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Which of the following is NOT one of the five key elements of social determinants of health?
Detailed Rationale
The five key SDOH domains are Economic Stability, Education Access/Quality, Health Care Access/Quality, Neighborhood/Built Environment, and Social/Community Context. Transportation is a component but not a separate domain.
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The nurse practitioner is evaluating the patient's understanding of the treatment plan for Chlamydia trachomatis. Which statement demonstrates proper understanding of the plan?
Detailed Rationale
CDC recommends abstinence for 7 days after single-dose treatment (azithromycin) or until completion of 7-day doxycycline regimen, plus until partners are treated and symptoms resolve.
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Showing signs of autism spectrum disorder. The symptom that would be most concerning is that the patient:
Detailed Rationale
Pointing with index finger is typical development. Lack of verbal communication or unusual response to sensory input (vacuum) is more concerning for ASD.
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A 19-year-old female presents with right-sided abdominal pain. The diagnosis that would NOT be included as part of the differential is:
Detailed Rationale
Diverticulosis is rare in 19-year-olds, typically seen in older adults. Cholecystitis, appendicitis, and PID are all possible in this age group.
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A 33-year-old patient returns to the clinic with complaints of new genital herpes lesions, despite being on acyclovir (Zovirax) for the past 5 days. The nurse practitioner should:
Detailed Rationale
New lesions after 5 days of treatment may indicate antiviral resistance or different HSV type. Culture helps guide therapy. Extending course or changing medication without diagnosis is premature.
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A 36-year-old patient has a midsystolic click and a murmur heard at the apex occurring in late systole. If symptomatic, the patient may also experience:
Detailed Rationale
Midsystolic click and late systolic murmur at apex = mitral valve prolapse. Symptomatic MVP can cause palpitations, chest pain, dyspnea, fatigue, not primarily angina or edema.
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A 13-year-old patient is suspected of having acute otitis media. When performing a physical examination, a positive tug test will elicit pain when:
Detailed Rationale
Positive tug test (pain with auricle traction) indicates otitis externa, not AOM. AOM pain is typically not reproduced by auricle movement.
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When counseling a female who is breastfeeding her 6-month-old infant, the nurse practitioner should recommend a caloric intake that is how many kilocalories higher than prepregnancy requirements?
Detailed Rationale
Breastfeeding requires approximately 500 extra kcal/day to support milk production while maintaining maternal health and energy.
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A 48-year-old recently widowed patient experiences a first episode of depression. The patient is started on an antidepressant. After complete remission of symptoms, the medication should be continued for at least:
Detailed Rationale
After first episode of depression, continue antidepressants for 6-12 months after remission to prevent relapse. Minimum is typically 6 months.
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A 20-year-old student presents with an oval salmon-colored macule on the chest that has progressed to a generalized exanthem from the top down over several weeks. The nurse practitioner knows that treatment for this condition may include:
Detailed Rationale
This describes pityriasis rosea (herald patch + Christmas tree distribution). Self-limiting in 6-8 weeks; treat pruritus only. Antifungals and corticosteroids are not indicated.
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A 19-year-old female patient with a BMI of 40 is diagnosed with migraine headaches. The nurse practitioner knows that migraine headaches are NOT usually treated prophylactically with:
Detailed Rationale
Sumatriptan is acute/abortive treatment, not prophylactic. Amitriptyline, verapamil, beta-blockers (metoprolol) are used for migraine prophylaxis.
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When treating a patient with heart failure, the medication class that is considered first-line therapy for vasodilatory effects and improved ejection fraction, and is relatively inexpensive, is:
Detailed Rationale
ACE inhibitors are first-line for HF with reduced EF due to vasodilation, afterload reduction, and mortality benefit. They are cost-effective. CCBs and nitrates are not first-line; diuretics manage symptoms only.
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A 25-year-old patient is suspected of having bacterial vaginosis. The diagnostic criterion that will confirm this diagnosis is:
Detailed Rationale
Clue cells (vaginal epithelial cells with stippled borders) are diagnostic for BV. Amsel criteria require 3 of 4: clue cells, thin discharge, pH>4.5, positive whiff test (amine odor).
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A nurse practitioner finds hematuria and an elevated prostate-specific antigen level. Prostate cancer is suspected if, on digital rectal exam, the prostate is:
Detailed Rationale
Prostate cancer typically presents with hard, irregular, nodular, or asymmetrical prostate on DRE. Tenderness suggests prostatitis; boggy suggests BPH.
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A 19-year-old veterinarian assistant presents with right epitrochlear lymphadenopathy. The nurse practitioner suspects atypical case of cat scratch disease (CSD) and knows that:
Detailed Rationale
Cat scratch disease (Bartonella henselae) is typically self-limiting; antibiotics not routinely recommended for mild cases. Transmission via scratches/saliva. Atypical CSD may require antibiotics.
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Which of the following antibiotics has the best safety profile for the treatment of urinary tract infection in pregnancy?
Detailed Rationale
Nitrofurantoin is preferred for UTI in pregnancy (except near term). TMP-SMX contraindicated in first trimester and near term. Amoxicillin has higher resistance. Azithromycin not first-line for UTI.
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A 35-year-old male complains of an abrupt onset of fever, malaise, pelvic pain, dysuria, and cloudy urine. The nurse practitioner is concerned about possible:
Detailed Rationale
Acute bacterial prostatitis presents with fever, malaise, pelvic/perineal pain, dysuria, often with systemic symptoms. Urethritis typically lacks systemic fever; epididymitis presents with testicular pain; renal calculi with colic.
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The sexual partner of a symptomatic male patient with gonorrhea should be empirically treated with:
Detailed Rationale
CDC recommends dual therapy for gonorrhea: ceftriaxone IM + doxycycline orally for 7 days (if chlamydia not ruled out). Partner treatment is essential to prevent reinfection.
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In a 56-year-old male, the sudden onset of symptoms indicating acute urolithiasis typically presents as:
Detailed Rationale
Acute urolithiasis presents with sudden severe flank pain radiating to groin (renal colic). Nausea/vomiting and hematuria are associated but not the hallmark initial presentation.
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When discussing breast cancer screening with a 45-year-old female, the nurse practitioner explains that:
Detailed Rationale
USPSTF recommends shared decision-making for mammography in women aged 40-49. Screening every 1-2 years. Not only for family history.
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Small-volume bladder voids that contribute to nocturia are most likely caused by:
Detailed Rationale
BPH causes nocturia due to incomplete emptying and small-volume voids. Stress incontinence is leakage with cough/sneeze. Diuretics increase total urine volume, not small voids.
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A 35-year-old patient complains of fatigue and weight gain over the past 6 months. The most appropriate initial test to evaluate for thyroid disorder is:
Detailed Rationale
TSH is the most sensitive initial test for thyroid dysfunction. If abnormal, then free T4 and possibly T3 are obtained. Antibodies are for autoimmune etiology.
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A 21-year-old sexually active male reports watery urethral discharge and complaints of dysuria. The MOST likely diagnosis is:
Detailed Rationale
Urethritis presents with urethral discharge (watery or purulent) and dysuria. Prostatitis has pelvic/perineal pain; epididymitis has testicular swelling/pain; proctitis has rectal symptoms.
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A widowed 85-year-old female was recently moved from her home of 65 years to a bedroom in her adult child's home. According to reports by family members, she is now 'cantankerous,' gets 'mixed up' easily, and cries for no apparent reason. The factor or factors in the patient history that are NOT consistent with delirium are:
Detailed Rationale
Delirium has acute onset, fluctuating course. Insidious, chronic progressive course suggests dementia. Medications, dehydration, environmental changes can trigger delirium.
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When developmental dysplasia of the hip (DDH) is suspected in a 1-month-old infant female, the nurse practitioner would expect to observe:
Detailed Rationale
Ortolani's maneuver (clunk with abduction) is positive in DDH in infants under 2-3 months. Asymmetric gluteal folds may be present but less specific. Limited abduction, not adduction.
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A 2-year-old child presents with persistent candidal diaper dermatitis. The child has been treated previously with several topical antifungal preparations in an attempt to clear the rash; nothing has been successful. The next step would be for the nurse practitioner to:
Detailed Rationale
Persistent candidal diaper rash despite treatment should prompt evaluation for underlying conditions like diabetes mellitus (glucosuria). Oral antibiotics would worsen candidiasis. Referral after ruling out systemic cause.
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The developmental task for the family of an adolescent is to:
Detailed Rationale
Family task for adolescents is to support increasing autonomy while maintaining connection, providing freedom with appropriate responsibility. Limits are needed but not the primary developmental task.
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Which of the following is the current recommendation for human immunodeficiency virus (HIV) screening during pregnancy?
Detailed Rationale
CDC and ACOG recommend opt-out HIV screening for all pregnant women at first prenatal visit, and repeat testing in third trimester for high-risk or in high-prevalence areas.
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Persistent symptoms of fatigue, lower extremity edema, and paroxysmal nocturnal dyspnea in a 48-year-old female patient would require an evaluation for:
Detailed Rationale
Paroxysmal nocturnal dyspnea + edema + fatigue suggest heart failure, often due to myocardial ischemia or cardiomyopathy. Aortic dissection presents with acute tearing chest pain; anxiety doesn't cause PND.
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A 65-year-old immunocompetent male with no underlying medical conditions presents in mid-October and requests the 'flu and pneumonia shots.' Record shows he received the influenza and PCV13 in January of the current year. The nurse practitioner recommends that he:
Detailed Rationale
PCV13 is not routinely recommended for immunocompetent adults >65 if already given. PPSV23 is given after PCV13 with minimum interval of 1 year. Influenza vaccine is annual.
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A 4-year-old female experienced a febrile seizure about 1 hour ago. The nurse practitioner informs the child's guardian that:
Detailed Rationale
Febrile seizures are benign in otherwise healthy children. The priority is identifying and treating the underlying cause of fever. Anticonvulsants are not indicated for simple febrile seizures.
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A nurse practitioner is counseling a patient on family planning. Which of the following women is LEAST likely to be at risk for inadequate micronutrient (e.g. vitamins and minerals) intake?
Detailed Rationale
Type 1 diabetes does not inherently increase risk of micronutrient deficiency if well-managed with balanced diet. Lactase deficiency (calcium/Vit D), bariatric surgery (multiple deficiencies), vegan diet (B12, iron, calcium) all increase deficiency risk.
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A 13-year-old patient was recently diagnosed with mild persistent asthma. The most effective drug combination to keep this child symptom-free is:
Detailed Rationale
Mild persistent asthma: daily low-dose ICS (controller) + SABA as needed for symptoms. ICS is the most effective anti-inflammatory. Cromolyn is alternative but less effective.
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Which of the following would NOT be included in the differential diagnosis list for a presentation of hyperthyroidism?
Detailed Rationale
Addison's disease (adrenal insufficiency) presents with fatigue, hypotension, hyperpigmentation - opposite of hyperthyroidism. Withdrawal syndrome can cause tachycardia/tremor; anticholinergic toxicity causes tachycardia/dry skin.
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When considering medications for a 42-year-old female, the choice that would NOT increase her risk for osteoporosis is:
Detailed Rationale
Escitalopram (SSRI) has minimal effect on bone density. PPIs (calcium absorption), antiepileptics (vitamin D metabolism), and glucocorticoids (bone resorption) increase osteoporosis risk.
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An 8-year-old male is on a catch-up schedule for immunizations. He returns today for his third hepatitis B injection. It has been 12 months since his second injection. The nurse practitioner should:
Detailed Rationale
If more than 5 months have elapsed between dose 2 and 3, give dose 3 as scheduled. No need to restart series. Serologic testing is not indicated for routine catch-up.
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A 63-year-old male patient presents for follow-up after a cerebrovascular accident. A neurologic examination identifies abnormalities in cranial nerves IX and X. This is likely to cause:
Detailed Rationale
CN IX (glossopharyngeal) and X (vagus) control swallowing and pharyngeal sensation. Damage causes dysphagia, risk of aspiration. Not constipation, salivation changes, or stricture.
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A 35-year-old female is concerned about her risk of developing breast cancer. The factor that is considered protective against breast cancer is:
Detailed Rationale
Breastfeeding is protective against breast cancer (relative risk reduction ~4% per 12 months). Oral contraceptives slightly increase risk. Self-exams don't affect risk; stature not clearly associated.
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The CAGE, MAST, and AUDIT questionnaires to detect problem drinking should be used:
Detailed Rationale
These validated tools are screening instruments to identify problem drinking and guide need for intervention. They are not diagnostic (C) nor detailed severity/pattern assessment (D).
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A 28-year-old female is considering pregnancy. She has been taking combined oral contraceptives for the last 5 years. The nurse practitioner advises her that after stopping the contraceptive, fertility should return:
Detailed Rationale
Fertility typically returns within 90 days after stopping OCPs. 80% of women conceive within 1 year. No long-term fertility impairment from OCP use.
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Precautions should be taken if a 65-year-old patient who wishes to receive the inactivated influenza vaccine (IIV):
Detailed Rationale
Influenza vaccine should be deferred in patients with moderate-to-severe acute illness with or without fever. Warfarin, COPD, CKD are not contraindications; intramuscular injection caution with bleeding disorders may be considered.
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The nurse practitioner examines a 6-year-old female who has had sore throat and fever for less than 24 hours. Based on the most common cause of pharyngitis in this age group, the most appropriate action is to:
Detailed Rationale
Viral pharyngitis is most common in children; supportive care is appropriate. Antibiotics only if GAS confirmed by testing. Asking about family members is not the most appropriate action.
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A 7-year-old child has had a 'slapped cheek' rash for the last 24 hours. During the physical exam, the NP identifies a bright red lacy-appearing rash on the upper trunk, back, and buttocks. The patient is afebrile and states that the rash does not itch. The nurse practitioner should instruct the mother to:
Detailed Rationale
Fifth disease (parvovirus B19) is contagious before rash appears. Once rash develops, child is no longer contagious. Pregnant women exposure is concern but child does not need to avoid them after rash.
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Which of the following is NOT an overarching goal of Healthy People 2030 as published by the U.S. Department of Health and Human Services?
Detailed Rationale
HP2030 goals focus on health equity, social determinants, and well-being. Specific provider accessibility is not an overarching goal; it's a strategy.
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A patient has a 24 pack year history of cigarette smoking and a chronic cough. The nurse practitioner suspects chronic obstructive pulmonary disease (COPD). The diagnostic criterion for COPD is an FEV1/FVC ratio of:
Detailed Rationale
GOLD criteria: post-bronchodilator FEV1/FVC < 0.70 (70%) confirms persistent airflow limitation. This is the diagnostic standard for COPD.
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A 16-year-old female presents with complaints of headache. A fundoscopic examination is performed. The nurse practitioner knows that a normal optic disc appears:
Detailed Rationale
Normal optic disc is yellowish-orange to creamy pink. Hyperemic suggests inflammation; pallor/white suggests optic atrophy.
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A 24-year-old patient is diagnosed with acute otitis media. The finding that strongly suggests rupture of the tympanic membrane as a result of infection is:
Detailed Rationale
Purulent or bloody otorrhea in setting of AOM indicates TM rupture. Yellow/erythematous/bulging/dull suggest AOM without perforation.
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Which one of the following symptoms is a common sign of a manic episode?
Detailed Rationale
Decreased need for sleep (often <4 hours) with high energy is characteristic of mania. Incomplete tasks may occur but not diagnostic; deflated self-esteem is depression; inappropriate answers occur in thought disorders.
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In an 11-year-old female, the earliest physical examination finding that is a secondary sexual characteristic is:
Detailed Rationale
Thelarche (breast development) is typically the first sign of puberty in girls, occurring around age 8-13. Pubic hair may appear simultaneously or slightly later. Menarche occurs later (average 12-13 years).
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In considering treatment goals for a 20-year-old patient with asthma, which of the following is considered secondary prevention?
Detailed Rationale
Secondary prevention aims to reduce impact of established disease. Preventing exacerbations is secondary prevention. Maintenance of daily activity and optimizing therapy are disease management goals.
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