FNP NR 511 FINAL EXAM STUDY GUIDE 2025/2026 COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES || 100% GUARANTEED PASS RECENT VERSION

FNP NR 511 FINAL EXAM STUDY GUIDE 2025/2026 COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES || 100% GUARANTEED PASS RECENT VERSION 1. Spinal fracture red flags - ANSWER a fall history, prolonged steroid use, osteopenia, osteoporosis 2. Cervical spondylosis - ANSWER Goes away with movement TX: cervival neck brace and this is a firstline tx 3. Cervical Myelopathy - ANSWER cervical cord compression Radicular symptoms of the upper extremities and weakness. In severe cases, leg weakness, gait disturbances, and loss of bowel and bladder control may occur. 4. Vertebral fractures - ANSWER Osteoporosis is most commonly associated with vertebral fractures 5. Symptoms of Nerve Root Involvement - ANSWER Paresthesia over the anterior thigh just above the knee indicates L4 involvement. 6. Myofacial Pain - ANSWER Painful contractions of muscles after exertion, such as heat cramps; may be related to hyponatremia or other electrolyte imbalances. 7. Gold standard for Sickle cell diagnosis - ANSWER hemoglobin electrophoresis check for hemoglobin S 8. Iron deficiency anemia- population at most risk - ANSWER 60 years or older, poverty, recent illness- ulcer, diverticulitis, colitis, hemorrhoids, gastrointestinal ulcers, 9. Iron deficiency anemia signs - ANSWER Pale conjunctivae and nail beds; Tachycardia. Heart murmur Cheiolosis- cracked corners of mouth Stomatitis Splenomegaly 10. Best test to catch low iron - ANSWER Ferritin 11. Ferrtin - ANSWER storage form of iron in liver 12. Reticuolocyte count - ANSWER Percentage of NEW maturing RBC % goes up when blood loss happens or when treatment of anemias is being done 13. Mean Corpuscular Volume (MCV) - ANSWER indicates size of RBC 76-96 14. Decreased MCV and MCHC indicates - ANSWER Microcytic hypochromic anemia 15. Microcytic hypochromic anemia test - ANSWER Serum iron levels, TIBC level and serum ferritin level 16. MCV is often increased in patients with - ANSWER Megalobastic anemias like B12 and folate deficiencies 17. most common cause of. megaloblastic anemia - ANSWER Vitamin B12 deficiency 18. megaloblastic anemia as known as - ANSWER Pernicious anemia 19. megaloblasic anemia characteristics - ANSWER Macrocytic and normochromic cells 20. Sideroblastic anemia - ANSWER Blood disorder. Body has enough iron but can't use it to make hemoglobin. 21. Iron accumulates in the mitochondria. Makes ringed nucleus 22. Sideroblastic anemia diagnostic test - ANSWER The Prussian blue stain 23. microcytic hypochromic anemia most seen in - ANSWER Pregnant women, children and elderly 24. microcytic hypochromic anemia serum ferritin - ANSWER Ferritin =30 25. NP should always check what level before starting iron supplementation in children - ANSWER A lead level 26. sickle cell anemia is a - ANSWER autosomal recessive. Both parents have to have it 27. Acute Lymphocytic Leukemia (ALL) is the most - ANSWER Common type of cancer in young children 28. Acute Lymphocytic Leukemia (ALL) symptoms - ANSWER Pallor, fatigue, bleeding, fever, bone pain, adenopathy, arthralgias, hepatosplenomegaly, 29. ALL CBC with differential shows - ANSWER Leukopenia with lymphoblasts 30. Acute Lymphocytic Leukemia (ALL) radiation in children has a high risk of developing what later - ANSWER Brain tumor as a secondary malignancy Refer to peds oncologist 31. Chronic Lymphocytic Leukemia (CLL) is the most - ANSWER Type of leukemia in US. Onset 70 years of age 32. functional urinary incontinence occurs due to - ANSWER Delirium, fecal impaction, lack of manual dexterity, decreased mobility, and meds 33. Meds that cause urinary incontinence - ANSWER diuretics, hypnotics, alcohol, narcotics, decongestants, 34. stress urinary incontinence - ANSWER -History of vaginal deliveries. -urine leakage with cough or sneezing 35. urinary incontinence work up - ANSWER A urinalysis and urine culture and sensitivity should be done, as well as measurements of serum electrolytes, blood urea nitrogen, creatinine, calcium (for polyuria in the absence of diuretics), and glucose. Ulcerative Colitis-occurs - ANSWER in the rectum and sigmoid colon 36. ulcerative colitis characterized by - ANSWER Bloody and purulent diarrhea 37. Diverticulitis signs and symptoms - ANSWER infection-fever, chills, and tachycardia, painless bloody stools 38. Diverticulitis patient presents with - ANSWER with localized pain and tenderness in the LLQ of the abdomen with associated anorexia, nausea and vomiting. 39. Diverticulitis test - ANSWER CT scan with contrast 40. Diverticulitis best management - ANSWER Higher fiber diet 41. C. difficile signs and symptoms - ANSWER Profuse, watery, mucoid diarrhea 42. C. diff mild to moderate - ANSWER Watery diarrhea three or more times/day for two or more days - Mild abdominal cramping and tenderness 43. C. diff severe - ANSWER Watery diarrhea (10-15 stools/day) -Strong foul odor =Acute abdomen secondary to toxic megacolon with perforation - Abdominal distention - Fever - Nausea/vomiting/dehydration requiring hospitalization - Blood or pus in the stools (severe cases) 44. C diff test - ANSWER CBC Elevated WBC count Enzyme-linked immunodeficiency assay ids toxins 45. C. diff treatment options - ANSWER - Vancomycin = DOC - Metronidazole (Flagyl) -Probiotics 46. C diff diet avoid: - ANSWER Avoid caffeine, spicy foods, milk, greasy foods 47. GERD not responding to optimal treatment after 6 weeks, what do you do next? - ANSWER Refer for endoscopy 48. Define Diagnostic Reasoning - ANSWER To solve problems, to promote health, and to screen for disease or illness. All require a sensitivity to complex stories, to contextual factors, and to sense of probability and uncertainty. Can be seen as a kind of critical thinking. 49. Discuss and identify subjective data - ANSWER reports, complaints of , replies to provider questions, includes ROS, CC, HPI 50. Discuss and identify objective data - ANSWER what you can see, hear, or feel as part of a clinical exam. Also includes laboratory data and test results. 51. Discuss and identify the components of and HPI - ANSWER OLDCARTS Onset of CC, Location of CC, Duration of CC, Characteristics of CC, Aggravating factors of CC, Relieving factors of CC, Treatment of CC, Severity of CC 52. Medical coding - ANSWER the use of codes to communicate with payers about which procedures were performed and why 53. Medical billing - ANSWER the process of submitting and following up on claims made to a payer in order to receive payment for medical services rendered by a healthcare provider 54. 2 Coding Classification systems that are currently used in the US healthcare system - ANSWER CPT-recognized universally and provide logical means to be able to track healthcare data, trends, and outcomes. 55. ICD-10-shorthand for the patient's diagnosis, which are used to provide the payer information on the necessity of the visit or procedures performed. 56. Specificity - ANSWER referring to the ability of the test to correctly detect a specific condition 57. Medial epicondylitis - ANSWER (AKA golfer's elbow) is less common. Overuse syndrome of wrist flexion. Pain on medial epicondyle worsens with wrist flexion. Treated same as lateral epicondylitis. Imaging: Usually unnecessary, but it may be useful if needed to rule out alternative diagnoses. 58. Discuss at least 3 vital body functions which thyroid hormones regulate - ANSWER Hyperthyroidism Metabolic--Increased appetite (Polyphagia), Weight Loss, hypercalcemia, K wasting, increased alkaline phosphatase Hypothyroidism Decreased appetite, Weight Gain General Hyperthyroidism: Fatigue, Muscle Atrophy, Tremors Hyperthyroidism: Fatigue, decreased libido, hypersomnia, periorbital puffiness Integumentary Hypothyroidism Diaphoresis, Heat Intolerance, thinning hair, pruritus, onycholysis Hyperthyroidism: Hair loss, ankle swelling, cold intolerance, dry cool rough skin, alopecia, dry course thick hair GI Hypothyroidism: Diarrhea, Increase in BM Constipation, nausea, hypoactive bowel sounds, ascites, enlarged tongue Eye Blurred vision, tearing, double vision, decreased visual acuity, photophobia, increased orbital pressure, lid lag, exophthalmos, corneal ulcer Hyperthyoidism N/A Neurological Hypothyroidism Tremors in hands, hyperactive reflexes Hyperthyroidism Memory deficits, personality changes, hyporeflexia, bradykinesia Hypothyroidism Cardiopulmonary Palpitations, SOBOE, tachycardia, HTN, CHF, A-Fib Hyperthyoidism Exercise intolerance, bradycardia, cardiac enlargement, pleural effusion GU Hypothyoridiam Decreased menstrual flow, gynecomastia Hyperthyroidism Irregular menses, decreased fertility Head & Neck Hypothyroidism Increased neck size, enlarged thyroid gland Hyperthyoridism Enlarged neck, enlarged tongue (late), hoarseness Psychosocial Hypothyroidism Anxiety, nervousness, insomnia, irritability, restlessness, emotional lability, Increase in HR, RR, and BP Hyperthyoridism Depression, slowing of mental processes Musculoskeletal Hypothyroidism Weakness, loss of muscle tone, Osteoporosis in women Hyperthyoridism Muscle weakness and cramping Hematological Hypothyroidism Fatigue, normochromic normocytic anemia 59. Describe a goiter and the type of thyroid dysfunction that can be associated with it - ANSWER A goiter is the hypertrophy and hyperplasia of the thyroid gland in response to TSH levels. Most commonly seen with Hashimoto's thyroiditis (hypothyroidism) in the United States. Toxic multinodular goiter (hyperthyroidism) in iodine deficiency. Grave's Disease (hyperthyroidism) has a firm goiter. 60. overt hypothyroidism - ANSWER o TSH above 10 and FT4 is decreased  Too little hormone is being produced  Pituitary is attempting to get the thyroid to produce more Low FT4 and high TSH 61. subclinical hypothyroidism - ANSWER o TSH levels are increased, but the FT4 is within range  Some have symptoms, others do not 62. Hashimoto's thyroiditis - ANSWER underproduction of thyroid leading to hypothyroidism -Identified via TPO and TBG Abs in blood 63. Grave's disease - ANSWER overproduction of thyroid leading to hyperthyroidism - 90% of hyperthyroidism cases 64. Identify at least 3 risks associated with obesity - ANSWER Diabetes, CVD, Afib, HTN, NSTEMI, varicosities, cancer, skin infections, arthritis Gallbladder disease, GERD, acute pancreatitis, NAFLD Stress incontinence, infertility, OSA 65. Identify at least 3 causes of obesity - ANSWER Calorie excess—either overeating or high intake of carbohydrates Food insecurity—eating from a fear of potential hunger or past experience with poor availability of food on a regular basis Genetic predisposition with familial history—influences of ghrelin and leptin levels Medication influences—antidepressants, anti-seizure, steroids, insulin, oral contraceptives Psychological factors—self-soothing, large CHO intake = increased serotonin Disease states—hypothyroidism, insulin resistance, PCOS, Cushing's 66. Discuss one primary prevention for obesity - ANSWER Obesity occurs when one's intake of calories exceeds metabolic needs. Primary prevention for obesity includes increasing activity level, and managing caloric intake. 67. Triad—Identify, Food, Activity • Identify those at risk—both adults and children— calculate BMI at every preventative visit: adult's minimum yearly and children at each preventative visit following routine schedule. • Provide targeted nutritional advice—low CHO diets with high protein, small frequent meals throughout the day. • Eliminate sweetened liquid calories including juice. • Recommend 60 minutes of activity on most days of the week for adults and children. • Encourage good nutrition and activity at the family level, not just the individual level. • 24-hour diet recall and use motivational interviewing techniques. • Promote good sleep hygiene. 68. Identify the categories of obesity based on the BMI - ANSWER Overweight BMI is 25-29.9; relative weight is 100%-120% Obesity BMI is 30-40 140%-200% Severe (morbid) obesity BMI is greater than 40 greater than 200% 69. Discuss how acute low back pain without neurological dysfunction does not warrant radiological imaging - ANSWER Acute back pain may have several differential diagnoses. If pain isn't found to be related to any neurological complaints, radiological imaging is not warranted. 70. Identify the roles of TSH - ANSWER Pituitary "messenger" to thyroid to increase or decrease thyroid hormone production. used to diagnose hypothyroidism. TSH and FT4 should be used to follow treatment. If the TSH is low or insufficiently elevated in the presence of low T4, central hypothyroidism caused by hypothalamic or pituitary disease should be excluded before starting replacement therapy. 71. Identify the roles of FT4 - ANSWER Circulating unbound thyroid hormone produced by the thyroid, replaced by levothyroxine medication, useful for the diagnosis of hypothyroidism both overt and subclinical *Primary hypothyroidism is associated with a low FT4 and elevated TSH *Subclinical hypothyroidism is a mildly increased TSH with a normal FT4 72. Identify the roles of TT3, - ANSWER Circulating unbound thyroid hormone that has been converted from T4. T3 is not routinely used as a diagnostic tool because it isn't sensitive or specific to the hypothyroidism. T3 levels may be normal in early disease, and may not fall until late in the disease. 73. Identify the roles of TPO Abs - ANSWER Useful in detecting autoimmune thyroiditis (Graves' or Hashimoto's) Diagnostic for Hashimoto's thyroiditis when found in high titers (1:400). Higher levels TPO = more thyroid destruction = more severe hypothyroidism - No universal screening recommendations for thyroid disease. - ATA recommends screening for  Baseline at 35  Pregnant women  Women older than 60  Individuals with autoimmune disease. 74. Identify at least one "at-risk" population who should be considered for thyroid screening - ANSWER Pregnant women -Women older than 60 years -Persons with other autoimmune diseases -Persons with pernicious anemia -Persons with a family history (1st degree relative) of thyroid disease -Persons with a history of prior thyroid surgery or dysfunction or neck radiation -Persons with Abnormal thyroid exam -Persons with psychiatric disorders 75. Discuss one physical characteristic seen in a hyperthyroid patient - ANSWER Smooth, velvety skin -Soft, thin hair -Skin with increased pigmentation, spider angiomas, and vitiligo -Onycholysis (splitting and spooning of the nails) -Exophthalmos (buldging eyes) Muscle atrophy, tremors, hyperpigmentation, warm flushed moist skin, fine silky hair, thin hair, increased LFT, Exopthalamos, lid lag and edema, corneal ulceration, sinus tach, elevated BP, A.Fib, symptoms of CHF, gynecomastia, osteoporosis, hypercalcemia, potassium wasting 76. Identify the CDC recommended antibiotic class for treatment of acute bacterial prostatitis - ANSWER Flouroquinolones (Ciprofloxacin, levofloxacin, ofloxacin, or norfloxacin) Alternatives to a fluoroquinolone include Doxycycline 100 mg Q 12 hours; and TMP-SMX [160 mg/800 mg] (Bactrim DS) one tab Q 12 hours 77. Identify at least one treatment for BPH - ANSWER -Medication (conservative): -Alpha Blockers (Terazosin, Tamsulosin) -5-alpha Reductase Inhibitors (finasteride, dutasteride) -Surgical -TURP (transurethral resection of the prostate) 78. Identify treatment options for obesity based on BMI and comorbid conditions - ANSWER Overweight BMI: 25-29.9kg/m2 Obesity BMI: 30-40 kg/m2 Severe (morbid) obesity BMI: 40kg/m2 Treatment options: lifestyle changes (diet, exercise- 45-60 minutes/day), managing behavior (i.e. H.A.L.T. - hungry, angry, lonely, tired, behavior modification), reduce caloric intake, drugs (i.e. fenfluramine/Fen Phen, dexfenfluramine/Redux, phentermine, diethylopropion, orlistat). Surgical intervention (vertical-banded (mason) gastroplasty and roux-en-Y bypass) for BMI over 40 OR over 35 with comorbities A structured weight loss diet is most effective. Encourage formal programs or weight loss groups (WW, etc.). Diet goals should include a program with calories per day for women and calories per day for men; 500-750 calorie deficit per day; low CHO diet, increased fiber, and decreased saturated fats; and less than 800 calories per day in certain circumstances under medical supervision 79. Describe the Spurling test and what condition it is used to diagnose - ANSWER Spurling's maneuver assesses nerve root compression (i.e. radiculopathy) in the neck resulting in pain. - Spurling's maneuver:  With patient's neck in extension, rotate the neck to the affected side  Apply downward pressure on the head  Assess for patient complaint of or accentuation of limb pain or paresthesia (THIS IS A POSITIVE SIGN). Also, observe for neck atrophy. 80. Describe how to perform a Phalen Test - ANSWER Purpose: Assess for median nerve compression Procedure: Have the patient maintain forced flexion of the wrist for 1 minute or more, with the dorsal surface of each hand pressed together. If the patient complains of numbness and paresthesia in the fingers =TEST IS POSTIVE 81. 31. Describe how to perform a Tinnel test - ANSWER Purpose: Assess for compression neuropathy Procedure: Percuss the median nerve at the wrist. If the patient complains of tingling in the digits (POSITIVE TINEL SIGN), compression at the site of percussion is likely. 82. Identify at least 3 physical exam maneuvers to assess the knee - ANSWER Diagnosing ACL injury: Lachman's, anterior drawer test Diagnosing meniscal tears: McMurray and Appley Diagnosing PCL injury: posterior drawer test and Thumb sign Diagnosing collateral (MCL and LCL) injury: Valgus and Varus stress test 83. Resting Tremors - ANSWER Occurs at rest, against gravity, or sitting still with arms resting in lap. The most common condition that causes resting tremors is Parkinson's Disease and medication tremors. 84. Postural tremors - ANSWER Seen when the patient is asked to extend the arm in front of them. The most common type is an essential tremor. It's bilateral and generally symmetric. There's often a family Hx. Drinking alcohol can reduce the tremor. 85. intention tremors - ANSWER -Characterized by an increase in amplitude when the patient attempts movement. Can be checked by having the patient perform finger to nose coordination. 86. Describe one disease with resting tremor as a clinical finding - ANSWER Parkinson's Disease. It is a progressive neurological disease - 4 hallmark signs:  resting tremor  cogwheel rigidity  bradykinesia,  postural instability - Other characteristics are facial masking, difficulty staining from sitting in a chair, "freezing", reduced arm swing, festinating (quick, short stride, with head down) and shuffling gait. Wilson's disease is another condition that is associated with resting tremor. This is a very rare genetic disorder associated with copper toxicity. Patients who are affected may have extrapyramidal symptoms [similar to Parkinson's] with a slow and progressive course. There may be symptoms of incoordination in the hands, dysarthria, and gait disorder, bradykinesia, rigidity, and ophthalmologic changes. The work up for Wilson's includes serum ceruloplasmin and copper. Diagnosis is confirmed with liver biopsy, which identifies the copper toxicity. Treatment is aimed at lowering copper levels. 87. Describe a medication commonly associated with tremors - ANSWER Extrapyramidal side effects similar to Parkinson's disease. Antipsychotics are the most common offending agent. Metoclopramide (Reglan) Phenothiazine -Compazine Steroids Caffeine Anti-epileptics Antidepressants Asthma medications 88. Intention tremor may be associated with medications, alcohol or drug abuse, multiple sclerosis, stroke, or a mass affecting the cerebellum. 89. Identify at least 3 laboratory tests to rule out systemic causes of tremor - ANSWER Electrolyte/ABGs (metabolic imbalances, drugs, caffeine, physiological fatigue) Serum glucose (hypoglycemia) Toxicology screen/drug levels (toxic conditions, antipsychotic drugs, caffeine) 90. Barbara, age 27, had her spleen removed after an automobile accident. You are seeing her in the office for the first time since her discharge from the hospital. She asks you how her surgery will affect her in the future. How do you respond - ANSWER "You may have difficulty salvaging iron from old red blood cells for reuse." 91. When the donor and recipient of a transplant are identical twins, this is referred to as what type of transplant? - ANSWER isograft