NR 661-667 Capstone Project APEA Exam Questions
A 45-year old man presents with malaise and a copper coloured macular rash that covers the trunk ,arms ,legs, palms, and soles of feet. These symptoms began 2days ago. The nurse practitioner suspects:
- primary syphilis
- secondary syphilis
- early latent syphilis
- late latent syphilis
A 10 year old infant girl has a history of prematurity and prolonged febrile seizures occurring on two occasions. When discussing the prognosis with the mother, the nurse practitioner informs her that:
- the child now has two risk factors for developing epilepsy
- the child already has the following Diagnosis of epilepsy because she has had two seizures
- febrile seizures are usually benign and alone do not signify epilepsy
- children with febrile seizures are more likely than general population to develop epilepsy
The diagnostic test to confirm acute lymphoblastic leukemia in a 5year old child is:
- chest radiography
- lumbar puncture
- bone marrow biopsy
- hemoglobin electrophoresis
Ferrous sulfate is initiated in a 24year old woman with iron deficiency anemia. Which of the following patient statement indicates a need for further patient teaching?
- “My body absorbs the iron pill better when l take it with my orange juice at breakfast or with my vitamin C pill in the evening”
- “When l come back to the clinic in a month, that finger stick test will show whether my anemia is getting better.”
- “l take my iron pill with a glass of milk so it won’t upset my stomach.”
- “I take my iron pill in the morning and my milk of magnesia at night.”
A 42 year old man presents with orbital edema, Facial edema , and proteinuria. He states that the symptoms pronounced in the morning or after lying supine. These findings are likely indicative of :
- nephronic syndrome
- cushing ‘s syndrome
- heart failure
At a follow-up visit, a pregnant patient asks for further explanation about inheritance patterns after completing a family history questionnaire . The nurse practitioner explains that X-linked dominant disordes occur.
- Only in men
- Through father-to-son transmission.
- In both men and women, with more severe disease in men.
- When the man and woman are both carriers.
In a 35 year old man, the symptoms that is most suggestive of testicular cancer is:
Dizziness with activity is the major complained of a 75ear old man with a longstanding history of hypertension and coronary artery disease Initially , the nurse practitioner should:
- order an echocardiogram
- order an ultra sound of the carotid arteries
- obtain blood pressure measurements white the patient is standing, sitting ,and supine
- order 24 –hour ECG monitoring
A 30 year old obese woman presents with a small , firm breast nodule .History is significant for fibrocystic breast disease. Axillary lymphadenopathy is palpated on exam .The most appropriate intervention is to:
- reassure her that the nodule is part of the fibrocystic breast disease
- inquire about her menstrual cycle
- order a diagnostic mammogram and ultra sound
- refer her for biopsy
The history and assessment of 50 year old woman identify stress incontinence .The patient asks what could cause this condition .The most appropriate responds is :
- urinary tract infection
- aging a estrogen deficiency
- diabetic neuropathy
The most common type of dysrhythmia in children is:
- atrial flutter
- sinus tachycardia
- premature atrial contractions
- paroxysmal supraventricular tachycardia.
A 35 year old recently widowed woman experiences her first episode of depression. She is started on an antidepressant .After complete remission of symptoms, the medication should be continued for at least :
- 4 months
- 6 months
- 12 months
A 32year old pregnant woman at 32 weeks gestation presents with complications of right upper quadrant pain ,midepigastric tenderness, headache ,and malaise. Blood pressure 135/90mm Hg .The MOST likely diagnosis is :
- HELLP ;syndrome
- chronic hypertension
Lifestyle modifications have not improved interstitial cystitis symptoms in a 38year old woman . Which oral medication is NOT considered an initial oral medication?
- hydroxyzine (Vistaril)
- tramadol (Ultram ER)
- amitriptyline (Elavil)
- ibuprofen(Motrin IB)
The sexually transmitted disease that is NOT likely to be transmitted through oral-penile contact in men who have sex with men is:
- human papillomavirus
An 80 year old man with symptoms of depression will benefit from treatment with a selective serotonin reuptake inhibitor (SSRI). Before prescribing, the nurse practitioner should order a (n):
- fall risk evaluation
- renal panel
A 24 year old pregnant woman states that she has been experiencing increased mucus formation during her first trimester .This is most likely :
- physiologic leucorrhea
- bacterial vaginosis
The mechanism of action of medication used to treat overactive bladder include selective stimulation of beta-3 adrenergic receptors, which relax the smooth muscle of the bladder .The medication that falls in this category is:
- finasteride (Procsar)
- dutasteride (Avodart)
A 22 year old woman is in the clinic with genital warts. Appropriate treatment for genital warts does NOT include:
- prodofilox (Condylox)0.5%gel
- salicylic acid (Virasal)
The nurse practitioner is evaluating the patient’s understanding of Chlamydia trachomatis treatment with mycin. Which statement demonstrates proper understanding of the medication?
- l should abstain from sexual intercourse for 24 hours after starting the medication
- I can have sexual intercourse f72 hours after completing the medication
- My partner should use a condom if we are going to have sexual intercourse within the next 5 days
- I should abstain from sexual intercourse for 7 days
A-68-year-old man has a history of long-term tobacco use, uncontrolled hypertension, and hyperlipidemia. He presents with sudden, intense left lower abdominal pain that radiates to the backs and has a tearing sensation. A pulsation is palpated in the mid abdomen. The MOST appropriate step should be to:
- order an outpatient abdominal CT scan.
- refer the patient to the emergency department.
- order an abdominal ultrasound.
- refer the patient for angiography.
The class of antihypertensive agents that should be avoided as initial therapy for a 38-year-old woman with uncomplicated hypertension is:
- Angiotensin-converting enzyme (ACE) inhibitors.
- Beta blockers.
- Calcium channel blockers (CCBs).
- Angiotensin receptor blockers (ARBs).
A 60-year-old man is experiencing paroxysmal nocturnal dyspnea. This condition typically occurs in combination with:
- Chest palpitations.
- Left ventricular hypertrophy.
- Nocturnal asthma attacks.
The MOST appropriate initial treatment of idiopathic facial nerve palsy (Bell’s palsy) for a patient who began to notice a facial droop 2days prior is:
- Acyclovir (Zovirax).
- Botox injections.
- Oral glucocorticoids.
- Gabapentin (Neurontin).
A 32-year-old man presents with a 24-hour history of fever, diarrhea, nausea, and dehydration. The symptom most suggestive of infection with an invasive organisms:
A 38-year-old man has polycythemia vera and is scheduled for phlebotomy. The goal of therapeutic is to reduce blood viscosity .It is at bringing which compound of the CBC into normal range?
- Mean corpuscular volume (MCV)
Which statement about the glomerular filtration rate (GFR)is true?
- The GFR correlates exactly to the loss of functioning nephrons
- GFR is used as the sole of chronic kidney disease
- A stable GFR implies stable rental disease
- An increase in GFR may indicate a compensatory hyper filtration response
A16year old girl presents with sore throat. Mononucleosis and streptococcal pharyngitis are suspected. Which medication should be avoided?
- Cephalexin (Keflex).
- Amoxicilin (Amoxil).
- Doxycycline (Vibramyclin).
- Azithromycin (Zithromax).
A 6-year-old boy exhibits nuchal rigidity. In children, this finding is indicative of.
- Seizure activity.
- Meningeal irritation.
- Mono paresis.
- Central nervous system damage.
A 20-years-old man has a history of testicular fixation due to testicular torsion. The nurse practioner should make the patient aware that he:
- Remains at risk for recurrent torsion, even many years later.
- Should have testosterone levels drawn annually.
- Is at risk for benign prostatic hypertrophy.
- Is at increased risk for urinary reflux syndrome.
Which of the following is NOT considered a potential trigger of migraine headaches?
- Folic acid
- Monosodium glutamate
Routine self-monitoring of capillary blood glucose is not required when taking:
- Basal insulin.
- Glipizide (Glucotrol XL).
- Metformin (Glucophage).
- Rapid-acting insulin
When evaluating a patient for postpartum depression, which tool is the most appropriate?
- The Hamilton Depression Rating Scale(HDRS)
- The beck depression inventory scale (EPDS)
- The Edinburgh Postnatal Depression(EPDS)
- The Patient Health Questionnaire(PHQ)
A 35 year old woman complains of fatigue and weight gain over the past 6 months. Which thyroid study should be ordered?
C-Free T4 and Free T3
A58year old woman is being treated with basal insulin for type 2 diabetes mellitus. In planning, the dietary component that directly determines postprandial blood sugar is the intake of:
- polyunsaturated fats
A repeat knee X-ray on a 60 year old woman with a previous right knee sprain revealed no evidence of a fracture. However, moderate osteopenia was noted. The most appropriate test to order at this time is:
- an MRI of right knee
- a CT scan of both knees
- bone densitometry
- an MRI of the spine
The physical examination of a 4 year old boy reveals large-appearing caves, and the child experiences mild difficulty when arising from a seated position. The nurse practitioner is considering Duchenne muscular dystrophy. To evaluate this, the nurse practitioner should order:
- a serum phosphorus level
- X-ray of the lower legs
- serum creatinine kinase level
- a consultation for a muscle biopsy
Renal function in a patient with diabetes is assessed by obtaining:
- a serum BUN
- whole blood for albumin level
- a routine urinalysis
- urinary albumin-to-creatinine ratio.
A 32 year old school teacher states that she been exposed to a student with pertussis. Which medication class is recommended for prophylaxis?
The factor that has the greatest impact on decreasing premature Deaths in the United States is:
- a patient’s sex
- a college education
- cultural influences
A 76 year old man has normocytic normochromic anemia with normal RDW. Which one of the following diagnosis is most likely?
- Acute gastrointestinal bleeding
- iron deficiency
- Pernicious anemia
Acute otitis media has been diagnosed in 10-month-old infant girl. This infant should be treated with an appropriate antibiotic for:
A pregnant woman is requesting the attenuated influenza vaccine because she is fearful of needles which response by the nurse practitioner is appropriate?
- “You can receive the immunization in your second trimester.”
- “The attenuated influenza is a live virus and not advised during pregnancy.”
- “The attenuated influenza vaccine is always a good choice if you are fearful of needles.”
- “The influenza vaccine in any form is not recommended during pregnancy.”
Vomitus that is bilious suggests:
- Gastrointestinal obstruction proximal to the duodenum.
- Obstruction of the small intestine.
- Gastric outlet obstruction.
- Peptic ulcer disease.
A 7-year-old girl presents with a urinary tract infection (UTI) for the first time. Which of the following statement is true?
- This is unusual at this age.
- This is indicative of an underlying problem.
- This is probably due to E. coli.
- This is likely caused by constipation.
The formal review and approval of educational degree or certification programs in nursing by a recognized agency is termed:
A 66-year-old woman presents with flu-like symptoms and a rash on the soles and palms. The BEST intervention is to:
- Order a rapid plasma reagin.
- Order a rapid plasma reagin and prescribe penicillin.
- Order an enzyme-linked immune sorbent assay.
- Prescribe penicillin and test for all STDs.
A 78-year-old woman has a mean corpuscular volume (MCV) of 85fL (norm=80-95fL), hematocrit (HCT) of 33% (norm= 37-47%), and hemoglobin (Hgb) of 11g/dL (norm= 12-16g/dL). The differential should include:
- Iron deficiency anemia.
- Anemia of chronic disease.
- Folic acid deficiency anemia.
- Thalassemia minor.
A 40-year-old man has acute bronchitis and presents to the nurse practitioner for treatment. The most likely reason for seeking treatment is:
- A sore throat.
- A cough.
During an acute episode of bacterial prostatitis, assessing the prostate by massage can result in:
An 18-year-old woman with anorexia nervosa returns for a 1month evaluation of the effectiveness of cognitive behavioral therapy (CBT). On examination, She is hypotensive, has a heart rate of 55, and a body temperature of 96 F.
Her weight has fallen below the 75th percentile. The nurse practitioner Should:
- Order bupropion (wellbutrin).
- Order a selective serotonin reuptake inhibitor (SSRI).
- Refer her to a dietitian.
- Refer her to a psychiatrist.
Evaluation of cognitive function in a 70-year-old man reveals that he has transient difficulty recalling names of people, objects , or certain details of specific events. Reasoning and judgement skills are intact. These symptoms are consistent with:
- Transient ischemic attacks.
- Benign forgetfulness.
The term syndactyly refers to a person who has:
- Webbed fingers or toes.
- An extra finger or toe.
- Less than five fingers or toes on one hand or foot.
- A missing thumb or great toe.
A 45-year-old man complains of acute flank pain radiating toward the groin and testicle. For suspected nephrolithiasis, the first-line treatment regimen includes ketorolac (Toradol) IM plus.
- Ciprofloxacin (Cipro) and hydrocodone orally.
- Hyoscyamine (Levsin) and sulfamethoxazole-trimethoprim (Bactrim DS) orally.
- Indomethacin (Indocin) and nitrofuration (Macrobid).
- Indomethacin (Indocin) and tamsulosin (Flomax).
A 30-year-old woman with iron deficiency anemia received a prescription for oral iron replacement therapy today. To evaluate response to therapy, the hemoglobin and hematocrit should be checked:
- Within 1week of initiating therapy.
- 2weeks after initiating therapy.
- 3weeks after initiating therapy.
- 4weeks after initiating therapy.
Graves’ disease is suspected in a 40-year-old woman. The first laboratory test(s) that should be ordered include:
- TSH, T3.
- Thyroid-stimulating hormone.
- Free T4
- Thyroid-stimulating hormone and T7
An adolescent visits the nurse practitioner for a pre-participation sports physical. While the patient is standing, the NP notices that the right shoulder is not symmetrical with the left. This is most likely related to:
- Poor posture.
- Dislocation of shoulder at birth.
- Curvature of the spine in the coronal plane.
- Congenital dysplasia of the hip.
Screening for human papillomavirus (HPV) infection in a 30-year-old woman is:
- A form of primary prevention.
- Considered secondary prevention.
- Initiated at the age of 30 and, If negative, no further screening is required.
- Not recommended if the received the HPV vaccine.
The appropriate pharmacologic choice for a pregnant woman with newly diagnosed deep vein thrombosis (DVT) in her left leg is:
- Direct thrombin inhibitor (Dabigatran).
- Oral anticoagulation (warfarin).
- Oral factor Xa inhibitor (Rivaroxaban).
- Low molecular weight heparin (lovenox).
When managing older adult patient’s preventive health services should be aimed at maintaining quality of life. In determining the appropriate interventions, the provider should:
A-consider the lag time to benefit
B-include all screening interventions, regardless of age
C-focus on disease management instead of prevention
D-consider Medicare payment guidelines to make decisions
A 40 year old man who has sex with men was exposed to the HIV virus 3 days ago. An antigen/antibody test can usually detect HIV infection as early as:
- 7 days after contact
- 10 days after contact
- 18 days after contact
- 30 days after contact
A 59 year old nurse has varicose veins in her lower extremities. Which of the following findings can be attributed to varicose veins?
A-Leg pain increases with ambulation
B-Bilateral orthostatic edema
C-Decreased pedal pulses
D-Diminished sensation in the feet
Pioglitazone (Actos) should be prescribed cautiously in patient who have a comorbidity of:
A 23 year old woman complains of breakthrough bleeding and spotting after starting an oral contraceptive 2 months ago. This is most consistent with:
A-too much estrogen
B-too little estrogen
C-too much progestin
D-too little progestin
Administration of the pneumococcal vaccine should be considered in patients at highest risk for invasive pneumococcal disease. Which of the following is NOT considered at highest risk?
A-children younger than 2 year old
B-adults younger than 65 with no comorbidities
C-A 20 year old with HIV infection
D-A 45 year with a history of pneumonia in the past year
A 38-year-old woman reports experiencing vaginal bleeding daily for the last 4 weeks. She describes it as a scant amount of brownish discharge. Differential diagnoses would NOT include:
- Ectopic pregnancy.
- Intrauterine pregnancy.
- Ruptured ovarian cyst.
- Cervical neoplasia.
A 27-year-old woman missed her follow-up appointment for migraine headaches today. The patient has called after hours for medication to treat the pain. How should the nurse practitioner respond?
- Refer the patient to the emergency department.
- Tell the patient to continue the sumatriptan and come to the office in the morning for assessment.
- Reprimand the patient about missing the appointment.
- Question the patient further about the headache.
Which of the following symptoms is most typical of trichomoniasis in a woman?
- Thick, cloudy or bloody vaginal discharge, painful bowel movements, and anal itching
- Clear, white or yellowish vaginal discharge, strong vaginal odor, and vaginal itching
- Vaginal itching or irritation with thick, white collage-cheese like discharge
- Fever, headache, and lymphadenopathy.
Which does NOT typically aggravate symptoms of reflux disease?
- Bending over
- Eating salty foods
- pylori infection
Accurate peak flow readings depends on:
- The patient’s ability to hold his breath for 10seconds before the procedure.
- The voluntary effort and muscular strength of the patient.
- Adherence to continued monitoring.
- The patient’s adherence to prescribed medications.
A 32-year-old woman with a confirmed pregnancy in the first trimester presents with abdominal pain, cervival motion tenderness and vaginal bleeding. She has a history of sexually transmitted disease and a tubal ligation. The MOST serious differential diagnosis is:
- Threatened miscarriage.
- An extra uterine pregnancy.
- A cervical pathology.
A term used to describe involuntary spasms of the stomach, diaphragm, and esophagus preceding and resulting in vomiting is:
A sexual maturity assessment of a 12-year-old boy indicates that he is starting puberty. The most likely finding was:
- Testicular enlargement.
- The presence of pubic hair.
- A rapid increase in vertical growth.
- Lengthening of the penis.
A highly contagious disease that causes a blister-like, pruritic rash with fatigue and fever can be prevented by receiving the:
- HPV vaccine
- Meningococcal vaccine
- Shingles (Herpes zoster)
- Varicella vaccine
Approximately 1 hour ago, a 10 month old infant experienced a febrile seizure. The mother should be informed that:
A-ibruprofen (Advil)and acetaminophen (Tylenol)should be administered every 2 hours for fever management.
B-the etiology of the fever must be determined
C-the infant requires 24-hour electroencephalogram (ECG)monitoring
D-anticonvulsant therapy should be initiated
Who would NOT qualify for Medicaid coverage?
A-A college student attending school on a visa
Nephrolithiasis should be suspended in 40 year old man presenting with:
- Tenderness in the scrotal area.
- A reported inability to void
- Nausea and an inability to keep still
- Frequency, urgency, and polyuria
A murmur is auscultated in a 64 year old man. Which finding indicates a need for a referral?
- The murmur is associated with a click
- The murmur is associated with anemia
- The murmur worsens with inspiration
- The murmur is associated with a thrill
An 81 year old woman comes to the office with mental status changes. Her daughter says that she has confused for the past 3days, and that she has complained of fatigue and headache. The initial diagnostic test in the evaluation of this patient is a:
- CT scan of the head
- Chest X ray
- Complete blood count
The nurse practitioner empirically suspects hypothyroidism in a 32 year old woman. A common symptoms of hypothyroidism is:
- Heat intolerance
A31 year old woman is diagnosed with vulvovaginal candidiasis. The finding that is LEAST likely associated with this diagnosis is:
- The absence of a vaginal discharge
- Vulvar erythema
- A malodorous discharge
A 50 year old immune competent woman with a 30 pack year history of tobacco use is diagnosed with community acquired pneumonia. The nurse practitioner prescribes azithromycin (Zithromax) the patient to return:
- In 2 weeks to repeat a CBC
- In 7weeks for a repeat chest X ray
- Within 24 hours if symptoms persist
- As needed because there is no need to follow if compete resolution occurs
A70 year old man is diagnosed with new onset delirium. The initial step by the NP should be to:
- Rule out infection and other medical causes
- Initiate IV fluid and recommended adequate hydration
- Obtain a mental health consult
- Order a sedating medication
When prescribing pregabalin (Lyrical)a schedule controlled substance, for a patient with neuropathy, the prescription should NOT:
- Be transmitted in writing
- Be faxed
- Have any refills
- Have more than 5 refills
Which condition is often associated with acanthosis nigricans in black adolescent patients?
- Type 1 diabetes
- Type 2 diabetes
- Diabetes insipidus
- Gestational diabetes. NR 661-667 Capstone Project APEA Exam Questions
A16 year old boy has sickle cell anemia. The nurse practitioner suspects a sickle cell crisis with pulmonary involvement due to fever and:
- Pulmonary hypertension
- Chest pain
A28 year old man presents with complaints of diarrhea. Which assessment finding is a strong indicator of ulcerative colitis?
- Negative hemoccult
- Bloody nocturnal diarrhea
- Mucosal thinning visible on abdominal radiography
- Stool positive for leukocytes
Iron supplementation is no longer in the treatment of iron deficiency anemia when laboratory testing reveals a normal:
- Hemoglobin, hematocrit and total iron binding capacity
- Complete blood count ,mean corpuscular volume and mean corpuscular hemoglobin
- Complete blood count with normal red cell distribution
- Complete blood count and serum ferritin
A 36 year old man with gastroesophageal reflux disease (GERD) is experiencing symptoms of esophagitis. The NP prescribed a proton pump inhibitor (PPI) instead of an H2 receptor antagonist because the PPI:
- Has better efficacy for healing of esophagitis.
- Has a more immediate onset of action.
- Is better at controlling nocturnal acid breakthrough.
- Fewer side effects.
A32-year-old woman presents with complains of brief periods of intense chest pain, shortness of breath, and a rapid heart rate. The symptoms occur unexpectedly and without an identified trigger. She expresses fear of having a serious physical condition.
- Posttraumatic stress disorder
- Munchausen by proxy.
- Panic disorder.
- Generalized anxiety disorder.
Mr. Poole presents to the clinic with complaints of a rash that has lasted for weeks. For about 10days, He has been using a typical steroid prescribed for his wife. Prolonged use of a topical steroid can increase the risk for:
- Skin cancer.
- Secondary bacterial infections.
- Actinic keratosis.
A nurse practitioner wishes to delegate medication administration to a medical assistant. To determine if this is an appropriate action, the nurse would refer to:
- State rules and regulations governing nurse practitioner practice
- The federal APRN regulatory model
- The American Association of Nurse Practitioner
- Institutional policies and procedures
Which of the following symptoms would be typical of gonorrhea or chlamydia infection in a woman?
- Vaginal discharge, pain or burning on urination
- Clear, white, or yellowish vaginal discharge , strong vaginal odor, and dyspareunia
- Vaginal itching or irritation with thick , white cottage –cheese like discharge
- Fever, headache, and lymphadenopathy
When examining the middle ear, the NP notes a malodorous discharge along with a retracted pocket in the upper part of the middle ear. Keratin formation is also note. The tympanic membrane is intact with mucoid appearance
The may be suggestive of:
- A cholesteatoma
- An osteoma
- A cyst
- An exostosis
When discussing breast cancer screening with a 40 year old woman, the nurse practitioner explains that:
- there is no need for screening at this age for a woman at average risk of developing breast cancer
- screening is only recommended in patients with an immediate family history of breast cancer
- the decision to begin screening is highly dependent on the patient’s values and preferences
- a baseline mammogram is recommended now, with follow up every 5years
Mr. Harris is started on metformin (Glucophage) for a hemoglobin A1C of 7.2%. The nurse practitioner experts the Hgb A1C :
- decreased by 20-0.5%within 1 month
- decreased by 1-2% in 3 months
- decreased by 3-4%in 6 months
- be inconsistent from patient to patient
A 26 year old pregnant woman in her third trimester complains of nocturnal leg cramps. The most appropriate pharmacologic treatment is:
- muscle relaxers
- magnesium supplementation
A nurse practitioner is performing diabetes screening at a church health fair. For screening, the American Diabetes Association advises AGAINST using:
- random capillary blood glucose
- serum hemoglobin A1C
- a glucose tolerance test
- A questionnaire about family history and medical symptoms
The measles, mumps, and rubella (MMR) vaccine:
- Contains an inactivated virus
- Is safe for patients who are immune compromised
- Can cause German measles
- May produce a rash a week or so after administration.