Family Nurse Practitioner Test Patient Management 2 — Questions and Answers
Question 1: A 14-year-old patient discloses substance use during a confidential visit. Under HIPAA and most state laws, the FNP should FIRST:
- Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality (Correct answer)
- Immediately notify parents
- Report to child protective services
- Refer to psychiatry without disclosure to parents
Correct answer: Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality
Minors have confidentiality rights for substance use treatment in most states; the FNP should assess safety and engage the patient in treatment before any breach.
Question 2: The FNP is counseling a 25-year-old female on combined oral contraceptive pills (COCs). Which absolute contraindication (WHOMEC Category 4) should be screened for?
- History of DVT or pulmonary embolism (Correct answer)
- Irregular menstrual cycles
- Smoking fewer than 15 cigarettes per day under age 35
- Controlled hypertension
Correct answer: History of DVT or pulmonary embolism
Personal history of DVT or PE is a WHO Medical Eligibility Criteria Category 4 (absolute) contraindication to estrogen-containing contraceptives due to thrombosis risk.
Question 3: A patient with CKD stage 3 (eGFR 35 mL/min) and diabetes has a blood pressure of 142/88 mmHg. The PREFERRED antihypertensive agent is:
- ACE inhibitor or ARB for renoprotection (Correct answer)
- Thiazide diuretic
- Calcium channel blocker only
- Beta-blocker only
Correct answer: ACE inhibitor or ARB for renoprotection
ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, providing renoprotection in diabetic CKD and are the preferred antihypertensive agents.
Question 4: A patient with alcohol use disorder requires treatment for acute alcohol withdrawal. Which medication class is FIRST-LINE?
- Benzodiazepines (e.g., lorazepam) (Correct answer)
- Antipsychotics (e.g., haloperidol)
- Beta-blockers (e.g., propranolol)
- Opioids
Correct answer: Benzodiazepines (e.g., lorazepam)
Benzodiazepines are first-line for alcohol withdrawal as they treat GABA deficiency, preventing seizures and progression to delirium tremens.
Question 5: The FNP is conducting a sports physical for a 16-year-old. Which finding warrants DISQUALIFICATION from contact sports?
- Single functional kidney (Correct answer)
- Well-controlled asthma
- History of simple concussion cleared by neurology
- Mild exercise-induced bronchospasm treated with albuterol
Correct answer: Single functional kidney
A single functional kidney is a relative-to-absolute contraindication for contact sports because trauma could result in loss of the only functioning kidney.
Question 6: A patient in the third trimester of pregnancy presents with severe headache, visual changes, and BP of 162/110. The FNP's IMMEDIATE action is:
- Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia (Correct answer)
- Start oral hydralazine and monitor in office
- Recheck BP in 4 hours
- Advise bedrest and low-sodium diet
Correct answer: Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia
Severe-range BPs (≥160/110) with CNS symptoms in the third trimester meet criteria for severe preeclampsia, requiring emergency hospitalization and IV antihypertensives.
Family Nurse Practitioner Test Patient Management 2
A 14-year-old patient discloses substance use during a confidential visit.
Under HIPAA and most state laws, the FNP should FIRST: