NURSING 7268.01
Advanced Nursing
Practice FNP Clinical
Practicum
Q & A w/ Rationales
2024
,1. A 45-year-old male patient presents to the FNP with
complaints of chest pain, dyspnea, and palpitations. He has
a history of hypertension, diabetes, and smoking. He is
currently taking metformin, lisinopril, and aspirin. The
FNP suspects that he may have an acute coronary
syndrome (ACS) and orders an electrocardiogram (ECG)
and cardiac biomarkers. Which of the following ECG
findings is most suggestive of an ACS?
a) ST-segment elevation in two contiguous leads
b) T-wave inversion in leads V1-V4
c) Q waves in leads II, III, and aVF
d) *ST-segment depression and/or T-wave inversion in two
or more leads*
Rationale: ST-segment depression and/or T-wave inversion
in two or more leads is indicative of ischemia, which is a
hallmark of ACS. ST-segment elevation in two contiguous
leads suggests a myocardial infarction (MI), which is a type
of ACS, but not the only one. T-wave inversion in leads
V1-V4 may indicate a right ventricular strain or pulmonary
embolism, which are not related to ACS. Q waves in leads
II, III, and aVF may indicate an old inferior MI, which is
not an acute condition.
2. A 32-year-old female patient visits the FNP for a routine
prenatal check-up at 28 weeks of gestation. She has no
significant medical or obstetric history and her pregnancy
has been uncomplicated so far. She reports feeling well and
has no complaints. The FNP performs a physical
examination and measures her blood pressure, which is
, 150/90 mmHg. She repeats the measurement after 10
minutes and obtains the same result. The FNP also checks
her urine dipstick, which shows 2+ proteinuria. Which of
the following is the most likely diagnosis for this patient?
a) Chronic hypertension
b) Gestational hypertension
c) *Preeclampsia*
d) Eclampsia
Rationale: Preeclampsia is defined as new-onset
hypertension (systolic blood pressure ≥140 mmHg or
diastolic blood pressure ≥90 mmHg) and proteinuria (≥300
mg/24 hours or ≥1+ on dipstick) after 20 weeks of
gestation in a previously normotensive woman. Chronic
hypertension is hypertension that predates pregnancy or is
diagnosed before 20 weeks of gestation. Gestational
hypertension is new-onset hypertension without proteinuria
after 20 weeks of gestation. Eclampsia is preeclampsia with
seizures.
3. A 60-year-old female patient comes to the FNP with
complaints of fatigue, weight gain, dry skin, hair loss, and
constipation for the past six months. She has a history of
hypothyroidism and takes levothyroxine 100 mcg daily.
She denies any changes in her medication regimen or diet.
The FNP orders a thyroid function test and obtains the
following results: thyroid-stimulating hormone (TSH) 12
mIU/L (normal range: 0.4-4.0 mIU/L), free thyroxine
(FT4) 0.8 ng/dL (normal range: 0.8-1.8 ng/dL), and free
triiodothyronine (FT3) 2.0 pg/mL (normal range: 2.3-4.2
pg/mL). Which of the following is the most appropriate
Advanced Nursing
Practice FNP Clinical
Practicum
Q & A w/ Rationales
2024
,1. A 45-year-old male patient presents to the FNP with
complaints of chest pain, dyspnea, and palpitations. He has
a history of hypertension, diabetes, and smoking. He is
currently taking metformin, lisinopril, and aspirin. The
FNP suspects that he may have an acute coronary
syndrome (ACS) and orders an electrocardiogram (ECG)
and cardiac biomarkers. Which of the following ECG
findings is most suggestive of an ACS?
a) ST-segment elevation in two contiguous leads
b) T-wave inversion in leads V1-V4
c) Q waves in leads II, III, and aVF
d) *ST-segment depression and/or T-wave inversion in two
or more leads*
Rationale: ST-segment depression and/or T-wave inversion
in two or more leads is indicative of ischemia, which is a
hallmark of ACS. ST-segment elevation in two contiguous
leads suggests a myocardial infarction (MI), which is a type
of ACS, but not the only one. T-wave inversion in leads
V1-V4 may indicate a right ventricular strain or pulmonary
embolism, which are not related to ACS. Q waves in leads
II, III, and aVF may indicate an old inferior MI, which is
not an acute condition.
2. A 32-year-old female patient visits the FNP for a routine
prenatal check-up at 28 weeks of gestation. She has no
significant medical or obstetric history and her pregnancy
has been uncomplicated so far. She reports feeling well and
has no complaints. The FNP performs a physical
examination and measures her blood pressure, which is
, 150/90 mmHg. She repeats the measurement after 10
minutes and obtains the same result. The FNP also checks
her urine dipstick, which shows 2+ proteinuria. Which of
the following is the most likely diagnosis for this patient?
a) Chronic hypertension
b) Gestational hypertension
c) *Preeclampsia*
d) Eclampsia
Rationale: Preeclampsia is defined as new-onset
hypertension (systolic blood pressure ≥140 mmHg or
diastolic blood pressure ≥90 mmHg) and proteinuria (≥300
mg/24 hours or ≥1+ on dipstick) after 20 weeks of
gestation in a previously normotensive woman. Chronic
hypertension is hypertension that predates pregnancy or is
diagnosed before 20 weeks of gestation. Gestational
hypertension is new-onset hypertension without proteinuria
after 20 weeks of gestation. Eclampsia is preeclampsia with
seizures.
3. A 60-year-old female patient comes to the FNP with
complaints of fatigue, weight gain, dry skin, hair loss, and
constipation for the past six months. She has a history of
hypothyroidism and takes levothyroxine 100 mcg daily.
She denies any changes in her medication regimen or diet.
The FNP orders a thyroid function test and obtains the
following results: thyroid-stimulating hormone (TSH) 12
mIU/L (normal range: 0.4-4.0 mIU/L), free thyroxine
(FT4) 0.8 ng/dL (normal range: 0.8-1.8 ng/dL), and free
triiodothyronine (FT3) 2.0 pg/mL (normal range: 2.3-4.2
pg/mL). Which of the following is the most appropriate
