APEA APEA Patient Management Questions and Answers 2 — Questions and Answers
Question 1: A 3-year-old child presents with sudden onset inspiratory stridor, drooling, and a toxic appearance, sitting in a tripod position. The NP's priority action is:
- Transfer immediately to ED without examining throat (Correct answer)
- Perform throat exam and obtain lateral neck X-ray
- Administer nebulized racemic epinephrine
- Obtain throat culture for strep
Correct answer: Transfer immediately to ED without examining throat
The presentation suggests epiglottitis; examining the throat can precipitate complete airway obstruction — immediate transfer to an ED with airway management capability is the priority.
Question 2: A patient with acute deep vein thrombosis has no contraindications. Which anticoagulation management is preferred per current guidelines?
- Direct oral anticoagulant (DOAC) as outpatient therapy (Correct answer)
- Inpatient IV heparin bridge to warfarin only
- Low-molecular-weight heparin indefinitely
- Aspirin for 3 months
Correct answer: Direct oral anticoagulant (DOAC) as outpatient therapy
DOACs such as rivaroxaban or apixaban are the preferred first-line treatment for DVT due to efficacy, safety profile, and convenience of outpatient oral dosing.
Question 3: A postmenopausal woman presents with vaginal bleeding. The NP's first priority diagnostic step is:
- Endometrial biopsy or transvaginal ultrasound (Correct answer)
- Pap smear
- Serum estrogen level
- Pelvic MRI
Correct answer: Endometrial biopsy or transvaginal ultrasound
Any postmenopausal bleeding requires prompt evaluation for endometrial cancer with endometrial biopsy or transvaginal ultrasound to measure endometrial stripe thickness.
Question 4: A 6-month-old is brought in with a bulging anterior fontanelle, fever, and irritability. The NP's immediate priority is:
- Transfer to ED for lumbar puncture and empiric antibiotics (Correct answer)
- Obtain CT scan before lumbar puncture in office
- Administer oral amoxicillin and recheck in 24 hours
- Observe in office for 2 hours and reassess
Correct answer: Transfer to ED for lumbar puncture and empiric antibiotics
Bulging fontanelle with fever and irritability in an infant strongly suggests bacterial meningitis requiring immediate emergency transfer for lumbar puncture and IV antibiotics.
Question 5: A patient with community-acquired MRSA skin infection has a fluctuant abscess with surrounding cellulitis. The primary treatment is:
- Incision and drainage plus TMP-SMX (Correct answer)
- Oral clindamycin alone
- IV vancomycin only
- Topical mupirocin and warm compresses
Correct answer: Incision and drainage plus TMP-SMX
Fluctuant abscesses require incision and drainage as the primary treatment; TMP-SMX is added to cover MRSA in the surrounding cellulitis.
Question 6: A patient with migraine with aura asks about contraceptive options. Which contraceptive is contraindicated due to increased stroke risk?
- Combined oral contraceptive pills (Correct answer)
- Progestin-only pills
- Copper IUD
- Levonorgestrel IUD
Correct answer: Combined oral contraceptive pills
Combined oral contraceptives are contraindicated in migraine with aura (WHO Category 4) due to synergistic increased risk of ischemic stroke.
APEA APEA Patient Management Questions and Answers 2
A 3-year-old child presents with sudden onset inspiratory stridor, drooling, and a toxic appearance, sitting in a tripod position.
The NP's priority action is: