PRIMARY CARE ART AND SCIENCE OF
ADVANCED PRACTICE NURSING EXAM STUDY
GUIDE 2026 QUESTIONS WITH ANSWERS
GRADED A+
◉ Headache - Continued Temporal arteritis or giant cell arteritis
(GCA). Answer: *Older adults have fewer headaches overall,
However, when an older adult presents with a new-onset headache,
suspicion should be high for an underlying systemic disease such as
temporal arteritis or intracranial lesion. These headaches require
immediate medical evaluation.
*Temporal arteritis or giant cell arteritis (GCA) affects men and
women equally and occurs predominantly in adults older than age
60. Its incidence increases with age and is rare in the young.
Associated symptoms include scalp allodynia, jaw claudication, and
concurrent polymyalgia rheumatica. Other symptoms are local
swelling; tenderness and pulselessness of the temporal artery; and
systemic symptoms of fever, anorexia, weight loss, and chills.
Systemic markers of inflammation also are present. Prompt
diagnosis is important since temporal arteritis can cause permanent
vision loss if left untreated.
◉ Headache - Continued thunderclap headache. Answer: A
"thunderclap headache" is an abrupt and severe, sudden onset
headache that reaches maximal intensity in under 1 minute. This
,type of headache requires emergent evaluation since it is often
caused by a subarachnoid hemorrhage. The headache from
subarachnoid hemorrhage commonly occurs from a ruptured
intracranial aneurysm, such as a "berry" aneurysm or dissecting
arterial aneurysm of the carotid or vertebral vessels. A berry
aneurysm, or berry-shaped aneurysm, results from a congenital
abnormality of intracranial vessels, primarily at the circle of Willis.
Ruptured intracranial aneurysms are the primary cause of
subarachnoid hemorrhage. Less often, a subarachnoid hemorrhage
is caused by an atrioventricular malformation (AVM) or bleeding
disorder. An AVM is a congenital disorder that results in the
formation of a tangled collection of dilated arteries and veins.
Symptoms are usually seen in persons aged 20 to 40 years. Two-
thirds of people affected by a subarachnoid hemorrhage are aged 40
to 60 years; women are affected slightly more frequently. In the
United States, 10 to 15 cases occur per 100,000 population per year.
Activities such as lifting, straining, sexual intercourse, or emotional
excitement can precipitate a hemorrhage.
◉ Headache - Continued arterial dissection and subdural hematoma.
Answer: The headache from a subdural hematoma is of venous
origin, typically resulting from a head injury that is usually mild and
easily forgotten by the patient. It occurs predominantly in persons
older than age 50 and is more common in men. Alcohol abuse and
use of anticoagulants contribute to its occurrence. It rarely is
associated with a fractured skull.
Arterial dissection, although occurring infrequently in young adults,
is characterized by cephalic pain or headache of sudden onset, often
,preceding transient ischemic attack (TIA) or stroke symptoms.
Carotid or vertebral artery dissection causes acute unilateral neck
pain that is sudden and often radiates to the ipsilateral face or eye.
The headache is related to cervical manipulation, sustained exertion,
or trauma. Recognition and proper treatment are important since
arterial dissections can lead to stroke.; send to ED
◉ Headache - Clinical Presentation. Answer: *Careful attention to
the patient's history is essential, including the headache's onset,
location, character, and severity; frequency and duration; associated
signs and symptoms; prodromal symptoms; precipitating factors; an
association with sleep patterns; emotional factors and the patient's
family and social history.
Information should be sought regarding other family members who
suffer from headaches, the type of headache, and the age at
occurrence. This information is essential to delineate the diagnosis
and rule out other problems.
A computed tomography (CT) scan or an MRI is recommended if the
patient's headache pattern is atypical, has changed in pattern or
character, or is accompanied by seizures, personality changes, or an
abnormal neurologic finding.
◉ Headache - Clinical presentation Continued Red flags indicative of
secondary problems, include the following:. Answer: *Red flags
indicative of secondary problems, include the following:
Progressive or fundamental change in headache that worsens over
time
, Patient states, "This is the worst headache of my life!"
New-onset headaches before the age of 5 or after age 50
Persistent headache precipitated by a Valsalva maneuver, exertion,
or sex
Fever, acute glaucoma, hypertension, myalgias, weight loss, or scalp
tenderness
Neurologic signs and symptoms: confusion, altered level of
consciousness, changes in memory, papilledema, sensory deficits,
reflex asymmetry, or gait disturbances
Headache with syncope or seizures
◉ Headache management*. Answer: Immediate hospitalization is
required for the person with a severe (secondary) headache
occurring suddenly or with signs of meningeal irritation. A patient
who states that he or she is having "the worst headache of my life" is
a red flag. Possible causes are intracranial hemorrhage or meningeal
infection. If examination reveals evidence of symptoms or signs of
increased intracranial pressure or severe intractable migraine,
urgent hospitalization is indicated.
Because the majority of headaches (tension-type and migraines) can
be recurrent and chronic, the principle of management is to design
an individual treatment plan that identifies therapeutic goals for the
patient. Goals should include strategies to avoid possible triggers
and the ability to abort an attack, to obtain relief from pain and
associated symptoms, and to decrease the frequency and severity of
attacks.
ADVANCED PRACTICE NURSING EXAM STUDY
GUIDE 2026 QUESTIONS WITH ANSWERS
GRADED A+
◉ Headache - Continued Temporal arteritis or giant cell arteritis
(GCA). Answer: *Older adults have fewer headaches overall,
However, when an older adult presents with a new-onset headache,
suspicion should be high for an underlying systemic disease such as
temporal arteritis or intracranial lesion. These headaches require
immediate medical evaluation.
*Temporal arteritis or giant cell arteritis (GCA) affects men and
women equally and occurs predominantly in adults older than age
60. Its incidence increases with age and is rare in the young.
Associated symptoms include scalp allodynia, jaw claudication, and
concurrent polymyalgia rheumatica. Other symptoms are local
swelling; tenderness and pulselessness of the temporal artery; and
systemic symptoms of fever, anorexia, weight loss, and chills.
Systemic markers of inflammation also are present. Prompt
diagnosis is important since temporal arteritis can cause permanent
vision loss if left untreated.
◉ Headache - Continued thunderclap headache. Answer: A
"thunderclap headache" is an abrupt and severe, sudden onset
headache that reaches maximal intensity in under 1 minute. This
,type of headache requires emergent evaluation since it is often
caused by a subarachnoid hemorrhage. The headache from
subarachnoid hemorrhage commonly occurs from a ruptured
intracranial aneurysm, such as a "berry" aneurysm or dissecting
arterial aneurysm of the carotid or vertebral vessels. A berry
aneurysm, or berry-shaped aneurysm, results from a congenital
abnormality of intracranial vessels, primarily at the circle of Willis.
Ruptured intracranial aneurysms are the primary cause of
subarachnoid hemorrhage. Less often, a subarachnoid hemorrhage
is caused by an atrioventricular malformation (AVM) or bleeding
disorder. An AVM is a congenital disorder that results in the
formation of a tangled collection of dilated arteries and veins.
Symptoms are usually seen in persons aged 20 to 40 years. Two-
thirds of people affected by a subarachnoid hemorrhage are aged 40
to 60 years; women are affected slightly more frequently. In the
United States, 10 to 15 cases occur per 100,000 population per year.
Activities such as lifting, straining, sexual intercourse, or emotional
excitement can precipitate a hemorrhage.
◉ Headache - Continued arterial dissection and subdural hematoma.
Answer: The headache from a subdural hematoma is of venous
origin, typically resulting from a head injury that is usually mild and
easily forgotten by the patient. It occurs predominantly in persons
older than age 50 and is more common in men. Alcohol abuse and
use of anticoagulants contribute to its occurrence. It rarely is
associated with a fractured skull.
Arterial dissection, although occurring infrequently in young adults,
is characterized by cephalic pain or headache of sudden onset, often
,preceding transient ischemic attack (TIA) or stroke symptoms.
Carotid or vertebral artery dissection causes acute unilateral neck
pain that is sudden and often radiates to the ipsilateral face or eye.
The headache is related to cervical manipulation, sustained exertion,
or trauma. Recognition and proper treatment are important since
arterial dissections can lead to stroke.; send to ED
◉ Headache - Clinical Presentation. Answer: *Careful attention to
the patient's history is essential, including the headache's onset,
location, character, and severity; frequency and duration; associated
signs and symptoms; prodromal symptoms; precipitating factors; an
association with sleep patterns; emotional factors and the patient's
family and social history.
Information should be sought regarding other family members who
suffer from headaches, the type of headache, and the age at
occurrence. This information is essential to delineate the diagnosis
and rule out other problems.
A computed tomography (CT) scan or an MRI is recommended if the
patient's headache pattern is atypical, has changed in pattern or
character, or is accompanied by seizures, personality changes, or an
abnormal neurologic finding.
◉ Headache - Clinical presentation Continued Red flags indicative of
secondary problems, include the following:. Answer: *Red flags
indicative of secondary problems, include the following:
Progressive or fundamental change in headache that worsens over
time
, Patient states, "This is the worst headache of my life!"
New-onset headaches before the age of 5 or after age 50
Persistent headache precipitated by a Valsalva maneuver, exertion,
or sex
Fever, acute glaucoma, hypertension, myalgias, weight loss, or scalp
tenderness
Neurologic signs and symptoms: confusion, altered level of
consciousness, changes in memory, papilledema, sensory deficits,
reflex asymmetry, or gait disturbances
Headache with syncope or seizures
◉ Headache management*. Answer: Immediate hospitalization is
required for the person with a severe (secondary) headache
occurring suddenly or with signs of meningeal irritation. A patient
who states that he or she is having "the worst headache of my life" is
a red flag. Possible causes are intracranial hemorrhage or meningeal
infection. If examination reveals evidence of symptoms or signs of
increased intracranial pressure or severe intractable migraine,
urgent hospitalization is indicated.
Because the majority of headaches (tension-type and migraines) can
be recurrent and chronic, the principle of management is to design
an individual treatment plan that identifies therapeutic goals for the
patient. Goals should include strategies to avoid possible triggers
and the ability to abort an attack, to obtain relief from pain and
associated symptoms, and to decrease the frequency and severity of
attacks.
