Nokea
A 74-year-old man who recently lost his spouse of 50 years in an auto accident tells the NP that "he has no purpose in this life":
- A. Have you told your family how you feel?
- B. Have you thought about hurting yourself?
- C. Are you taking your medication?
- D. Do you have any friends?
Correct Answer: B
Rationale: This is a key screening question to assess for suicidal ideation.
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Chronic bloody diarrhea could be suggestive of:
- A. Irritable bowel syndrome
- B. Crohn’s disease
- C. Hepatitis A
- D. Celiac disease
Correct Answer: B
Rationale: Chronic bloody diarrhea is common in inflammatory bowel diseases like Crohn’s disease.
Randall Johnson, an 80-year-old man with a history of high blood pressure and hypothyroidism, presents with ongoing dizziness. What is the most likely cause of his dizziness?
- A. Orthostatic hypotension
- B. Benign positional paroxysmal vertigo
- C. Overcontrol of thyroid
- D. Ménière disease
Correct Answer: A
Rationale: Orthostatic hypotension is the most likely cause of dizziness in this patient with high blood pressure and hypothyroidism.
Two years later Mr. Hunter reports progression of his urinary symptoms and desires “a pill to make this better.” His current IPSS is 17, with a bother score of 3 indicating moderate voiding symptoms with moderate impact on his quality of life. On review of systems he notes that his vision has worsened, especially in his left eye. His ophthalmologist has recommended cataract surgery. For which of the following medications would initiation of therapy be delayed until after cataract surgery?
- A. Finasteride
- B. Tamsulosin
- C. Tadalafil
- D. Oxybutynin
Correct Answer: B
Rationale: Tamsulosin may cause intraoperative floppy iris syndrome, so it is often delayed until after cataract surgery.
Recommended combination therapy for uncomplicated anorectal and pharyngeal gonorrhea is?
- A. Ceftriaxone and benzathine penicillin
- B. Benzathine penicillin and doxycycline
- C. Doxycycline and ciprofloxacin
- D. Ceftriaxone and azithromycin
Correct Answer: D
Rationale: The recommended treatment for gonorrhea is ceftriaxone and azithromycin for uncomplicated infections.
A woman is 11 weeks pregnant and has a maternity history of one full term vaginal delivery, a set of premature triplets delivered vaginally, and a first trimester abortion. Using her TPAL system to document her maternal status:
- A. Gravida 4 para 1114
- B. Gravida 4, para 1314
- C. Gravida 3, para 1114
- D. Gravida 3, para 1112
Correct Answer: A
Rationale: TPAL system: Gravida (pregnancies), Para (full-term, preterm, abortions, living children).