1. The 27 year old patient is experiencing secondary amenorrhea. At the time of her visit her period is 5 weeks late. she has given birth twice before and says she does not believe she is pregnant since she is not experiencing any symptoms of pregnancy. What is your first step as her nurse practitioner a) Perform a public ultrasound to check her anatomical abnormalities b) refer the patient to an endocrinologist c) refer the patient to an oncologist d) order a pregnancy test D 2. a 50 year old male has weakness in his quadriceps, pain rating into the medical malleolus comma along with numbness and a diminished patellar reflex period you suspect an L34 disc herniation period which screening exam is appropriate to confirm this diagnosis a) Have the patient walk on heels of feet b) have the patient walk on toes c) have the patient reach upward keeping head forward d) have the patient squat and rise D 3. A mother of a 15 year old high school student is inquiring about contraception options for her daughter. She mentions oral contraceptives but is curious about the disadvantages of this method. What would be your best response? a) Oral contraceptives though effective in many cases are considered too expensive for some women can lead to mood changes offer no protection against HIV and can cause rare circulatory complications b) oral contraceptives are very cost effective for women and provide a great choice for protection against HIV. Oral contraceptives, however, must be taken daily and have possible side effects such as nausea, headaches, and breakthrough bleeding. c) Oral contraceptives are difficult to locate and offer no protection against HIV. Furthermore, oral contraceptives increase the risk of rare liver tumors and must be taken daily. d) oral contraceptives provide protection against HIV infections and are cheap for most women. Oral contraceptives do, however, increased the risk of rare liver tumors, must be taken daily, and have possible side effects such as nausea headaches and breakthrough bleeding. A 4. From the following, which is a characteristic of the 2007 National Heart lung and blood Institute or national asthma education and prevention program guidelines for the diagnosis and management of asthma? a) If continued controlled asthma is sustained for two months of treatment, step down treatment may begin b) patients are organized into four distinct age groups based on current impairment and future risk c) for the treatment of persistent asthma, ICS are typically contraindicated for patients younger than five years of age d) long acting beta agonists may be combined with inhaled cortical steroids to act as a step up treatment for persistent asthma D 5. You are performing a quad screen on a pregnant patient, which component of the screen is most telling in detecting Down syndrome? a) Amniotic fluid b) human chorionic gonadotropin c) estriol d) Alpha fetoprotein D 6. A woman was in a motor vehicle crash in which she states her abdomen hit the steering wheel. She tells you that as she is approximately 3 months pregnant. Given your knowledge of obstetrics, what will you assess? a) Braxton Hicks b) the fundus which should be palpable below the umbilicus c) fetal heart tones d) Leopold maneuvers C 7. A 24 year old is presented to the urgent care clinic with a markedly solin scrotum. He admits to being moderately sexually active with several partners in the past year. He denies any trauma or injury. He also adds "it hurts when I pee". Based on your suspected diagnosis which agent would be most appropriate to order at this time a) Trimethoprim-sulfamethoxazole + ciprofloxacin b) finasteride + oflaxacin c) Trimethoprim-sulfamethoxazole + ceftriaxone d) Ceftriaxone + doxycycline D 8. After insistence from his girlfriend, 18 year old Tim is seeing you regarding persistent headaches that have occurred since high school. While interviewing Tim, who is overweight, you learn that his symptoms have a slow onset and sometimes he sees stars when the symptoms are at their worst. He also reports that his headaches, which usually occur during the afternoon, can last for up to several hours. Which of the following is the most likely diagnosis a) migraine headaches b) headaches due to severe hypertension c) tension headaches d) cluster headaches