A 72 year old patient is seen in clinic with a concern for depressed mood. He has had depression in the past, which was successfully treated with paroxetine.  He now reports sadness, lack of energy, feelings of helplessness and apathy. Past medical history is significant for depression (age 45), CAD, hypertension, and chronic kidney disease, stage 2.  Medications include aspirin, metoprolol, lisinopril and atorvastatin.  VSS, physical exam unremarkable.   Which medication is recommended to treat this patient’s depression?

Using a shared decision making model with your patient, you have decided to treat her anxiety with a medication. Which of the following is a true statement regarding medication management for anxiety for this patient?

The incidence of multi-drug resistant (MDR) organisms causing UTIs is increasing along with mortality. Identifying risk factors for the development of MDR gram negative bacteria could have a big impact on patient care and management. Which of the following details of a patient’s history, occurring in the past 3 months, is NOT a risk factor for multi-drug resistant gram negative UTIs?

The pre-participation sports physical is an excellent opportunity to provide education related to healthy behaviors and injury prevention, as well as identifying risk factors that affect well-being. Which of following is NOT typically included in a pre-participation sports physical?

Your next patient presents with acute jaundice, there are many causes of this condition. It is important to determine the underlying cause of jaundice. Which of the following is NOT considered a common risk factors for acute jaundice?

A 51-year-old patient with a history of diverticular disease asks what he/she can do to minimize acute symptoms. What is the best recommendation for the APRN to give this patient?

Abdominal pain is complex and sometimes hard to diagnosis condition.  This encompasses several systems and requires diligent listening, assessment and follow up.  Abdominal pain is often disregarded in the older patients, especially patients with dementia, leading to alarming complications.   Your next patient is 68-year-old man, who came to his clinic visit today with acute symptoms of nausea, vomiting and abdominal distention.  He has had intermittent and crampy abdominal pain for several days.  He has not had a bowel movement for a week, he usually has a BM every day or other day.  He was too afraid to try a laxative.  He is not sure about flatus, he really doesn’t pay attention to things like that.  He hasn’t eaten anything different than his wife over the past week, either before or after his symptoms started.  In fact, he has not been able to eat over the past 48 hours, just drinking water and some coffee to prevent a caffeine withdrawal headache. He has generally enjoyed good health.  He prides himself on only taking a multivitamin, no prescription medications, he is very active and still working.  PMH/PSH:  Wisdom teeth out at age 20, appendectomy at age 15.     PE:  Ill-appearing, T:  100.3, HR 114, BP 144/78.  CV:  S1S2, NSR without murmur or ectopy Pulmonary:  breath sounds clear bil without wheezing, rhonchi or crackles  Abdomen:  distended, bowel sounds hyperactive and percussion tympanic throughout.   What is your next step with this patient?

A 44-year-old male patient with the diagnosis of pre-diabetes is seeing you for a pre-op evaluation for an anal fissure repair.  According to the American Diabetes Pre-Operative Guidelines, patients who are taking metformin (an oral diabetes medication) should:

Orthostatic hypotension is the second most common cause of syncope and more commonly affects older adults. Orthostatic hypotension is commonly seen in outpatient clinics. During the HPI and ROS careful attention should be paid to symptoms that may reveal the underlying cause.  Which question is less important to ask a patient that you are concerned may have orthostatic hypotension?

Cholelithiasis (gallstones) are caused by hardened deposits of bile and increased cholesterol secretions. Some people are more prone to the development of cholelithiasis (gallstones) than other people.  Which of the following is NOT considered a common risk factor for cholelithiasis (gallstone) formation?