Family Nurse Practitioner Knowledge Flashcards

A 68-year-old patient with type 2 diabetes has an HbA1c of 9.2%. Which medication adjustment is most appropriate if they are already on metformin 1000mg twice daily?

Answer: Add a GLP-1 receptor agonist

GLP-1 receptor agonists are preferred add-on agents due to cardiovascular benefits, weight loss, and low hypoglycemia risk in patients with uncontrolled T2DM on metformin.

A mother brings her 18-month-old with fever, bulging anterior fontanelle, and irritability. Which diagnosis must be ruled out immediately?

Answer: Bacterial meningitis

Bulging anterior fontanelle with fever and irritability in an infant is a classic presentation of bacterial meningitis requiring immediate evaluation and empiric treatment.

Which cervical cancer screening guideline applies to a 32-year-old woman with no prior abnormal results?

Answer: Co-testing (Pap + HPV) every 5 years

Current USPSTF guidelines recommend co-testing with Pap smear and HPV test every 5 years for women aged 30–65 as a preferred option.

A patient taking warfarin presents with an INR of 7.2 but no active bleeding. What is the most appropriate management?

Answer: Hold warfarin and administer oral vitamin K 2.5mg

For supratherapeutic INR without bleeding, holding warfarin and giving low-dose oral vitamin K (2–2.5mg) is the recommended approach per ACCP guidelines.

A 55-year-old male smoker presents with a 3-cm solitary pulmonary nodule on CT scan. What is the recommended next step?

Answer: PET scan

A solid nodule >8mm in a high-risk patient warrants a PET scan or tissue sampling per Fleischner Society guidelines to assess malignancy risk.

Which finding on urinalysis is most consistent with nephrotic syndrome?

Answer: Massive proteinuria (>3.5g/day)

Nephrotic syndrome is characterized by heavy proteinuria (>3.5g/day), hypoalbuminemia, edema, and hyperlipidemia.

A postmenopausal woman on hormone replacement therapy presents with unexpected vaginal bleeding. What is the priority next step?

Answer: Order pelvic ultrasound and endometrial biopsy

Any postmenopausal bleeding must be evaluated promptly with endometrial biopsy and/or transvaginal ultrasound to rule out endometrial cancer.

A 45-year-old with newly diagnosed hypertension also has chronic kidney disease (eGFR 42). Which antihypertensive is the first-line choice?

Answer: Lisinopril

ACE inhibitors (e.g., lisinopril) are first-line in CKD with hypertension due to their nephroprotective effects and reduction of proteinuria.

Which vaccine is contraindicated in a pregnant woman at 20 weeks gestation?

Answer: MMR

MMR is a live-attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection.

A 7-year-old child is brought in with a rash that started on the face and moved to the trunk, along with low-grade fever and Koplik spots. What is the diagnosis?

Answer: Measles

Koplik spots (white spots on the buccal mucosa) are pathognomonic for measles (rubeola), which presents with cephalocaudal rash spread.

A patient with rheumatoid arthritis on methotrexate develops oral ulcers and fatigue. Which supplement should be routinely recommended?

Answer: Folic acid

Folic acid supplementation reduces methotrexate-related adverse effects including mucositis, GI upset, and cytopenias.

A 72-year-old presents with sudden onset of painless vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?

Answer: Retinal detachment

Painless, sudden vision loss described as a descending curtain is the classic presentation of retinal detachment, an ophthalmologic emergency.

Which parameter is used to calculate the CURB-65 score for pneumonia severity?

Answer: Blood urea nitrogen >19 mg/dL

CURB-65 includes Confusion, Urea >7 mmol/L (BUN >19 mg/dL), Respiratory rate ≥30, Blood pressure <90/60, and age ≥65 to assess pneumonia severity.

A 16-year-old athlete presents with anterior knee pain worsened by stairs and prolonged sitting. Examination reveals tenderness at the inferior pole of the patella. What is the most likely diagnosis?

Answer: Sinding-Larsen-Johansson syndrome

Sinding-Larsen-Johansson syndrome involves traction apophysitis at the inferior pole of the patella, distinct from Osgood-Schlatter which affects the tibial tuberosity.

A 28-year-old woman presents with a painless, indurated genital ulcer with a clean base and no exudate. Inguinal lymphadenopathy is non-tender. What is the most likely diagnosis?

Answer: Primary syphilis

A clean, painless, indurated ulcer (chancre) with non-tender lymphadenopathy is the hallmark of primary syphilis caused by Treponema pallidum.

An adult patient on lithium therapy presents with coarse tremor, confusion, and GI upset. Serum lithium level is 2.4 mEq/L. What is the immediate priority?

Answer: Discontinue lithium and provide supportive care with hydration

Lithium toxicity at levels >2.0 mEq/L with symptoms requires immediate discontinuation, volume resuscitation, and possibly hemodialysis for severe cases.

Which physical exam finding is most consistent with aortic stenosis?

Answer: Harsh systolic crescendo-decrescendo murmur at the right upper sternal border

Aortic stenosis produces a harsh systolic ejection (crescendo-decrescendo) murmur best heard at the right upper sternal border, radiating to the carotids.

A 40-year-old woman with fatigue, weight gain, cold intolerance, and constipation has a TSH of 9.2 mIU/L and free T4 of 0.6 ng/dL. What is the treatment?

Answer: Levothyroxine therapy

Primary hypothyroidism with elevated TSH and low free T4 is treated with synthetic levothyroxine (T4) replacement therapy.

A 5-year-old presents with periorbital edema, frothy urine, and abdominal pain. Urinalysis shows 4+ protein. Which condition is the most common cause in this age group?

Answer: Minimal change disease

Minimal change disease is the most common cause of nephrotic syndrome in children aged 1–8 years and typically responds well to corticosteroids.

A 60-year-old man with a 40 pack-year history undergoes low-dose CT lung cancer screening. What are the eligibility criteria per USPSTF guidelines?

Answer: Ages 50–80, 20 pack-year history, current or former smoker quit within 15 years

USPSTF 2021 guidelines recommend annual low-dose CT for adults aged 50–80 with a 20 pack-year history who currently smoke or quit within the past 15 years.