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    Exam Review

    1. A 55 year-old patient presents with shoulder pain after falling during an ice storm. On examination, there is localized shoulder pain when the advanced practice registered nurse (APRN) performs the "crossover test" (arm moved across the chest toward the opposite side while extended at the elbow). Which of the following is the most likely site of injury?
      A)
      Rotator cuff
      B)
      Bicipital tendon
      C)
      Glenohumeral joint
      D)
      Acromioclavicular joint
    2. The advanced practice registered nurse (APRN) assesses the skin on the face of a 70 year-old patient. The APRN notes a small (7 mm), pink, raised, papule with overlying telangiectasias on the patient's nasojugal fold. The APRN recommends a biopsy of the papule. What diagnosis does the APRN suspect?
      A)
      Sebaceous hyperplasia
      B)
      Fibrous papule
      C)
      Basal cell carcinoma
      D)
      Actinic Keratosis
    3. The advanced practice registered nurse (APRN) performs a routine check-up on a patient in the vascular surgery clinic. The APRN notices that they have a history of chronic arterial insufficiency. Which physical examination finding in the lower extremities would be expected?
      A)
      Bounding pulsations
      B)
      Normal temperature
      C)
      Marked edema
      D)
      Thin, shiny, atrophic skin
    4. The advanced practice registered nurse (APRN) assesses an 18 year-old patient who reports 2 months of foul-smelling, profuse, yellowish-green vaginal discharge. There is also itching and burning during urination. Visualization of the vulva shows minor erythema. The vaginal mucosa is diffusely erythematous. Bimanual examination is unremarkable. What diagnosis is most likely?
      A)
      Atrophic vaginitis
      B)
      Trichomonal vaginitis
      C)
      Candidal vaginitis
      D)
      Bacterial vaginosis
    Page 1 of 13

    Exam Review

    1. The advanced practice nurse (APRN) is assessing the functional status of an older adult in the primary care office. While assessing vision the patient reports difficulty in seeing while reading. What is the most appropriate next step?
      A)
      Order an MRI of the head with contrast
      B)
      Perform an ophthalmoscopic visual examination of each eye with the lights dimmed
      C)
      Test each eye with Snellen chart without the patient wearing their corrective lenses
      D)
      Refer the patient to ophthalmology
    2. The advanced practice registered nurse (APRN) knows which of the following systemic symptoms are usually associated with osteoarthritis (OA)?
      A)
      Low grade fever and malaise
      B)
      Fatigue and generalized weakness
      C)
      Systemic symptoms are usually absent
      D)
      Weight loss and anorexia
    3. The advanced practice registered nurse (APRN) assesses a 75 year-old patient in the primary care office. The patient presents with concerns of bilateral tender, stiff wrists associated with metacarpophalangeal (MCP) and distal interphalangeal (DIP) joint pain. They report associated stiffness that is worse in the morning for about an hour or more and after periods of Inactivity. On physical exam the APRN notes tender, warm, non-erythematous joints. What is the most likely cause of the patient's joint pain?
      A)
      Rheumatoid arthritis
      B)
      Osteoarthritis
      C)
      Gouty arthritis
      D)
      Trigger finger
    4. A 52 year-old patient presents with a two month history of intermittent pain in their wrist and forearm on both sides, in addition to numbness and tingling in the thumb and index fingers after prolonged use. During the examination, the advanced practice registered nurse (APRN) notes both a positive Tinel's and Phalen's test. What is the most appropriate primary diagnosis based on these findings?
      A)
      Flexor tenosynovitis (trigger finger)
      B)
      Carpal tunnel syndrome
      C)
      Psoriatic arthritis
      D)
      Occult scaphoid fracture
    Page 2 of 13

    Exam Review

    1. All of the following are visible signs of breast cancer EXCEPT
      A)
      Skin dimpling
      B)
      Nipple retraction
      C)
      Peau d'orange (orange peel) sign
      D)
      Erythema of the breast
    2. In which condition would the advanced practice registered nurse (APRN) anticipate a bounding radial pulse?
      A)
      Mitral stenosis
      B)
      Hypothyroidism
      C)
      Aortic regurgitation
      D)
      Arterial embolism
    3. Which of the following vaccines is safe during pregnancy?
      A)
      Intranasal influenza
      B)
      Tetanus, Diphtheria and Pertussis
      C)
      Measles/Mumps/Rubella
      D)
      Varicella
    4. The advanced practice registered nurse (APRN) is assessing a 17 year-old patient who presents with complaints of a nontender mass in the right scrotum, which "comes and goes" per patient report. During the physical exam of the genitalia, the APRN asks the patient to "cough". While the patient coughs, the APRN uses their index finger to assess the inguinal canal and notes a bulge touching the finger during coughing. What is the most likely cause of the mass?
      A)
      Acute orchitis
      B)
      Indirect inguinal hernia
      C)
      Acute epididymitis
      D)
      Hypospadias
    Page 3 of 13

    Exam Review

    1. An advanced practice registered nurse (APRN) teaches an 87 year-old patient about home safety. Which of the following would the APRN include in the education?
      A)
      Avoid wearing shoes inside the house.
      B)
      Install bright lighting and lightweight curtains.
      C)
      Place throw rugs around the home.
      D)
      keep medications on the counter for easy access.
    2. When performing a physical examination of a newborn, the advanced practice registered nurse (APRN) knows which approach is best for examination?
      A)
      Complete the examination quickly with the newborn fully dressed to minimize handling time.
      B)
      Examine the newborn away from caregivers to minimize distraction.
      C)
      Begin the examination with the newborn swaddled and undress gradually as the exam proceeds.
      D)
      Stimulate the newborn by turning on bright lights to assess eye opening.
    3. An advanced practice registered nurse (APRN) assesses brachial and radial pulses and notes they are bounding. How should the APRN document the pulses?
      A)
      3+
      B)
      1-
      C)
      2-
    4. A 68 year-old retired truck driver comes to your office for evaluation of swelling in his legs. The patient is a smoker and has been taking medications to control hypertension for the past 25 years. You are concerned about the risk for peripheral vascular disease. Which test is most appropriate to order initially to evaluate for this condition?
      A)
      venogram
      B)
      CT scan of the lower legs
      C)
      Ankle-Brachial Index (ABI)
      D)
      PET scan
    Page 4 of 13

    Exam Review

    1. Which of the following are signs of joint inflammation? Select All That Apply.
      A)
      Swelling
      B)
      Redness (erythema)
      C)
      Pain or tenderness
      D)
      Coolness to touch
    2. During a neurologic assessment, the advanced practice registered nurse (APRN) notes that a patient keeps their eyes closed but opens them when spoken to loudly, answers questions appropriately, and then quickly falls back asleep. How should this level of consciousness be documented?
      A)
      Alert
      B)
      Obtunded
      C)
      Lethargic
      D)
      Stuporous
    3. Polypharmacy is a leading cause of morbidity in the older adult population. Advanced practice nurses (APRNs) can improve medication safety in their older adult patients by doing all the following EXCEPT:
      A)
      Assess medications for drug-drug interactions.
      B)
      Perform thorough medication history and reconciliation.
      C)
      Assess for non-adherence, underuse and inappropriate use of medications.
      D)
      Routinely prescribe opioids for pain.
    4. As part of a routine infant assessment, the advanced practice registered nurse (APRN) regularly assesses bilateral hips for signs of dislocation until the child is walking. What special physical exam maneuvers are used to detect hip instability in the newborn? Select All That Apply.
      A)
      Barlow test
      B)
      Trendelenberg test
      C)
      Ortolani test
      D)
      Leopold test
    Page 5 of 13

    Exam Review

    1. The advanced practice registered nurse (APRN) assesses the knee of a patient who presents with swelling of their right knee. The APRN places their thumb and index finger of their right hand on each side of the patella; with the left hand the APRN compresses the suprapatellar recess against the femur (as shown in the figure below). The APRN is able to palpate ejected fluid or "ballooning" of fluid. The APRN documents a positive "balloon sign", which is associated with:
      A)
      Bursitis
      B)
      Minor effusion
      C)
      Rheumatoid arthritis
      D)
      Major effusion
    2. A 45 year-old patient presents acutely with respiratory distress. The advanced practice registered nurse (APRN) intends to place an arterial line in the right radial artery. Prior to drawing placement, the APRN will perform which test to ensure the patency of the ulnar artery prior to puncturing the radial artery?
      A)
      Trendelenburg test
      B)
      Allen test
      C)
      Tiner's test
      D)
      Phalen's test
    3. A patient reports an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with sun exposure. On examination, the advanced practice registered nurse (APRN) observes plaques with a silvery scale and pitting in the nails. What diagnosis is most likely?
      A)
      Atopic dermatitis
      B)
      Pityriasis rosea
      C)
      Tinea versicolor
      D)
      Plaque psoriasis
    4. A 66 year-old patient with a 40-pack-year history of smoking presents with pain and cramping in the legs during exertion that is relieved by rest within 10 minutes. How would the advanced practice registered nurse (APRN) document this finding?
      A)
      Intermittent claudication
      B)
      Chronic venous insufficiency
      C)
      Acute lymphangitis
      D)
      Retrograde filling defect
    Page 6 of 13