APEA PREDICTOR EXAM |PRE- PREDICTOR EXAM 336 QUESTIONS ANSWERS WITH RATIONALES 2025- 2026, Exams of Pathophysiology

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APEA PREDICTOR EXAM |PRE-

PREDICTOR EXAM 336 QUESTIONS

ANSWERS WITH RATIONALES 2025 -

2026 update already A graded New

!!! (NSG 6440)

1. A. 15 .years .old .high .school .student .with .a .mild .sore .throat .and .low-grade .fever .that .has .persisted .for .about. 3 .weeks. .She .reports .general .malaise, .fatigue, .and .loss .of .appetite. .The .NP .suspects .mononucleosis. .Which .of .the .following .is .the .LEAST .appropriate .intervention? a. Palpate .the .lymph .nodes .and .spleen b. Examine .the .posterior .oropharynx .for .petechiae c. Obtain .a .CBC, .throat .culture, .and .heterophil .antibody .test. d. Obtain .an .urinalyses .and .serum .for .LFTs .and .amylase

Explanation:. mononucleosis .is .a .symptomatic .infection .caused .by .the .Epstein-Bar .virus. .Common .is .people .15-24 .years .of .age. .Common .signs .and .symptoms .following .incubation .period .(1-2 .months) .include .fatigue, .chills, .malaise, .anorexia, .white .tonsillar .exudates .and .lymphadenopathy .or .posterior .cervical .region. .Splenomegaly .can .be .present. .A .maculopapular .or .occasionally .a .petechial .rash .occurs .in .less .than .15% .of .patients. .A .diagnosis .is .usually .made .using .the .Monospot. .In .addition, .neutropenia .and .lymphocytosis .are .usually .detected .in .the .CBC.

2. A. 32 .years .old .male .patient .complaint .of .urinary .frequency .and .burning .on .urination .for. 3 .days. .Urinalyses .reveals .bacteriuria .and .positive .nitrites. .He .denies .any .past .hx. .Of .urinary .tract .infections. .The .initial .treatment .should .be: a. trimethoprim-sulfamethoxazole .(Bactrim, .Sulfatrim) .for. 7 - 10 .day b. ciprofloxacin .(Cipro) .for .3-5 .days c. Trimethoprim-Sulfamethoxazole .for. 3 .days d. 750 .mg .ciprofloxacin .as .a .one-time .dose

Explanation:. trimethoprim-sulfamethoxazole .(TMPS) .is .usually .n .appropriate .medication .to .treat .urinary .tract .infections .in .most .patients.. In .the .case .of .community .resistance .to .TMPS

20%^, .another .medication .should .be .substituted. .In .men, .the .appropriate .length .of .time .is .7- 10 .days. .Women .may .be .treated .for. 3 .days .for .uncomplicated .UTI

3. Which .agent .is .most .effective .for .the .treatment .of .nodulocystic. acne? a. Benzoyl .peroxide .(Benzac) b. Retinoic .acid .(Retin .A) c. Topical .tetracycline d. Isotretinoin)

Explanation:. Isotretinoin .(Accutane) .is .a .systemic .agent .indicated .for .treatment .with .severe .inflammatory .acne. .Guidelines .for .its .use .must .be .clearly .understood .by .the .patient. .A .woman .of .childbearing .age .must .use .an .effective .method .of .contraception .because .isotretinoin .is .teratogenic. .There .are .many .restrictions .in .prescribing .this .medication .because .of .the .teratogenic .effects .is .given .during .pregnancy. .Therefore, .it .is .a .pregnancy .category .X.

4. An. 18 .y/o .woman .is .taking .a .combined .hormonal .oral .contraceptive. .She .should .be .instructed .to .use .a .backup .method .for .the .prevention .of .pregnancy a. Throughout .the .week .of .placebo .pills

c. If .prescribed .amoxicillin/clavulanate .(Augmentin) .for .a .sinus .infection d. if .she .forgets .to .take .a .single .dose .of .the .contraceptive

Explanation:. Anticonvulsant .including .phenytoin .(Dilantin), .carbamazepine .(Tegretol), .primidone .(Mysoline), .topiramate .(Topamax) .and .oxcarbazepine .(Trileptal) .reduce .the .effectiveness .of .contraceptives. .Depo-medroxyprogesterone .acetate. injections .or .levonorgestrel- .releasing .intrauterine .devices .would .be .a .better .method .of .contraceptive .for .patients .taking .anticonvulsants. .Most .commonly .used .antibiotics .have .not .been .proven .to .reduce .the .effectiveness .of .contraceptives. .Rifampin .is .an .exception, .and .additional .…. .Be .used .by .women .taking .this .drug .and .using .oral .contraceptives, .transdermal, .or .vaginal .ring .preparations. Additional .backup .contraception .should .be .used .if .taking .antifungal .agents. .No .additional .protection .is .needed .thought .the .week .of .placebo .pills. .Missing .one .single .dose .of .contraceptive .does .not .require .additional .protection, .missing .more .than .one .doses .does.

5. A. 44 .years .old .female .patient .has .diabetes. .Her .total .cholesterol .(TC) .is. 250 .mg/dl .(6. .mmol/L), .LDL=. 190 .mg/dL .(4.94 .mmol/L), .HDL=. 25 .mg/dL .(65 .mmol/L), .and .triglycerides=. 344 .mg/dL .(8.94 .mmol/L). .What .agent .have .the .greatest .effect .on .improving .her .lipid .profile .and .reducing .morbidity .and .mortality .associates .with .dyslipidemia? a. Niacin .(Niaspan) b. Atorvastatin c. Omega. 3 .fatty .acids d. Fenofibrates Explanation:. First .and .foremost, .it .is .essential .to .educate .individuals .on .a .heart-healthy .lifestyle. .LDL-C .is .one .of .the .major .culprits .in .the .development .of .atherosclerotic .heart .disease. .The .target .level .of .LDL-C .is .between. 50 .to .70mg/dl .to .prevent .plaque .formation .in .the .blood .vessels. .Guidelines .strongly .recommend .statin .therapy .because .they .primarily .lower .LDL-C .levels, .but .they .also .have .the .secondary .effects .of .lowering .triglyceride .and .increasing .HDL-C .levels.

6. A. 30 .years .old .female .comes .into .a .clinic .with .classic .signs .and .symptoms .of .appendicitis. .The .NP .fails .to .refer .the .patient .to .a .surgeon. .The .appendix .ruptures .and .the .woman .die. .This .is .an .example .of a. Failure .of .diligence b. Professional .liability c. Negligence d. Malpractice

Explanation : .malpractice, .a .negligence .tort, .occurs .when .a .health .care .professional’s .actions .fall .bellow .the .appropriate .standard .of .care .and .hurts .the .patient. .In .this .case .the .patient .came .with .sings .and .symptoms .indicating .appendicitis .and .the .NP .failed .to .refer .the .patient..

7. A .NP .has .recently .been .hired .to .work .in .a .fast .track .facility. .The .NP .employer .asked .if .she .has .―a .problem .prescribing .medications .for .emergency .contraception.‖ .The .NP .replies .affirmatively. .This .is: a. Grounds .for .dismissal b. An .ethical .dilemma .for .the .NP

c. Illegal .according .to .the .standards .of .nursing d. Patient .abandonment. Explanation:. in .this .instance, .the .NP .has .a .difference .of .opinion .with .her .employer .based .on .her .religious .or .moral .belief .about .providing .emergency .contraception. .This .situation .is .an .example .of .an .ethical .dilemma. .Failure .to .participate .in .the .provision .of .care .to .the .patient .based .on .the .NP’s .beliefs .is .neither .against .the .law .nor .a .violation .of .the .standards .of .practice

8. A .patient .presents .with .pruritic .lesions .on .both .knees. .There .are .visible .silver .scales. .How .Should .this .condition .be .managed? a. Topical .antifungal .cream .or .ointment b. Oral .antibiotics c. Topical .corticosteroids .cream d. Topical .anti-fungal/ .steroid .cream

Explanation:. Psoriasis .is .characterized .by .erythematous .papules, .as .well .as .itchy, .red, .precisely .defined .plaques .with .silvery .scales. .Auspitz .sings .is .another .common .finding. .Topical .agents .containing .tar .and .salicylic .acid .may .be .used. .Topical .steroids, .such .as .betamethasone, .may .also .be .ordered.

9. Antidepressant .discontinuation .syndrome .is .less .likely .if .the .patient a. Is .male b. Is .less .than. 35 .y/o c. Has .taken .an .SSRI .with .a .short .half .life d. Gradually .tapers .SSRI .use

Explanation:. Antidepressant .discontinuation .syndrome .is .most .often .seen .in .the .primary .care .office .in .association .with .SSRI .discontinuation, .because .SSRIs .are .the .most .commonly .prescribed .class .of .antidepressant .medications. .Interruption .of .treatment .with .an .anti- depressant .medication .is .sometimes .associated .with .an .antidepressant .discontinuation .syndrome; .in .early .reports .it .was .referred .to .as .a .―withdrawal .reaction. .Symptoms .of .antidepressant .discontinuation .syndrome .can .include .flu-like .symptoms, .insomnia, .nausea, .imbalance, .sensory .disturbances, .and .hyperarousal. .Tapering .is .recommended .by .experts.

10. Patient .with .benign .prostatic .hyperplasia .(BPH) .should .be .taught .to .avoid .which .one .of .the .following .drug .classes? a. Alpha .adrenergic .antagonist b. Anti-androgen .agents c. Tricyclic .antidepressant .(TCA) d. Sulfonamides Explanation:. tricyclic .antidepressant .should .not .be .used .by .men .with .benign .prostatic .hyperplasia .because .of .the .increased .risk .of .urinary .retention .secondary .to .the .anticholigergic .effects .of .TCAs.

11. Which .of .the .following .is .the .best .response .to .a .woman .who .has .just .admitted .she .is .a .victim .of .spousal .abuse? a. What .was .if .you .did .to .make .him .angry?

Explanation:. Herpangina .is .a .viral .infection .common .in .toddlers .and .young .children .caused .by .Coxsackie .virus. .The .clinical .findings .of .numerous, .small .(1-2 .mm) .ulcerations .on .the .tonsils .and .uvula .are .typical .of .herpangina. .The .ulcerations .can .be .very .painful .but .usually .resolve .in. 7 .to. 10 .days. .Treatment .is .symptomatic.

15. A .patient .has .Kawasaki .syndrome. .Which .characteristics .would .be .UNUSUAL? a. Age .>. 15 .years b. Fever .>. 101 .F .(38.3 .C) c. Exudative .pharyngitis d. Painful .rash explanation:. Kawasaki .disease .is .an .acute .febrile .vasculitis .syndrome .that .evolves .inflammation .of .the .blood .vessels. .This .condition .often .causes .cardiac .complication .in .children .by .damaging .the .coronary .arteries .is .most .prevalent .in .children .of .Asian .ethnicity. .Diagnosis .of .Kawasaki .disease .requires .presentation .of .fever .and. 4 .of .the .following .criteria: .bilateral .bulbar .conjunctival .injection, .oral .mucous .membrane .changes, .peripheral .extremity .changes, .polymorphous .rash, .and .cervical .lymphadenopathy.

16. According .to .the .JNC. 8 .guideline .hypertension .in .a. 40 .y/o .can .be .diagnosed .when .blood .pressure .exceeds a. 140/ b. 130/ c. 125/ d. 150/ Explanation:. According .to .JNC. 8 .guidelines, .hypertension .is .a .sustained .elevation .of .systolic .BP .greater .than .or .equal .to. 140 .mmHg .or .diastolic .BP .greater .or .equal .than .90mmHg, .taken .from. 2 .or .more .readings .on. 2 .different .occasions .after .an .initial .screening.

17. A. 48 .y/o .female .complains .of .pain .and .stiffness .in .her .right .hip .and .knee .that .is .mild .on .awakening .in .the .morning, .get .worse .as .the .day .progresses .and .is .relived .with .hot .baths .and .ibuprofen. .Crepitus .is .palpated .on .range .of .motion .of .the .knee. .Signs .of .inflammation .are .notably .absent. .What .is .the .most .likely .diagnosis? a. Rheumatoid .arthritis .(RA) b. Gout c. Osteoarthritis .(OA) d. Osteoporosis Explanation:. Rheumatoid .arthritis .is .characterized .by .several .joint .deformities, .usually .bilaterally .symmetrical. .RA .is .characterized .by .inflammatory .processes, .while .OA .is .not. .RA .and .OA .are .chronic .conditions. .Gout .is .characterized .by .acute .exacerbations .related .to .a .defect .in .purine .metabolism, .increased .uric .acid .production, .or .decreased .uric .acid .excretion.

18. A .7-year .old .female .patient .presents .with .severe .injuries .that .are .inconsistent .with .the .explanation .given .for .them. .The .nurse .practitioner .questions .the .mother .about .abuse. .She .admits .that .her .husband, .the .child’s .father, .beat .the .child. .How .should .the .nurse .practitioner .proceed? a. Inform .the .mother .that .the .abuse .must .be .reported .to .child .protection .authorities. b. Counsel .the .mother. that .if .it .happens .again .it .will .be .reported .to .child .protection .service. c. Ask .the .child .what .she .did .to .cause .the .punishment

d. Refer .the .family .to .the .National .Domestic .Violence .hotline. Explanation:. An .awareness .of .all .the .unique .presentations .of .child .abuse, .subjective .or .objective, .physical, .sexual, .or .neglect, .is .essential .for .NPs. .Objective .findings, .such .as .broken .bones, .burns, .and .bruises, .may .be .as .a .result .of .an .intentional .injury .from .physical .abuse .or .from .an .unintentional .injury .as .a .result .of .neglect. .Both .must .be .considered. .Repeated .visits .to .the .emergency .department, .frequent .or .suspicious .injuries, .or .bilateral .or .multiple .healing .fractures .are .often .indicators .of .physical .abuse. .Once .the .diagnosis .of .child .abuse .has .been .made, .the .primary .role .of .the .NP .is .to .ensure .the .child .is .safe. .If .the .NP .suspect .that .a .child .is .undergoing .abuse, .it’s .critical .to .report .it—and .to .continue .reporting .each .separate .incidence .if .it .continues .to .recur.

19. A .1-month-old .presents .with .reported .recurrent .diarrhea, .screaming, .and .drawing .up .of .the .legs .followed .by .periods .of .lethargy. .On .physical .examination, .a .―sausage-like‖ .mass .in .the .upper .right .quadrant .of .the .distended .abdomen. .Which .of .the .following .is .the .most .likely .diagnosis? a. Intussusception b. Volvulus c. Crohn’s .disease d. Foreign .body .in .the .GI .tract .explanation:. Intussusception .is .one .of .the .most .common .causes .of .abdominal .obstruction .in .children .prior. 2 .years .of .age; .is .best .described .as .a .portion .of .the .intestine .which .telescopes .into .a .more .distal .intestinal .segment. .The .classic .triad .of .intussusception .include .crampy .(intermittent, .also .known .as .colicky) .abdominal .pain, .vomiting, .and .bloody .stools. .The .patient .may .pull .up .his .knees .with .crying. .The .patient .may .develop .vomiting .with .bilious .emesis. Progressive .lethargy/altered .level .of .consciousness .and .pallor .is .common. .The .etiology .of .this .lethargic .presentation .is .not .known, .but .it .tends .to .occur .in .younger .infants. .As .intussusception .progresses, .a .palpable, .sausage-shape .mass .may .develop. .Some .hypothesize .that .this .is .due .to .release .of .endogenous .opioids .or .endotoxins .released .from .ischemic .bowel. .Intussusception .in .a .child .presenting .with .lethargy .is .often .difficult .to .diagnose .since .other .causes .of .lethargy .such .as .dehydration, .hypoglycemia, .sepsis, .toxic .ingestion, .post-ictal .state, .etc., .must .also .be .considered. .Ultrasound .is .the .preferred .diagnostic .test. .Enemas .is .considered .the .first .line .of .treatment .prior .surgery. .Volvulus .occurs .more .frequently .in .middle- aged .and .elderly .men. .Cronos’s .is .most .often .diagnosed .between. 13 .–. 30 .years .of .age.

20. A .middle-aged .female .complains .of .insomnia, .night .sweats, .feeling .intensely .hot, .emotional .lability, .extreme .nervousness .and .impatience. .The .LEAST .likely .cause .of .her .symptoms .is a. Thyrotoxicosis b. Menopausal .vasomotor .instability c. Alcohol .or .another .drug .withdrawal d. New .onset .type. 2 .diabetes .mellitus

Explanation:. New .onset .diabetes .produces .elevated .serum .glucose .levels .less .than. 200 .mg/dL .(7.0 .mmol/L) .and .usually .no .clinical .signs .or .symptoms. .At .higher .levels, .the .patient .may .report .lethargy, .fatigue, .weakness, .weight .loss, .and .polydipsia, .polyuria, .and/or

be .caused .by .thyroxine .excess, .menopausal .instability, .or .withdrawal .from .alcohol .or .other .drugs .of .addiction.

21. Which .of .the .following .indicated .need .for .further .evaluation? a. A. 7 .y/o .girl .with .vaginal .bleeding b. A. 7 .years .old .girl .with .no .true .pubic .hair c. A. 12 .years .old .boy .with .sparse, .slightly .pigmented .pubic .hair d. A .12-year-old .girl .with .breast .buds explanation:. In .newborn .girls, .withdrawal .bleeding .may .occur .as .a .normal .response .to .maternal .estrogen .leaving .the .infant’s .uterine .lining. .Vaginal .bleeding .after .the .first .few .weeks .of .life .and .before .puberty .is .considered .abnormal. .Early .vaginal .bleeding .can .indicate .trauma, .foreign .bodies .(toilet .paper .is .the .most .common), .vulvovaginitis, .hemangiomas, .benign .polyps, .precocious .puberty, .or .sexual .abuse.

22. A .young .couple .is .being .seen .by .the .NP .for .preconception .counseling. .They .express .a .wish .for .pregnancy .within .the .next. 3 .month .and .are .very .eager .to .know .what .they .can .do .now .to .―make .the .baby .as .healthy .as .possible‖. .Which .of .the .following .should .the .NP .encourage .to .decrease .the .chance .of .neural .tube .defect .in .the .fetus? a. Maternal .alpha-fetoprotein .level b. Folic .acid .0.4 .mg .daily c. Rubella .vaccine .today d. Vitamin .E. 400 .IU .daily Explanation:. Supplementation .with .folic .acid .decreases .the .development .of .neural .tube .defects, .such .as .spina .bifida .and .anencephaly. .Folic .acid .plays .an .essential .role .in .neural .tube .closure. Neural .tube .development/closure .takes .place .in .the .fist. 4 .weeks .of .embryonic .life .(6 .weeks’ .gestation). .U.S. .Public .Health .Service .and .the .CDC .recommend .that .all .women .of .childbearing .age .consume .0.4 .mg .of .folic .acid .daily .to .prevent .tube .defects.

23. A .patient .with .a .past .history .of .documented .coronary .arterial .blockage .less .than .70% .complains .of .chest .pain .several .time .p…. .which .is .relived .with .nitroglycerin. .Which .is .the .most .appropriate .initial .action .for .the .NP? a. Refer .to .a .cardiologist .as .soon .as .possible b. Prescribe .long-acting .nitroglycerin c. Order .treadmill .stress .test d. Prescribe .an .ACE .inhibitor .and .re-evaluate .in. 24 .to. 48 .hours Explanation:. The .patient .has .at .least .a .70% .occlusion .of .a .major .coronary .artery. For .a .patient .to .be .considered .for .CABG, .the .coronary .arteries .to .be .bypassed .must .have .approximately .a .70% .occlusion .(60% .if .in .the .left .main .coronary .artery).

24. A. 3 .y/o .has .enlarged, .warm, .tender .cervical .lymph .nodes, .indicating: a. Infection .proximal .to .the .nodes b. A .possible .cancer .diagnosis c. Shorty .nodes, .a .common .normal .variant .in .children d. An .infectious .process .distal .to .the .nodes explanation:. size .of .lymph .nodes .is .important. .Nodes .>. 1 .cm .are .significant .and .should .be .asses .carefully. .Nodes .>. 5 .cm .are .almost .always .neoplastic. .Tenderness .of .a. node .usually .suggest

inflammation. .Cancerous .nodes .frequently .are .larger, .non-tender, .and .stone-like .in .consistency. .Nodes .are .pea-sized, .non-tender, .mobile, .discrete .and .reflect .pre-existent .infection.

25. The .NP .examines .a .2-month-old .with .unequal .gluteal .and .thigh .skin .folds. .What .should .the .NP .do .next? a. Send .the .infant .for .x-ray .of .the .hips b. Send .the .infant .for .ultrasound .of .the .hips c. Perform .Ortolani .and .Barlow .test d. Examine .the .infant .for .unequal .arm .length Explanation:. Gluteal .and .thigh .skin .fold .asymmetry .may .indicate .congenital .hip .dysplasia. .X- .ray .studies .are .not .useful .before. 3 .months-of-age .because .the .femoral .head .has .not .completely .ossified.

26. A .very .active. 35 .years .old .male .has .painful .hemorrhoid, .but .he .does .not .want .hemorrhoidal .surgery .at .this .time. .His .diet .has .been .indiscriminate .as .his .job .requires .frequent .travel. .The .most .appropriate .recommendation .is .for .him .to .select .food .that .are: a. Low .in .fiber .such .as .milk .and .other .dairy .products b. High .in .simple .carbohydrates .such .as .white .bread .and .mashed .potatoes c. High .in .fiber .such .as .bran, .complex .carbohydrates .and .fresh .fruit d. High .protein .such .a .meat, .poultry .and .fish .Explanation : .Hemorrhoid .disease .is .the .most .common .reason .patients .seek .evaluation .by .a .colon .and .rectal .surgeon. .The .majority .of .hemorrhoids .can .be .managed .nonoperatively .with .medical .management .or .office-based .procedures. .Patients .should .benefit .from .minimizing .straining .and .avoiding .constipation. .Bulking .of .the .stool .facilitates .this .and .can .be .accomplished .by .increasing .dietary .fiber .and .fluid .intake. .Stool .softeners .may .also .be .used.

27. Correct .instructions .to .give .new .parent .who .are .transporting .their .newborn .infant .is a. A .rear-facing .infant .car .seat .secured .in .the .backseat .is .required .until .the .infant .weight

. 20 .lbs. b. The .infant .car .set .may .be .secured .in .the .back .or .front .seat, .but .must .rear-facing c. The .infant .car .seat .may .be .front .facing .when .the .infant .is. 1 .year .old d. A .rear .or .front-facing .infant .car .seat .must .be .secured .in .the .back .seat .until .the .infant .weight. 20 .lbs. Explanation:. The .American .Academy .of .Pediatrics .(AAP) .recommends .that .infants .and .toddlers .ride .in .a .rear-facing .seat .until .they .are. 2 .years .old .or .until .they .have .reached .the .maximum .weight .and .height .limits .recommended .by .the .manufacturer

28. A. 13 .y/o .pt. .complains .that .he .fell .while .running .during .football .practice. .Now .his .knee .hurts .and .sometimes .―lucks‖. .The .NP .conducts .McMurrays .test. .Which .of .the .following .is .TRUE .about .this .test? a. An .audible .or .palpated .―click‖ .is .positive .for .a .torn .meniscus b. A .various .stress .is .applied .to .the .flexed .knee c. The .straight .leg .is .internally .rotated .with .the .patient .supine .and .flat d. The .knee .is .grasped .with .the .examiner’s .fingers .placed .laterally. Explanation:. Mac .Murray’s .test .is .conducted .while .the .patient .is .in .the .supine .position. .The .NP .places .the .distal .hand .on .the .foot .and .raises .the .knee .slowly, .keeping .the .foot .and .knee

rotated .with .the .proximal .hand .resting .on .the .join .line. .The .knee .is .flexed .and .then .quickly .straightened. .If .an .audible .or .palpable .click .occurs .during .the .this .test, .the .outcome .is .positive .for .medial .meniscal .injury.

29. A. 20 .y/o .male .patient .complains .of .―scrotal .swelling‖. .He .states .his .scrotum .feels .heavy .but .denies .pain. .On .examination, .the .NP .notes .transillumination .of .the .scrotum. .What .is .the .most .likely .diagnosis? a. Hydrocele b. Orchitis c. Testicular .torsion d. Indirect .inguinal .hernia .Explanation:. Hydrocele .is .common .in .newborns .and .usually .disappears .without .treatment .within .the .first .year. .Older .men .can .develop .hydroceles, .sometimes .due .to .inflammation .or .injury. .Hydroceles .are .usually .painless, .but .may .become .large .and .inconvenient. .An .ultrasound .may .be .needed .to .diagnose .the .condition.

30. A. 15 .y/o .male .has .a .hx .of .cryptorchidism .which .was .surgically .repaired. .Because .of .this .information, .it .is .essential .for .the .NP .to .teach .him .about a. Testicular .self-examination b. Protection .of .the .testes .during .sports .activities c. Risk .of .testicular .torsion d. Practicing .safer .sex Explanation:. Cryptorchidism, .even .with .surgical .repair, .is .associated .with .increased .risk .for .testicular .cancer.

31. A .pt. .present .with .classic .symptoms .of .gastroesophageal .reflux .diseases’ .(GERD). .He .is .instructed .in .lifestyle .modification, .and .drug .initialed. .Two .month .later, .he .returns .and .report .that .he .still .has .symptoms.. The .next .steps .are .to. a) Refer .for .surgical .interventions .such .as .partial .or .complete .fundoplication. b) Refer .for .endoscopy, .namometry, .and/or .PH .testing c) Repeat .the .8*-week .course .of .drug .therapy .while .continuing .lifestyles .modifications. d) .Review .proper .proton .pump .inhibitor .dosing .time .and .adherence .with .the .patient.

. Explanation:. poor .adherence .is .an .importance .cause .of .inadequate .acid .suppression .and .refractory .GERD. .Determining .adherence .to .proton .pump .inhibitor .(PPI) .therapy .and .superficially .timing .in .relation .to .meals, .should .be .sought .first .alarm .features .such .as .iron .deficiency .anemia, .unexplained .weight .loss, .and .persistent .vomiting .would .precipitate .the .need .for .further .diagnostic .testing. .Diagnostic .testing .procedures .should .proceed .any .surgical .intervention .like .fundoplication.

32. A. 51 .–year- .old .post-menopausal .female, .request .guidance .regarding .osteoporosis .risk. The .NP .would .be .correct .to .recommend .all. of .the .following .EXCEPT a. Moderate .weight .bearing .exercise. 3 .times .per .week b. 1200 .–. 1500 .mg .calcium .daily c. Avoidance .of .alcoholic .beverages d. Weight .loss

Explanation:. the .recommended .calcium .intake .is .1,200 .mg .–. 1500 .mg .a .day. .Regular .weight- .bearing .and .muscle-strengthening .exercise .reduce .the .risk .of .falls .and .fractures. .Moderate .alcohol .intake .has .no .known .negative .effect .on .bone .and .may .even .be .associated .with .slightly .higher .bone .density .and .lower .risk .of .fracture .in .postmenopausal .women. .However, .alcohol .intake .of .more .than .two .drinks .per .day .for .women .or .three .drinks .a .day .for .men .may .be .detrimental .to .bone .health, .increases .the .risk .of .falling .and .requires .further .evaluation .for .possible .alcoholism. .In .addition, .Risk .factors .for .osteoporosis .include .age .greater .than .65, .white .or .Asian .ethnicity, .cigarette .smoking, .inactive .lifestyle, .low .weight .and .postmenopausal .estrogen .deficiency .including .premature .menopause.

33. According .to .Erickson, .the .developmental .task .of .the .elderly .adult .is: a. Intimacy .VS. isolation b. Ego .integrity .VS .despair c. Industry .VS .self-doubt d. Trust .Vs .mistrust explanation:

34. Moderate .weight .loss, .particularly .of .visceral .adipose .tissue .in .patients .with .type. 2 .diabetes .mellitus .may .have .all .of .the .following .beneficial .effects .EXCEPT: a. Improved .insulin .sensitivity b. Increased .glucose .uptake .and .utilization .by .the .cells c. Increase .lean .muscle .mass’ d. Improved .lipid .profile Explanation:. Regular, .consistent .exercise .is .an .essential .part .of .diabetes .and .prediabetes .management. .The .ADA .recommends .that .people .with .diabetes .perform .at .least. 30 .minutes,. 5

38. The .hallmark .of .neurofibromatosis .(von .Recklinghousen .disease) .present .in .almost .100% .of .patients .is: a. Acoustic .neuroma b. Astrocytoma .of .the .retina c. Distinctive .osseous .lesion d. Café .au .lait .spots Explanation:. Von .Recklinghausen .disease .is .also .known .as .neurofibromatosis. .It .is .characterized .by .multiple .neurofibromas, .or .tumors, .forming .that .vary .in .shape, .size, .and .location. .Neurofibromatosis .type. 1 .and .neurofibromatosis .are .differentiated .by .clinical .features. .They .both .include .benign .tumors .of .the .nerve .tissue .(neurofibromas). .Only .neurofibromatosis .type. 1 .(90%) .has .prominent .clinical .features, .such .as .cafe-au-lait .pigmentation. Neurofibromatosis .type. 2 .consists .of .neurofibromas .only .without .clinical .features.

39. The .NP .correctly .teaches .an .elderly .patient .with .pernicious .anemia .that .food .sources .of .B12 .include a. Red .meat, .poultry, .fish, .eggs, .dairy .products b. Canned .and .frozen .fruit c. Whole .grain .breads, .cereals .and .pastas d. Fresh .vegetables explanation:. Pernicious .anemia .is .a .type .of .vitamin .B12 .anemia. .VB12 .can .be .found .in .foods .such .as .meat, .poultry, .shellfish, .eggs, .and .dairy .products. .A .special .protein, .called .intrinsic .factor .(IF), .helps .the .intestines .absorb .vitamin .B12. .This .protein .is .released .by .cells .in .the .stomach. When .the .stomach .does .not .make .enough .intrinsic .factor, .the .intestine .cannot .properly .absorb .vitamin .B12.

40. An .18-year-old .female .applying .for .college .admission. present .to .the .health .clinic .because .evidence .of .rubella .vaccination .is .required .for .admission. .She .says, .―don’t .remember .ever .getting .that .shot‖ .She .has .negative .serologic .evidence .of .rubella. antibody. .The .NP .should: a. Tell .her .that .her .serologic .evidence .demonstrates .that .she .is .immune .to .the .rubella .and .that .she .probably .has .the .disease .as .a .child b. Administer .the .vaccination .after .a .negative .pregnancy .test .and .advise .the .patient .that .she .must .not .get .pregnant .for. 28 .days c. Tell .her .that .she .needs. the .immunization. and .can .get .today .if .her .pregnancy .test .is .negative d. Administer .the .rubella .vaccination .after .a .negative .pregnancy .test .and .advise .her .not .to .get .pregnant .for .at .least. 6 .months. Explanation:. Due .to .this .very .small .chance .of .illness, .the .Centers .for .Disease .Control .and .Prevention .(CDC) .recommend .waiting. 28 .days .after .getting .the .MMR .vaccine .before .trying .to .get .pregnant.

41. A. 45 .y/o .obese .pre-menopausal .female .complains .of .indigestion, .flatulence, .RUQ .pain .and .epigastric .―crampy .pain‖. .Symptoms .are .exacerbated .by .high-fat .meal. .What .is .the .most .likely .diagnosis?

a. Hepatitis

a. Cephalexin .(Keflex) b. Tetracycline c. Rifampin d. Metronidazole .(flaggyl) Explanation:. Children .younger .than. 8 .years .old .should .not .take .tetracycline. .Deposition .in .the .bone .and .primary .dentition .occurs .during .calcification .in .growing .children. .This .causes .discoloration .and .hypoplasia .of .the .teeth .and .a .temporary .stunting .of .growth.

46. Which .of .the .following .descriptions .of .Denver .II .Developmental .Screening .Test .is .most .accurate? a. Applicable .to .children .from .birth .to. 2 .years; .evaluates .four .major .categories .of .development: .motor, .intellectual, .emotional, .and .language .to .determine .whether .a .child .is .within .normal .range .for .various .behaviors .or .is. developmentally .delayed b. Applicable .to .children .from .birth .to. 5 .years; .evaluates .four .major .categories .of .development: .motor, .vision,. hearing .and .psychosocial .to .determine .whether .a .child .is .normal

. or .developmentally .compromised c. Applicable .to .children .from .age. 6 .months .to. 6 .years; .evaluates. 4 .major .categories .of .development: .intellectual, .verbal, .social .and .memory .to .determine .IQ .and .aptitude d. Applicable .to .children .from .birth .to. 6 .years; .evaluates .four .major .categories .of .development: .gross .motor, .fine .motor-adaptive, .language, .and .personal .social .to .determine .whether .a .child .is .within .normal .range .for .behaviors .or .is .developmentally .delayed.

Explanation : .The .Denver .Developmental .Screening .Test .(DDST) .is .a .screening .test .for .cognitive .and .behavioral .problems .in .children .from .birth .until .the .age .of. 6 The .purposes .of .the .DDST .and .Denver .II .are .to .screen .children .or .possible .developmental .problems .and .to .verify .suspected .problems .with .an .objective .measure. The .Denver .II .screens .general .development .in .four .areas: Social .– .Personal:. Aspects .of .socialization .inside .and .outside .the .home .– .eg, .smiling. Fine .motor .function .– .Adaptive:. Eye/hand .co-ordination, .problem .solving .and .manipulation .of .small .objects .– .eg, .grasping .and .drawing. Language:. Production .of .sounds, .and .ability .to .recognize, .understand .and .use .language .– .eg, .ability .to .combine .words Gross .motor .functions:. Motor .control, .sitting, .walking, .jumping, .and .overall .large .muscle .movements.

47. A .12-month-old .has .conjunctivitis .in .his .right .eye .with .a .mucopurulent .discharge. .The .mother .asks .if .the .child .can .forego .for .antibiotic .eye .drops .because .he .does .not’s .like .drops .in .his .eyes. .The .NP .replies .that: a. If .untreated, .conjunctivitis .may .permanently .damage .the .cornea b. Conjunctivitis .is .usually .caused .by .a .virus. .Let’s .wait .a .few .days c. If .no .one .else .at .the .daycare .has .it, .we .can .wait .a .few .days. d. An .oral .antihistamine .may .be .prescribed .instead .of .eye .drops. Explanation:. Pink .eye .does .not .normally .cause .loss .of .vision, .especially .when .treatment .is .administered .in .a .timely .manner. .However, .if .bacterial .conjunctivitis .is .serious .and .left .untreated, .it .may .damage .the .eye .permanently, .leading .to .loss .of .vision.

48. which .oral .hypoglycemic .agent .would .be .safest .for .an .elderly .patient .if .hypoglycemia .is .a .major .concern? a. Tolbutamide .(orinase) b. Glipizide .(Glucotrol) c. Metformin .(Glucophage) d. Chlorpropamide .(diabinese) Explanation:. When .used .alone, .metformin .typically .does .not .cause .hypoglycemia .and .is .usually .weight .neutral .or .causes .modest .weight .loss. .Given .the .low .risk .of .hypoglycemia, .metformin .has .an .important .role .in .elderly .patients .with .diabetes, .as .long .as .patients .are .selected appropriately .to .avoid .the .risk .of .lactic .acidosis.

49. the .components .of .the .Denver .II .Developmental .screening .test .are: a. Personal/social, .fine .motor, .gross .motor, .language b. Intelligence, .motor .performance, .language .development c. Vocabulary, .clarity .of .speech, .abstract .thinking d. Problem-solving, .speech, .gross .motor, .fine .motor Explanation:. The .Denver .II .Developmental .Screening .Test .is .the .most .widely .used .tool .to .assess .early .childhood .development .and .rates .the .categories .of .personal–social, .fine .motor– .adaptive, .language, .and .gross .motor .skills. .The .nurse .should .explain .to .the .parent .before .administering .the .test .that .this .test .does .not .measure .intelligence .but .of .the .child's .level .of .development .or .ability .to .perform .age-appropriate .tasks. DDST .II .Assesses: Gross .motor .function .Language .development .Fine .motor-adaptive .skills .Personal-social .skills

50. A .patient .has .been .taking .fluoxetine .(prozar) .since .being .diagnosed .with .major .depression

. 7 .month .ago. .She .reports .considerable .empowerment .in .her .symptoms .and .her .intention .to .discontinue .the .medication .what .should .be .the .NP’s .recommendation? a. Advice .the .patient .to .stop. the .antidepressant .medication b. Question .the .patient .to .determine .if .the .self-assessment .is .correct .before .advising .her .to .discontinue .the .medication c. Recommend .that .the .patient .continue .the .antidepressant .medication .for .at .least. 4 .more .month d. Discuss .with .the .patient .that .need .to .take .the .antidepressant .medication .indefinitely . Explanation:. Anxiety .Treatment .Clinical .guidelines .for .managing .MDD .also .recommend .that .patients .should .maintain .antidepressant .use .for .at .least. 6 – 9 .months .after .full .symptom .remission .and .that .patients .with .some .risk .factors.

51. for .the .general .adult .population, .total .dietary .fat .intake .should .be .no .more .than .what .percent .of .total .calories?