Book Updates

Family and Adult-Gero Nurse Practitioner Certification Questions Book (3rd Edition)




Page: 11

Question: 22

Correct Answer: C Question is missing the following lab values:

Total Cholesterol = 240 mg/dL

LDL Cholesterol = 140 mg/dL

HDL Cholesterol = 35 mg/dL

Triglycerides = 129 mg/dL


Page: 29

Question: 11

Correct Answer: C Question is missing the following lab values:

Total Cholesterol = 200 mg/dL

LDL Cholesterol = 120 mg/dL

HDL Cholesterol = 45 mg/dL

Triglycerides = 309 mg/dL

Glycosylated Hemoglobin (Hgb A1c) = 9.2%



Page: 59

Question: 11

Correct Answer: C

Question is missing the following lab values:

WBC = 6 thousand cells x 106uL

RBC = 4.0 x 106 cells/mL

Hemoglobin = 10.8 grams/dL

Hematocrit = 32.4%

MCV = 71.2 fL

MCH = 21 pg



Page: 80

Question: 3

Correct Answer: D

Rationale should read:

This patient probably has Bell’s palsy. This is an acute unilateral event that affects the facial nerve (CN VII) and forehead muscles. Sometimes this results in smoothing of the forehead on the affected side. Stroke must always be considered in the differential in a patient who has these complaints. Stroke may spare the muscles of the forehead. Early treatment with oral steroids like prednisone (60 mg/d and tapered over 10 days) should be started within 72 hours of the onset of symptoms. This has been found to decrease the risk of permanent facial paralysis. Oral antiviral agents may be added in severe acute cases of Bell’s palsy but studies are inconclusive as to their benefit.



Page: 93

Question: 13

Correct Answer: C

Question and answer choices should read: Which medication is recommended by the 2020 American College of Rheumatology guidelines as a first-line agent for osteoarthritis pain in the knee?



Page: 94

Question: 13

Correct Answer: C

Rationale should read:  Osteoarthritis is a chronic condition, and nonpharmacologic interventions should be the first-line treatment choice. When these do not provide relief of pain, or bring incomplete relief of pain, medications should be considered. Medications and interventions that are strongly recommended for osteoarthritis of the knee are weight loss, tai chi, topical NSAIDs, oral NSAIDs, steroid injections, and use of a brace. Conditional recommendations include duloxetine and topical capsaicin. Glucosamine is not recommended.




Page: 95

Question: 17

Correct Answer: B

Question and answer choices should read: A 75-year-old woman who is otherwise healthy has mild osteoarthritis in her right knee. She complains of pain not relieved by acetaminophen 4,000 mg daily. What should be done?



Page: 96

Question: 17

Correct Answer: B

Rationale should read:  Acetaminophen should be restricted to 3,250 mg daily. Daily doses of 4 g increase the risk of hepatotoxicity. Medications strongly recommended by the American College of Rheumatology guidelines (2020) are topical or oral NSAIDs. Because of her age, prudence should be used when selecting dose, NSAID type, and duration.




Page: 101

Question: 11

Correct Answer: D

Question should read:

A pregnant patient in her second trimester is found to have positive leukocytes and positive nitrites in a second voided urine specimen. She is asymptomatic. This patient should be prescribed:

  1. Doxycycline (Doryx).
  2. Trimethoprim-sulfamethoxazole (Bactrim DS).
  3. No medication, symptoms will resolve spontaneously.
  4. Nitrofurantoin (Macrobid).


Page: 102

Question: 11

Correct Answer: D

Rationale should read:

This patient has asymptomatic bacteriuria. In pregnant women, this should be confirmed with a second voided urine before prescribing medication. Asymptomatic bacteriuria during pregnancy increase the risk of pyelonephritis and has been associated with preterm birth and low birth weight infants, as well as other negative outcomes. Therefore, she should be treated empirically with antimicrobial therapy. Nitrofurantoin (Macrobid) is the best choice listed for this patient. Nitrofurantoin should be used cautiously in the first trimester, when other options are not available. It is contraindicated in at 38-42 weeks due to the possibility of hemolytic anemia in the neonate. Other options include beta-lactams (e.g. Penicillins, Cephalosporins). The shortest course possible should be prescribed Doxycycline (Doryx) and trimethoprim-sulfamethoxazole (Bactrim DS) are not considered safe during pregnancy and should be avoided.



Page: 119

Question: 17

Correct Answer: D

Question and choices should read:

According to the DSM-5 criteria, which criterion is NOT part of the diagnostic criteria for anorexia nervosa?

  1. Intense fear of weight gain
  2. Significantly low weight
  3. Distorted perception of body weight
  4. Muscle wasting


Page: 120

Question: 17

Correct Answer: D

Rationale should read:

Muscle wasting is NOT part of the diagnostic criteria for anorexia nervosa. It is, however, considered a medical complication which can occur in many organ systems of the patient with anorexia nervosa. A few other medical complications may include muscle wasting, seizures, anemia, electrolyte imbalances, osteoporosis, amenorrhea, and hypotension. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the diagnosis of anorexia nervosa requires: a restriction of energy intake that leads to a low body weight, given the patient’s age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected; an intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight, and; a distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight.




Page: 125

Question: 2

Correct Answer: A

Question and answer choices should read: The most common cause of pneumonia in people of all ages is:



Page: 126

Question: 2

Correct Answer: A

Rationale should read:  Streptococcus pneumoniae is the most common pathogen in community-acquired pneumonia (CAP) worldwide. It is more common in age extremes (the very young and very old) and during winter months. Group A Streptococcus can cause a fulminant pneumonia even in patients who are immunocompetent. Mycoplasma is the most common atypical pathogen that causes pneumonia. Staphylococcus pneumonia is more common postinfluenza in the very young and very old.




Page: 127

Question: 8

Correct Answer: D

Question and answer choices should read: A 26-year-old man has been diagnosed with community-acquired pneumonia (CAP). What antibiotic should be considered initially to treat his pneumonia?



Page: 127

Question: 11

Correct Answer: B

"Question and answer choices should read: “Good control” of asthma is measured by the number of times weekly a patient experiences an exacerbation of symptoms. What choice below indicates “good control”?



Page: 128

Question: 8

Correct Answer: D

Rationale should read:  A 26-year-old patient with CAP should receive amoxicillin 1 g TID for 5-10 days. ATS/IDSA guidelines (2019) recommend amoxicillin initially for a patient without comorbidities, because a likely pathogen is Streptococcus pneumoniae. Amoxicillin is a narrow-spectrum antibiotic that provides coverage against Streptococcus pneumoniae.



Page: 128

Question: 11

Correct Answer: B

Rationale should read:  Good asthma management is characterized by the use of short-acting bronchodilators (rescue medication) no more than twice weekly during the day or twice monthly at night. Using short-acting inhaled bronchodilators 2 times weekly necessitates use of prophylactic medications such as inhaled steroids and possible use of long-acting bronchodilators in conjunction with inhaled steroids.



Page: 131

Question: 22

Correct Answer: B

Question and answer choices should read: An 83-year-old healthy adult is diagnosed with pneumonia. He is febrile but in no distress. What is the preferred treatment for him?


Page: 132

Question: 22

Correct Answer: B

Rationale should read: 

At age extremes, the most common pathogen is Streptococcus pneumoniae. Because of the age of the patient and the consequences of potential treatment failure, a respiratory quinolone should be considered. Quinolone antibiotics can produce QT prolongation and should be used cautiously in older adults. Azithromycin or doxycycline would only be chosen if the patient had no comorbidities.




Page: 135

Question: 5

Correct Answer: B

Question should read:

A male patient complains of dysuria. His urinalysis is positive for nitrites, leukocyte esterase, and bacteria. What medication should be given and for how many days?



Page: 143

Question: 24

Correct Answer: C

Question and answer choices should read: A nonpregnant woman has been diagnosed with chlamydia. Which of the following is the initial management choice?

  1. Treat with azithromycin.
  2. Treat with ceftriaxone by injection.
  3. Treat with doxycycline.
  4. Also treat for gonorrhea.


Page: 144

Question: 24

Correct Answer: C

Rationale should read: The initial treatment choice for patients with Chlamydia trachomatis is doxycycline 100 mg PO BID x 7 days. Evidence shows that doxycycline is more efficacious for rectal C. trachomatis infection in men and women than azithromycin. Concern about concomitant rectal infection exists when a urogenital infection is present. Azithromycin and levofloxacin are alternative treatment choices if the patient cannot tolerate doxycycline. If the patient is pregnant, azithromycin is safe and effective. Doxycycline should be avoided in the second and third trimester due to risk of tooth discoloration in the fetus. This patient should be screened for other STDs now, including HIV and hepatitis B and C. According to the 2015 STD guidelines, this patient should not be treated for gonorrhea unless this is diagnosed as well.




Page: 150

Question: 19

Correct Answer: C

Question and answer choices should read: A 30-year-old patient with intermittent asthma is using his rescue medication once daily. How should this be managed? He should receive a prescription for:



Page: 151

Question: 28

Correct Answer: B

Question should read:

The most effective way to decrease neural tube defects is to prescribe folic acid. For a woman with normal risks, how much is needed daily prior to becoming pregnant?

  1. 0.2 mg
  2. 0.4 mg
  3. 1 mg
  4. 2 mg


Page: 156

Question: 54

Correct Answer: C

Question should read:

A 50-year-old non-pregnant female presents for an annual exam. She complains of fatigue and weight gain. She has the following lab results. What should the NP order next?

TSH 7 mlU/L (0.4-3.8 mlU/L)



Page: 175

Question: 19

Correct Answer: C

Rationale should read:

The patient is using his bronchodilator (rescue medication) more than twice weekly. This is a signal to the healthcare provider that the patient’s asthma is not well controlled and another medication needs to be used. A reasonable step for this patient is a trial of an inhaled steroid. This should relieve his symptoms and decrease the use of his rescue medication. If an inhaled bronchodilator is overused, it will not continue to produce bronchodilation over time.




Page: 180

Question: 54

Correct Answer: C

Rationale should read:

The patient presents with an elevated TSH as well as symptoms suggestive of hypothyroidism. In the presence of an elevated serum TSH, the next step is to repeat the TSH measurement along with a serum free T4. If the TSH remains elevated and the serum free T4 is low, this is consistent with primary hypothyroidism, and replacement therapy would be initiated. If the serum TSH is still high but the serum free T4 value is within the normal range, this indicates subclinical hypothyroidism. Replacement of T4 is generally not initiated in subclinical hypothyroidism until the TSH is > 10. There is no indication (i.e. nodule or thyromegaly) in this scenario to justify the need for a thyroid ultrasound. Hypothyroidism may be associated with an increased risk of cardiovascular disease, including hyperlipidemia. However, this would not be helpful in determining a diagnosis of hypothyroidism.




Page: 181

Question: 56

Correct Answer: C

Rationale should read:

A patient with meningitis may experience a positive Kernig or Brudzinski sign. A positive Kernig sign will elicit pain with knee extension when flexing the patient’s hip 90 degrees. A positive Brudzinski sign causes flexion of the patient’s hips and knees when flexing the neck. Patients who have septic bursitis or septic arthritis will not have a positive Kernig sign. HIV-positive patients are more likely to exhibit pneumonia secondary to pneumocystis infection, but he has no respiratory symptoms.



Page: 198

Question: 18

Correct Answer: D

Question and answer choices should read: A 65-year-old patient presents to your clinic today. Which statement about pneumococcal immunization is accurate for this patient?



Page: 209

Question: 88

Correct Answer: C

Question should read:

A pregnant patient, in her first trimester, is found to have a urinary tract infection. What is the appropriate course of action?

  1. Prescribe TMP/SMX (Bactrim DS)
  2. Prescribe ciprofloxacin (Cipro)
  3. Prescribe Amoxicillin-clavulanate (Augmentin)
  4. Prescribe no antibiotic


Page: 212

Question: 105

Correct Answer: B

Question should read:

A nurse practitioner is taking care of a patient who has chronic perennial allergic rhinitis. The patient has health insurance. The NP has become aware that the patient is not using her prescribed allergy medication. Instead, the patient is giving the medication to her husband because he does not have insurance. What should the NP do?


  1. Prescribe the medication only once more.
  2. Only prescribe the medication if the patient promises to use it.
  3. Stop prescribing the medication for the patient.
  4. Continue to prescribe the medication.


Page: 216

Question: 125

Correct Answer: A

Question should read:

A pregnant patient with urinary frequency is found to have a UTI. The most appropriate treatment choice for this patient is:

  1. Cefpodoxime (Vantin) for 7 days.
  2. Ciprofloxacin (Cipro) for 3 days.
  3. Amoxicillin for 10 days.
  4. Doxycycline (Doryx) for 5 days.


Page: 216

Question: 129

Correct Answer: D

Question and answer choices should read: A 26-year-old patient has eosinophilia. This could be associated with:



Page: 223

Question: 18

Correct Answer D

Rationale should read:

This patient should receive a PPSV23 immunization today because he is 65 years old. The CDC does not recommend immunizing this patient every 5 years. Two pneumococcal immunizations are available (PCV13 and PPSV23), but only the PPSV23 is recommended by the CDC. The PCV13 is optional for this patient. Neither of the pneumococcal vaccines should be administered annually.




Page: 227

Question: 44

Correct Answer: A

Rationale should read: In a pregnant patient, chlamydia is treated with azithromycin. If the patient were not pregnant, doxycycline would be the preferred choice. Azithromycin is given as a single 1-gram dose. Amoxicillin 500 mg orally TID for 7 days is an acceptable alternative if the patient is unable to take azithromycin. This patient should be screened for other STIs now, and all STIs again before delivery. The patient should be advised to report the detection of the STI to their OB/GYN so that they may be screened later. It is common for a pregnant patient to be reinfected before delivery.



Page: 228

Question: 53

Correct Answer: A


No corrections to rationale.



Page: 228

Question: 54

Correct Answer: A

Rationale should read: 

The guidelines recommend amoxicillin for the initial treatment of uncomplicated pneumonia in outpatients who are otherwise healthy and have not had recent antibiotic exposure. The initial choices can be amoxicillin, doxycycline or a macrolide. Amoxicillin is usually chosen due to the strength of evidence. Fluoroquinolones may be used first line in these patients; however, the guidelines strongly recommend fluoroquinolones for patients with comorbidities or patients who have recent antibiotic exposure.



Page: 233

Question: 88

Correct Answer: C


Rationale should read:

In 2016, FDA eliminated pregnancy categories for prescription medications. Over-the-counter medications still contain the pregnancy categories A-X. Amoxicillin-clavulanate (Augmentin), cephalexin (Keflex) (e.g. Beta-lactam antibiotics) and Nitrofurantoin (Macrobid) are considered probably safe for use during pregnancy. It provides coverage for the most common urinary tract pathogens. Bactrim is a folic acid antagonist and may be associated with an increased risk of congenital malformations. Ciprofloxacin is a fluoroquinolone (old category C) and may not be safe during pregnancy. Use of this medication during pregnancy may increase the risk of fetal harm (impaired bone and cartilage formation in the fetus). However, it may be given if the benefits outweigh the risks. A pregnant patient with bacteriuria is at high risk for the development of pyelonephritis and preterm labor if bacteriuria is left untreated.




Page: 234

Question: 96

Correct Answer: C


No corrections to rationale.



Page: 235

Question: 103

Correct Answer: C


No corrections to rationale.



Page: 235

Question: 105

Correct Answer: B

Rationale should read:

The nurse practitioner has an ethical duty to the prescriber/patient relationship to treat the patient accordingly. The nurse practitioner exhibits beneficence and non-maleficence by prescribing the patient the medication and getting her assurance that she will use the medication for her own symptoms. If the NP abruptly stops prescribing the medication for the patient, then maleficence and a breach of duty is evident. The patient has a diagnosis of chronic perennial allergic rhinitis of which she needs medication. The legally defensible action of the nurse practitioner is to treat the patient, educate her on the risks and benefits of the medication and the risks of sharing her medications with others. Should the NP knowingly prescribe the medication, possibly even prescribing more than is warranted to “help” the patients husband, then the NP has violated veracity, standards of practice, and ethics in prescribing and is now medically liable. The NP has now knowingly diverted medications to someone in whom an assessment and diagnosis has not been made.



Page: 238

Question: 125

Correct Answer: A

Rationale should read:

Medication safety during pregnancy is of utmost concern. In 2016, FDA eliminated pregnancy categories letter categories: A,B,C,D, and X. Cefpodoxime (Vantin) is a beta-lactam with a broad spectrum of coverage and is considered safe during pregnancy. The optimal duration of treatment of acute cystitis during pregnancy is uncertain, however, the shortest course of the safest antibiotic is best to minimize the risk of exposure to the fetus. Amoxicillin is probably as safe as nitrofurantoin but has a lower efficacy against typical urinary tract pathogens. Doxycycline is associated with fetal tooth discoloration and so it should be avoided. Ciprofloxacin is not recommended during pregnancy due to potential problems with bone and cartilage formation.



Page: 244

Question: 11

Correct Answer: C

Question and answer choices should read: A 49-year-old patient has osteoarthritis in the lumbar spine and hip. His hip X-ray demonstrates bone on bone. What can be done to resolve his complaints of pain in his hip?



Page: 249

Question: 38

Correct Answer: D

Question and answer choices should read:

A 24-year-old college student who does not smoke is diagnosed with pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic represents the best choice for treatment for him?

  1. Cefdinir
  2. Levofloxacin
  3. Sulfamethoxazole-Trimethoprim
  4. Amoxicillin


Page: 251

Question: 54

Correct Answer: C

Question and answer choices should read: A 6-year-old being treated for community-acquired pneumonia (CAP) has been taking azithromycin in therapeutic doses for 72 hours. His temperature has gone from 102° F to 101° F. What should be done?



Page: 260

Question: 104

Correct Answer: B

Question should read:

A 19-year-old female presents with a temp of 100.8°F and lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms?



Page: 263

Question: 120

Correct Answer: A

Question should read:

A diagnosis of Type 2 diabetes mellitus can be made:


  1. following fasting glucose values of 126 and 130 mg/dL on different days.
  2. if glucose values of 110, 119, and 115 mg/dL are observed on different days.
  3. with Hgb A1C of 6.3%.
  4. if risk factors plus a family history of diabetes are present.


Page: 267

Question: 143

Correct Answer: A

Question and answer choices should read: A patient with asthma uses one puff twice daily of fluticasone and has an albuterol inhaler for prn use. He requests a refill for his albuterol inhaler. His last prescription was filled 5 weeks ago. What action by the NP is appropriate?



Page: 270

Question: 11

Correct Answer: C

Rationale should read:

X-ray results showing bone on bone indicate severe osteoarthritis. This patient should be treated with something that will help manage his pain (NSAID initially). He needs referral to an orthopedic specialist for evaluation, if this is consistent with his long-term health plans. Medications alone will likely not resolve the patient's hip pain. Additionally, he is 49 years old with no mention of other diseases and would likely be a good surgical candidate because of his young age.




Page: 274

Question: 38

Correct Answer: D

Rationale should read: 

The preferred treatment in this patient is high-dose amoxicillin. Amoxicillin is active against the most causative organism, S. pneumoniae. Macrolides (such as azithromycin and clarithromycin) have rising rates of resistance against S. pneumoniae. Fluoroquinolones are commonly used first, however, guidelines strongly recommend using fluoroquinolones for patients with comorbidities and/or those who have suspected macrolide-resistant strains of Streptococcus. Inappropriate use of fluoroquinolones will promote development of fluoroquinolone-resistant pathogens. Appropriate antibiotic selection is dependent on the patient's comorbid conditions, likelihood of resistance, and the potential for adverse medication reactions/interactions.




Page: 276

Question: 54

Correct Answer: C

Rationale should read: 

A 6-year-old with CAP should show symptom improvement in 24-48 hours if he is on appropriate antibiotic therapy. Azithromycin treats atypical pathogens like Mycoplasma and Chlamydia, but it has poor Streptococcal coverage. The likely pathogen that causes pneumonia in this age group is an atypical one, but at this point the most common typical pathogen, Streptococcus pneumoniae, must be considered. The best choice is to consider S. pneumoniae as the pathogen and to treat with a penicillin. Specifically, this patient should receive high-dose amoxicillin because of the increased incidence of resistant S. pneumoniae.




Page: 278

Question: 66

Correct Answer: D

Rationale should read:

This child’s platelet count is decreased. The term used to describe this is thrombocytopenia. Acute lymphocytic leukemia (ALL) is often characterized by low platelet count and other red or white cell abnormalities. The peak incidence occurs between 2-5 years of age. The most common presenting signs of ALL are bleeding, fever, and lymphadenopathy. Idiopathic thrombocytopenia (ITP) is the most common type found in children between the ages of 2-4 years and is preceded by a recent (less than 4 weeks) upper respiratory infection. The nonblanchable rash over the joints probably represents petechiae, a common manifestation of thrombocytopenia and can be seen with both ITP and ALL. Nosebleeds and bleeding gums, especially with brushing of teeth, are also common with thrombocytopenia; however if the thrombocytopenia is mild, there may no presenting symptoms. The CBC is otherwise normal in ITP, unlike ALL. The underlying cause is unknown, hence the name idiopathic. Septic arthritis would be characterized by an elevated white count. Von Willebrand's disease (VWD) is a common autosomal dominant bleeding disorder that may include easy bruising or prolonged bleeding, but is characterized by a normal platelet count.




Page: 278

Question: 65

Correct Answer: A

Rationale should read:

The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and Shigella. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. All three pathogens are identifiable with culture if present. Pts with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after exposure and will usually resolve in 5-7 days. Shigella is very contagious and is shed continuously in the stool during active illness and for weeks after symptoms have resolved. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.




Page: 289

Question: 143

Correct Answer: A

Rationale should read:

The patient is using a short-acting bronchodilator excessively if he needs a refill of his inhaler in only 5 weeks. Inhalers typically contain 200 puffs. They should be used two or fewer times per week. His inhaled steroid dose could be increased and his albuterol inhaler should be refilled. In fact, he should not be without a prescription for the albuterol. Consideration could be given to prescribing a long-acting bronchodilator with a steroid for prn use and increasing the steroid, but this is not the best choice because this does not include a refill of the albuterol and this patient should have access to a rescue inhaler.




Page: 300

Question: 55

Correct Answer: A

Question Should Read:

A 67-year-old patient with COPD presents an immunization record that reflects having last received the pneumococcal immunization (PPSV23) when he was 60 years old. Which statement below reflects the current standard of practice recommended by CDC for this patient?

  1. Discuss PCV13 vaccination with patient.
  2. He should receive the pneumococcal immunization every 5 years after age 65.
  3. He should receive PPSV23 only.
  4. He does not need the immunization.


Page: 311

Question: 123

Correct Answer: B

Question and answer choices should read: A 30-year-old patient with intermittent asthma is using his rescue medication once daily. How should this be managed? He should receive a prescription for:



Page: 312

Question: 130

Correct Answer: C

Question and answer choices should read: A 72-year-old patient complains of knee pain when she climbs stairs or walks long distances. Crepitus is palpable in the affected knee. What is the likely cause?



Page: 315

Question: 148

Correct Answer: B

Question should read:

A 50-year-old non-pregnant female presents for an annual exam. She complains of fatigue and weight gain. She has the following lab results. What should the NP order next?

TSH 7 mlU/L (0.4-3.8 mlU/L)



Page: 324

Question: 55

Correct Answer: A

Rationale Should Read:

The CDC recommends shared decision making for this patient with COPD. The NP should discuss PCV13 vaccination with the patient. If the patient and provider decide together that PCV13 is appropriate, it should be administered, then followed by one dose of PPSV23 at least 1 year later. If the NP and the patient decide against the PCV13 vaccine, one dose of PPSV23 should be administered now. If the PPSV 23 immunization was given prior to age 65 years, 5 years should elapse before another PPSV23 vaccine is given.




Page: 334

Question: 123

Correct Answer: B

Rationale should read: 

The patient is using his bronchodilator (rescue medication) more than twice weekly. This is a signal to the healthcare provider that the patient’s asthma is not well controlled and another medication needs to be used. A reasonable step for this patient is a trial of an inhaled steroid. This should relieve his symptoms and decrease the use of his rescue medication. If an inhaled bronchodilator is overused, it will not continue to produce bronchodilation over time.




Page: 335

Question: 130

Correct Answer: C

Rationale should read: 

This is probably osteoarthritis of the knee. Typical symptoms of osteoarthritis include the ones mentioned in the question, plus pain with standing up after sitting. This patient may report stiffness after sitting for long periods and after awakening in the morning. She should try nonpharmacologic approaches to pain relief, such as heat and exercise. NSAIDs may be used, but with caution. X-rays will indicate the severity of the disease. She may be a candidate for knee replacement if severe disease is present.




Page: 337

Question: 148

Correct Answer: B

Rationale should read:

The patient presents with an elevated TSH as well as symptoms suggestive of hypothyroidism. In the presence of an elevated serum TSH, the next step is to repeat the TSH measurement along with a serum free T4. If the TSH remains elevated and the serum free T4 is low, this is consistent with primary hypothyroidism, and replacement therapy would be initiated. If the serum TSH is still high but the serum free T4 value is within the normal range, this indicates subclinical hypothyroidism. Replacement of T4 is generally not initiated in subclinical hypothyroidism until the TSH is > 10. There is no indication (i.e. nodule or thyromegaly) in this scenario to justify the need for a thyroid ultrasound. Hypothyroidism may be associated with an increased risk of cardiovascular disease, including hyperlipidemia. However, this would not be helpful in determining a diagnosis of hypothyroidism.



Page: 348

Question: 59

Correct Answer: A

Question and answer choices should read: A 65-year-old patient presents to your clinic today. Which statement about pneumococcal immunization is accurate for this patient?



Page: 348

Question: 60

Correct Answer: C

Question should read:

A nurse practitioner is taking care of a patient who has chronic perennial allergic rhinitis. The patient has health insurance. The NP has become aware that the patient is not using her prescribed allergy medication. Instead, the patient is giving the medication to her husband because he does not have insurance. What should the NP do?

Continue to prescribe the medication.

Stop prescribing the medication for the patient.

Only prescribe the medication if the patient promises to use it.

Prescribe the medication only once more.



Page: 350

Question: 70

Correct Answer: A

Question and answer choices should read: A 26-year-old patient has eosinophilia. This could be associated with:



Page: 373

Question: 59

Correct Answer: A

Rationale should read: 

This patient should receive a PPSV23 immunization today because he is 65 years old. The CDC does not recommend immunizing this patient every 5 years. Two pneumococcal immunizations are available (PCV13 and PPSV23), but only the PPSV23 is recommended by the CDC. The PCV13 is optional for this patient. Neither of the pneumococcal vaccines should be administered annually.




Page: 373

Question: 60

Correct Answer: C

Rationale should read:

The nurse practitioner has an ethical duty to the prescriber/patient relationship to treat the patient accordingly. The nurse practitioner exhibits beneficence and non-maleficence by prescribing the patient the medication and getting her assurance that she will use the medication for her own symptoms. If the NP abruptly stops prescribing the medication for the patient, then maleficence and a breach of duty is evident. The patient has a diagnosis of chronic perennial allergic rhinitis of which she needs medication. The legally defensible action of the nurse practitioner is to treat the patient, educate her on the risks and benefits of the medication and the risks of sharing her medications with others. Should the NP knowingly prescribe the medication, possibly even prescribing more than is warranted to “help” the patients husband, then the NP has violated veracity, standards of practice, and ethics in prescribing and is now medically liable. The NP has now knowingly diverted medications to someone in whom an assessment and diagnosis has not been made.



Page: 381

Question 116

Correct Answer: D

Rationale should read: 

The guidelines recommend amoxicillin for the initial treatment of uncomplicated pneumonia in outpatients who are otherwise healthy and have not had recent antibiotic exposure. The initial choices can be amoxicillin, doxycycline or a macrolide. Amoxicillin is usually chosen due to the strength of evidence. Fluoroquinolones may be used first line in these patients; however, the guidelines strongly recommend fluoroquinolones for patients with comorbidities or patients who have recent antibiotic exposure.




Page: 387

Question: 3

Correct Answer: D

Question should read:

A diagnosis of Type 2 diabetes mellitus can be made:

  1. if risk factors plus a family history of diabetes are present.
  2. with Hgb A1C of 6.3%.
  3. if glucose values of 110, 119, and 115 mg/dL are observed on different days.
  4. following fasting glucose values of 126 and 130 mg/dL on different days.


Page: 401

Question: 85

Correct Answer: C

Question should read:

A 19-year-old female presents with a temp of 100.8°F and lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms?




Page: 405

Question: 112

Correct Answer: D

Question and answer choices should read: A patient with asthma uses one puff twice daily of fluticasone and has an albuterol inhaler for prn use. He requests a refill for his albuterol inhaler. His last prescription was filled 5 weeks ago. What action by the NP is appropriate?



Page: 407

Question: 120

Correct Answer: A

Question and answer choices should read:

A 24-year-old college student who does not smoke is diagnosed with pneumonia. He is otherwise healthy and does not need hospitalization at this time. Which antibiotic represents the best choice for treatment for him?

  1. Amoxicillin
  2. Sulfamethoxazole-Trimethoprim
  3. Levofloxacin
  4. Cefdinir


Page: 412

Question: 148

Correct Answer: B

Question and answer choices should read: A 49-year-old patient has osteoarthritis in the lumbar spine and hip. The hip X-ray demonstrates bone on bone. What can be done to resolve this patient's complaints of hip pain?



Page: 422

Question: 70

Correct Answer: A

Rationale should read: 

The American College of Rheumatology recommends exercise as first-line treatment for osteoarthritis. Because osteoarthritis is a chronic condition, medications are not the first intervention. Nonpharmacologic interventions like heat and exercise are always attempted initially. When initial interventions are unsuccessful, they are continued and medications are added. Relief of pain is the primary indication for use of medications.




Page: 423

Question: 76

Correct Answer: D

Rationale should read:

The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and Shigella. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. All three pathogens are identifiable with culture if present. Pts with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after exposure and will usually resolve in 5-7 days. Shigella is very contagious and is shed continuously in the stool during active illness and for weeks after symptoms have resolved. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen.




Page: 428

Question: 112

Correct Answer: D

Rationale should read: 

The patient is using a short-acting bronchodilator excessively if he needs a refill of his inhaler in only 5 weeks. Inhalers typically contain 200 puffs. They should be used two or fewer times per week. His inhaled steroid dose could be increased and his albuterol inhaler should be refilled. In fact, he should not be without a prescription for the albuterol. Consideration could be given to prescribing a long-acting bronchodilator with a steroid for prn use and increasing the steroid, but this is not the best choice because this does not include a refill of the albuterol and this patient should have access to a rescue inhaler.




Page: 429

Question: 120

Correct Answer: A

Rationale should read:

The preferred treatment in this patient is high-dose amoxicillin. Amoxicillin is active against the most causative organism, S. pneumoniae. Macrolides (such as azithromycin and clarithromycin) have rising rates of resistance against S. pneumoniae. Fluoroquinolones are commonly used first, however, guidelines strongly recommend using fluoroquinolones for patients with comorbidities and/or those who have suspected macrolide-resistant strains of Streptococcus. Inappropriate use of fluoroquinolones will promote development of fluoroquinolone-resistant pathogens. Appropriate antibiotic selection is dependent on the patient's comorbid conditions, likelihood of resistance, and the potential for adverse medication reactions/interactions.




Page: 433

Question: 148

Correct Answer: B

Rationale should read: 

X-ray results showing bone on bone indicate severe osteoarthritis. This patient should be treated with something that will help manage his pain (NSAID initially). He needs referral to an orthopedic specialist for evaluation, if this is consistent with his long-term health plans. Medications alone will likely not resolve the patient's hip pain. Additionally, he is 49 years old with no mention of other diseases and would likely be a good surgical candidate because of his young age.



Page: 441

Question: 13

Correct Answer: B

Question and answer choices should read: In infants, the pneumococcal immunization has:



Page: 441

Question: 17

Correct Answer: D

Question and choices should read:

A 7-year-old boy who was previously unimmunized received his first tetanus, diphtheria, and acellular pertussis (TDaP), Hepatitis A, Hepatitis B, inactivated polio (IPV), measles, mumps, and rubella (MMR), and Varicella vaccinations one month ago. He returns today for his second series of immunizations. He should receive:

Hepatitis A, Hepatitis B, TDaP, Hib, IPV, and MMR

Hepatitis B, TDaP, IPV, MMR, and Varicella

IPV only

Hepatitis B, TD, IPV, and MMR



Page: 442

Question: 13

Correct Answer: B

Rationale should read: 

The heptavalent pneumococcal conjugate vaccine (PCV13; Prevnar) protects children from 13 types of pneumococcal bacteria. It has reduced the incidence of ear infections caused by Streptococcus pneumoniae and has reduced the incidence of recurrent ear infections and tube placement by 10-20%. The pathogenesis of acute otitis media has shifted to more cases of H. influenzae, but this organism is less likely to become resistant, as S. pneumoniae has.




Page: 442

Question: 17

Correct Answer: D

Rationale should read:

The minimum length of time between Hepatitis B, DTaP/DT, IPV, and MMR is 1 month or 4 weeks. Therefore, he can receive all of these today. Children ages 7 through 10 who aren't fully vaccinated against pertussis, including children never vaccinated or with an unknown vaccination status, should get a single dose of the TDaP vaccine and follow-up with TD 4 weeks later. Note, if the child is unable to tolerate the pertussis component of the TDaP, he can receive the DT instead at the same intervals. The minimum length of time between varicella immunizations is 3 months if he is younger than 13 years of age and the second dose of Hepatitis A is not due until 6 months later. HIB is not administered to children older than 59 months (5 years).



Page: 450

Question: 41

Correct Answer: D

Rationale should read:

The chest circumference is not routinely measured at well-child visits, but is assessed if there is concern about the circumference of either the head or the chest. An exception to this observation can occur in premature infants where the head grows very rapidly. Normally, the head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24 months the head and chest circumference should be about equal and by 2 years of age the chest should be larger than the head. The chest circumference is measured at the nipple line.



Page: 458

Question: 64

Correct Answer: B

Rationale should read: 

In children who are older than 5 years, Streptococcus pneumoniae is the most common pathogen. This pathogen should be suspected in children who present with a sudden onset of fever with chills and have an ill appearance. If symptoms progress, moderate to severe respiratory distress may develop. Additionally, because this child has asthma and uses an inhaled steroid daily, S. pneumoniae should be suspected. The drug of choice for empiric treatment of this patient is amoxicillin. This is due to its efficacy, cost, and tolerability. Dosing is 90 mg/kg per day in 2 or 3 divided doses, with a maximum of 4 g/day. A higher dose is suggested due to concerns about antibiotic-resistant S. pneumoniae. The patient presentation would be different if the causative organism is an atypical pathogen (e.g., Mycoplasma pneumoniae). Azithromycin is the drug of choice if atypical pathogens are suspected. Doxycycline is not an appropriate choice because it has poor Strep coverage and it is contraindicated in children younger than 8 years.



Page: 461

Question: 76

Correct Answer: C

Question and answer choices should read: A healthy 7-year-old child is diagnosed with Mycoplasma pneumoniae. He is febrile but not in distress. What is the preferred treatment for him?



Page: 462

Question: 76

Correct Answer: C

Rationale should read:  Streptococcus pneumonia is the most common bacterial pathogen in all age groups. Atypical pathogens such as Mycoplasma pneumoniae and Chlamydia pneumoniae are common in children older than 5 years who present with abrupt onset of symptoms including malaise, cough, sore throat and headache, but are not ill enough for hospitalization. The initial preferred antibiotic to treat an atypical pathogen such as Mycoplasma is a macrolide antibiotic (e.g., azithromycin). Alternative options include doxycycline if the patient cannot take a macrolide. Amoxicillin would be an appropriate choice for the patient with pneumonia related to S. pneumoniae.



Page: 472

Question: 5

Correct Answer: C

Rationale should read: 

NSAIDs are contraindicated in patients who have renal insufficiency. They may produce a transient decrease in renal function and likely produce sodium retention and thus, water retention. For the same reason, this may worsen hypertension. Acetaminophen, mild narcotics, and/or topical agents could be used to treat her osteoarthritis pain. NSAIDs will have no effect on her varicose veins or hypothyroidism.



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