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NEW GENERATION APEA 3P EXAMS REAL QUESTIONS AND ANSWERS
APEA 3P Exam all questions answered 100% correct
Which headache sign does not warrant an immediate investigation?
Answer: Relieved with use of common analgesics
Rationale:
Headaches that are relieved with common analgesics are usually primary headaches such as
tension-type headaches or migraines. These headaches are typically not associated with serious
underlying pathology and therefore do not warrant immediate investigation.
During a migraine, what happens to the cerebral arteries?
Answer: They dilate
Rationale:
During a migraine, cerebral arteries dilate, leading to increased blood flow to the brain, which
contributes to the headache pain.
You are evaluating a 15-year-old patient for bipolar disorder. His parents tell you that he has
severe mood swings, is easily distracted, and constantly corrects his teachers. You would have a
high suspicion for bipolar if which symptom was present?
Answer: He sleeps less than 4 hours nightly
Rationale:
Decreased need for sleep, often coupled with increased energy, is a common symptom of bipolar
disorder, particularly during manic episodes.
Which risk factor is not associated with breast cancer?
Answer: Low socioeconomic status
Rationale:
Low socioeconomic status is not a recognized independent risk factor for breast cancer.
However, it may indirectly influence risk due to barriers to healthcare and early detection.
A 26-year-old woman with bulimia is likely to be:
Answer: of average weight
Rationale:
Unlike anorexia nervosa, individuals with bulimia nervosa often maintain a relatively normal
weight or may be slightly overweight.

What medication is used to relieve acute wheezing in a patient with asthma?
Answer: Short-acting beta-agonist
Rationale:
Short-acting beta-agonists like albuterol are the first-line medications for relieving acute
bronchospasm and wheezing in asthma.
You are evaluating an 80-year-old patient for recent episodes of incontinence and confusion. His
family states that this is unusual for him, and he has become increasingly forgetful over the past
two weeks. Which medication might be responsible for this?
Answer: Tagamet (cimetidine)
Rationale:
Cimetidine (Tagamet) is an H2 receptor antagonist commonly used to treat peptic ulcers, but it
can have central nervous system side effects, including confusion and delirium, particularly in
elderly patients.
What suggests hyperandrogenism in an adolescent female?
Answer: Hirsutism
Rationale:
Hirsutism, or excessive hair growth in a male pattern, is a common sign of hyperandrogenism in
females.
Which is a synovial joint?
Answer: Shoulder
Rationale:
The shoulder joint is a classic example of a synovial joint. It is a ball-and-socket joint that allows
for a wide range of motion.
A 67-year-old woman with atrial fibrillation and an ejection fraction of 48% is on digoxin and
has had normal digoxin levels of 0.8 to 2 ng/dL for the past 9 months. Today, the level is 0.4
ng/dL. What could account for this change?
Answer: Regular use of an antacid
Rationale:
Antacids, especially aluminium hydroxide, can decrease the absorption of digoxin, leading to
decreased serum levels and potential loss of therapeutic effect.

Which medication is contraindicated in a child with acute sinusitis?
Answer: Nasal steroids
Rationale:
Nasal steroids are not recommended as first-line treatment for acute sinusitis in children. They
may be considered in chronic sinusitis but are not typically used in the acute phase.
Which best describes the lower extremity calf pain associated with peripheral artery disease?
Answer: Dull aching or cramping
Rationale:
Lower extremity calf pain associated with peripheral artery disease is typically described as a
dull, aching, or cramping pain that occurs with exertion and is relieved with rest, known as
intermittent claudication.
Jugular venous distention accompanied by chest pain is associated with:
Answer: Heart failure
Rationale:
Jugular venous distention (JVD) is a classic sign of fluid overload, which commonly occurs in
heart failure due to impaired cardiac function. Increased venous pressure from heart failure leads
to distension of the jugular veins, which can be observed on physical examination.
Which immunization protects against a virus that is transmitted through blood and body fluids
and can lead to chronic liver disease?
Answer: Hepatitis B
Rationale:
Hepatitis B immunization protects against the Hepatitis B virus (HBV), which is transmitted
through blood and body fluids. Chronic HBV infection can lead to chronic liver disease,
including cirrhosis and liver cancer.
A paediatric patient has areas of scaling on the scalp with round patches of hair loss.What is the
likely diagnosis?
Answer: Tinea capitis
Rationale:
Tinea capitis is a fungal infection of the scalp caused by dermatophytes. It presents with scaling,
erythema, and hair loss in round patches on the scalp. It is more common in children than adults.

Your 70-year-old patient complains of a sore mouth that prevents her from eating. On exam you
note a beefy red, glossy smooth tongue. What do you suspect?
Answer: Pernicious anemia due to insufficient intrinsic factor
Rationale:
The description of a beefy red, glossy smooth tongue is classic for glossitis, a common symptom
of pernicious anemia. Pernicious anemia is caused by a deficiency of intrinsic factor, which is
necessary for the absorption of vitamin B12 in the small intestine.
A 62-year-old male presents with leg pain and occasional numbness that is worse with
ambulation and improved with lumbar flexion. What is the likely diagnosis?
Answer: Spinal stenosis
Rationale:
The patient's symptoms are classic for neurogenic claudication, which is associated with spinal
stenosis. Spinal stenosis is the narrowing of the spinal canal, leading to compression of the spinal
cord and nerves, resulting in symptoms such as leg pain and numbness that worsen with
ambulation and improve with lumbar flexion.
Which is not a typical symptom of late-stage HIV?
Answer: Persistent vomiting
Rationale:
Late-stage HIV infection is characterized by severe immunosuppression, leading to opportunistic
infections and malignancies. While gastrointestinal symptoms are common, persistent vomiting
is not typically associated with late-stage HIV. Common gastrointestinal symptoms include
diarrhoea, abdominal pain, and weight loss.
A pregnant patient presents for her 16-week prenatal visit. Her blood pressure had reduced from
118/79 to 109/68. What hemodynamic change is responsible for this?
Answer: Decrease in systemic vascular resistance
Rationale:
During pregnancy, there is a decrease in systemic vascular resistance due to hormonal changes
and increased blood volume. This decrease in systemic vascular resistance leads to a decrease in
blood pressure, which is a normal physiological adaptation to pregnancy.

Your 62-year-old patient has been taking Griseofulvin 500 mg po BID for 3 weeks to treat tinea
capitis and has only had marginal improvement. What is your next step?
Answer: Continue the current therapy for 6-8 weeks
Rationale:
Treatment for tinea capitis typically requires prolonged therapy, often for 6-8 weeks.
Griseofulvin is an antifungal medication commonly used to treat tinea capitis. Marginal
improvement after 3 weeks of therapy is not uncommon, and continuing the current therapy for
the recommended duration is appropriate.
Rapid HIV testing would be most appropriate for a patient with complaints of:
Answer: Painful urination, dyspareunia, and penile or vaginal discharge
Rationale:
Rapid HIV testing would be appropriate for patients with symptoms suggestive of acute HIV
infection, such as painful urination, dyspareunia, and penile or vaginal discharge. Rapid testing
allows for quick identification of HIV infection, enabling early intervention and prevention of
further transmission.
What is a frequent side effect of SSRIs?
Answer: Sexual dysfunction
Rationale:
Sexual dysfunction, including decreased libido, delayed ejaculation, and anorgasmia, is a
common side effect of selective serotonin reuptake inhibitors (SSRIs). It is thought to be due to
the increased serotonin levels in the brain, which can interfere with sexual function.
You might suspect small bowel obstruction in a patient who complains of:
Answer: Vomiting and pain
Rationale:
Small bowel obstruction typically presents with symptoms of crampy abdominal pain, distension,
nausea, and vomiting. Vomiting is a prominent symptom due to the blockage of the small
intestine, and pain is caused by the increased pressure in the obstructed bowel.
What finding would be suggestive of osteosarcoma in a paediatric patient?
Answer: Pain in the affected bone
Rationale:

Osteosarcoma, a primary malignant bone tumor, often presents with localized pain in the affected
bone. The pain may worsen at night and may be associated with swelling and decreased range of
motion.
What clinical manifestation suggests primary syphilis?
Answer: Chancre
Rationale:
Primary syphilis is characterized by the development of a painless, indurated ulcer called a
chancre at the site of infection, typically on the genitals, anus, or mouth. The chancre is usually
solitary and persists for 3-6 weeks before resolving spontaneously.
What medication is used first-line for a patient with benign positional vertigo?
Answer: Meclizine
Rationale:
Meclizine, an antihistamine, is commonly used as the first-line treatment for benign paroxysmal
positional vertigo (BPPV). It helps alleviate vertigo symptoms by blocking histamine receptors
in the brain.
Which symptom is most associated with testicular torsion?
Answer: Testicular pain
Rationale:
Testicular torsion is a surgical emergency characterized by severe, sudden onset testicular pain,
often accompanied by scrotal swelling and nausea/vomiting. The affected testicle may appear
higher than normal and the cremasteric reflex may be absent.
A clinical breast exam should include palpation at the tail of Spence. Where is this located?
Answer: Laterally across the anterior axillary fold
Rationale:
The tail of Spence is an extension of the breast tissue into the axilla (armpit) that extends laterally
across the anterior axillary fold. Palpating this area during a clinical breast exam is important for
detecting any abnormalities.
Which area does not drain to the right lymph duct?
Answer: The right leg
Rationale:

The right lymphatic duct drains lymph from the right side of the head, neck, and thorax, as well
as the right upper extremity. However, lymph from the lower extremities, including the legs,
drains into the thoracic duct.
Which presentation is most suspicious for penile cancer?
Answer: A nontender, indurated penile nodule
Rationale:
Penile cancer often presents as a painless, indurated nodule or ulcer on the glans or shaft of the
penis. Other symptoms may include bleeding, discharge, and phimosis.
What is important to consider before prescribing metronidazole for giardiasis?
Answer: Whether the patient drinks alcohol
Rationale:
Metronidazole is an antiprotozoal medication commonly used to treat giardiasis. However, it can
cause a disulfiram-like reaction when consumed with alcohol, leading to symptoms such as
nausea, vomiting, flushing, and headache. Therefore, patients should be advised to avoid alcohol
while taking metronidazole and for 48 hours after completing the course of treatment.
In which condition would the use of triptans for migraine headaches be contraindicated?
Answer: Hypertension
Rationale:
Triptans are contraindicated in patients with uncontrolled hypertension due to their
vasoconstrictive effects, which could potentially worsen hypertension and increase the risk of
cardiovascular events.
Which is a true statement about varicose veins?
Answer: They are more symptomatic during ovulation.
Rationale:
Varicose veins may worsen during ovulation due to hormonal changes that increase venous
pressure. This can lead to symptoms such as pain, heaviness, and swelling in the legs.
When measuring the fundal height of a pregnant woman at 32 weeks, which measurement would
prompt the nurse practitioner to suspect fetal growth restriction?
Answer: 29 cm
Rationale:

At 32 weeks gestation, the fundal height in centimeters should be roughly equivalent to the
number of weeks of gestation. A fundal height measurement significantly less than expected may
suggest fetal growth restriction and should prompt further evaluation.
What is the term for excess fluid that accumulates in the pleural cavity between the visceral and
parietal spaces?
Answer: Pleural effusion
Rationale:
A pleural effusion is an abnormal accumulation of fluid in the pleural cavity, the space between
the visceral and parietal pleura of the lungs. It can result from various medical conditions,
including congestive heart failure, pneumonia, and malignancy.
Which pathogen is associated with common UTIs?
Answer: E. coli
Rationale:
Escherichia coli (E. coli) is the most common pathogen associated with urinary tract infections
(UTIs), accounting for approximately 80-90% of cases. Other pathogens, such as Klebsiella,
Proteus, and Enterococcus species, may also cause UTIs, but E. coli is the most frequently
isolated organism.
Which medication inhibits blood coagulation by selectively blocking the active site of factor X?
Answer: Eliquis (apixaban)
Rationale:
Apixaban is a direct factor Xa inhibitor that inhibits blood coagulation by selectively and
reversibly blocking the active site of factor Xa, thereby preventing the conversion of
prothrombin to thrombin and the subsequent formation of fibrin clots.
Which is a contraindication for menopausal estrogen replacement therapy in a 55-year-old
woman?
Answer: Prior breast or uterine carcinoma
Rationale:
Estrogen replacement therapy is contraindicated in women with a history of estrogen-dependent
cancers, such as breast or uterine carcinoma, due to the potential for hormone stimulation of
residual cancer cells, which could lead to cancer recurrence or progression.

During an abdominal exam, which sound over the bulging area of the abdomen would indicate
ascitic fluid?
Answer: Dullness
Rationale:
Dullness on percussion indicates the presence of fluid or solid tissue beneath the surface being
tapped. In the case of ascitic fluid in the abdomen, dullness would be heard over the bulging area
due to the presence of fluid.
What is a typical finding in a patient with a meniscal tear?
Answer: Positive McMurray's test
Rationale:
McMurray's test is used to assess for meniscal tears in the knee joint. A positive McMurray's test
is indicated by a clicking or popping sound along with pain or a palpable click during the
maneuver, suggesting a tear of the meniscus.
What is the most common presenting symptom of a woman with trichomoniasis?
Answer: Vaginal discharge
Rationale:
The most common presenting symptom of trichomoniasis in women is a frothy, malodorous
vaginal discharge, typically described as greenish-yellow in color. Other symptoms may include
vulvar itching, dysuria, and dyspareunia.
What is the single-dose treatment for chlamydia?
Answer: Zithromax (azithromycin) 1 g Po
Rationale:
Azithromycin 1 g PO as a single dose is one of the recommended treatments for uncomplicated
chlamydia infection according to CDC guidelines. Alternatively, doxycycline 100 mg PO twice
daily for 7 days is also an effective treatment option.
What is the mechanism of action of prostaglandin E1 in a patient with transposition of the great
arteries?
Answer: To produce vasodilation and adequate oxygen saturation
Rationale:

In transposition of the great arteries, prostaglandin E1 (PGE1) is used to maintain patency of the
ductus arteriosus, allowing for mixing of oxygenated and deoxygenated blood in the systemic
circulation, thereby improving oxygen saturation.
How do 5-alpha-reductase inhibitors work to reduce the symptoms of BPH?
Answer: Decrease the size of the prostate
Rationale:
5-alpha-reductase inhibitors, such as finasteride and dutasteride, work by inhibiting the
conversion of testosterone to dihydrotestosterone (DHT), which is responsible for prostate
growth. By reducing DHT levels, these medications can shrink the prostate gland, relieving
symptoms of benign prostatic hyperplasia (BPH).
Which condition is best treated by using alpha-adrenergic antagonists?
Answer: Overflow incontinence
Rationale:
Alpha-adrenergic antagonists, such as tamsulosin and alfuzosin, are commonly used to treat
overflow incontinence by relaxing the smooth muscle of the bladder neck and prostate,
improving urinary flow and reducing symptoms of urinary retention.
What should not be prescribed for migraine prophylaxis in a 42-year-old woman?
Answer: Amitriptyline (Elavil)
Rationale:
Amitriptyline is a tricyclic antidepressant that can be used for migraine prophylaxis, but it may
not be the best choice for a 42-year-old woman due to its side effect profile, which includes
anticholinergic effects and potential for cardiac arrhythmias. Other options such as beta-blockers,
calcium channel blockers, or antiepileptic drugs may be more appropriate.
How would a 60-year-old man typically describe prostate pain?
Answer: Located in the perineum
Rationale:
Prostate pain in a 60-year-old man is typically described as discomfort or pain located in the
perineum, the area between the scrotum and anus. This may be due to prostatitis or benign
prostatic hyperplasia (BPH).
What is the most common characteristic among patients with migraine headache?

Answer: Family history
Rationale:
A family history of migraine headache is the most common characteristic among patients with
migraines. Genetic factors play a significant role in the development of migraines, and
individuals with a family history of migraines are more likely to experience them themselves.
Which patient would be at the highest risk for contracting TB?
Answer: A low-income immigrant
Rationale:
Individuals with lower socioeconomic status, including low-income immigrants, are at higher
risk for tuberculosis (TB) due to factors such as crowded living conditions, poor nutrition,
limited access to healthcare, and higher prevalence of latent TB infection in their countries of
origin.
Which is not a location of pain associated with kidney and ureter disorders?
Answer: Suprapubic
Rationale:
Pain associated with kidney and ureter disorders typically presents in the flank, lower abdomen,
and groin. Suprapubic pain is more commonly associated with bladder disorders, such as cystitis
or bladder cancer.
Which medication is appropriate for a woman with bladder sphincter dysfunction and stress
incontinence?
Answer: Urispas (flavoxate)
Rationale:
Flavoxate is an anticholinergic medication used to treat bladder spasms and urinary incontinence
by relaxing the smooth muscle of the bladder. It helps reduce symptoms of urgency, frequency,
and urge incontinence associated with bladder sphincter dysfunction and stress incontinence.
Which condition is associated with chronic, bloody diarrhea?
Answer: Crohn's disease
Rationale:

Crohn's disease is a chronic inflammatory bowel disease (IBD) characterized by inflammation of
the digestive tract, leading to symptoms such as abdominal pain, diarrhea, and in some cases,
bloody stools.
Which medication is indicated for patients with Generalized Anxiety Disorder (GAD)?
Answer: Buspirone (Buspar)
Rationale:
Buspirone is a medication commonly used to treat generalized anxiety disorder (GAD). It is a
serotonin receptor agonist and has anxiolytic effects without causing significant sedation or
dependence.
At what point in pregnancy should Rh negative women receive Rhogam (Rho D immune
globulin)?
Answer: 28 weeks
Rationale:
Rh negative women should receive Rhogam (Rho D immune globulin) at 28 weeks of pregnancy
to prevent hemolytic disease of the newborn.
Which is common among patients with psoriasis?
Answer: pitted nails and plaques
Rationale:
Psoriasis is a chronic autoimmune condition characterized by red, itchy, and scaly skin patches.
Pitted nails and plaques are common clinical manifestations of psoriasis.
What historical finding may predispose a patient to testicular cancer?
Answer: cryptorchidism
Rationale:
Cryptorchidism, or undescended testicle, is a known risk factor for testicular cancer. Men with a
history of cryptorchidism have an increased risk of developing testicular cancer compared to
those without this condition.
What would you advise for a patient taking an oral glucocorticoid?
Answer: take it with food
Rationale:

Taking oral glucocorticoids with food can help minimize gastrointestinal irritation and reduce the
risk of ulcers.
A child with enuresis should be treated with nasal desmopressin (DDAVP) for which symptom?
Answer: nocturnal enuresis
Rationale:
Nasal desmopressin (DDAVP) is indicated for the treatment of nocturnal enuresis (bedwetting) in
children.
Which medication is contraindicated in a patient with sulfa allergy?
Answer: silver sulfadiazine (Silvadene)
Rationale:
Silver sulfadiazine contains a sulfa moiety and is contraindicated in patients with a known sulfa
allergy due to the risk of allergic reaction.
What is likely to be elevated in a woman with polycystic ovarian syndrome?
Answer: insulin
Rationale:
Insulin levels are often elevated in women with polycystic ovarian syndrome (PCOS),
contributing to insulin resistance, which is a common feature of the condition.
Which medication should not be prescribed during an acute gout flare?
Answer: Allopurinol
Rationale:
Allopurinol is a xanthine oxidase inhibitor used to prevent gout attacks by reducing uric acid
levels. However, it should not be initiated or adjusted during an acute gout flare as it can worsen
symptoms.
A Hispanic woman at 26 weeks of pregnancy tells you that she has been eating ice. What should
the NP do?
Answer: check the patient for anemia
Rationale:
Pica, the craving and consumption of non-food items such as ice, can be a sign of iron deficiency
anemia. Checking the patient for anemia is indicated in this scenario.

A 40-year-old female patient has breasts with a soft texture but uneven contour bilaterally. What
is the most likely diagnosis?
Answer: cystic breasts
Rationale:
Cystic breasts are characterized by soft breast tissue with uneven contours due to the presence of
cysts. This condition is common and usually benign.
What test of renal function is the best measure of renal insufficiency?
Answer: 24-hour creatinine clearance
Rationale:
24-hour creatinine clearance is considered the gold standard for assessing renal function as it
provides an accurate measure of the glomerular filtration rate (GFR), which reflects overall
kidney function.
You are seeing a 63-year-old male who has decreased chest expansion, symmetric thorax with
moderate kyphosis, and bilateral diaphragm distention of 2 cm. What is the most likely
diagnosis?
Answer: COPD
Rationale:
The clinical presentation described is consistent with chronic obstructive pulmonary disease
(COPD), characterized by decreased chest expansion, thoracic deformities, and diaphragmatic
flattening.
Which cranial nerves are assessed when assessing bilateral eye movement?
Answer: III, IV, and VI
Rationale:
Cranial nerves III (oculomotor), IV (trochlear), and VI (abducens) are responsible for controlling
the movements of the eyes. Assessment of these cranial nerves is necessary to evaluate bilateral
eye movement.
What pathological finding is noted in asthma?
Answer: hypertrophy of smooth muscle
Rationale:

Asthma is characterized by chronic inflammation of the airways, bronchoconstriction, and
increased mucus production. Hypertrophy of smooth muscle in the bronchi is a pathological
finding associated with asthma.
Which type of incontinence is most likely in a patient with Alzheimer's disease who cannot reach
the toilet in time?
Answer: Functional
Rationale:
Functional incontinence occurs when a person is aware of the need to urinate but cannot reach
the toilet in time due to physical or cognitive impairments, such as those seen in Alzheimer's
disease.
Using GTPAL nomenclature, how would you document a patient currently pregnant with a
history of an uncomplicated term vaginal delivery, preterm delivery of liveborn twins, and an 8week elective abortion?
Answer: G4 T1 P1 A1 L3
Rationale:
G (Gravida) 4 (current pregnancy plus history of previous pregnancies), T (Term births) 1
(uncomplicated term vaginal delivery), P (Preterm births) 1 (preterm delivery of liveborn twins),
A (Abortions) 1 (8-week elective abortion), L (Living children) 3 (liveborn twins from the
preterm delivery).
The right lymphatic ducts drain into what part of the circulatory system?
Answer: Venous
Rationale:
The right lymphatic duct drains lymph from the right upper limb, the right side of the thorax, and
the right halves of the head and neck directly into the venous circulation, specifically into the
right subclavian vein.
What is the most likely presenting symptom in a pediatric patient with croup?
Answer: A barking cough
Rationale:
Croup is characterized by a barking cough, which is typically the most prominent and distinctive
symptom. Other symptoms may include inspiratory stridor and hoarseness.

Which medication targets postprandial glucose by blocking its transport across the intestine into
the bloodstream?
Answer: Acarbose (Precose)
Rationale:
Acarbose is an alpha-glucosidase inhibitor that delays the digestion of carbohydrates, thereby
reducing the postprandial rise in blood glucose levels by inhibiting the enzyme alpha-glucosidase
in the intestines.
Which type of insulin will help to reduce nocturnal hypoglycemia?
Answer: Long-acting
Rationale:
Long-acting insulins, such as insulin glargine (Lantus) and insulin detemir (Levemir), provide a
basal level of insulin over an extended period, which can help to prevent nocturnal hypoglycemia
by providing a steady level of insulin throughout the night.
What symptoms in a college student living in a dorm would be suspicious for atypical
community-acquired pneumonia?
Answer: Temp of 101.2, sore throat, and diminished lung sounds on auscultation
Rationale:
Atypical community-acquired pneumonia may present with symptoms such as low-grade fever,
sore throat, and non-specific respiratory symptoms, as well as findings such as diminished lung
sounds on auscultation.
How would you describe the lesions of condyloma acuminata in a male patient?
Answer: Multiple papular lesions with a verrucous appearance
Rationale:
Condyloma acuminata, caused by human papillomavirus (HPV), presents as multiple papular or
verrucous lesions on the genitalia. In males, these lesions often have a verrucous appearance and
can occur on the penis, scrotum, or perianal area.
When performing a visual acuity test, the nurse practitioner notes 20/30 in the left eye and 20/60
in the right eye. The next step is to:
Answer: Refer the patient to an ophthalmologist
Rationale:

A significant difference in visual acuity between the two eyes (anisometropia) warrants further
evaluation by an ophthalmologist to rule out any underlying pathology.
The American Psychiatric Association's Diagnostic and Statistical Manual Disorder fifth edition
(DSM-5) describes Munchausen Syndrome by Proxy as:
Answer: A caregiver making up or causing an illness or injury in a person under his or her care
Rationale:
Munchausen Syndrome by Proxy involves a caregiver, often a parent, fabricating or inducing
illness or injury in someone under their care to gain attention or sympathy.
Symptoms of depression are a side effect of which neurotransmitter medication?
Answer: Dopamine
Rationale:
Dopamine is not typically associated with symptoms of depression; however, medications that
decrease dopamine levels, such as certain antipsychotics, can lead to depressive symptoms as a
side effect.
Which lesion is dark, raised, and asymmetric with irregular borders?
Answer: Melanoma
Rationale:
Melanoma is characterized by darkly pigmented, asymmetric lesions with irregular borders.
Other features include a diameter greater than 6 mm and evolving or changing lesions.
A pediatric patient has areas of scaling on the scalp, with round patches of alopecia. This clinical
finding is consistent with:
Answer: Tinea capitis
Rationale:
Tinea capitis, a fungal infection of the scalp, commonly presents with scaling and circular
patches of alopecia. Other findings may include broken-off hairs, erythema, and pruritus.
A patient with an acute presentation of acute aortic regurgitation (AR) typically presents with
sudden severe shortness of breath, lower extremity edema, a rapid heartbeat, and:
Answer: Chest pain
Rationale:

Acute aortic regurgitation (AR) can cause sudden severe shortness of breath, lower extremity
edema, a rapid heartbeat, and chest pain due to the sudden increase in left ventricular volume and
pressure.
Which of the following conditions is associated with chronic bloody diarrhea?
Answer: Crohn's disease
Rationale:
Crohn's disease, a form of inflammatory bowel disease (IBD), can present with chronic bloody
diarrhea, along with abdominal pain, weight loss, and other gastrointestinal symptoms.
Which condition is caused by an insufficient production of intrinsic factor by the gastric mucosa
and vitamin B12 insufficiency?
Answer: Pernicious anemia
Rationale:
Pernicious anemia is caused by a lack of intrinsic factor, which is necessary for the absorption of
vitamin B12. Without intrinsic factor, vitamin B12 deficiency occurs, leading to anemia and
neurological symptoms.
A 32-year-old woman presents with dull puffiness of the eyes with pronounced non-pitting
periorbital edema. This finding is suggestive of what condition?
Answer: Myxedema
Rationale:
Dull puffiness of the eyes with pronounced non-pitting periorbital edema is a classic finding in
myxedema, which is a severe form of hypothyroidism.
A 52-year-old woman is inquiring about estrogen replacement therapy for symptoms of
menopause. Which of the following is a contraindication?
Answer: Prior breast or uterine carcinoma
Rationale:
Estrogen replacement therapy is contraindicated in patients with a history of breast or uterine
carcinoma due to the potential for estrogen to stimulate the growth of hormone-sensitive tumors.
Patients with asthma have a pathological finding of:
Answer: Hypertrophy of smooth muscle
Rationale:

In asthma, chronic inflammation of the airways leads to hypertrophy and hyperreactivity of
smooth muscle, contributing to airway narrowing and airflow limitation.
A 65-year-old patient with a history of deep vein thrombosis (DVT) is being treated for a dental
abscess. Which antibiotic is safe to use with warfarin (Coumadin)?
Answer: Amoxicillin (Amoxil)
Rationale:
Amoxicillin is safe to use with warfarin because it does not significantly interact with the
metabolism of warfarin, unlike other antibiotics that may potentiate its anticoagulant effect.
What is the area of fundal height palpation on a woman who is 12 weeks pregnant?
Answer: At the level of the symphysis pubis (12 weeks)
Rationale:
At 12 weeks of gestation, the fundal height is at the level of the symphysis pubis, corresponding
approximately to the height of the uterus at this stage of pregnancy.
Which of the following is NOT associated with assessment findings in a patient with diabetic
retinopathy?
Answer: Papilledema (swelling of the optic nerve/optic disc)
Rationale:
Diabetic retinopathy is characterized by microaneurysms, hemorrhages, exudates, and
neovascularization, but it is not associated with papilledema, which is swelling of the optic
nerve/optic disc typically seen in conditions like increased intracranial pressure.
A 3-year-old child has enterobiasis (PINWORM). When should the dose of mebendazole
(Vermox) be repeated?
Answer: In 2 weeks
Rationale:
The dose of mebendazole for enterobiasis (pinworm) is usually repeated in 2 weeks to ensure
eradication of the parasite and prevent reinfection.
Which area does not allow lymphatic fluid to be drained from the right lymph duct?
Answer: The right leg
Rationale:

The right lymphatic duct drains lymph from the right upper limb, the right side of the thorax, and
the right halves of the head and neck, but not from the right leg. Lymph from the right leg is
drained by the right inguinal lymph nodes.
Snellen chart evaluation indicates that a patient's vision is 20/30. What is the proper description
of this result?
Answer: At 20 feet, this patient can see what a person with normal vision can see at 30 feet
Rationale:
A Snellen visual acuity of 20/30 means that the patient can see at 20 feet what a person with
normal vision can see at 30 feet.
Based on the mechanism of hearing, sensorineural loss in an adult involves the:
Answer: Cochlea and the cochlear nerve
Rationale:
Sensorineural hearing loss involves damage to the cochlea (the sensory organ for hearing) or the
cochlear nerve (the nerve that carries auditory information from the cochlea to the brain).
Which is the appropriate medication choice for a 31-year-old pregnant patient diagnosed with a
urinary tract infection?
Answer: Nitrofurantoin (Macrobid) or Ciprofloxacin (Cipro)
Rationale:
Nitrofurantoin (Macrobid) and Ciprofloxacin (Cipro) are both commonly used antibiotics for the
treatment of urinary tract infections in pregnant women. Nitrofurantoin is preferred in the first
trimester, while Ciprofloxacin is considered safe in the second and third trimesters.
Pregnant women are evaluated for syphilis with serology testing because?
Answer: Syphilis during pregnancy predisposes the fetus to spontaneously abort or the newborn
to have congenital syphilis.
Rationale:
Untreated syphilis in pregnancy can result in congenital syphilis, which can lead to serious
complications such as stillbirth, neonatal death, and congenital abnormalities.
Which of the following is a typical finding in a patient with a meniscal tear?
Answer: A positive McMurray's test
Rationale:

A positive McMurray's test, characterized by a click or pop with pain along the joint line during
knee flexion and extension, is a typical finding in patients with a meniscal tear.
Hyperkalemia is associated with:
Answer: Diminished renal function
Rationale:
Hyperkalemia is often associated with diminished renal function because the kidneys play a
crucial role in potassium regulation and excretion.
Short bands of tough, flexible, ropelike, collagen fibrils that connect two bones is called:
Answer: Ligaments
Rationale:
Ligaments are short bands of tough, flexible, ropelike, collagen fibrils that connect two bones
and help stabilize joints.
The finding of a dome-shaped lesion in the dermis that forms a benign closed, firm sac attached
to the epidermis is?
Answer: A cutaneous cyst
Rationale:
A cutaneous cyst is a dome-shaped lesion in the dermis that forms a benign closed, firm sac
attached to the epidermis. It contains fluid, semisolid material, or keratin.
Vitamins prescribed for pregnant women should contain what two components?
Answer: Folic acid and Iron
Rationale:
Folic acid and iron are essential components of prenatal vitamins prescribed for pregnant women.
Folic acid helps prevent neural tube defects, while iron helps prevent anemia.
A prostate gland that is found to be tender, swollen, boggy, and warm on a digital rectal exam is
consistent with:
Answer: Acute bacterial prostatitis
Rationale:
Acute bacterial prostatitis typically presents with a tender, swollen, boggy, and warm prostate
gland on digital rectal examination, along with symptoms such as fever, chills, dysuria, and
urinary frequency.

Which medication can cause a false positive result for amphetamines in a urine drug screen?
Answer: Bupropion
Rationale:
Bupropion, an antidepressant and smoking cessation aid, can cause a false positive result for
amphetamines in a urine drug screen due to its structural similarity to amphetamines.
Fine, silky appearance of the hair is a common finding in:
Answer: Hyperthyroidism
Rationale:
Hyperthyroidism is associated with fine, silky hair due to increased metabolic activity and
stimulation of hair growth by thyroid hormones.
Which of the following is commonly associated with an increased risk for prostatic hypertrophy?
Answer: Urinary tract infections
Rationale:
Urinary tract infections are commonly associated with an increased risk for prostatic
hypertrophy, which can lead to symptoms of benign prostatic hyperplasia (BPH) such as urinary
frequency, urgency, and hesitancy.
Patients with bacterial meningitis experience headache symptoms due to:
Answer: Increased intracranial pressure
Rationale:
Headache in bacterial meningitis is caused by increased intracranial pressure resulting from
inflammation and edema of the meninges.
What diagnostic test is performed to diagnose acute lymphocytic leukemia (ALL)?
Answer: A bone marrow examination
Rationale:
A bone marrow examination is performed to diagnose acute lymphocytic leukemia (ALL) by
assessing the presence of abnormal lymphoblasts in the bone marrow.
Which of the following medications should NOT be prescribed during an acute gout flare?
Answer: Allopurinol (Zyloprim)
Rationale:

Allopurinol is a xanthine oxidase inhibitor used for chronic management of gout by reducing uric
acid levels. However, it should not be prescribed during an acute gout flare as it can exacerbate
symptoms.
What is the appropriate prophylactic medication for an 18-year-old woman with a past medical
history of migraine headache?
Answer: Propranolol
Rationale:
Propranolol is a beta-blocker commonly used for migraine prophylaxis due to its ability to reduce
the frequency and severity of migraine attacks.
Which of the following is the single-dose treatment for a patient diagnosed with chlamydia?
Answer: Azithromycin (Zithromax) 1 gram orally
Rationale:
Azithromycin is the preferred single-dose treatment for chlamydia infection due to its high
efficacy and convenience of administration.
The nurse practitioner prescribes deferoxamine (Desferal) for a pediatric patient with betathalassemia and hemosiderosis because the medication:
Answer: Eliminates excessive iron and prevents organ damage.
Rationale:
Deferoxamine (Desferal) is a chelating agent used to treat iron overload in patients with
conditions such as beta-thalassemia and hemosiderosis. It works by binding to excess iron in the
body and promoting its excretion, thereby preventing organ damage caused by iron
accumulation.
The combination of benzoyl peroxide and erythromycin is prescribed for acne because benzoyl
peroxide:
Answer: Decreases the risk of resistance to erythromycin
Rationale:
Benzoyl peroxide has both antibacterial and keratolytic properties, making it an effective
treatment for acne. When combined with erythromycin, it reduces the risk of bacterial resistance
to erythromycin.
Which of the following conditions is NOT associated with the symptom of hemoptysis?

Answer: Viral pneumonia
Rationale:
Hemoptysis, or coughing up blood, is associated with conditions such as tuberculosis, lung
cancer, and pulmonary embolism, but it is not typically associated with viral pneumonia.
Why would a combined hormonal contraceptive be contraindicated in a 36-year-old patient with
a past medical history of Type 2 diabetes, obesity, current smoking, and sedentary lifestyle?
Answer: Her age and tobacco use
Rationale:
Combined hormonal contraceptives are contraindicated in women over 35 years old who smoke
due to an increased risk of cardiovascular events such as myocardial infarction and stroke.
During the breast examination of a perimenopausal woman, the NP detects a bloody spontaneous
discharge from the right nipple. This indicates further evaluation for:
Answer: An intraductal papilloma (a small, benign tumor that forms in a milk duct in the breast)
Rationale:
Bloody spontaneous discharge from the nipple is concerning for an underlying breast pathology,
such as an intraductal papilloma, which may require further evaluation with imaging studies and
possibly biopsy.
A 26-year-old woman complains of acute right lower abdominal pain. Which of the following
conditions is NOT associated with this symptom?
Answer: Irritable bowel syndrome
Rationale:
Irritable bowel syndrome typically presents with chronic, recurrent abdominal pain that is often
relieved by defecation and not specifically localized to the right lower quadrant.
During an abdominal examination, the nurse practitioner percusses the bulging area of the
abdomen. Which sound suggests the presence of ascitic fluid?
Answer: Dullness
Rationale:
Dullness on percussion of a bulging area of the abdomen suggests the presence of ascitic fluid,
which is commonly seen in conditions such as liver cirrhosis and malignancy.
What is the drug of choice for the paediatric patient diagnosed with scabies?

Answer: Permethrin (Nix) cream
Rationale:
Permethrin cream is the drug of choice for the treatment of scabies in both adults and children
due to its safety and efficacy.
When interpreting a complete blood count (CBC) lab report, which of the following results
describes the size of the RBCs?
Answer: Mean corpuscular volume (MCV)
Rationale:
The mean corpuscular volume (MCV) is a measure of the average size of red blood cells (RBCs)
in a blood sample.
What medication should be avoided when prescribing prophylactic therapy for headache in a
patient with a past history of asthma and chronic migraines?
Answer: Propranolol
Rationale:
Propranolol is a beta-blocker that can exacerbate asthma symptoms and is contraindicated in
patients with a history of asthma.
A nonpregnant woman diagnosed with trichomoniasis should be treated with:
Answer: Metronidazole (Flagyl)
Rationale:
Metronidazole is the treatment of choice for trichomoniasis in both men and women.
A 17-year-old is diagnosed with mild bronchospasm. Which of the following would provide
relief?
Answer: Inhaled levalbuterol (Xopenex)
Rationale:
Inhaled short-acting beta agonists such as levalbuterol provide rapid relief of bronchospasm by
relaxing the smooth muscles of the airways.
Which patient causes the greatest concern for complications related to scoliosis?
Answer: 17-year-old girl with a 10-degree curve
Rationale:

Although a 10-degree curve is considered mild, scoliosis in a 17-year-old girl is concerning
because she is still growing. Without appropriate intervention, there is a risk that the curvature
may progress and cause complications.
Which of the following complaints best describes lower extremity calf pain associated with
peripheral artery disease?
Answer: A dull pain or cramp
Rationale:
Lower extremity calf pain associated with peripheral artery disease is typically described as a
dull pain or cramp that occurs with exertion and is relieved with rest.
The immunization that protects against the contagious disease that causes fever, headache, stiff
neck, photophobia, and altered mental status is?
Answer: Meningococcal vaccine
Rationale:
Meningococcal vaccine protects against Neisseria meningitidis, the contagious bacterium that
can cause meningitis, characterized by fever, headache, stiff neck, photophobia, and altered
mental status.
A 75-year-old man who recently lost his spouse of 50 years in an auto accident tells the nurse
practitioner that he "has no purpose in this life". The next most appropriate question for the nurse
practitioner to ask is:
Answer: "Have you thought about hurting yourself?"
Rationale:
The patient's statement raises concerns about suicidal ideation. Asking directly about thoughts of
self-harm or suicide is crucial to assess the patient's risk and initiate appropriate interventions if
necessary.
Which of the following conditions is NOT a typical finding of hyperprolactinemia in a 47-yearold premenopausal woman?
Answer: Gynecomastia
Rationale:

Gynecomastia is the development of breast tissue in males and is not a typical finding of
hyperprolactinemia in women. Typical findings in women with hyperprolactinemia include
amenorrhea, galactorrhea, and infertility.
Which structure in the eye is affected by cataract disease?
Answer: The lens
Rationale:
Cataract disease affects the lens of the eye, causing it to become cloudy or opaque, leading to
blurred vision and visual impairment.
Which medication is used as an anticoagulant reversal agent for dabigatran etexilate (Pradaxa)?
Answer: Idarucizumab (Praxbind)
Rationale:
Idarucizumab is a specific reversal agent for dabigatran etexilate (Pradaxa), a direct thrombin
inhibitor, used to reverse its anticoagulant effects in cases of life-threatening bleeding or
emergency surgery.
Which immunization reduces a patient's risk for infection with the virus that causes a painful,
localized, blistering rash?
Answer: Shingles (herpes zoster) vaccine
Rationale:
The shingles vaccine reduces the risk of developing herpes zoster, a painful, localized, blistering
rash caused by reactivation of the varicella-zoster virus, which also causes chickenpox.
A 34-year-old man presents with complaints of abdominal pain. The nurse practitioner suspects
hemorrhagic pancreatitis due to the finding of superficial edema, bruising around the umbilicus,
and what other assessment finding?
Answer: A positive Cullen's sign (Cullen's sign is superficial edema and bruising)
Rationale:
Cullen's sign, which is superficial edema and bruising around the umbilicus, is a classic finding
of hemorrhagic pancreatitis, along with Grey Turner's sign (ecchymosis of the flanks). These
signs indicate intra-abdominal hemorrhage and are associated with severe pancreatitis and
pancreatic necrosis.

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