Domain 1: APRN Core Competencies

1. Mr. Keller has been in the CCU for 3 days, and he is

progressing well. During rounds, you note that he is leaning
forward in his bed. When you ask him why he is leaning
forward, he states that he has constant chest pain that worsens
with deep inspiration. He reports that leaning forward is the only
position that seems to provide him with some relief. vital signs
include BP 120/80, HR 114, RR 22, and Sp02 98% on 2 L NC.
A 12-Iead EKG reveals widespread ST-segment elevations.
Which of the following is the most likely diagnosis?
a) Costochondritis
b) Pneumonia
c) Extension of his MI from 3 days ago
d) Pericarditis

2. Pale RBCs mat lack iron are considered to be:

a) Macrocytic
b) Normocytic
c) Hypochromic
d) Normochromic

3. Which of the following tests is useful in distinguishing iron

deficiency anemia (IDA) from
anemia of chronic disease (ACD)?
a) B12 and folate
b) Ferritin and TIBC
c) HbA2 and HgA1
d) Serum iron and serum transferrin

4. A 73- year-old female presents with Lower GI bleed. The

patient is unable to quantify the amount of blood she has lost.
However, you are an experienced ACNP and recognize that the
following objective data represents a severe hypovolemic state:
a) Heart rate 80 bpm, SBP 120 mmHg, and UO > 30 ml/hr
b) Heart rate 100 bpm, SBP > 100 mmHg, and UO > 30 ml/hr
c) Heart rate 120 bpm, SBP < 100 mmHg, and UO
markedly decreased
d) Heart rate > 120 bpm, SBP < 80 mmHg, and absent UO

5. Which of the following statements is true regarding

transitioning pain medication and equivalent dosing?
a) Morphine 5 mg IV equals Fentanyl 100 mcg IV
 b) Dilaudid 1 mg lV equals Dilaudid 2 mg PO
c) Methadone 1 mg IV equals Methadone 1 mg P0
d) Morphine 10 mg IV equals Dilaudid 2 mg IV

6. Anemia of chronic disease may be associated with:

a) Postsurgical blood loss
b) Hemolysis
c) Rheumatoid arthritis
d) G6PD deficiency

7. A 65 year old male presents to the ED complaining of

epigastric pain that occurs approximately 3 hours after eating
meals. He describes the pain as burning, aching, and pressure-
like. It often awakens him from sleep. It is relieved with TUMS
(calcium carbonate) or by having small meals. The patient
admits to a 10-pack/year history of smoking. You suspect he has
a peptic ulcer. Based on his history, which type of ulcer do you
suspect?
a) Curling's ulcer
b) Duodenal ulcer
c) NSAID induced ulcer
d) Gastric ulcer

8. You are evaluating a patient for acute renal failure. You need
to determine if it is from a pre- renal cause or a renal cause.
Which of the following lab values would indicate a pre-renal
cause?
a) FENa > 1%
b) FENa < 1%
c) Urine sodium > 20
d) Urine osmolality < 300

9. In pulmonary function tests, a decreased diffusing capacity of

the lung for carbon monoxide (DLCO) is seen with which of the
following:
a) Polycythemia
b) Anemia
c) Asthma
d) Pulmonary hemorrhage

10. Which organism is associated with peptic ulcer disease

(PUD)?
a) Haemophilic influenzae
b) Helicobacter pylori
c) Haemophilic aphrophilus
d) Histoplasmosis capsulatum
11. A 57-year—old male presents with a history of fatigue of
unknown duration He has no significant past medical history,
and his physical examination is unremarkable. Laboratory
assessment reveals a hemoglobin of 10 g/dL and a hematocrit of
29%. The mean corpuscular value (MCV) is 75 µ, and the mean
corpuscular hemoglobin concentration (MCHC) is 30%. The
AGACNP knows that further evaluation of this patient must
include:
a) A serum B12 level
b) A Coombs test
c) A folate level
d) Endoscopic evaluation of the upper and lower GI tract

12. While examining a new patient in the hospital, you find

impaired vibratory and position sense as well as spastic
weakness. Upon questioning, the patient also reports
paresthesias in his fingers and toes. The lab data reveals a
hemoglobin of 10. What is the most likely cause of this patient’s
anemia?
a) vitamin B12 deficiency
b) Folate deficiency
c) Iron deficiency
d) Sickle cell disease

13. T.K. has taken an intentional overdose of olanzapine

(Zyprexa). The advanced practice nurse (APN) will need to
closely assess his EKG for:
a) Sinus arrhythmias
b) Atrial fibrillation
c) Prolonged QT interval
d) Premature ventricular contractions

14. Angiotensin convening enzyme (ACE) inhibitors would be

expected to slow progression of renal insufficiency in which of
the following conditions?
a) Analgesic-induced nephropathy
b) Contrast dye-induced nephropathy with a creatinine > 3
c) Amphotericin-induced nephropathy
d) Chronic glomerulonephritis with > 1 g/dL proteinuria

15. Ms. B. is a 49-year-old female who attempted suicide with

Benadryl overdose. She has been admitted to the intensive care
unit for anti-cholinergic syndrome. You would expect to see
which of the following symptoms?
a) Alertness. hyperthermia. constricted pupils. hypotension.
and tachycardia
b) Confusion, hypothermia, normal pupils, hypertension, and
 tachycardia
c) Confusion, hyperthermia, dilated pupils, hypertension,
and tachycardia
d) Alertness. hypothermia. dilated pupils. hypotension, and
bradycardia

16. Which of the following features is more commonly

associated with ulcerative colitis than with Crohn’s disease?
a) Fistulas
b) Segmental involvement
c) Abdominal mass
d) Rectal bleeding

17. Following acetaminophen overdose, when would you

anticipate the patient to have elevated liver function tests
(LFTs)?
a) Within 1 week of ingestion
b) Within 24—48 hours of ingestion
c) Within 3—5 days of ingestion
d) Within 4—8 hours of ingestion

18. When working up your patient for suspected restrictive lung

disease, the most important part of the workup is:
a) Complete history and physical
b) Lab work
c) Biopsy
d) Imaging

19. Your patient is being worked up for SIADH. Which of the

following lab values may indicate SIADH?
a) Serum sodium greater than 130 mEq/L and serum
creatinine 0.9
b) Serum sodium less than 130 mEq/L and serum osmolality
greater than 280 mOsm/kg
c) Serum sodium less than 130 mEq/L and serum creatinine
greater than 3.2
d) Serum sodium less than 130 mEq/L and serum
osmolality less than 280 mOsm/kg

20. Renal failure occurs when there is a decrease in renal

function with a resultant retention of urea nitrogen and
creatinine in the blood. A variety of physiologic insults can
cause this decrease in renal function (classified as pre-renal,
renal, and post-renal). Which statement is TRUE regarding post-
renal dysfunction?
a) It damages the epithelial basement membrane.
b) It can be reversed when the underlying cause of
 hypoperfusion is corrected
c) It occurs due to mechanical or functional urine flow
obstruction.
d) It can be a result of vasodilator therapy

21. Left middle cerebral artery infarct will exhibit which of the
following signs and symptoms:
a) Right side gaze preference
b) Left side sensory loss
c) Left facial weakness
d) Aphasia

22. Mrs. H has been on levothyroxine 100 mcg IV daily. She is

going to the general medical unit and needs to be converted to
an oral dose. What is the correct oral dose for this patient?
a) 100 mcg PO daily
b) 200 mcg PO daily
c) 300 mcg PO daily
d) 50 mcg PO daily

23. You are teaching a woman with iron deficiency anemia

(IDA) about her disease. You tell her which of the following?
a) IDA is the most common form of anemia in the US.
b) Transfusion therapy will be required.
c) Correction of anemia will occur within 1 week of iron
supplementation.
d) Iron supplements will need to be taken for the rest of her
life.

24. Diagnostic testing for a 70-year-old male patient revealed

intermittent segments of erosion in the small bowel and colon.
This is most characteristic of:
a) Crohn‘s disease
b) Abscess formation
c) Ulcerative colitis
d) Diverticulosis

25. A 52-year-old male who is in cardiogenic shock and has

ARDS in on mechanical ventilation with an FiO2 of 100% and a
PEEP of 20 cm. You are paged STAT because the O2 sat has
decreased from 94% to 70%. The patient is Tachycardic and
hypotensive. Which of the following is the most likely cause?
a) Spontaneous pneumothorax
b) Bacterial endocarditis
c) Tension pneumothorax
d) Severe bronchospasm
26. A patient presents with the following pulmonary function
test/spirometry findings: decreased FEV1, decreased FVC, and
increased FEV1/FVC. This pattern is typical of which type of
disease?
a) Asthma
b) Neuromuscular disease
c) Bronchitis
d) Emphysema

27. Which of the following statements best describes pleural

effusion exudates?
a) Pleural effusion exudates may result from alteration in
local factors that determine formation and absorption
of pleural fluid.
b) Lymph blockage by malignancy causes 20,000 cases of
pleural effusion exudates per year.
c) Typical mechanisms of pleural effusion exudate formation
Include systemic disease with decreased capillary
permeability and/or decreased lymphatic drainage
d) Viral infections and bacterial pneumonia can cause pleural
effusion exudates via decreased capillary permeability.

28. Replacement therapy for primary adrenal insufficiency

includes:
a) Mineralocorticoids
b) Combination of glucocorticoids and mineralocorticoids
c) Thyroxine
d) Glucocorticoids

29. Which statement is true about depression in the elderly

patient?
a) It is easily recognized. diagnosed' and treated.
b) Therapy should continue for at least 6 to 12 months
after remission of symptoms.
c) Women who are suicidal tend to use more lethal methods.
d) It is the most common psychiatric disorder in people over
55.

30. A 55-year-old male has been hospitalized for 2 months

following a hemicolectomy for Crohn's disease. The
postoperative course has been complicated by a wound infection
with methicillin-resistant Staph aureus (MRSA). You note when
checking his CBC that the patient has developed normocytic
anemia. In normocytic anemia of chronic disease:
a) Treatment is given only if symptomatic.
b) Serum iron and TIBC are the most specific and sensitive
 diagnostic tests.
c) Long-term B12 and folate supplementation is needed.
d) Treatment is focused on the associated disease.

31. A 60-year-old female patient presents to the ED with

complaints of severe weakness, nausea, and vomiting and
weight loss for the past month. Serum sodium is 127, potassium
5.2, and BUN 35. BP is 86/60, Differential diagnosis for this
patient includes adrenal insufficiency. Which of the following
would you expect to find on physical exam in a patient with
adrenal insufficiency?
a) Gait disturbance, increased reflexes
b) Skin rash. jugular vein distension
c) Hyperpigmentation, tachycardia
d) Bradycardia, coarse hair

32. The initial treatment of choice for symptoms of palpitation,

tachycardia, and tremor seen in thyroid storm is:
a) Radioactive iodine
b) Propranolol (Inderal) 20 mg PO QID
c) Lorazepam (Ativan) 0.5mg PO BID
d) Levothyroxine 500 mcg PO daily

33. B12 deficiency anemia can be distinguished from folic acid

deficiency anemia by which of the following physical findings?
a) Folic acid deficiency presents with a red, beefy tongue.
b) B12 deficiency anemia presents with chronic fatigue.
c) B12 deficiency anemia presents with neurologic
changes,
d) Folic acid deficiency presents with neurologic changes.

34. Which of the following is the most important immediate

assessment for a C1-2 injury?
a) Temperature
b) Heart rate
c) Motor ability
d) Respiration

35. Which of the following findings is consistent with an

obstructive pattern of lung disease?
a) Normal FEV1
b) Increased FEV1
c) Increased FEV1/FVC
d) Decreased FEV1/FVC

36. Which of the following laboratory assessments is specific for

diagnosing sickle cell anemia?
 a) Erythropoietin level
b) RBC indices
c) Hemoglobin electrophoresis
d) Cell blood count (CBC) differential

37. An 80-year-old female presents to the ED for the fifth time

in 6 months because of a headache. In order to classify these
attacks as migraines, which of the following is necessary?
a) It is bilateral in location and has a pulsating quality.
b) It is unilateral in location and has moderate to severe
pain intensity
c) There is photophobia and mild intensity.
d) There is phonophobia and mild intensity.

38. An 80-year-old African American woman presents to the

ED with complaints of chest pain and shortness of breath. The
workup reveals a microcytic anemia and a low reticulocyte
count. The most likely diagnosis is:
a) Sideroblastic anemia
b) Folic acid deficiency
c) Sickle cell disease
d) vitamin B12 deficiency

39. A patient presents to the ED with a migraine that he is

unable to “break" at home. You consider giving him a “triptan”
but cannot because of his past medical history. Which of the
following conditions precludes him from receiving sumatriptan
(Imitrex)?
a) Intermittent claudication
b) High blood pressure
c) Diabetes
d) Mitral valve replacement

40. Which of the following statements is accurate with regard to

folic acid deficiency anemia?
a) It is the most common type of anemia
b) B12 levels must be evaluated prior to treatment with
folate.
c) Homocysteine levels are low in folic acid deficiency
anemia,
d) It presents with neurologic symptoms.

41. For the patient with dyspnea, the physical exam has:
a) Greater negative predictive value
b) Greater positive predictive value
c) Greater sensitivity
d) Little clinical significance
42. You are evaluating a 35-year-old male patient in the ED
who presents with acute onset of shortness of breath. He denies
any recent injury. During your thorough exam you reveal he has
no known medical history, is positive lor smoking, has pleuritic
chest pain and is anxious. Your objective data reveals decreased
chest excursion on one side. You are most concerned for:
a) Pleural effusion
b) Acute myocardial infarction
c) Spontaneous pneumothorax
d) Hemothorax

43. You are the AGACNP working in the cancer center. Mrs. T.
is a planned admission for treatment of her multiple myeloma.
During your admission history and physical, you note Mrs. T.
has changes from her baseline exam from 1 previous
admissions. She is confused and her heart rate is 52 bpm: normal
is 80-85 bpm. You suspect hypercalcemia. Which of the
following critical manifestations may be present with oncology
patients who have hypercalcemia?
a) Diarrhea
b) Weight gain
c) Hyperreflexia
d) Bone pain

44. A patient presents to me ED with dyspnea. The physical

exam reveals dry crackles bilaterally. This finding is most likely
due to which of the following?
a) Asthma
b) Heart failure
c) Emphysema
d) Pneumonia

45. Mrs. Morris is a patient in the Oncology Center. She

developed a pleural effusion that has been tapped. The fluid was
sent for analysis and the results are: pleural fluid LDH to serum
LDH ratio 0.8, pleural fluid protein to serum fluid ratio 0.9.
Based on these results, her effusion fluid is most likely:
a) Empyema
b) Exudate
c) Transudate
d) Hemorrhagic

46. B.P. is a 72-year-old male who has dementia and lives at

home with his wife. She brings him to the ED for increased
confusion and decreased alertness from baseline. His last visit to
his PCP revealed a creatinine level of 1.1. Other PMH includes
HTN and DM. Medications are HCTZ 25 mg PO daily and
Aricept. Physical exam reveals T 36.5° C, HR 82, BP 170/82,
and RR 18. He is somnolent and oriented to person. Lungs with
basilar crackles. Normal S1 and 82. Abdomen with positive
bowel sounds. Trace pedal edema. Lab data: Na 140, K 6.5, CI
95, CO3 15. BUN 180, Creat 1.5, and glucose 180. UA with
trace protein, few granular casts, and FENa > 1%. Your next
step for workup would include which of the following?
a) HIV
b) Complement levels
c) Head CT to rule out progression of dementia
d) Renal sonography

47. Which of the following are the most common symptoms

associated with pneumothorax?
a) Dyspnea and chest pain on the unaffected side due to
afferent nerve pathways
b) Dyspnea and chest pain on the affected side
c) Chest pain with ST-segment elevation
d) Chest pain with ST-segment depression

48. Mr. Mitchell is a 64-year-old male admitted to the unit for

recent onset of seizures. He says that when he has a seizure he
smells something burning, suddenly becomes unresponsive, and
then begins to posture and smack his lips, He is exhibiting signs
consistent with:
a) Simple partial seizure
b) Secondary generalized partial seizure
c) Absence or petit mal seizure
d) Complex partial seizure

49. Seizure activity is classified into various categories

depending on symptoms and affected area(s) of the brain. Which
of the following is descriptive of simple partial seizures?
a) They are common in adolescents and often involve rapid
eye blinking.
b) There is no loss of consciousness
c) The patient may have aura, staring, and automatisms.
d) They begin with tonic and progress to clonic contractions.

50. Damage to organs in blunt trauma patients is caused by the

transfer of force and application of energy to surrounding
tissues. Which of the following forces is known to produce
traumatic axonal injury?
a) Shearing
b) Bursting
c) Crushing
 d) Compression

51. Mrs. P is a 64-year-old woman who presents to the ED with

a 3-month history of episodes of diplopia, dysphagia, dizziness,
and tingling in her right arm. These episodes have occurred five
times over the past 3 months and they last 5-15 minutes. Mrs. P
has a past medical history significant for smoking and
hypertension. Her physical exam is unremarkable. She is 62
inches tall and weighs 200 pounds. Her BP is 156/80. Given this
clinical picture, the most likely cause for Mrs. P’s episodes is:
a) Multiple sclerosis
b) Simple partial seizure
c) Transient ischemic attack
d) Cerebral neoplasm

52. A history of sudden severe headache, photophobia, vomiting,

and focal neurological deficit is most consistent with:
a) Acute transient ischemic attack
b) Acute subarachnoid hemorrhage
c) Acute ischemic stroke
d) Thrombotic stroke

53. Hallmark laboratory features of tumor lysis syndrome

include which of the following?
a) Hypokalemia
b) Hypercalcemia
c) Hypocalcemia
d) Hyponatremia

54. Ms. Smith is a 58-year-old female who has adenocarcinoma

of the breast with newly diagnosed metastasis to the spine and
bilateral hips. She is being admitted for uncontrolled pain. At
home she has been taking Tylenol 650 mg PO every 4 hours and
oxycodone 5 mg PO every 4 hours PRN. Over the last few days
she increased her oxycodone use lo 245 mg/day without
significant pain relief. According to the World Health
Organization Ladder, your treatment plan for her should include
which of the following?
a) Dilaudid 0.5-1 mg IV every 2 hours PRN, Toradol 15
mg IV every 6 hours, and Tylenol 650 mg P0 every 4
hours
b) Oxycodone 5 mg PO every 4 hours PRN, Tylenol 650 mg
PO every 4 hours, and Toradol 15 mg IV every 6 hours
c) Discontinue the Tylenol and add oxycodone 10 mg PO
every 4 hours around the clock
d) Dilaudid PCA at basal of 0.5 mg/hour and bolus at 1 mg
every 10 minutes with lockout of 6 mg/hour
55. Mr. G. is a 54-year-old male who was brought into the ED
status post an MVA. He has suffered a fracture of his femur and
ankle. He has no significant past medical history. He denies
substance abuse. You are performing your assessment, and you
would expect him to have symptoms of nociceptive pain, which
include the following:
a) Extreme pain with pinching or squeezing at site of injury
b) Burning, tingling, and pinching
c) Aching, burning, tingling, and localized
d) Aching, throbbing, and localized

56. Exceeding the livers ability to metabolize dextrose can lead

to:
a) Elevated international normalized ratio (INR)
b) Hypoglycemia
c) Elevated LFTs
d) Low triglycerides

57. Which of the following best describes a transient ischemic

attack?
a) A stroke due to a bleeding cerebral aneurysm
b) A temporary neurologic deficit that resolves within 24
hours
c) A stroke with a bilateral permanent neurological deficit
d) An episode of unilateral paralysis

58. Your patient with COPD has been intubated for a

hypercapnic respiratory failure. His first blood gas after
intubation reads 7.17/72/70/20/98%. His current ventilator
settings are PRVC rate 15/TV 350/ PEEP 5/ Fi02 40%. Patient is
sedated and breathing at 15 times/minute. What changes would
you like to make for this patient?
a) Increase his PEEP to 12 and recheck an ABG in 45
minutes.
b) Lessen his sedation and recheck his ABG in 45 minutes,
c) Increase his respiratory rate (RR) to 18 and recheck an
ABG in 45 minutes
d) Increase Fi02 to 50% and follow his O2 sats on the pulse
ox.

59. Pre-renal failure is most commonly caused by:

a) Acute tubular necrosis
b) Urine flow obstruction
c) Hypoperfusion
d) Nephrotoxicity
60. Iron deficiency anemia (IDA) is described as a:
a) Hyperchromic, microcytic anemia
b) Hypochromic, macrocytic anemia
c) Hyperchromic, macrocytic anemia
d) Hypochromic, microcytic anemia

61. Which of the following cranial nerves is activated in the

migraine pathway?
a) Cranial nerve VII (Facial)
b) Cranial nerve II (Optic)
c) Cranial nerve V (Trigeminal)
d) Cranial nerve I (Olfactory)

62. A 40-year-old male is admitted lo a subacute care facility for

aggressive rehabilitation after a motor vehicle accident. He was
previously diagnosed with thalassemia. The most likely
representation of his hematologic abnormalities is:
a) A microcytic, hypochromic anemia commonly found in
Mediterranean populations
b) Classified as a macrocytic, hypochromic anemia commonly
found in German populations
c) A genetically inherited disorder requiring iron
supplementation
d) An autosomal recessive disorder that results in
thrombocytopenia

63. Right middle cerebral artery infarct will exhibit which of the
following signs and symptoms?
a) Right facial weakness
b) Left inattention
c) Right-sided sensory change
d) Left gaze preference

64. Mr. Williams is a 55-year-old gentleman who has HIV. His

CD4 count is 250. He presents to the ED with a headache. In
doing his history and physical, which of the following should
cause concern?
a) His body habitus is barrel-chested,
b) His sensory function is intact
c) He describes floaters and occasional blurred vision.
d) He has lymphadenopathy on exam.

65. When treating a patient with dementia, which of the

following medications has shown positive
results?
a) Opioids
b) Risperidone
 c) Clozapine
d) Antihistamines

Domain 2: Clinical Practice

1. Most patients who present to the ED with delirium are

admitted for further management. Which of the following
patients may be sent home safely from the ED if the delirium
has resolved?
a) 67-year-old with new-onset seizure
b) 45-year-old with diabetes mellitus type 2 on oral agents
c) 34-year-old with history of thyroid disease
d) 29-year-old with insulin induced hypoglycemia

2. Mr. Jones is a 79-year-old man who presents to the ED with

severe pain in the periorbital and temporal region. On exam,
nasal drainage, lid drooping, and conjunctival retraction is
noted. His most likely diagnosis is:
a) Tension headache
b) Migraine headache
c) Brain tumor
d) Cluster headache

3. In a patient with ulcerative colitis. you are most likely to find

which of the following?
a) Positive pANCA titer with negative ASCA lgG
b) Presence of small bowel emerocutaneous fistula
c) Colonoscopy showing ulcers, skip lesions, or granulomas
d) Sparing of the rectosigmoid on endoscopy

4. What laboratory data would you expect to see in patients with

hyperthyroidism?
a) Lowered thyroid-stimulating hormone (TSH). decreased T4
b) Elevated thyroid-stimulating hormone (TSH), increased T4
c) Lowered thyroid-stimulating hormone (TSH). increased
T4
d) Elevated thyroid-stimulating hormone (TSH), decreased T4

5. Diagnosis of a suspected lower GI bleed includes:

a) Large bore IV and intravenous fluid
b) Triple lumen catheter placement
c) Endoscopic retrograde cholangiopancreatography
d) Rectal exam

6. A 65-year-old man is admitted to your unit with the diagnosis

of endocarditis. During the admission history and physical you
hear a holosystolic murmur in the area of the apex of the heart.
This murmur is most likely due to:
a) Aortic regurgitation
b) Tricuspid regurgitation
c) Mitral regurgitation
d) Pulmonary regurgitation

7. Ms. Lee is on a mechanical ventilator with a synchronized

intermittent mandatory ventilation (SIMV) mode, a tidal volume
of 800 mL, a respiratory rate of 10, and an FiO2 of 0.3. This
means she will:
a) Receive 10 breaths/minute at a tidal volume of 800 mL,
and will be unable to initiate any spontaneous breaths on
her own
b) Receive 10 breaths/minute at a tidal volume of 800 mL,
and when she initiates spontaneous breaths, each
spontaneous breath will have a tidal volume determined
by the patient
c) Receive 10 breaths/minute at a tidal volume of 800 mL,
and when she initiates spontaneous breaths, they will be at
a tidal volume of less than 800 mL
d) Receive 10 breaths/minute at a tidal volume of 800 cm of
pressure, and when she initiates her own breaths
spontaneously. each spontaneous breath will be at a tidal
volume of 800 mL

8. According to the American Stroke Association, hypervolemia,

hypertension, and hemodilution (triple H) therapy is
recommended following which type of stroke?
a) Right middle cerebral artery (MCA) ischemic stroke
b) Subdural hematoma (SDH)
c) Aneurysmal subarachnoid hemorrhage
d) Left MCA stroke

9. The ideal position oi the patient for insertion of a subclavian

central line is:
a) Lithotomy
b) Trendelenburg
c) Semi-Fowler's
d) Reverse Trendelenburg

10. A 54-year-old male comes into your ER with a new onset of

painful blisters and ulcerations on his genitals. You suspect HSV
type 2. What is the best treatment for this patient?
a) Send an HSV antibody test and start the patient on
acyclovir 200 mg PO BID for 5 days
b) Send culture for herpes and have patient follow up with
PCP for results
 c) Send an HSV antibody test and start the patient on
acyclovir 400 mg PO three times per day for 7-10 days
d) Send an RPR and begin the patient on benzathine penicillin
G 2.4 million units weekly for 3 weeks

11. Mrs. Henry is a 78-year-old woman who fell down four

steps. She arrives at the ED disoriented and calling for her cat.
She is wearing a hard cervical collar that she insists be taken off
immediately. You can take off the collar for the following
reason:
a) She has had radiographic tests that show there is no
fracture or ligamentous injury,
b) She is not having any neck pain.
c) She has normal sensory-motor function.
d) There are no step-off fractures detected in her cervical
spine.

12. Mechanism of injury Is an important consideration in the

initial care and stabilization of the trauma patient in the ED
because:
a) Based on the mechanism of injury, the nurse practitioner
can order diagnostic testing prior to the patient’s arrival in
the ED.
b) It is helpful to identify which consulting services will be
needed to manage the patient, prior to the patient's arrival
in the ED.
c) It is helpful to know whether or not the incident will be on
the evening news.
d) Understanding the mechanism of injury can help
predict injury patterns

13. Which of the following lab results diagnose

hypothyroidism?
a) Lowered TSH, increased T3, increased T4
b) Elevated TSH, increased T3, increased T4
c) Lowered TSH, decreased T3, decreased T4
d) Elevated TSH, decreased T3, decreased T4

14. Initial management of a patient with lowered thyroid-

stimulating hormone (TSH) levels and increased T4 levels
(hyperthyroidism) includes:
a) Levothyroxine 75—100 mcg daily
b) Propylthiouracil (PTU) 150 mg every 8 hours
c) Hydroconisone 200 mg daily for 7 days in 3 or4 divided
doses
d) Conrosyn (cosymropin) 250 mcg x one dose
15. A 74-year-old female is seen in the ED tor evaluation of
fever of 101.2 °F for the past 2 days. She has new onset
confusion. Her vital signs are BP 92/64 mmHg, P = 121 bpm,
RR = 26. Her O2 saturation is 94% on 4 liters nasal cannula, A
chest X-ray is significant for RLL infiltrate. The patient is
diagnosed with community acquired pneumonia. Which of the
following patient characteristics suggests that hospitalization is
indicated?
a) Age and mental status
b) Heart rate and chest X-ray findings
c) Blood pressure and respiratory rate
d) Oxygen saturation and duration of symptoms

16. A 66-year-old man presents to the ED with COPD

exacerbation Due to his deteriorating condition, you make the
decision to admit the patient. Your admission orders should
include which of the following?
a) A beta-blocker
b) A steroid
c) A sedative
d) A cholinergic agent

17. What does the Glasgow Coma Scale measure?

a) Pupillary response and motor responses
b) Pupillary response and verbal responses
c) Pupillary response. motor and verbal responses
d) Eye opening, motor and verbal responses

18. You are called to the floor to evaluate a patient with an

admission diagnosis of severe asthma. Upon admission the
patient’s ABG reveals a pH of 7.36, PaC02 of 59, PaO2 of 49,
and HCO3 29 on 2 L nasal cannula. The patient is anxious and
sitting on the edge of the bed. He has circumoral cyanosis, and
lung fields auscultate for expiratory wheezes bilaterally. The
most important initial treatment is:
a) Lorazepam 2 mg IV
b) Albuterol two puffs every 2-4 hours
c) Prednisone 60 mg every 6 hours
d) Oxygen 60% via face mask

19. Mrs. Anderson is a 42-year-old woman who reports

menstrual irregularities and believes she is experiencing an early
menopause. She reports feeling fatigued and restless at times.
Physical findings reveal a thin woman with fine hair; moist,
warm skin; and a goiter with a bruit present. Heart rate is 110
bpm, BP 140/80, These finding are consistent with:
a) Graves' disease
 b) Myxedema
c) Thyroid cancer
d) Hypothyroidism

20. Which of the following drugs would be the most efficacious

for long-term migraine management?
a) Beta-blockers
b) NSAIDS
c) Sedatives
d) Calcium channel blockers

21. You are called to the bedside of an 86-year-old female to

evaluate new onset dyspnea. The patient has a history of recent
MI, HTN, NIDDM, and COPD. Her vital signs are BP 102/70,
HR 78, RR 40, T 35.6°C. Her WBCs are 14,000/µl. Based on
these findings you:
a) Direct the respiratory therapist to initiate nebulizer therapy
every 12 hours.
b) Direct the nurse to continue observing the patient because
she is stable
c) Direct the nurse to infuse IV fluids and begin
antibiotics.
d) Direct the tech to take the patient to the X-ray department
for a chest X-ray.

22. A 67-year-old patient presents to the ED with a change in

mental status and weakness. Part of the initial diagnostic
assessment should include:
a) STAT MRI of the head
b) Blood glucose fingerstick
c) Lumbar puncture
d) Administer hypotonic IV fluids

23. One of the most useful and predictive tools in evaluating the
condition of a patient with an acute asthma attack and in
assessing response to therapy is:
a) Measurement of peak expiratory flow
b) An ABG
c) Pulse oximetry
d) A chest radiograph

24. A 50-year-old female patient presents with chest discomfort

and difficulty breathing. An EKG was done and showed ST-
segment elevations in leads I, avL, and V1-V3. The most likely
diagnosis is:
a) Posterior wall injury
b) Anteroseptal wall injury
 c) Lateral wall ischemia
d) Lateral wall injury

25. Which of the following statements about stroke is true?

a) Diabetes does not increase your risk for a stroke
b) More than 20% of patients suffering a stroke will have a
recurrent stroke within 1 year.
c) Stroke is the fifth-leading cause of deaths in the United
States
d) Stroke mortality is greater in women and African
Americans

26. Which macronutrient in the TPN solution significantly

increases the osmolarity of the solution?
a) Dextrose
b) Multivitamins
c) Protein
d) Lipids

27. A 66-year-old male patient smokes one pack/day of

cigarettes. He was treated for pneumonia and has returned 4
weeks later for a follow-up visit. His symptoms have not
improved. At this time it would be appropriate to:
a) Order another round of the same antibiotics
b) Start him on nebulizer treatments.
c) Order a complete blood cell count.
d) Obtain a chest X-ray.

28. Which therapy is unique to the treatment of cluster

headaches?
a) Antiemetics
b) NSAIDS
c) Antidepressants
d) 100% oxygen inhalation

29. Which of the following patients has a red flag for a

secondary headache?
a) Mr. Talbot has a headache that was made worse by
exertion.
b) Mr. Henderson has a severe headache that occurs after
dinner nightly.
c) Mr. Jones is 47 with a new onset of a headache.
d) Mr. Smith has a headache with associated nausea and
vomiting.

30. Which of the following statements regarding headache

assessment and management is correct?
 a) In obtaining a history, it is known that unilateral
location with a pulsating quality is a key distinguishing
feature for a migraine headache.
b) In obtaining a history, it is known that tension headaches
are the most common secondary headache.
c) In secondary headaches, food additive triggers need to be
considered,
d) In primary headaches. underlying pathology needs to be
considered.

31. A reasonable therapeutic goal for a patient with COPD

exacerbation and oxygen therapy is an oxygen saturation of:
a) 0.98
b) 0.85
c) 0.9
d) 0.82

32. A 57-year-old male presents to the ED following a

generalized tonic-clonic seizure while at work. The patient has
no significant medical history or known history of trauma. The
first diagnostic test(s) to be done is/are:
a) EEG
b) Lumbar puncture
c) Serum chemistry, calcium, magnesium, toxicology
screen
d) MRI scan of the brain

33. The diagnostic imaging modality of choice to rule out

diverticulitis is:
a) Abdominal X-ray
b) CT scan of the abdomen and pelvis with PO and IV
contrast
c) Abdominal ultrasound
d) Barium enema

34. Most elder abuse is committed by:

a) In-home service providers
b) Friends and neighbors
c) Spouse
d) Adult children

35. In a patient with a hemorrhagic cerebral vascular accident

(CVA), which test must be performed to determine the possible
cause?
a) EEG
b) Cerebral angiogram
c) CT scan
 d) MRI scan

36. A 60-year-old female presents to the ER with fever, chills,

abdominal pain, and dysuria. She tells you she is sexually active
and is positive for dyspareunia. On exam, she has cervical
motion tenderness and bilateral adnexal pain. What is the most
likely diagnosis?
a) Appendicitis
b) Urinary tract infection
c) Pelvic inflammatory disease
d) Genital warts

37. The best marker of viral load in patients with HIV disease is:
a) Quantitative RNA PCR
b) CD4 count
c) Qualitative bDNA
d) Beta 2 microglobulin

38. A 69-year-old male with previously diagnosed diabetes

mellitus presents to your ED. Your differential includes the
diagnosis of diabetic ketoacidosis (DKA). Which of the
following lab values are indicative of this condition?
a) pH 7.23, HCO3 26, PCO2 28. PO2 90, glucose 250 mg/dl
b) pH 7.38, HCO3 22, PCO2 36. PO2 92, glucose 300 mg/dl.
urine + for glucose
c) pH 7.25. HCO3 16. PCO2 33, PO2 84, glucose 100 mg/dl
d) pH 7.23, HCO3 15, PCO2 34. PO2 88, glucose 300 mg/dl

39. An elderly patient is brought into the ED in a confused state

that began 3 days ago after her cat died. The family states that
the patient could no longer recognize them, was restless and
agitated, and had episodes of incontinence, The most likely
diagnosis is:
a) Pseudodementia
b) Alzheimer's disease
c) Delirium
d) Depression

40. A 65-year-old patient presents to the ED and is diagnosed

with community-acquired pneumonia. Which of the following
would qualify him for hospital admission?
a) Blood pressure 95/65 mmHg
b) Blood urea nitrogen of 24 mg/dl
c) Respiratory rate of 27
d) Alert and oriented

41. Mr. Jackson is a 47-year-old male with HIV. His CD4 count
is 350. A common opportunistic infection for a person with his
CD4 count includes:
a) Cryplococcosis
b) Cryptosporidiosis
c) Miliary tuberculosis
d) Toxoplasmosis

42. For the mechanically ventilated patient, the addition of

CPAP:
a) Increases functional residual capacity
b) Creates a plateau pressure
c) Gives an inspiratory: expiratory ratio of 1:2
d) Decreases functional residual capacity

43. A life-threatening cause of delirium is:

a) Hypoxia
b) Hypothyroidism
c) Hyperglycemia
d) Cerebral aneurysm

44. A posterior wall MI is diagnosed by:

a) Tall R waves in V5 and V6 leads
b) Tall and wide R waves and ST depression in V1 and V2
leads
c) Deep side Q waves in the anterior leads
d) ST-segment elevation in V1 and V2 leads

45. Acute adrenal insufficiency is a medical emergency, Initial

management includes:
a) Levothyroxine 75-100 mcg daily
b) Cosyntropin (Conrosyn) 250 mcg x one dose
c) Propylthiouracil (PTU) 150 mg every 8 hours
d) Hydrocortisone 50 mg every 6 hours intravenously or
100 mg every 8 hours intravenously for 7 days

46. Mr. T. is a 74-year-old male. He weighs 70 kg. He is

admitted to your unit with a diagnosis of respiratory failure
secondary to pneumonia. He is currently intubated and on
assisted mandatory ventilation (AMV) with a tidal volume of
550 mL, ventilator RR of 10 with a total rate of 20, and PEEP of
6 cm. His ABG values are as follows: pH 7.45, PaCO2 35, PaO2
64, FiO2 0.8. Which modification in treatment would be
indicated based on the blood gas values?
a) Increase the respiratory rate
b) Increase the FiO2 and increase the rate
c) Increase the PEEP and then try to reduce the FiO2
d) Increase the tidal volume
47. A 63-year-old female presents with symptoms of recent 10-
pound (unintentional) weight loss, increased sweating, insomnia,
and frequent palpitations. Your physical examination reveals
thinning hair, a thyroid gland that is symmetrically enlarged
without nodules but with a bruit. The skin is warm and smooth
without lesions, and you auscultate a new-onset atrial
fibrillation. The most likely deferential diagnosis is:
a) Adrenal insufficiency
b) Addison's disease
c) Hyperthyroidism
d) Hypothyroidism

48. A 62-year-old male presents to the ED for the second time in

24 hours. He came in the day before complaining of abdominal
discomfort but his exam was unremarkable. Routine lab
screening was within normal limits. Today he reports that the
pain is now in the RLQ. His white count is 16,000 cells/uL. His
temperature is 101.3 °F. Physical exam reveals pain when the
right hip and knee are flexed and the right hip is internally
rotated. This is a positive:
a) Psoas sign
b) Murphy’s sign
c) McBurney's sign
d) Obturator sign

49. A typical complication of mitral stenosis is:

a) Ventricular fibrillation
b) Right-sided heart failure
c) Left-sided heart failure
d) Hypotension

50. If a CT scan of a suspected stroke patient shows an

intracerebral or subarachnoid hemorrhage, which of the
following actions would be appropriate?
a) Administer 10 to 20 mg of labetalol IV push over 5
minutes.
b) Consult a neurosurgeon.
c) Begin thrombolytic therapy
d) Administer a bolus of 50 mL of 5% dextrose immediately.

51. Ms. Jones is a 32-year-old woman with HIV. She has had
HIV for the past several years. You
are now concerned that she has AIDS. Which of the following
test results confirms your
suspicion?
a) Her CD4 Count is 300.
 b) Her CD4 Count is 225.
c) Her CD4 percent is 250.
d) Her CD4 percent is 12.

52. You are called to the bedside to evaluate a patient with an

admission diagnosis of severe asthma. The nurse tells you that
the patient has become more dyspneic during the past hour. Your
exam findings include labored breathing, diaphoresis, and
decreased mental status. He is only able to speak in fragmented
sentences, The most appropriate action is:
a) Obtain an EKG.
b) Obtain an ABG.
c) Order a portable chest X-ray.
d) Intubate the patient.

53. A 65-year-old man was brought to the ED with 8/10

pressure-like substernal chest pain of 2 hours’ duration. The
EKG shows ST-segment elevation in V1-V3. What is the first
step in this patient’s management?
a) Give the patient morphine, oxygen. nitrates, and
aspirin,
b) Prepare the patient for a percutaneous transluminal
coronary angioplasty (PTCA).
c) Give a dose of a beta-blocker immediately.
d) Repeat the EKG to make sure these are not transient
changes

54. The immediate treatment for a tension pneumothorax is:

a) Emergent chest decompression with needle
thoracostomy
b) lnotropic therapy to maintain BP
c) Rapid infusion of IV fluids
d) STAT portable chest X-ray

55. Which of the following statements is TRUE regarding the

use of oxygen therapy during COPD exacerbation?
a) The risks of MI, tissue ischemia, and muscle fatigue
should outweigh the risk of reduced hypoxic drive
b) The risk of reducing ventilation outweighs the risk oi
continued severe hypoxemia
c) The patient with a partial correction of hypoxia and mild
respiratory acidosis is at highest risk for apnea.
d) The use of supplemental oxygen is contraindicated due to
the risk of inducing apnea by removing the hypoxic drive to
breathe.

56. Management of hypothyroidism includes:

 a) Propylthiouracil (PTU) 150-300 mg every 8 hours
b) Levothyroxine 50-200 mcg daily. It should be started at
12.5 mcg and titrated upward.
c) Cosyntropin (Conrosyn) 250 mcg x one dose
d) Hydrocortisone 200 mg daily for 7 days in 3 or 4 divided
doses

57. Ms. S is a 78-year-old patient with type 2 diabetes mellitus.

She was admitted following emergency cholecystectomy. Her
glucose levels remain elevated (over 300 mg/dL) in spite of the
fact that she is still NPO. What is the main reason for her
glucose elevation?
a) Counterregulatory hormone response from stress
b) Somogyi effect from surging growth hormone
c) Surging catecholamine levels from vasopressors
d) Dawn phenomenon from elevated glucagon levels

58. In a TPN/PPN solution, calcium is never given as:

a) Calcium chloride
b) Calcium citrate
c) Calcium gluconate
d) Calcium acetate

59. An EKG is diagnostic of STEMI if:

a) QRS confounders are present
b) It shows > 1 mm ST elevation in two or more
contiguous leads
c) It shows > 1 mm ST elevation in two or more leads
d) It shows > 1 mm ST elevation in one lead

60. Which of the following patients should have a head CT scan

in the ED?
a) Ms. Simmons, age 45, with a history of migraines
b) Mr. Jones, age 32, with a history of cluster headaches
c) Mr. Wilson, age 52, with a tension headache and normal
neuro exam
d) Mrs. Peters, age 68, with a history of atrial fibrillation
on dabigatran (Pradaxa) and a recent fall

61. The “gold standard” for diagnosing the hemodynamically

stable patient suffering from abdominal trauma is:
a) Abdominal flat plate X-ray
b) Angiogram
c) Abdominal CT scan
d) Diagnostic laparoscopy

62. Which of the following laboratory findings would you

expect to find in a patient with adrenal insufficiency?
a) High serum sodium, low serum potassium, elevated plasma
ACTH, low plasma cortisol level
b) Low BUN. low serum sodium. high serum potassium
c) Low serum sodium, high serum potassium, elevated plasma
ACTH, low plasma cortisol level
d) Elevated BUN. low serum sodium. high serum
potassium

63. Mrs. Neil has been having chest pain for at least 12 hours
before her family brings her to the ED. Because Mrs. Neil is
confused, she may really have been experiencing chest pain for
a longer period. In this situation, which is the best cardiac
marker to detect myocardial infarction?
a) Serum myoglobin
b) Serum CK-MB isoenzyme
c) Serum troponin
d) Serum LDH

64. Ms Smith is a 24-year-old who presents lo the ED with some

vague complaints. You have ordered an HIV ELISA on her
because she admits to engaging in high-risk behavior. The result
is positive. Which of the following tests is usually ordered as a
confirmation of these results?
a) P24 antigen
b) HIV RNA PCR
c) Western blot
d) Absolute T cell count

65. Which of the following is a risk factor for delirium?

a) Advancing age
b) Stroke
c) Diabetes mellitus
d) Family history

66. A 67-year-old man presents with a 4-day history of fever,

LLQ abdominal pain, and tenderness and diarrhea. Other than
chronic constipation, he denies any history of colon problems.
His most likely diagnosis is:
a) Ulcerative colitis
b) Irritable bowel syndrome (IBS)
c) ischemic colitis
d) Diverticulitis

67. A 54-year-old male with no significant past medical history

presents to an urgent care center, where he is seen by an
AGACNP. He has been experiencing severe right flank pain for
2 days, is currently afebrile, and denies urgency or hesitancy. A
urinalysis reveals < 10 (10/mm3) WBC, negative for leukocyte
esterase, and TNTC RBCs. The most likely diagnosis would be:
a) Cystitis
b) Pyelonephritis
c) Renal artery stenosis
d) Urethral calculi

68. An adult male patient presents to the ED with painful blisters

on the palms of his hands and the soles of his feet. He reports flu
like symptoms. What is the most likely diagnosis for him?
a) Genital warts
b) Gonorrhea
c) Herpes zoster
d) Syphilis

69. An 81-year-old presents to the ED with complaints of

increasing dyspnea. He denies cough, chest pain, or sputum
production Initial orders must include:
a) IV steroids
b) EKG
c) Chest X-ray
d) Blood cultures

70. A 30-year-old female with a 6-month history of three UTIs

associated with hematuria is seen in your ED for an arm
laceration. You are discharging her to home. What should be
included in your discharge instructions?
a) See your primary care physician for outpatient ultrasound
b) Take Cipro 500 mg PO twice daily for 3 days, and if you
have another episode, make an appointment with a
urologist.
c) Make an appointment with a urologist
d) Return to the ED in 14 days to have your sutures removed

71. As the AGACNP, you respond to a cardiopulmonary

resuscitation situation. The anesthesiologist is intubating the
patient. An RN is performing chest compressions and another
RN has not been successful in obtaining venous access. You are
asked to place a central line. Which of the following approaches
would be best in this situation?
a) Femoral vein
b) External jugular
c) Internal jugular
d) Subclavian vein

72. A 68-year-old male presents with aortic stenosis. In addition

to chest pain, which of the following would indicate an urgent
need for aortic valve replacement?
a) Aortic calcification
b) Pulmonary hypertension
c) syncope
d) Left ventricular hypertrophy

73. Mr. Smith is a 67-year-old African American male brought

to the ED by his wife. she states that he fell down 20 minutes
ago and has been unable to speak or move his right side since
then. Mr. Smith has no significant past medical history On exam
he is conscious and anxious and his speech is garbled and
unintelligible. He has a left facial droop and he is completely
right hemiplegic. The most likely etiology for his symptoms is:
a) Cerebral vascular accident
b) Brain tumor
c) Delirium
d) Traumatic brain injury

74. What is the most serious complication at any site of a central

line insertion?
a) Pneumothorax
b) Infection
c) Insertion into the wrong vessel
d) Air embolism

75. A 72-year-old man presents with a temperature of 100.5° F

and complaints of LLQ abdominal pain, poor appetite, and
constipation. Physical exam reveals hypoactive bowel sounds
and tenderness to palpation in the LLQ. Rectal exam reveals
brown stool, hemoccult negative. Which is the most likely
diagnosis?
a) Irritable bowel syndrome
b) Ischemic colitis
c) Crohn’s disease
d) Diverticulitis

76. A 62-year-old female is admitted with “the worst headache

I've ever had.” CT reveals an aneurysm in the circle of Willis.
Which of the following are major complications of subarachnoid
hemorrhage from an aneurysm that require close observation?
a) Hemiplegia and hemiparesis
b) Cerebral vasospasm and rebleeding
c) Infection and aspiration
d) Hypotension and respiratory distress

77. The following monitoring is recommended for a patient

receiving TPN:
a) Daily triglycerides
b) Weekly basic metabolic panel (basic electrolytes)
c) Weekly LFTs
d) Weekly magnesium phosphate. and calcium

78. A 62-year-old man who smokes and has hypertension

presents with 20 minutes of chest pain while gardening that was
relieved with rest. His vital signs, EKG, and chest X-ray are
normal. He received aspirin 325 mg orally. What is the most
appropriate management for this patient?
a) Start a nitroglycerine drip.
b) Consult a cardiologist,
c) Draw cardiac enzymes and admit the patient for
observation and exercise stress test.
d) Discharge to home to follow up with his PCP within 1
week for an exercise stress test.

79. The following is/are the most important piece(s) of history

needed to differentiate tension headaches from migraine
headaches:
a) Intensity of pain
b) Quality of pain
c) Family history
d) Pattern of attack (onset, duration, and location of pain;
recurrence)

80. Which of the following excludes a stroke patient from

receiving r-tPA?
a) Blood pressure of 230/115 mmHg
b) Total elapsed time since onset of symptoms is 160 minutes
c) History of prior stroke 1 year ago
d) History of myocardial infarction 1 year ago

81. The most important management consideration for patients

in status epilepticus is:
a) Inserting a tongue blade to avoid teeth or tongue damage
b) Administration of glucose
c) Administration of phenytoin
d) Administration of lorazepam

82. Mr. O'Brien is on a mechanical ventilator and his arterial

CO2 has risen from a baseline of 41 to 47 mmHG. Which of the
following changes in the ventilator settings is most likely to be
made?
a) Increase in the FiO2
b) Decrease in the tidal volume
 c) Decrease in the respiratory rate
d) Increase in the respiratory rate

83. The most common missed injury in the trauma patient is:
a) Vascular injury
b) Brain injury
c) Cervical spine injury
d) Extremity fracture

84. Which of the following findings is most consistent with

Crohn's disease?
a) Colonoscopy or sigmoidoscopy showing ulcerations,
friability, and edema beginning in the rectum and extending
proximally without skip lesions
b) Inflammation that extends through the full thickness of
the bowel wall
c) Gross rectal bleeding and bloody diarrhea
d) Positive pANCA with positive ASCA IgG

85. Which of the following is true regarding oxygen therapy for

the patient experiencing a severe asthma attack?
a) Oxygen therapy is indicated to keep the oxygen saturation
greater than or equal to 80%.
b) Oxygen therapy is indicated to keep the oxygen
saturation greater than or equal to 90%
c) Oxygen therapy is contraindicated because it will increase
airway reactivity.
d) Oxygen therapy is contraindicated because it will diminish
the hypoxic drive.

86. Mr. Williams is a 57-year-old male who presents to the ED

with complaints of chest pain on and off for the last few hours.
He has a past medical history of CHF. His Vitals are HR 99, BP
100/70, O2 sat 99% on RA. An EKG done on arrival shows ST
elevations in leads II, III, and aVF. Precordial leads on the right
show ST elevations. The most appropriate order would be:
a) Lasix 20 mg IV once
b) Nitroglycerine IV drip
c) Norvasc 5 mg PO x1 dose
d) IV fluid bolus

87. A 62-year-old female with a history of diabetes, coronary

artery disease, hyperlipidemia, and glaucoma presents to the ED
complaining that she cut her foot on a piece of glass in the
grocery store and sustained a 4 cm laceration lo her right instep.
The area is tender, swollen, and erythematous. What is your first
priority in her evaluation?
 a) Evaluate for two-point discrimination
b) Get an X-ray of her foot to evaluate for a foreign body
c) Check a fingerstick
d) Give her a tetanus shot

88. A patient was admitted for GI bleeding secondary to PUD.

The bleeding resolved with IV PPI infusion and the patient is
being prepared for discharge today. However, this morning the
patient is found to be febrile, has significant abdominal pain, and
has a distended, rigid abdomen with rebound tenderness on
palpation. Which test will help you in diagnosing the patient’s
current problem?

a) CT scan of the abdomen

b) Abdominal ultrasound
c) CBC with differential
d) Abdominal X-ray with flat and upright views

89. Which of the following is considered the “gold standard” for

differential diagnosis of a hemorrhagic stroke?
a) MRI
b) Noncontrast head CT
c) Lumbar puncture
d) MRA

90. Euthyroid sick syndrome is controversial with regard to

diagnosis and management, particularly in those who are
critically ill. Which of the following lab tests would be
consistent with euthyroid sick syndrome?
a) Normal/elevated TSH, normal/elevated T3,
normal/elevated T4
b) Elevated TSH, decreased T3, decreased T4
c) Lowered TSH, increased T3, increased T4
d) Normal/lowered TSH, normal/lowered T3,
normal/lowered T4

91. ST-segment elevation and deep wide Q waves in leads II, III,
and aVF are a sign of which of the following?
a) Anterior wall ischemia
b) Septal wall ischemia
c) Old inferior wall Ml
d) Acute inferior wall MI

92. A patient is referred for colonoscopy after being treated for a

presumed diverticulitis episode. The colonoscopy reveals a
continuous area of inflammation and ulceration extending from
the rectum to the sigmoid colon. Colonic biopsies reveal crypt
abscesses. Which of the following is the patient most likely to
have?
a) Diverticulitis
b) Ulcerative colitis
c) Ischemic bowel
d) Crohn’s disease

93. A disadvantage of TPN is:

a) It is less costly than tube needs
b) There is potential for systemic infections.
c) It is physiologic
d) It is metabolized by the GI tract.

94. Mr. Jones is a 78-year-old gentleman who was a pedestrian

struck by a car while crossing the street. Witnesses report that
the car was going approximately 20 mph. At the scene, a
cervical collar was placed and one 14 gauge IV was placed in
the left antecubital area. Upon arrival to the ER. the patient does
not open his eyes to speech or pain and has no verbal response
but withdraws from painful stimuli. Breath sounds are minimal
on the right. Tracheal deviation to the left is noted. Heart sounds
are normal. He is bleeding from a large laceration to the
forehead. Vitals are BP 102/72, HR 84, RR 32, T 36.7° C. The
most important intervention for this patient is:
a) Assess sensory-motor function
b) Apply pressure to the head laceration
c) Infuse warmed fluids
d) Establish a definitive airway

95. TPN is used:

a) When a patient has a fistula without enteral access
b) When therapy is anticipated to be 5-14 days
c) For those patients who require larger volumes
d) For patients with peripheral access only

96. A 72-year-old man is being evaluated for profound

abdominal pain. His history is significant for coronary artery
disease with myocardial infarction (at age 68). He continues to
smoke one pack/day. He is currently managed for his heart
disease with metoprolol. He was in his usual state of health until
this morning when he developed severe, generalized abdominal
pain. The abdominal exam is unremarkable. His BP is 88/58
mmHg, pulse 110 bpm, stool heme positive. The most likely
diagnosis is:
a) Ulcerative colitis
b) Peritonitis
c) Mesenteric ischemia
 d) Perforated ulcer

Domain 3: Role-Professional Responsibility

1. As a nurse practitioner, you are aware that subconscious or

unintentional bias:
a) Is usually similar between ethnicities
b) Is something that afflicted individuals are aware of
c) Does not predict future behavior
d) Is difficult to overcome

2. According to the Health Insurance Portability and

Accountability Act (HIPAA), choose the following scenario that
is in compliance.
a) Telling a friend about the presence of a patient in the
hospital
b) Mailing information about a patient's medication regimen
to the incorrect patient
c) Discussing a patient's condition about a rare finding with
your colleagues
d) Leaving a message on a patient’s voicemail machine.

3. Your patient is a Jehovah's Witness and you are assessing

their cultural beliefs. After the patient lets you know he is not
willing to receive blood products, you acknowledge his beliefs,
recommend he donate his own blood for auto-transfusion prior
to major surgeries, and negotiate a treatment plan with him. This
scenario is an example of:
a) Effective ethnicity association
b) Cultural competence
c) Autonomy
d) Dignity

4. As a provider who is responsible for calculating a patient's

cardiovascular risk to undergo surgery, you look to current
guidelines to decide the best method. The multiple guidelines
use different methods of analysis. How do you decide which one
to use?
a) Review methods of pre-operative surgical clearance with
your peers lo determine the most popular method of
practice
b) Compare older gold standard guidelines to the new
guidelines to determine which is valid
c) Consensus could not be reached between authors of each
guideline, so the data of each guidelines is unreliable and
should not be utilized.
 d) Assess each guideline for its quality

5. A 64-year-old patient has been on your service for the last 2

weeks. She was admitted for open reduction of a hip fracture.
Her hospitalization has been complicated by postoperative
emboli. Today, you note a new onset fever. A chest X-ray
showed multifocal airspace consolidation and her oxygen
saturation on a 50% FiO2 face mask is 92%. A CBC with
differential demonstrates 90% neutrophils. She is diagnosed
with hospital-acquired pneumonia. According to the American
Thoracic Society guidelines, empiric therapy for pneumonia
should cover:
a) Staphylococcus aureus
b) Pseudomonas aeruginosa
c) Candida albicans
d) Enterococcus

6. As a new nurse practitioner, you are offered a new position

within a large healthcare system. What process will allow you to
perform specific aspects of care, such as admitting, prescribing,
and performing procedures?
a) Privileging
b) Obtaining an NPI number
c) Completion of the Collaborative Practice Agreement
d) Credentialing

7. In transitioning from IV to subcutaneous insulin, how might

recurrent hyperglycemia best be prevented?
a) Using a higher dose of intermediate acting subcutaneous
insulin after the IV insulin infusion is discontinued
b) Giving the first subcutaneous insulin dose 2-3 hours
before discontinuing IV insulin infusion
c) Using short-acting subcutaneous insulin instead oi
intermediate-acting subcutaneous insulin
d) Giving subcutaneous insulin coverage when the blood
glucose is less than 250 mg/dL for at least 24 hours

8. When seeing a new patient in outpatient clinic, you develop a

plan to treat your patients stable angina. You share the plan with
your patient, but he is not interested in invasive measures. So
together you choose to proceed with medical management. Your
patient is comfortable with the new plan. Which ethical principle
does this scenario represent?
a) Dignity
b) privacy
c) cultural beliefs
d) autonomy
9. You are a nurse practitioner interested in starting your own
practice. You are considering the benefits of using clinical core
applications, such as electronic health records, computerized
provider order entry, and decision support systems. Your
decision to use clinical core applications in your practice is
based on this fact: The use of clinical core applications…
a) is expensive to implement and update with little overall
benefit for small to medium practices.
b) reduces confidentiality of patient information due to the
electronic format.
c) improves efficiency and patient data confidentiality.
d) increases workload without overall improvement of patient
outcomes.

10. Adequate support of patient’s spiritual care needs during

their end of life care results in higher rates of hospice utilization
and less aggressive care at end of life. As an acute care nurse
practitioner, how can you provide adequate spiritual support to
your patients?
a) Assess the patient's social support group for their input on
how to support the patient's spiritual needs
b) Collaborate with hospice to address the patient's spiritual
needs
c) Enter into conversation with the patient about their hospice
care early in their illness
d) Ensure the multidisciplinary care team is addressing
the patient’s spiritual needs including making pastoral
services available.

11. As a consumer of evidence based practice' you decide to find

the most robust trial to support a new method of treatment for
your patient population focus. What type of trial is this most
likely to be?
a) Case control trial
b) Randomized Control Trial
c) Cohort study
d) Non-randomized control trial

12. As a nurse practitioner sewing the gerontology population,

you must alter your patient education techniques for older adults
because:
a) they acquire knowledge at a slower rate compared to
the younger population.
b) Learning is to be most beneficial if teaching is performed
in the early morning, as this is the older adult is most alert.
c) they require detailed step by step instruction as they do not
 easily follow directions
d) learning is improved by teaching in a group setting rather
than a 1:1 setting

13. A 63-year-old female who has been previously diagnosed

with diabetes mellitus has been admitted to your unit with the
diagnosis of diabetic ketoacidosis (DKA). The nurse pages you
to report the patient’s lab results: Na 135 mg/dI, K 5.5 mg/dI,
glucose 175 mg/dl, pH 7.30, HCO3 18, PCO2 30. anion gap 18.
The most appropriate intervention is to:
a) Administer 0.2 units/kg regular insulin subcutaneously
(SQ) x1 dose and start an insulin drip.
b) Administer potassium 10 mEq/hour IV.
c) Change current infusion of normal saline (NS) to D5W
IV at the current rate.
d) Decrease normal saline (NS) IV infusion to a rate of 30
cc/hour.

14. Nurse practitioners are expected to provide education to their

patients with attention to the patients’ health literacy, culture,
and age. What is the nurse practitioners initial step in planning
what type of educational materials and methods her patient
needs?
a) Standardize patient education materials
b) Performing a reading examination
c) Using proven tools to assess the patient’s level of
education and background
d) Determining cultural background and religious beliefs

15. As a practitioner, you strive for equality in healthcare, so

you decide to analyze your own practice for subconscious or
unintentional bias. You begin the process by:
a) Being willing to acknowledge and examine your own
bias
b) Reviewing past patient complaints about care you provided
c) Performing cross examination with your peers
d) Discussing unintentional bias with a counselor

16. Many health care organizations are beginning to use

alternate methods of communication other than face to face
visits. What is a barrier to making this type of communication
successful?
a) Ensuring the method of communication is secure to
protect sensitive patient information
b) Increasing cost of communication software systems leading
to decreased revenue.
c) Reduced efficiency of the provider as they must manage
 different sources of input from the patient.
d) Poor support of this type of service by patients above their
fifth decade of life.

17. In your outpatient clinic, you are seeing a new patient with
hypertension and diabetes. The patient is non-compliant with
medication, and his A1C is 8.0%. You provide education to the
patient about modifying risk factors and medication compliance.
Considering the best utilization of resources, the most
appropriate plan includes:
a) Consulting the diabetes nurse educator to continue close
follow up with the patient
b) Calling the patient twice weekly to assist him remembering
to take his medications, and monitoring his lifestyle
changes
c) Consulting endocrine service to assist in managing this
patient's poorly controlled diabetes
d) Close follow up with the patient in one month in clinic with
labs, to evaluate patient tor compliance and provide further
education

18. As a provider, you realize you may have a subconscious or

unintentional bias towards a certain ethnicity, gender, or body
type. What is true about this type of bias?
a) It can lead to inconsistent treatment recommendations
when comparing care given to similar patients
b) It does not change the patient’s compliance to their medical
treatment plan
c) It has no effect on treatment outcomes
d) Clinicians are not capable of changing their unintentional
bias

19. A 65-year-old diabetic male is going to the OR in the

morning tor a percutaneous endoscopic gastrostomy (PEG)
placement. Which of the following will you include in your pre-
op orders?
a) Hold routine Lantus
b) Increase sliding scale aspart
c) Decrease sliding scale aspart
d) Administer routine Lantus

20. According to the Guidelines for COPD, a cardinal sign

indicating the need for antibiotic
treatment during COPD exacerbation is:
a) Hypotension
b) Tachycardia
c) Increased temperature
 d) Increased sputum purulence

21. You are reviewing relevant research related to a new

intervention that you would like to institute in a specific patient
population. A control trial is reviewed for validity. You
determine that the study is not valid because:
a) The number of participants is greater than the planned
number for inclusion in the trial
b) The participants in the trial are not reflective of the
patients in the general population
c) The trial’s probability is calculated to be too low
d) Changes were made to inclusion criteria lo obtain better
representation of the population focus

22. After completing an outpatient clinic visit, you decide to bill

as “incident to" to collect 100% of the physician’s fee schedule
for reimbursement. What must occur for this billing to be
legitimate?
a) The physician must have a "face to face" encounter with
the patient to include a physical examination
b) The physician must be immediately available via telephone
to provide assistance and direction as needed
c) The physician must be immediately available in the
office suite to provide assistance and direction when
needed
d) The physician must be within a 30-mile radius of the clinic
setting

23. Interventions including cognitive behavior therapy to modify

risk factors for disease in minority populations will be more
effective when the program is tailored to the minorities:
a) average level of education
b) average reading level
c) level of poverty within each community
d) culture and language

24. You are a hospitalist nurse practitioner leaving your 12 hour

shift. You are reporting on each patient to the nurse practitioner
coming on shift. You each feel differently about how best to
manage a patient’s antibiotic regimen. As each of you cannot
agree on an appropriate treatment method, you reach out to a
physician working on the same hospitalist team. This is an
example of what type of conflict management strategy?
a) Avoidance
b) Collaboration
c) Compromise
d) Negotiation
25. Nurse practitioners can influence policy governing their
professional roles, responsibilities, and independence in practice
by:
a) being a member of large organizations that can best
influence decisions of legislation.
b) practicing to the full extent of their education and training
c) advocating to policy makers about key issues
d) caring for populations with complex acute health problems.

26. You are making morning rounds on the unit. You evaluate a
71-year-old man who had a hernia repair 3 days ago. The patient
demonstrates an acute change in his mental status since the last
time you saw him (yesterday). His current vital signs are BP
160/60 mmHg, HR 82, RR 18, temp 98.4 F. O2 sat is 98% on 2L
NC. He is unable to articulate and has profound right-sided
weakness. A STAT head CT reveals a cerebral infarction. Which
of the following could preclude the use of thrombolytics?
a) NIHSS score of 8
b) Time of onset of symptoms
c) Current BP
d) Recent hernia repair

27. Computerized physician order entry (CPOE) reduces risk to

the patient by:
a) Allowing the computer to make appropriate clinical
decisions based on the patient's problem list.
b) Ensuring the correct medication is ordered tor the correct
patient.
c) Ensuring the provider orders the correct medication tor the
correct indication.
d) Allowing the computer to double check for drug
interactions.

28. Collecting and analyzing patient reported outcomes in the

clinical setting is:
a) an effective method of analyzing quality of patient care
b) an optimal method of assessing the structure of an
organization
c) a precise means of assessing patient compliance to the
treatment regimen
d) unreliable as a measure of quality of patient care because a
health care professional is not involved in obtaining the
correct data

29. To improve health literacy in the outpatient clinical setting,

current methods of patient education are reviewed and revised.
These changes will result in improved:
a) patient safety
b) efficiency in the education process
c) Improved collaboration between multidisciplinary care
team members
d) access to care

30. Two programs were developed to determine the

effectiveness and outcomes of care of a Provider. The programs
are Joint Commission Practice Evaluation Standards and The
Hospital Value-Based Purchasing Program. These evaluation
tools are valuable for the evaluation of the acute care nurse
practitioner because:
a) the acute care nurse practitioner is providing
increasingly complex care in the hospital setting and
having an accurate outcomes evaluation will strengthen
their position as in- hospital providers
b) mandatory reporting of outcomes data state wide provides
accurate comparison of each facilities quality oi care for
general knowledge to the public when deciding who they
wish to supply their health care needs
c) accreditation of nurse practitioner programs depends on
positive outcomes data that is comparable to the nurse
practitioner's physician counterparts
d) standards of practice for all providers in the facility best be
measured for the hospital to maintain their accreditation

31. A 69-year-old female is brought into the ED by her family

after she started to seize approximately 35 minutes ago. Her
blood glucose fingerstick is 102 mg/dl. She vomits and
continues to have generalized tonic-clonic seizure activity. What
is the best management for her?
a) Supplemental oxygen, IV access, Dilantin 1000 mg IV,
obtain EEG
b) Supplemental oxygen, IV access. IV lorazepam, obtain
EEG
c) Supplemental oxygen, IV access. 50 ml/25 g of 50%
dextrose in water IV
d) Supplemental oxygen, IV access. diazepam 20 mg IV.
obtain EEG

32. When considering your patient’s adherence to their

medication regimen, which antibiotic do you prescribe for
bronchitis?
a) Sulfamethoxazole 800mg/trimethoprim 160mg by
mouth twice daily for three days
b) Ciprofloxacin 500mg by mouth every 12 hours for 7 days
 c) Nitrofurantoin 100mg twice daily for seven days
d) Nitrofurantoin 50mg by mouth four times daily for seven
days

33. You are a nurse practitioner in a busy outpatient clinic. You

are seeing a patient for follow up for coronary artery disease,
hypertension, and hyperlipidemia. Your collaborative practice
physician did an initial consult on this patient six months ago.
You note the patient's pulse is irregular, so you obtain an EKG.
The EKG shows atrial flutter. Prior EKGs show sinus rhythms,
and the patient denies having had an abnormal heart rhythm in
the past. Can you bill this visit “incident to” your collaborative
practice physician’s services?
a) No, because this patients care is of moderate complexity
and requires a face to face visit from your collaborative
practice physician.
b) No, because atrial fibrillation is a new condition for this
patient,
c) Yes, because your collaborative practice physician
established care with this patient at a prior visit.
d) Yes. As long as your collaborative practice physician is on
site.

34. You begin a new position as an inpatient nurse practitioner.

Your new employer is not familiar with the nurse practitioner
role, and asks you how you know what you can and cannot
legally do in your position. You refer to the scope of practice
because:
a) It defines the population that the nurse practitioner can
serve based on her certification.
b) It defines how much oversight the nurse practitioner is
required to have by her collaborative physician(s) when
seeing new and returning patients.
c) It defines the minimum number of procedures that the
nurse practitioner has to complete in a supervised setting
before performing procedures independently
d) It defines the boundaries of the license held by the nurse
practitioner

35. A 60-year-old patient with a history of type 2 diabetes is

brought into the emergency department (ED) in a near comatose
state. His heart rate is 124 bpm and BP is 86/50 mmHg. Initial
laboratory evaluation reveals a blood glucose level of 625
mg/dL with negative serum ketones. Urine glucose is 4+ and
ketones are present in the urine. Serum potassium is 4.0 mEq/dL
and serum osmolality is 320 mOsm/L. Immediate treatment
must include which of the following?
 a) Normal saline solution (NSS) infusion
b) Humulin R 20 units intravenous push (IVP)
c) D51/2 normal saline solution (NSS) infusion
d) Humulin R 1 u/kg/hr intravenous drip

36. Physicians in the hospital are questioning the effectiveness

of the care nurse practitioners provide compared to the care
provided by a physician. How can you best provide support to
other acute care nurse practitioners providing care in the hospital
setting at a local level?
a) Explain the scope of practice to the physicians questioning
the effectiveness of care of nurse practitioner.
b) Request that the physicians complete a detailed chart
review for review of your past patient encounters to
analyze the quality of care that you provide.
c) Ensure your facility is tracking appropriate data for
physicians and nurse practitioners alike.
d) Provide the physicians with a detailed analysis of your
educational and clinical preparation for your position as a
nurse practitioner.

37. You see a patient in the clinic for follow up of existing

medical conditions. Your collaborative practice physician is not
on sites At what rate can you bill for?
a) 100% of the fee according to the Medicare Nurse
Practitioner Fee Schedule
b) 100% of the physician fee as you are billing "incident to”
c) 55% of the lesser of the actual charge
d) 85% of what a physician is paid under the Medicare
Physician Fee Schedule

38. Who is responsible for protecting the data that your practice
utilizes in me electronic health record?
a) The Electronic health record developer
b) The electronic information security agent at the practice
c) The practice
d) The program manager at the practice

39. Your team of nurse practitioners decides to institute a new

method of surgical site closure for a certain procedure, and
analyze the incidence of surgical site infection for each method.
A null hypothesis has been identified as true. The new method of
surgical site closure is:
a) ineffective in decreasing the incidence of surgical site
infection. Consider using the initial closure method.
b) Effective. Consider continuing the trial for an additional 6
months to be certain the trial has an adequate number of
 participants to improve validity
c) Inferior. Consider altering the hypothesis to better reflect
the actual outcomes
d) Superior. Consider publication in a peer reviewed journal

40. You are caring for a patient who was admitted to the ICU
with anemia of unknown origin two days ago. Yesterday
hemoglobin was stable at 7.5g/dL. Today’s hemoglobin is
6.5g/dL. The patient complains of left substernal chest pain. Lab
work is ordered for cardiac enzymes, and an ECG is obtained
which shows new ST segment depression in leads II, III, and
AVF. The nurse administers one sublingual nitroglycerin 0.4mg,
and the patient's pain is relieved within one minute, Vital signs
are unchanged and stable. What do you do next?

a) Start acute coronary syndrome protocol by administering

aspirin, and initiating a heparin infusion.
b) Consult cardiology and GI services,
c) Activate the cardiac catheterization lab for emergent heart
catheterization
d) Hold all antiplatelet and anticoagulant agents, and
administer 1u PRBC.

41. According to the ADA guidelines for the diagnosis of

diabetes, which one of the following pairs of readings would be
sufficient for a diagnosis of diabetes mellitus?
a) Fasting plasma glucose (FPG) levels of 124 mg/dL and 110
mg/dL
b) Glucose reading taken 2 hours after a 75 g load) of 143
mg/dL and FPG level of 109 mg/dL
c) Fasting plasma glucose level of 130 mg/dL and an oral
glucose tolerance test (OGTT) of > 200 mg/dL
d) Oral glucose tolerance test of 197 mg/dL and FPG level of
105 mg/dL

42. Which of the following treatment plans would you order for
your patient with known restrictive lung disease?
a) Oxygen therapy, pulmonary rehabilitation, and NSAIDS
b) Oxygen therapy, pulmonary rehabilitation, and steroids
c) Diuretics, pulmonary rehabilitation. and transplant consult
d) Transplant consult, oxygen therapy, and NSAIDS

43. You are providing care to patient who comes in with acute
shortness of breath. Lab tests show that their D-Dimer is
positive. The patient had chronic kidney disease stage III. You
send the patient for a V/Q scan to determine if they have a
pulmonary embolism. The V/Q scan results reveal an
indeterminate probability. You weight the risks and benefits of
performing a CTA chest on this patient, versus treating the
patient for a pulmonary embolism. This risk to benefit analysis
is an example of:
a) Veracity
b) Beneficence
c) Non-maleficence
d) Autonomy

44. The outpatient clinic where you work is transitioning from

paper records to an Electronic Health Record. Your patient asks
you what the benefits of the new system are. You tell the patient,
“The Electronic Health Record has been shown to...
a) decrease the amount of time it takes for an office visit and
improve timeliness of documentation."
b) improve patient privacy and security"
c) lower cost of maintaining patient records and increase
productivity,"
d) improve patient safety and quality of patient care."

45. The nurse practitioner peer review and evaluation process

was developed to:
a) measure the practitioners practice performance
compared to standards of practice and scope of
practice.
b) satisfy state regulations for oversight of the nurse
practitioner’s practice
c) meet criteria for recertification of the nurse practitioner
license.
d) provide a review of 10% of records for credentialing and
privileging.

46. Physicians opposition to full practice authority for nurse

practitioners:
a) is due to findings that the nurse practitioner does not
provide care that is equivalent to physicians as measured by
patient satisfaction scores
b) results from the nurse practitioner’s inability to generate
revenue
c) will be difficult to overcome due to the resultant revenue
that will be lost by physicians.
d) is based on their differences in methods, length, and
rigor of education.

47. A 76-year-old woman with a history of COPD, stroke, recent

MI. and HTN presents with the chief complaint of increased
dyspnea. She states that her dyspnea has gotten significantly
worse over the past 24 hours and she is no longer able to walk
more than a few feet without gasping for breath. She lives alone
and has no sources of support. Which is the most appropriate
discharge plan for this patient?
a) Discharge home
b) Admit to rehabilitation unit
c) Transfer to a skilled nursing facility
d) Admit to the intermediate care unit

48. As a nurse practitioner, you decide to conduct a randomized

control trial, to test the effectiveness of a new program to
improve pain control by the Physical Therapy group at your
facility. You find that several subjects have completed therapy
sessions, and each individual has obtained different results after
each session. What aspect of validity may be compromised in
your trial?
a) Outcomes variability
b) Reliability
c) Generalizability
d) Transferability

49. As a nurse practitioner, you advocate for full practice

authority to:
a) improve patient's access to health care.
b) increase reimbursement rates for nurse practitioners.
c) allow nurse practitioners to open up their own practice.
d) secure the ability of nurse practitioners to admit patients to
the hospital.

50. You are reviewing a cross sectional study, which states that a
new method of rapid virus testing has a 90% sensitivity, and a
50% specificity. Your team of researchers has determined it is
very important to choose a testing system that will accurately
predict negative tests. You determine the test is poor because it
will accurately determine:
a) 10% of positive cases
b) 90% of negative cases
c) 50% of negative cases
d) 90% of positive cases

51. One barrier to nurse practitioners practicing to the full extent

of their education and training is:
a) a lack of support from the American Association of
Colleges of Nursing.
b) Medicare reimbursement regulations.
c) a lack of confidence of nurse practitioners to provide care,
d) state licensure and nurse practice acts
52. When considering methods of reducing risk factors for
disease, primary and secondary prevention methods are not as
effective alone as when combined with:
a) Self-esteem building therapy
b) A class focusing on risk factor modification and disease
prevention
c) Providing curriculum that focuses on preventative
strategies
d) Cognitive behavioral therapy

53. One component of the electronic health records is clinical

decision support (CDS) which makes suggestions to the provider
for patient care based on programmed guideline data. Barriers to
use of CDS systems include:
a) difficulty in timely updating guidelines within CDS
systems
b) reduced compliance with preventative care practices due to
distractions caused by CDS system.
c) reduced adherence to guidelines when using CDS systems.
d) difficulty in maintaining workflow and efficiency due to
demand for increasing the amount of data to be reviewed

54. After completing your nurse practitioner program and

achieving national board certification, you accept a position at a
large healthcare system. Who is responsible for completing the
credentialing process so that you have the authority to practice
in the hospital setting?
a) The Nurse Credentialing Center
b) The State Board of Nursing
c) The Hospital
d) The Joint Commission

55. You are the nurse practitioner caring for a patient in the
Emergency Department (ED) who is unconscious after a
traumatic brain injury. A friend of the patient’s presents to the
ED asking for the patient by name, inquiring about their
condition. In accordance with the Health Insurance Portability
and Accountability Act (HIPAA), what information can you
provide to the friend?
a) the patient's location and condition,
b) No information can be disclosed without the patient's
consent
c) The patient's location, condition, and medical management
plan
d) the patient's location. but not their condition
56. Your patient is a 72-year-old male who is non-compliant
with his diabetes medications. What can you do during your
patient encounter that could improve his compliance to his
medication regimen?
a) Ensure the patient has a support person, and educate this
individual so they may be more involved in the patients
care and assist the provider in improving the patient's
compliance.
b) Add intensive medical therapy to include oral
hypoglycemic and insulin if necessary
c) Create a treatment plan that includes attending diabetes
education courses, while implementing an exercise
regimen. Additionally, improving diet by decreasing
portions and eating more frequently.
d) Involve the patient in all treatment decisions

57. You are the nurse practitioner providing care to a critically

ill patient with respiratory failure, who is dependent on the
ventilator. The nurse reports concern because the patient’s
significant other is writing details about all conversation and
patient encounters down in her notebook. What should you do?
a) Politely ask the patients significant other to discontinue her
documentation and dispose of the patient’s information in a
secure manner.
b) Support the significant other by assessing their
knowledge of the situation, and encourage them to keep
notes.
c) Notify the representative of privacy and security, as this
type of documentation is a Health Insurance Portability and
Accountability Act (HIPAA) violation.

d) Discuss with the patient's significant other the importance

of protecting the patient's personal health information so
the documents she keeps can be stored securely.

58. As a nurse practitioner and member of the multidisciplinary

health care team, the nurse practitioner works as team member
rather than a superior or inferior team member. The team strives
for mutual respect. This method of practice, which results in
improved patient outcomes, is an example of:
a) Evidence Based Practice
b) Integrated care
c) Accountability
d) Collaboration

59. The acute care nurse practitioner's practice environment is

defined as:
 a) working in the hospital setting.
b) practice locations serving patients with acute illness.
c) specialty care areas such as cardiology, pulmonary,
oncology. or intensive care.
d) inpatient and outpatient settings to exclude services
provided in the home health care setting.

60. This regulating body determines the nurse practitioner's

ability to practice to full, restricted, or reduced practice:
a) The State Board of Nursing where you are licensed
b) The American Nurse Credentialing Center
c) The Association of Critical Care Nurses
d) The American Association of Nurse Practitioners

61. As a nurse practitioner, you are reviewing a randomized

control trial to determine if the results are statistically significant
for consideration of instituting the findings into your practice
setting. Researchers reject a null hypothesis when the
probability is:
a) Non-inferior
b) High
c) Not statistically significant
d) Low

62. You are the nurse practitioner providing care for a patient
who is non-compliant with the treatment plan and becomes
angry, having frequent outbursts during clinic visits. You decide
to discharge the patient. To avoid patient abandonment
litigation. you must provide the patient:
a) sufficient notice of termination of the patient—provider
relationship so they may find another provider to
provide their medical care.
b) a certified letter containing a list of appropriate alternate
providers within a thirty-mile radius.
c) notification of cancellation of future appointments. As the
provider, you have the right to end the patient provider
relationship.
d) three month’s notice of termination of the patient-provider
relationship.

63. Creating and using practice protocols for specific conditions

lo ensure treatment methods are based on scientific findings is an
example of what?
a) Transformative Health Care
b) Quality Improvement Initiatives
c) Paradigm Initiative
d) Evidence-Based Practice
64. The level of coding that you choose for your patient after
your inpatient or outpatient visit is determined by what?
a) Complexity of the patient
b) Acuity of the patient
c) The number of diagnostics required for workup oi the acute
illness
d) Length of time spent with the patient

65. You are serving as an experienced nurse practitioner mentor

to a group of nurse practitioner students. You ask your students
to identify reasons to institute evidence based practice into
clinical decision making, Choose their best answer:
a) By using standardized treatment protocols that are evidence
based, providers can easily and efficiently provide care for
patients at any facility in the United States, improving
access to care and decreasing medical errors.
b) Tested and proven interventions provide for the most
consistent outcomes
c) Using individualized treatment methods according to each
patient's unique scenario results in improved and consistent
clinical outcomes.
d) Standardizing treatment with evidence based interventions
according to a patient's illness results in improved clinician
skills

66. Advanced practice nurses are held legally accountable to

their scope of practice. An employer's malpractice insurance
policy will protect:
a) the nurse practitioner and their personal assets if they are
named individually in a lawsuit
b) the employing agencies and the nurse practitioner, looking
out for each entities best interests
c) the nurse practitioners license to practice
d) The employing agencies' assets if a medical lawsuit is
filed

Domain 4: Healthcare Systems

1. Lung cancer screening guidelines have changed in recent

years to be performed with increasing frequency depending on
risk. This change was made after comparing the cost of
screening to the benefit of finding and treating cancer, resulting
in decreased morbidity and mortality. The benefit of an
intervention must exceed the cost by a wide margin for it to be
considered in this model:
 a) Outcomes Driven Interventions
b) Comparative Healthcare Delivery Effectiveness
c) Cost Benefit Analysis
d) Healthcare Expenditure

2. As a nurse practitioner, you are involved in healthcare politics

and have developed a
relationship with local congressmen, and regularly write letters
and make phone calls to make
them aware of your viewpoint on key issues that will affect
delivery of care to the patient's you
serve. What is true about your role as a political advocate?
a) Influencing policy makers is discouraged by the American
Nurse Credentialing Center.
b) Advocacy in legislation fulfills the practitioner's obligatory
duty as a health care provider to provide expert opinion on
the impact of policies
c) Lobbying by health care providers has little impact on
policy development and revision.
d) By making lawmakers aware of the impact of their
policies, you are acting as a patient advocate.

3. The consensus model for APRN regulation mandated that

nurse practitioners must complete three core competencies
including advanced pharmacology, advanced physical
assessment, and advanced pathophysiology. This was done in an
effort to:
a) align the education and preparation of nurse practitioners to
that of their physician counterparts.
b) ensure that all nurse practitioners completing an NP
program have the knowledge necessary to safely prescribe
medications.
c) align and merge the course content of nurse practitioner
program and doctoral of nursing practice programs.
d) prepare nurse practitioners tor the changing healthcare
environment to meet the health care needs of the future
population.

4. The United States healthcare system, compared to other high

income countries, is sub optimal when considering lifespan of
US citizens. Why is this?
a) differences in mandatory vaccinations between the US and
other nations
b) differences in national health codes such as safe drinking
water and regulation of food handling
c) different resources, procedures, medications, and medical
equipment
 d) differences in the structure of healthcare of each nation

5. An effective method of reducing health care costs is allotting

a budget for the healthcare expenditure and choosing to employ
interventions that will have the largest impact on the health of
the people. Interventions with the largest impact on
improvement of health would be priority. This method is called:
a) Outcomes Driven Interventions
b) Value Based Care
c) Cost Effectiveness Analysis
d) Minimalistic Medicine

6. As a new nurse practitioner. you note several practices that do

not meet adequate quality and safety standards within the
institution you are working. What can you refer to from your
education to help you make institutional changes for improved
patient outcomes?
a) Consult with your mentors for guidance about how to
approach the leaders of the institution to most effectively
deliver the suggestion for changing the delivery of health
care to improve patient safety and quality of care.
b) Refer to roles and responsibilities within your coursework
to identify the position of the nurse practitioner as a change
agent and leader of improving safety and quality in health
care delivery.
c) Course content focusing on leadership and development
which will guide you in identifying key stake holders and
obtaining the support for making systems changes to
improve quality and safety,
d) Quality and Safety Education for Nurses (QSEN) which
focuses on changing the infrastructure of the healthcare
delivery system to meet adequate quality and safety
initiatives

7. Meaningful Use Criteria designed by the Centers for

Medicare and Medicaid Services consists of timeline goals for
facilities providing healthcare services to transition to electronic
methods of data collection and charting. As a nurse practitioner,
you are aware that complying with the documentation goals
will:
a) allow capture of specific data points, that when
reported, result in monetary incentives.
b) Be required for accreditation and certification from the
Joint Commission
c) allow your facility to receive reimbursement for care
provided to patients with Medicare and Medicaid insurance
policies
 d) allow your facility to be eligible for magnet status from the
American Nursing Credentialing Center.

8. Third parties, such as health insurance companies, pay the

vast majority of medical bills in the United States. Patients are
not paying for services at the same time as they are receiving
them. What is the effect?
a) Increased utilization of health care services by patients
b) Higher insurance premiums paid by the insured
c) Lower cost of health care services.
d) Increased cost to the facility providing health care services.

9. You are an experienced nurse practitioner evaluating a patient

who does not have health insurance. The patient asks you how
much the echocardiogram, lab work, and new medication that
you ordered costs. Why do you think you, as the nurse
practitioner, may have difficulty answering this question?
a) Cost for services is rendered based on the amount of time
that each task takes, so it may not be calculated accurately
prior to services being rendered.
b) It is unethical for the nurse practitioner to choose treatment
methods for a patient based on their ability to pay
c) It is the responsibility of the pharmacy, lab, and
imaging/radiology departments, etc. to notify the patient of
the cost of services provided.
d) The nurse practitioner likely see's mostly insured
patients who are not as concerned with cost for services
as they must only pay a small portion, compared to
their uninsured counterparts who are responsible for
paying for all costs for services.

10. The most effective method of prevention of disease, when

considering the cost of prevention and comparing the cost of
treatment had the prevention not occurred, you can recommend
for your patient population is:
a) lifestyle and risk factor modification
b) colonoscopy and regular intervals per guidelines
recommendations
c) self-breast exams and routine mammography per guideline
recommendations
d) yearly prostate specific antigen labs and prostate exams