Family Nurse Practitioner-questions for FNP review with complete solution

Family Nurse Practitioner-questions for FNP review with complete solution A 72 year old woman has been on hydrochlorthiazide 12.5 mg for many years to control her Stage II hypertension. Her BP at this visit is 168/96. She is currently complaining of pain in her right hip and both knees. She has increased her dose of ibuprofen from 400 mg TID to 800 mg TID. She is still in pain and would like something stronger. Which of the following statements is the best explanation of the effects of ibuprofen on her disease. a. It increases the chances of adverse effects to her health b. it inhibits the effect of renal prostaglandins and blunts the effectiveness of the diuretic c. it prolongs the therapeutic effects of HCTZ and other diuretics d. none of the above All of the following are infections that affect mostly the labia and vagina except? a. Bacterial vaginosis b. candidiasis c. trichomoniasis d. chlamydia trachomatis The nurse practitioner would test the obturator and iliopsoas muscle to evaluate for? a. cholecystitis b. acute appendicitis c. inguinal hernia d. gastric ulcer Treatment for mild preeclampsia includes all of the following except? a. bedrest except for bathroom privileges b. close monitoring of weight and blood pressure c. close follow-up of urinary protein, serum creatinine, and platelet count d. a prescription of methyldopa to control BP All of the following services are covered under Medicare Part A except? a. inpatient hospitalization b. medicines administered to a patient while hospitalized c. nursing home care d. surgeons A 28 year old student is seen in the school health clinic with complaints of a hacking cough that is productive of small amounts of sputum and a runny nose. He does not take medications, denies any allergies, and has no significant medical history. Physical exam reveals low-grade temperature of 99.9 degrees, respirations of 16 per minute, heart rate of 90 beats per minute, and diffuse fine crackles in the base of the lungs. A chest xray shows diffuse infiltrates on the lower lobe of the right lung. The total WBC is 10,000. What is the most likely diagnosis? a. streptococcal pneumonia b. mycoplasma pneumonia c. acute bronchitis d. legionnaire's disease A 39 year old migrant worker presents to the clinic 2.5 days after a PPD skin test. The minimum size of induration would be considered positive in this patient? a. 3 mm b. 5 mm c. 10 mm d. 15 mm All of the following are correct statements regarding a durable power of attorney's role except? a. their decisions are legally binding b. it can be used in other areas of a patient's life such as financial issues c. they can decide for the patient who is on life support when it can be terminated d. the patient's spouse has the right to override a durable power of attorney All of the following are true statements regarding Munchausen syndrome except: a. it is considered a mental illness b. the patient has a medical illness that causes an anxiety reaction and denial c. the patient fakes an illness in order to gain attention from health care providers d. the patient has an inconsistent medical history along with a past history of frequent hospitalizations Which of the following antihypertensive medications should the nurse practitioner avoid when treating patients with emphysema? a. calcium channel blockers b. ACE inhibitors c. beta blockers d. diuretics A 30 year old chef complains of pruritic hives over her chest and arms but denies difficulty swallowing or breathing. SHe reports a family history of allergic rhinitis and asthma. Which of the following interventions is most appropriate? a. perform a complete and thorough history b. prescribe an oral antihistamine such as diphenhydramine 25 mg PO QID c. give an injection of epinephrine 1:1000 IM stat d. call 911 Which of the following findings is most likely in young prima gravidas with pregnancy induced hypertension? a. abdominal cramping and constipation b. edema of the face and upper extremities c. shortness of breath d. dysuria and frequency Which of the following symptoms is associated with B12 deficiency anemia? a. spoon-shaped nails and pica b. an abnormal neurological exam c. a vegan diet d. tingling and numbness in both feet A second triple screen on a 35 year old primigravida reveals abnormally low levels of the alpha fetoprotein and estriol and high levels of human chorionic gonadatropin. Which of the following interventions is the best choice for this patient? a. order and ultrasound b. order CT scan of abdomen c. order a 24 hour urine for protein clearance d. assess for history of illicit drug or alcohol use. All of the following are true statements about diverticula except: a. diverticula are located in the colon b. a low-fiber diet is associated with the condition c. most diverticula in the colon are infected with Gram-negative bacteria d. supplementing with fiber such as psyllium is recommended Patients who are diagnosed with gonorrhea should also be treated for which of the following infections? a. chancroid b. chlamydia trachomatis c. herpes genitalis d. PID Kyphosis is a late sign of: a. old age b. osteopenia c. osteoporosis d. osteoarthritis A 35 year old primigravida who is at 28 weeks gestation is expecting twins. You would expect her alpha fetoprotein values to be? a. normal b. higher than normal c. lower than normal d. none of the above Which of the following antihypertensive medications has beneficial effects to an elderly white female with osteoporosis? a. calcium-channel blockers b. ACE inhibitors c. beta blockers d. diuretic The Lachman maneuver is used to detect which of the following? a. knee instability b. nerve damage of the knee due to past knee injuries c. integrity of the patellar tendon d. tears on the meniscus of the knee When an adolescent male's penis grows more in length than in width, which of the following Tanner stages is he classified at? a. Tanner Stage II b. Tanner Stage III c. Tanner Stage IV d. Tanner Stage V Fetal TORCH infections can cause microcephaly, mental retardation, hepatosplenomegaly, and intrauterine growth retardation. The acronym TORCH stands for? a. toxoplasmosis gondii, other infections, rubella, cytomegalovirus, and herpes b. toxic shock syndrome, ocular infections, rubella, cytomegalovirus, and herpes zoster c. tetanus, opthalmic infections, roseola, cancer, and head abnormalities d. toxins, other infections, roseola, candidiasis, and head abnormalities Human papilloma virus HPV infection of the larynx has been associate with? a. laryngeal neoplasm b. esophageal stricture c. cervical cancer d. metaplasia of esophageal squamous cells Mr. Brown is a 65 year old carpenter complaining of morning stiffness and pain in both his hands and right knee upon awakening. He feels some relief after warming up. On exam the nurse notices the presence of Heberden's nodes. Which of the following is most likely? a. osteoporosis b. rheumatoid arthritis c. degenerative joint disease d. Reiter's syndrome What does a positive posterior drawer sign in a 10 year old soccer player signify? a. an abnormal knee b. instability of the knee c. a large amount of swelling in the knee d. an injury of the meniscus A multigravida who is at 28 weeks gestation has a fundal height of 30 cm. Which of the following is the best recommendation for this patient? a. advise the mother that her pregnancy is progressing well b. order an ultrasound of the uterus c. refer her to an obstetrician for an amniocentesis d. recommend bedrest with bathroom privileges A multigravida who is 34 weeks gestation wants to know at what level her uterine fundal height should be. The best answer is to advise the mother that her fundus is: a. midway between the umbilicus and the lower ribs b. at the level of the umbilicus c. from 33 to 35 cm d. from 32 to 34 cm Which of the following laboratory tests is used in primary care to evaluate renal function? a. electrolyte panel b. creatinine c. alkaline phosphatase d. blood urea nitrogen to creatinine ratio All of the following are false statements regarding acute gastritis except? a. chronic intake of non-steroidal anti-inflammatory drugs can cause the disorder b. chronic lack of dietary fiber is the main cause of the disorder c. the screening test for the disorder is the barium swallow test d. the gold standard to evaluate the disorder is the colonoscopy Signs and symptoms of depression include all the following except? a. anhedonia and changes in appetite b. decreased energy and irritability c. apathy and low self-esteem d. apraxia and fatigue Which of the following is an accurate description of eliciting for Murphy's sign? a. upon deep inspiration by the patient, palpate firmly in the right upper quadrant of the abdomen below the costovertebral angle b. bend patient's hips and knees at 90 degrees, then passively rotate hip externally, then internally c. ask the patient to squat, then place the stethoscope on the apical area d. press into the abdomen deeply, then release suddenly A 28 year old multipara who is at 32 weeks gestation presents to your office complaining of sudden onset of small amounts of bright red vaginal bleeding. she has had several episodes and appears anxious. On exam, her uterus is soft to palpation. Which of the following is most likely? a. placenta abruptio b. placenta previa c. acute cervicitis d. molar pregnancy Epidemiologic studies show that Hashimoto's disease occurs most commonly in: a. middle-aged to older women b. smokers c. obese individuals d. older men A 48 year old woman is told by a physician that she is starting menopause. All of the following are possible findings except? a. hot flashes b. irregular menstrual periods c. severe vaginal atrophic changes d. cyclic mood swings A 63 year old patient with a 10 year history of poorly controlled hypertension presents with a cluster of physical findings. Which of the following indicate target organ damage commonly seen in hypertensive patients? a. pedal edema, hepatomegaly, and enlarged kidneys b. hepatomegaly, AV nicking, bibasilar crackles c. renal infection, S3, neuromuscular abnormalities d. glaucoma, jugular vein atrophy, heart failure A 30 year old primigravida is diagnosed with a possible threatened abortion. The result of the urine pregnancy test is positive. Which of the following statements is true regarding a threatened abortion? a. vaginal bleeding and cramping are present, but the cervix remains closed b. vaginal bleeding and cramping are present along with a dilated cervix c. the fetus and placenta are all expelled d. the products of conception and the placenta remain inside the uterus along with a dilated cervix A 30 year old female who is sexually active complains of a large amount of milk-like vaginal discharge for several weeks. A microscopy slide reveals a large amount of squamous epithelial cells that have blurred marins. There are very few white blood cells seen. The vaginal pH is 6.0. What is most likely? a. trichomonas infection b. bacterial vaginosis c. candidal infection d. a normal finding The pap smear result on a 20 year old sexually active student who uses condoms inconsistently shows a large amount of inflammation. Which of the following is the best follow-up action? a. call the patient to return to the clinic so she can get tested for a possible cervical infection b. treat the patient with metronidazole vaginal cream over the phone c. call the patient and tell her she needs to repeat the pap smear in 6 months d. advise her to use a Betadine douche at bed time x 3 days While performing a pap smear on a postmenopausal patient, several areas of flat white skin lesions that are irregularly shaped are found on the patient's labia. the patient reports that the lesions are extremely itchy and have been present for several years without much change. Which condition is best described? a. chronic scabies infection b. lichen sclerosus c. chronic candidal vaginitis d. a physiologic variant found in some older women The heart sound S2 is caused by? a. closure of the AV valves b. closure of the semilunar valves c. opening of the AV valves d. opening of the semilunar valves A pelvic exam on a woman who is 12 weeks pregnant would reveal that her uterus is located at which of the following areas? a. between the umbilicus and the suprapubic bone b. just rising above the suprapubic bone c. between the suprapubic bone and the xyphoid process d. between the umbilicus and the xiphoid process All the following are covered under Medicare Part B except? a. persons age 65 years or older b. durable medical equipment c. mammograms annually starting at age 50 d. anesthesiologist's services All of the following patients are at higher risk for suicide except? a. a 66 year old white male whose wife of 40 years recently died b. a high school student with a history of bipolar disorder c. a depressed 45 year old female with a family history of suicide d. a 17 year old teen who has only one close friend at school A 70 year old patient complains of bright red spot in his left eye for 2 days. He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent viral upper respiratory infection. The only medicine he is on is Bayer aspirin one tablet a day. Which of the following is most likely? a. corneal abrasion b. acute bacterial conjunctivitis c. acute uveitis d. subconjunctival hemorrhage Which of the following is appropriate follow-up for this 70 year old patient? a. referral to an optometrist b. referral to an opthalmologist c. advise the patient it is a benign condition and will resolve spontaneously d. prescribe an opthalmic antibiotic solution Jason, a 9 year old with type I diabetes, is being seen for a 3 day history of frequency and nocturia. He denies flank pain and is afebrile. The urinalysis result is negative for blood and nitrites but is positive for a large amount of leukocytes and ketones. He has a trace amount of protein. Which of the following is the best test to order initially? a. urine for culture and sensitivity b. 24 hour urine for proteine and creatinine clearance c. 24 hour urine for microalbumin d. an intravenous pyelogram All of the following are not recommended for the outpatient treatment of mild preeclampsia except: a. severe sodium restriction b. restrict fluid intake to less than 1 liter in 24 hours c. Aldomet 250 PO BID d. bedrest on the left side with bathroom privileges The best test for diagnosing congenital glaucoma is which of the following? a. fluorescein staining b. tonometry c. Snellen vision exam d. the refractive index Rocky Mountain spotted fever is caused by the bite of the? a. mosquito b. tick c. insect d. flea All of the following are false statements about the atopic dermatitis except? a. contact with cold objects may exacerbate the condition b. it does not have a linear distribution c. it is associated with bullae d. the lesions have vesicles that are full of serous exudate A mother brings in her 4 year old daughter who just started attending preschool. She tells the nurse practitioner that her child is complaining of burning and itching in both eyes along with a runny nose. During the physical exam, the child's eyes appear injected bilaterally. The throat is red and her inferior nasal turbinates are swollen. Which of the following is most likely? a. herpes keratitis b. corneal ulcer c. viral conjunctivitis d. bacterial conjunctivitis A sexually active woman is complaining of amenorrhea and vaginal spotting. On exam her left adnexa is tender and cervical motion tenderness is positive. Which test should the nurse order initially? a. flat plate of abdomen b. CBC with diff c. urine pregnancy test d. pelvic ultrasound A toddler with congenital heart disease is seen for a 1 week history of facial and lower extremity edema accompanied by shortness of breath. The child's mother reports that the child's appetite has been poor. The chest xray reveals that the child has congestive heart failure. Which of the following heart sounds are found in these patients? a. S1 and S2 b. S1, S2, and S3 c. S1, S2, and S4 d. Still's murmur and S4 A 53 year old crossing guard complains of twisting his right knee while working that morning. The knee is swollen and tender to palpation. The NP diagnoses a Grade II sprain. The initial treatment plan includes which of the following? a. application of cold packs the first 24 hours followed by application of low heat at bedtime b. elevation of the affected limb and intermittent application of cold packs for the next 48 hours c. rechecking the knee in 24 hours and isometric exercises d. the application of an ACE bandage to the affected knee Erythromycin 200 mg with sulfisoxazole 600 mg suspension (Pediazole) is contraindicated in which of the following conditions? a. G6PD deficiency anemia b. lead poisoning c. beta thalassemia minor d. B12 deficiency anemia The mother of an 11 year old boy with sickle cell anemia calls on the phone complaining her son woke up because of a painful penile erection that will not go away. The NPs most appropriate intervention is? a. Insert foley catheter and measure child's intake and output for next 24 hours b. insert foley catheter and obtain a specimen for a urinalysis and urine C&S c. redommend an increase in the child's fluid intake d. recommend immediate referral to the ER A positive Coombs test in an Rh-negative pregnant woman means? a. the mother has autoantibodies against Rh positive RBCs b. the fetus has autoantibodies against the maternal RBCs c. the mother does not have Rh factor against fetal RBCs d. the fetus does not have RBC autoantibodies Folic acid supplementation is recommended for women who are planning pregnancy in order to? a. prevent renal agenesis b. prevent anencephaly c. prevent kidney defects d. prevent heart defects All the following are possible causes for secondary hypertension except? a. acute pyelonephritis b. pheochromocytoma c. renovascular stenosis d. coarctation of the aorta Fitz-Hugh-Curtis syndrome is associated with the following infection? a. syphilis b. chlamydia trachomatis c. herpes genitalis d. lymphogranuloma venereum A nursing home resident reports to his physician that his previous roommate was recently started on tuberculosis treatment. A Mantoux test and chest xray are ordered for the patient. What is the minimum size of induration considered positive for this patient? a. 3 mm b. 5 mm c. 10 mm d. 15 mm In small children with acquired immunodeficiency syndrome (AIDs), which of the following vaccines is contraindicated? a. diphtheria and tetanus b. hepatitis B and mumps c. varicella d. Td and oral polio A 44 year old female who is undergoing treatment for infertility complains of not having a menstrual period for a few months. The night before, she started spotting and is now having cramp-type pains in her pelvic area. Her blood pressure is 160/80, the pulse rate is 110, and she is afebrile. Her labs reveal a mild anemia with mild leukocytosis. On pelvic exam, the uterine fundus is found above the symphysis pubis. The cervical os is dilated to 3 cm. Which of the following is more likely? a. inevitable abortion b. threatened abortion c. incomplete abortion d. acute pelvic inflammatory disease A 14 year old female who is sexually active is brought in by her mother for an immunization update. According to the mother, her daughter had one dose of Hepatitis B vaccine. Which of the following vaccines would you administer at this visit? a. Td and Hepatitis B b. DTaP and Hepatitis B c. Hepatitis B only d. MMR and Td An Rh-negative pregnant woman with negative rubella titers should be vaccinated at what time period in pregnancy? a. she can be vaccinated at any time in her pregnancy b. during the second trimester c. during the third trimester d. during the postpartum period Medicare Part B will pay for all of the following services except? a. outpatient physician visits that are medically necessary b. durable medical equipment c. outpatient lab and radiology tests d. eyeglasses and routine dental Which of the following is used to screen for color blindness in a 7 year old boy? a. Snellen chart b. Ishihara chart c. cover/uncover test d. red reflex A 67 year old retired clerk presents with complaints of shortness of breath, and weight gain over a 2 week period. A non productive cough accompanies her symptoms. The lung exam is positive for fine crackles in the lower lobes with no wheezing. The exam is positive for egophony. Which of the following conditions is most likely? a. acute exacerbation of asthma b. left-heart failure c. right-heart failure d. chronic obstructive pulmonary disease Which of the following drugs is most likely to relieve the patient's symptoms? a. atenolol b. trimethoprim/sulfamethoxazole c. furosemide d. hydrocodone/guaifenesin A patient has recently been diagnosed with migraine headache with aura. She wants advice on what she should eliminate from her diet to reduce her risk of headaches. The best response is to advise this patient to avoid? a. foods with aspartame because they can trigger migraines b. foods with monosodium glutamate because they promote diuresis c. foods with garlic because they promote hypertension d. foods with nitrates because they do not induce flushing A patient with a history of mitral valve prolapse is requesting prophylaxis before her dental surgery. Which of the following would you prescribe for this patient? a. amoxicillin a half hour before and 2 hours after the procedure b. amoxicillin 1 hour before the procedure c. amoxicillin 1 hour before and 3 hours after the procedure d. prophylaxis is not recommended for this patient Koplik's spots are associated with? a. pox-virus infections b. measles c. Kawasaki disease d. Reye's syndrome Stella, a new mother, complains to you that she has been feeling irritable and jittery almost daily for the past few months. She complains of frequent palpitations and more frequent bowel movements along with weight loss. Her BP is 160/70, her pulse is 110, and she is afebrile. All of the following conditions should be considered in the differential diagnosis for this patient except? a. mitral regurgitation b. Graves disease c. generalized anxiety disorder d. illicit drug use An elderly patient with a productive cough and fever is diagnosed with pneumonia. ALl of the following organisms are capable of causing community acquired pneumonia except? a. haemophilus influenzae b. mycoplasma pneumoniae c. treponema pallidum d. streptococcus pneumoniae Human chorionic gonadotropin is produced by the? a. placenta b. hypothalamus c. anterior pituitary d. ovaries The majority of serum alpha fetoprotein is produced by the? a. fetal liver b. mother's liver c. placenta d. fetal neural tube Stella works in the housekeeping department of a hospital. She presents to the employee health clinic with a complaint of a needlestick to her left thumb. The needle was in one of the garbage bags from the emergency room. The patient had a little bleeding that stopped spontaneously. Which of the following is the next step? a. order an enzyme-linked immunosorbent assay (ELISA) test ASAP b. recommend a tetanus booster in 1 week c. offer the patient Hepatitis B immunoglobulin d. order a chest xray An elderly woman has been on digoxin for 10 years. Her EKG is showing a new onset of atrial fibrillation. Her pulse is 64. She denies syncope and dizziness. Which of the following interventions is most appropriate? a. order an electrolyte panel and dig level b. order a serum thyroid-stimulating hormone, dig level, and an electrolyte panel c. order a serum dig level and decrease her digoxin dose in half while you wait on the results d. discontinue digoxin and order another 12 lead EKG You note the following result on a routine urinalysis of a 37 year old primigravida who is at 30 weeks gestation. Leukocyte = trace, nitrite = negative, protein = 2+, blood = negative. Her weight has increased by 5 lbs during the past week. Which of the following is most likely? a. HELLP syndrome b. pregnancy induced hypertension (preeclampsia) c. eclampsia of pregnancy d. primary hypertension The NP who suspects one of her hypertensive patients has Cushing's syndrome would expect to find which of the following lab results? a. hyponatremia b. hypoglycemia c. elevated serum cortisol levels d. decreased urine 17-ketosteroids