia
