Sarah Michelle FNP Practice Test QUESTIONS & ANSWERS Already GRADED A

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Sarah Michelle FNP Practice Test QUESTIONS & ANSWERS Already GRADED A-1. 1. Question A 65 year old female patient presents today to the clinic with worsening back pain over the last week. She appears... to be sweating and states that she is profusely dizzy. Which of the following findings on her urinalysis would indicate the most immediate need for referral to the emergency department ? o Red blood cell (RBC) casts, as they are indicative of possible cytomegalovirus o White blood cell (WBC) casts, as they are indicative of pyelonephritis o Hyaline casts, as they are indicative of dehydration after exercise o Glucose, as it confirms a new diagnosis of Diabetes Correct With the patient’s presenting symptoms, it appears that the likely diagnosis is pyelonephritis. WBC casts in conjunction with the presenting symptoms would warrant an immediate referral as it can be life threatening. Dehydration does not always warrant an immediate referral, and glucose in the urine does not confirm a diagnosis of Diabetes. RBC casts are not indicative of possible Cytomegalovirus (CMV). 2. 2. Question A middle aged patient recently started taking Benadryl (diphenhydramine) for issues with allergic rhinitis symptoms. Which of the following signs or symptoms would be least likely for the patient to report after regularly taking this medication? o Blurred vision o Dry mouth o Diarrhea o Urinary hesitancy Correct Benadryl (Diphenhydramine) is a second line treatment for allergic rhinitis. This drug belongs to the antihistamine drug class which is notorious for anticholinergic side effects. The typical anticholinergic side effects that can occur are constipation, vision complaints, dry mouth, and urinary hesitancy. 3. 3. Question A patient presented with suspected gallstones, and the ultrasound results indicate there are no gallstones present. However, the patient continues to have symptoms of acute cholecystitis. Which of the following would be the most appropriate next action for this patient? o Refer the patient for an MRI o Repeat the ultrasound as it can take weeks for gallstones to appear o Refer the patient for a HIDA scan o Refer to general surgery to have the gallbladder removed Correct An ultrasound is the first line diagnostic test for cholecystitis. If the ultrasound is negative for gallstones, the next appropriate step would be to refer the patient for a HIDA scan, which is more sensitive. The patient does not necessarily need surgery right away, and an MRI is not as sensitive as a HIDA scan is for cholecystitis. An ultrasound is used prior to a HIDA scan to rule out gallstones due to safety concerns. 4. 4. Question A 56-year-old male patient comes into the clinic after falling on ice. He states he was carrying groceries in one arm and used the other to break his fall. He is now having pain and tenderness in the hand which he fell on. Where would the nurse practitioner palpate to examine this patient for a scaphoid fracture? o The humeral tuberosity o The radial head o The boxer’s anatomical position o The anatomic snuffbox Correct The anatomical snuffbox is a triangle-shaped depression on the lateral aspect of the back of the hand. It is best seen and palpated when the thumb is extended. Tenderness in this area is indicative of a scaphoid fracture, also known as a navicular fracture. 5. 5. Question A patient is having excruciating pain in the side of their face and is placed on carbamazepine (Tegretol) for this condition. The nurse practitioner understands which cranial nerve is affected? o CN IV o CN VII o CN VI o CN V Correct Trigeminal neuralgia presents as severe, excruciating pain due to the trigeminal nerve (CN V) 6. 6. Question A middle aged patient presents to the clinic requesting hormone replacement therapy for her menopausal symptoms. Which of the following in the patient’s history is not a contraindication to starting hormone replacement therapy? o 2 pack per day smoker o Deep vein thrombosis o New vaginal spotting that began two weeks ago o Endometriosis Incorrect The American Academy of Family Physicians notes that undiagnosed vaginal bleeding is an absolute contraindication to hormone replacement therapy (HRT). Endometriosis and previous history of thromboembolism are relative contraindications. At this time, smoking is ill advised while taking HRT but is not considered a contraindication. 7. 7. Question A 68-year-old male presents with complaints of swelling and redness in his right lower leg. He explains that he has always had veins that “stuck out” but now his skin itches and looks “leathery”. During the exam, the nurse practitioner notes a reddish-brown discoloration of the legs with mild edema present. There are also several varicose veins on the right lower leg, sparing the foot. What is the most likely diagnosis? o Deep Vein Thrombosis (DVT) o Cellulitis o Lymphedema o Chronic Venous Insufficiency (CVI) Correct Chronic venous insufficiency (CVI) is characterized by lower extremity edema, varicose veins, pruritus of the skin, discoloration of the skin, and possible ulcerations or abrasions to the skin. It is due to inadequate venous circulation caused by a partial vein blockage or leakage of a venous valve that increases pressure. Although DVTs can be caused by CVI – it is important to remember that this can happen from other things as well such as sitting or standing too long, smoking, obesity, or trauma to the leg. 8. 8. Question An 82 year old patient presents to the office today with complaints of severe pain, redness, warmth, and swelling of the distal interphalangeal joint on her right hand. Which of the following diagnoses may be responsible for her acute symptoms? Select all that apply by choosing two of the following answer choices. o Carpal tunnel syndrome o Rheumatoid arthritis o Gout o Cellulitis o Ganglion cyst Incorrect Based on the pain, redness, warmth, and swelling this patient is experiencing in her finger, both gout and cellulitis should be considered. Gout, although more common in the great toes and knees, can occur in the fingers. Herberden’s nodes are traditionally associated with osteoarthritis rather than rheumatoid arthritis. Finally, a ganglion cyst may present with pain and swelling, but will likely not present with redness and warmth. 9. 9. Question A 63 year old patient diagnosed with COPD has a CAT (COPD Assessment Test) score of 6 and has not had any severe exacerbations in the last year, placing them in treatment Group A. Which medications might this patient be on? Select all that apply by choosing two of the following answer choices. o Levoalbuterol (Xopenex) o ipatropium bromide and albuterol (Combivent) o Budesonide (Pulmicort) o Theophylline (Theochron) o Cromolyn sodium (Gastrocom) o Fomoterol (Perforomist) Correct Patients in COPD group A should be prescribed a bronchodilator – either a short acting or a long acting bronchodilator depending on the patient’s response. Therefore, this patient could be prescribed levoalbuterol (a SABA) or fomoterol (a LABA) from the list above. 10. 10. Question A 46 year old African American patient with a history of GERD presents to the clinic today with a blood pressure of 134/89 mmHg. Three months ago his blood pressure was 137/85 and he was educated on lifestyle modifications like smoking cessation, low sodium diet, and exercise. According to the JNC 8 hypertension guidelines, what treatment should the nurse practitioner initiate for this patient? o Amlodipine (Norvasc) o Hydrochlorothiazide (HCTZ) o Captopril (Capoten) o Continue lifestyle modifications Correct According to the JNC 8 hypertension guidelines, patients less than 60 years old do not need treatment with antihypertensives until the blood pressure reaches >140/90. Since this patient’s systolic and diastolic blood pressure are still under that threshold, we can continue encouraging lifestyle modifications. In patients 60 years old or greater, we do not need to initiate antihypertensive treatment until their blood pressure is >150/90 according to the JNC 8 guidelines. There are variations in these cutoffs if the patient has either diabetes or chronic kidney disease. 11. 11. Question An 89 year old patient presents to the office accompanied by his daughter. He has not been into the office in over three years but to your knowledge, has no significant past medical history. He appears agitated and overall withdrawn at the visit today, and his daughter reports that he has stopped paying bills and is repeatedly checking to ensure the doors are locked at home. She states he will wander around the house for hours and accuse family members of stealing his personal belongings. Based on this information, which of the following would be the most appropriate medication for this patient? o Dicycloverine (Bentyl) o Quetiapine (Seroquel) o Donepezil (Aricept) o Olanzapine (Zyprexa) Correct This patient has stereotypical symptoms of Alzheimer’s disease. Donepezil (Aricept), a cholinesterase inhibitor, has been shown to help patients with Alzheimer’s disease by improving cognitive function and their ability to complete activities of daily living, as well as improve some psychiatric symptoms. Other examples of cholinesterase inhibitors include Rivastigmine (Exelon) and Galantamine (Razadyne). Quetiapine (Seroquel) and Olanzapine (Zyprexa) are not routinely recommended and should only be used to treat the symptoms of hallucinations, delusions, or paranoia when alternative options have proven unsuccessful. Dicycloverine (Bentyl), commonly used to treat irritable bowel syndrome, would not be appropriate for this patient’s symptoms and belongs to the anticholinergic drug class, making it even less appropriate for an elderly patient. 12. 12. Question A 45 year old male patient presents to the clinic with increasing abdominal pain and loss of appetite over the last several days. He has been unable to have a bowel movement in three days, and you suspect a possible bowel obstruction. Which of the following assessment findings would be a sign of an early obstruction specifically? o Absent bowel sounds o High pitched bowel sounds o Severe abdominal pain o Bilious vomit Correct In the early stages of a bowel obstruction, bowel sounds are increased and high pitched. In later stages, the bowel sounds dissipate altogether. Severe abdominal pain and bilious vomit are also more likely to be seen in the later stages as the obstruction progresses. 13. 13. Question The nurse practitioner is assessing a child whose legs resemble the picture above. At what age would the nurse practitioner refer this child for further evaluation if this had not resolved on its own? o 5 years old o 2 years old o 7 years old o The nurse practitioner should refer patients with this condition regardless of age as it is always abnormal [Show More]

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