1. A community health nurse practitioner is teaching a group of female high school students about the importance of regular Papanicolaou (Pap) smears. The nurse recognizes that which of the following items underlies the rationale for this teaching? (Points : 2)
The active substitution of normal cells in the cervix correlates to cancer risk.
Undifferentiated stem cells are an early indicator of cervical cancer.
Cancer of the uterine cervix develops incrementally at a cellular level.
Dysplasia in the connective tissue of the cervix is a strong precursor to cancer.
Question 2.2. Following a biopsy, a 54-year-old man has been diagnosed as having a benign neoplastic tumor. Which of the following characteristics most likely applies to his tumor? (Points : 2)
The tumor is poorly approximated and has the potential to break loose.
The tumor may secrete hormones or cytokines.
The well-differentiated neoplastic cells are clustered together in a single mass.
It has a rapid rate of growth and can induce ischemia.
Question 3.3. A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by the student would warrant correction by the nurse practitioner?
(Points : 2)
“As vessel wall thickness increases, tension decreases.”
“Smaller blood vessels require more pressure to overcome wall tension.”
“The smaller the vessel radius, the greater the pressure needed to keep it open.”
“Tension and vessel thickness increase proportionately.”
Question 4.4. A child has been diagnosed with thalassemia. Which of the following other health problems is the child at risk for? (Points : 2)
Iron and ferritin deficiencies
Splenomegaly and hepatomegaly
Question 5.5. A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia and she is suspected of having sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points : 2)
Exercise stress testing
Question 6.6. A nurse practitioner is doing the admission assessment on a patient who has been transferred to the floor after being diagnosed by the emergency room physician with bilateral pleural effusion. Which of the following findings from the nurse practitioner’s initial assessment of the patient is incongruent with the patient’s diagnosis, and would require further investigation? (Points : 2)
The patient complains of sharp pain exacerbated by deep inspiration.
The patient’s breath sounds are diminished on auscultation.
Pulse oximetry indicates that the patient is hypoxemic.
The patient complains of dyspnea and increased work of breathing.
Question 7.7. A 22-year-old female with a history of intermittent flank pain, repeated UTIs, and hematuria has been diagnosed with autosomal dominant polycystic kidney disease (ADPKD). Which of the following phenomena has most likely contributed to the development of her health problem? (Points : 2)
UTIs coupled with an impaired immune response have caused her ADPKD.
She has inherited a tendency for epithelial cell in her tubules to proliferate inappropriately.
Severe hypertension and portal hypertension are likely precursors.
She has inherited undersized kidneys that are prone to calculi formation.
Question 8.8. A 16-year-old female has been brought to her primary care nurse practitioner by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the nurse practitioner to rule out infectious mononucleosis? (Points : 2)
The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.
Her liver and spleen are both enlarged.
Blood work reveals an increased white blood cell count.
Chest auscultation reveals crackles in her lower lung fields bilaterally.
Question 9.9. A patient has been admitted to an inpatient medical unit of a hospital with an acute viral infection. The health care team providing care for the patient would recognize which of the following statements as an accurate description of the role of viruses in human infections? (Points : 2)
Viruses have limited or absent genetic material of their own.
Some viruses are capable of transforming normal host cells into malignant cells.
Viruses are often implicated in cases of transmissible neurodegenerative disease.
Viruses require stimulation after a latent period before they are able to produce symptoms.
Question 10.10. The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft. Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 2)
“Your blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation.”
“Only around one quarter of your blood is in your heart at any given time.”
“Blood pressure and blood volume roughly mimic one another at any given location in the circulatory system.”
“Left-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution.”
Question 11.11. Which of the following patients who presented to a walk-in medical clinic is most likely to be diagnosed with a rhinosinusitis rather than a common cold?
(Points : 2)
A man complaining of general fatigue, a headache, and facial pain with a temperature of 100.9°F
A woman presenting with malaise, lethargy, and copious nasal secretions
A man with a dry, stuffy nasopharynx, a sore throat, and temperature of 98.9°F
A woman complaining of generalized aches who has a hoarse voice and reddened, painful upper airways
Question 12.12. A 62-year-old female smoker is distraught at her recent diagnosis of small cell lung cancer (SCLC). How can her nurse practitioner most appropriately respond to her? (Points : 2)
“I’m sure this is very hard news to hear, but be aware that with aggressive treatment your chances of beating this are quite good.”
“This is very difficult to hear, I’m sure, and we have to observe to see if it spreads because that often happens.”
“I’m very sorry to have to give you this news; I’d like to talk to you about surgical options, however.”
“This is a difficult diagnosis to receive, but there is a chance that the cancer may go into remission.”
Question 13.13. A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? (Points : 2)
The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.
Viruses are killing some of his B cells and becoming incorporated into the genomes of others.
The EBV inhibits the maturation of white cells within his peripheral lymph nodes.
The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.
Question 14.14. Which target of both chemotherapy and radiation treatment accounts for adverse as well as therapeutic effects?
(Points : 2)
Circulating hormone levels
Rapidly proliferating cells
Question 15.15. The blood work of a 44-year-old male patient with a diagnosis of liver disease secondary to alcohol abuse indicates low levels of albumin. Which of the following phenomena would a clinician be most justified in anticipating? (Points : 2)
Impaired immune function
Question 16.16. A 68-year-old woman with a new onset of vascular dementia has recently begun retaining urine. Which of the following physiological phenomena would her care providers most realistically expect to be currently occurring as a result of her urinary retention? (Points : 2)
Hypertrophy of the bladder muscle and increased bladder wall thickness
Decreased urine production and nitrogenous wasted excretion by the kidneys
Decompensation, bladder stretching, and high residual urine volume
Overflow incontinence and loss of contraction power
Question 17.17. Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly? (Points : 2)
A woman with diagnoses of syphilis and cirrhosis of the liver
A woman who has herpes simplex and recently recovered from endocarditis
A woman with chronic obstructive pulmonary syndrome and tuberculosis
A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy
Question 18.18. At which of the following locations in the nephron would a nurse practitioner first expect blood to be largely free of plasma proteins? (Points : 2)
Proximal convoluted tubule
Loop of Henle
Question 19.19. A definitive test for cystic fibrosis is (Points : 2)
The sweat test
A sputum culture
A fecal fat test
A Chymex test for pancreatic insufficiency
Question 20.20. Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 2)
The man’s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells).
The man’s blood pressure is 178/102 and he has abnormal liver function tests.
The man is acutely short of breath and his oxygen saturation is 87%.
The man’s temperature is 101.9°F and he is diaphoretic (heavily sweating).
Question 21.21. The NP is providing care for a 21-year-old female patient with gas gangrene of a compound fracture in her arm. Which of the following assessment findings would the nurse most reasonably expect to find when caring for a patient with a diagnosis of gas gangrene?
(Points : 2)
Inflammation of the affected tissue
A positive culture for Staphylococcus
Impaired alveolar gas exchange
Question 22.22. Which of the following phenomena is most likely occurring during a child’s alveolar stage of lung development?
(Points : 2)
Terminal alveolar sacs are developing and surfactant production is beginning.
A single-capillary network exists and the lungs are capable of respiration.
The conducting airways are formed, but respiration is not yet possible.
Primitive alveoli are formed and the bronchi and bronchioles become much larger.
Question 23.23. A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilation and a decrease in systemic vascular resistance. What is this patient’s most likely diagnosis? (Points : 2)
Question 24.24. Which diuretic acts by inhibiting sodium chloride reabsorption in the thick ascending limb of the loop of Henle?
(Points : 2)
Question 25.25. A 61-year-old woman who has had an upper respiratory infection for several weeks has presented to her nurse practitioner with complaints of a recent onset of urinary retention. She reveals to her nurse practitioner that she has been taking over-the-counter cold medications at higher than the suggested dose for the past two weeks. Which of the following phenomena will her nurse practitioner most likely suspect is contributing to her urinary retention? (Points : 2)
Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction.
Antihistamine effects inhibit communication between the pons and the thoracolumbar cord.
The anticholinergic effects of the medication are impairing normal bladder function.
Over-the-counter medications such as cold medicine stimulate the parasympathetic nervous system and inhibit bladder emptying.
Question 26.26. Which of the following patients would be considered to have a significant risk of developing the prerenal form of acute renal failure?
(Points : 2)
A 22-year-old male who has lost a large amount of blood following a workplace injury
A 41-year-old female who is admitted for intravenous antibiotic treatment of pyelonephritis
A 79-year-old male with diagnoses of poorly controlled diabetes mellitus and congestive heart failure
A 20-year-old male who is admitted for treatment of an overdose of a nephrotoxic drug
A 68-year-old male with a diagnosis of benign prostatic hyperplasia (BPH)
An 80-year-old female who has been admitted for treatment of dehydration, hyponatremia, and malnutrition
Question 27.27. A 22-year-old female who adheres to a vegan diet has been diagnosed with iron-deficiency anemia. Which of the following components of her diagnostic blood work would be most likely to necessitate further investigation? (Points : 2)
Decreased mean corpuscular volume (MCV)
Decreased hemoglobin and hematocrit
Microcytic, hypochromic red cells
Decreased erythropoietin levels
Question 28.28. A couple who are expecting their first child have been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple have approached their nurse practitioner with this request and are seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting them. How can the nurse practitioner best respond to the couple’s inquiry? (Points : 2)
“Stem cells can help correct autoimmune diseases and some congenital defects.”
“Stem cells can be used to regenerate damaged organs should the need ever arise.”
“Stem cells can be used as a source of reserve cells for the entire blood production system.”
“Stem cells can help treat some cancers and anemias, but they must come from your child himself or herself.”
Question 29.29. Which of the following clinical findings would be most closely associated with a patient who has interstitial lung disease rather than COPD? (Points : 2)
Audible wheezing on expiration
Diminished expiratory flow rates
Increased respiratory rate with decreased tidal volume
Normal compliance of alveolar tissue
Question 30.30. A patient is brought to the emergency department with complaints of shortness of breath. Assessment reveals a full, bounding pulse, severe edema, and audible crackles in the lower lung fields bilaterally. What is the patient’s most likely diagnosis? (Points : 2)
Fluid volume excess
Question 31.31. A 25-year-old Asian American man arrives at the emergency department in a panic. Except for a bout with bronchitis a week earlier, he has been healthy his entire life; today he has blood in his urine. What is the most likely cause of his hematuria and how should it be treated? (Points : 2)
His Goodpasture syndrome should be treated with plasmapheresis and immunosuppressive therapy.
His membranous glomerulonephritis should be treated with corticosteroids.
His immunoglobulin A (IgA) nephropathy has no known effective treatments.
His Kimmelstiel-Wilson syndrome should be treated with control of high blood pressure and smoking cessation.
Question 32.32. A 77-year-old male patient with a diagnosis of stomach cancer has been found to have metastases in his liver. The patient and his family are surprised at this turn of events, stating that they don’t see how he could have developed cancer in his liver. Which of the following facts would underlie the reply that the care team provides? (Points : 2)
The parenchymal tissue of the liver is particularly susceptible to secondary malignancies.
The portal circulatory system brings venous blood from the gastrointestinal tract into the liver.
Hepatic stromal tissue shares characteristics with cancerous cells, including lack of anchorage dependence.
The proximity of the liver to the stomach allows for direct spread of cancerous cells due to a lack of contact inhibition.
Question 33.33. A student nurse practitioner asks her preceptor about the origins of different tissues, and their cellular origins during the process of development. Which of the following statements by the preceptor best describes the process of cell differentiation? (Points : 2)
“Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”
“A single stem cell differentiates into approximately 200 different types of cells.”
“A fertilized ovum undergoes a series of divisions, yielding many different cell types.”
“Cells differentiate into necessary body cells, peaking after conception, and ceasing near the time of birth.”
Question 34.34. The nurse practitioner is providing care for a patient with a diagnosis of cirrhosis, and he notes that the patient’s sclerae are jaundiced. The nurse practitioner recalls that jaundice is caused by excess accumulation of bilirubin, a pigment that can accumulate in which part of the cell? (Points : 2)
Rough endoplasmic reticulum (ER)
Question 35.35. A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation. Her blood pressure is 154/110 mm Hg and she has proteinuria. What other labs should be ordered for her? (Points : 2)
Plasma angiotensin I and II and renin
Urinary sodium and potassium
Platelet count, serum creatinine, and liver enzymes
Urinary catecholamines and metabolites
Question 36.36. A nurse practitioner has ordered the measurement of a cardiac patient’s electrolyte levels as part of the patient’s morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient’s heart? (Points : 2)
Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.
Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.
The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.
Question 37.37. A nurse practitioner is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 2)
A 61-year-old man who has a heart valve infection and recurrent fever
An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness
A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week
A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance
Question 38.38. A patient with poorly controlled diabetes mellitus presents to the emergency department with suspected ketoacidosis. Which of the following diagnostic results would be most likely to confirm this diagnosis? (Points : 2)
Low O2 levels, increased anion gap, base excess
High ammonia levels, decreased anion gap, high potassium
Increased CO2, increased anion gap, base deficit
Decreased CO2, decreased anion gap
Question 39.39. A short, nonsmoking middle-aged man presents to the emergency department with left-sided chest pain and a cough. He says that the pain started abruptly, just after lunch, and that breathing and coughing make it worse. He denies recent injury. He is breathing shallowly and rapidly and expresses fear that he may be having a heart attack. Breath sounds are normal, and he is not cyanotic. Which condition is most likely causing his symptoms? (Points : 2)
Pleuritis related to infection
Question 40.40. A woman is surprised to read on the Internet that certain infections can cause cancer and has sought clarification from her nurse practitioner during an office visit. How can the NP best respond to the woman’s query? (Points : 2)
“Though it’s not particularly common, it’s true that certain bacteria and viruses can lead to cancer.”
“Most cancers that cannot be attributed to family history or lifestyle are in fact associated with viruses.”
“There are many viruses, but only a very few of them have been shown to cause cancer in humans.”
“This is true; for example, HIV has been shown to cause cancer in some patients.”
Question 41.41. The family of a 68-year-old man who is in the end stages of small cell lung cancer is distraught at his visible body wasting that has worsened in recent weeks. Which of the following phenomena best accounts for the patient’s anorexia and cachexia? (Points : 2)
Inadequate cellular metabolism of glucose results from tumor factors
High fat losses coupled with preservation of muscle mass exaggerate the appearance of wasting
Products of the tumor itself as well as a hypermetabolic state cause cachexia
Inadequate food intake due to symptoms and treatment results in loss of both muscle and fat
Question 42.42. A 66-year-old female patient has presented to the emergency department because of several months of intermittently bloody stools that has recently become worse. The woman has since been diagnosed with a gastrointestinal bleed secondary to overuse of nonsteroidal anti-inflammatory drugs that she takes for her arthritis. The health care team would realize that which of the following situations is most likely? (Points : 2)
The woman has depleted blood volume due to her ongoing blood loss.
She will have iron-deficiency anemia due to depletion of iron stores.
The patient will be at risk for cardiovascular collapse or shock.
She will have delayed reticulocyte release.
Question 43.43. Following a winter power outage, a patient who had been using a home gasoline generator began to experience dizziness and headaches and was diagnosed with carbon monoxide poisoning. What is the goal of hyperbaric oxygen treatment for carbon monoxide poisoning? (Points : 2)
To increase the amount of oxygen dissolved in plasma
To increase the production of unbound hemoglobin
To stimulate the release of oxygen at the capillaries
To remove bound CO from hemoglobin
Question 44.44. A pediatric unit will be receiving from a rural medical outpost a patient transfer of an 8-day-old infant with a suspected congenital renal disorder. Which of the following possibilities is the care team most likely to be able to rule out early? (Points : 2)
One of the infant’s kidneys may have failed to develop to a normal size.
The kidneys may be misshapen and have cysts.
The upper or lower poles of the two kidneys may be fused.
Renal cell carcinoma may be present.
Question 45.45. Which of the following statements best conveys an aspect of the respiratory pressures that govern ventilation?
(Points : 2)
Intrapleural pressure slightly exceeds that of the inflated lung
The chest wall exerts positive pressure on the lungs that contributes to expiration
The lungs are prevented from collapsing by constant positive intrapulmonary pressure
Negative intrapleural pressure holds the lungs against the chest wall
[removed] One of the infant’s kidneys may have failed to develop to a normal size.
[removed] Conservation or formation of new HCO3– by the kidneys
[removed] Alterations in blood pH, peripheral edema
[removed] Increased nitrogenous waste levels, decreased glomerular filtration rate (GFR)
[removed] His Goodpasture syndrome should be treated with plasmapheresis and immunosuppressive therapy.
[removed] Low O2 levels, increased anion gap, base excess
[removed] Cholinergic actions of the cold medicine are triggering internal and external sphincter contraction.
[removed] Hypertrophy of the bladder muscle and increased bladder wall thickness
[removed] “Your diet may have played a part in this, but in fact genetics is likely primarily to blame.”
[removed] An 81-year-old man with right-sided heart failure and hypothyroidism
[removed] Stress incontinence due to damage to CNS inhibitory pathways
[removed] Bumetanide (Bumex)
[removed] “Nephrons are delicate structures that cannot endure the high pressure that exists in capillary beds elsewhere in the body.”
[removed] Uroflowmetry to determine to rate of the patient’s urine flow
[removed] Loss of appetite and complaints of nausea
[removed] Exchange of Na+ and H+ ions
[removed] Gastric lavage
[removed] UTIs coupled with an impaired immune response have caused her ADPKD.
[removed] An 81-year-old female patient with osteoporosis and anemia
[removed] An inordinate amount of interstitial fluid is accumulating in the patient’s abdomen.
[removed] Proximal convoluted tubule
[removed] A 60-year-old man with a history of cardiovascular disease who is recovering in the hospital from a coronary artery bypass graft
[removed] Neurologic diseases like MS often result in flaccid bladder dysfunction.
[removed] A 32-year-old woman who had a healthy delivery of her third child 4 months ago