Family Nurse Practitioner Skill Flashcards

A 58-year-old male with hypertension is started on lisinopril. Two weeks later he reports a dry, persistent cough. What is the most appropriate next step?

Answer: Switch to an ARB such as losartan

ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB (which does not affect bradykinin) is the preferred management.

Which of the following findings on a diabetic foot exam requires immediate referral to a vascular surgeon?

Answer: Ankle-brachial index (ABI) of 0.55 with rest pain

An ABI below 0.6 with rest pain indicates critical limb ischemia requiring urgent vascular surgery evaluation.

A 4-year-old presents with a barky cough, inspiratory stridor, and low-grade fever. What is the most likely diagnosis?

Answer: Croup (laryngotracheobronchitis)

Croup typically affects children aged 6 months to 3 years but can occur at 4, presenting with a seal-like barky cough, stridor, and low-grade fever caused by parainfluenza virus.

A patient with newly diagnosed atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to current guidelines, what is the recommended management?

Answer: Oral anticoagulation with a DOAC or warfarin

A CHA₂DS₂-VASc score of 2 or higher in males (or 3+ in females) warrants oral anticoagulation to reduce stroke risk.

Which screening test is recommended by the USPSTF for colorectal cancer starting at age 45 in average-risk adults?

Answer: Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT

The USPSTF recommends starting colorectal cancer screening at age 45 with several acceptable strategies, including colonoscopy every 10 years or annual stool-based tests.

A 30-year-old woman at 10 weeks gestation presents with nausea and vomiting. She has lost 5 lbs, has dry mucous membranes, and urine specific gravity of 1.030. What is the diagnosis?

Answer: Hyperemesis gravidarum

Hyperemesis gravidarum is characterized by severe nausea/vomiting with weight loss >5% of pre-pregnancy weight and signs of dehydration.

Which medication is first-line for acute gout flare management in a patient with no contraindications?

Answer: Colchicine or NSAIDs

NSAIDs or colchicine (started within 24 hours of flare onset) are first-line treatments for acute gout; allopurinol and probenecid are used for chronic prophylaxis.

A 65-year-old woman with osteoporosis has a T-score of -2.8 on DEXA scan. In addition to calcium and vitamin D, which pharmacologic therapy is first-line?

Answer: Oral bisphosphonate (alendronate or risedronate)

Oral bisphosphonates are the first-line pharmacologic treatment for postmenopausal osteoporosis due to proven efficacy in reducing vertebral and hip fractures.

A 2-year-old child is brought in with a bulging fontanelle, high fever, and nuchal rigidity. Which action should the FNP take FIRST?

Answer: Administer empiric IV antibiotics without delay

Bacterial meningitis is a life-threatening emergency; empiric antibiotics must not be delayed even if lumbar puncture or imaging is planned.

Which of the following is the most appropriate initial antibiotic for uncomplicated community-acquired pneumonia in a healthy adult without comorbidities?

Answer: Azithromycin or doxycycline

IDSA/ATS guidelines recommend a macrolide (azithromycin) or doxycycline as monotherapy for outpatient CAP in otherwise healthy adults with no comorbidities.

A 45-year-old male presents with fatigue, weight gain, cold intolerance, and constipation. TSH is 8.5 mIU/L and free T4 is low. What is the treatment of choice?

Answer: Levothyroxine (T4 replacement)

Hypothyroidism is treated with levothyroxine, the synthetic form of T4, titrated to normalize TSH.

A mother brings her 6-week-old infant who vomits forcefully after every feeding and appears hungry immediately afterward. The FNP palpates an olive-shaped mass in the epigastrium. What is the most likely diagnosis?

Answer: Pyloric stenosis

Pyloric stenosis classically presents at 3–6 weeks of age with projectile non-bilious vomiting, persistent hunger, and a palpable 'olive' mass representing the hypertrophied pylorus.

Which of the following is the most important risk factor for the development of type 2 diabetes mellitus?

Answer: Central obesity and insulin resistance

Central obesity leading to insulin resistance is the predominant modifiable risk factor for type 2 diabetes mellitus.

A 70-year-old male smoker reports painless gross hematuria. He has no UTI symptoms. What is the priority next step?

Answer: Refer for urgent cystoscopy to rule out bladder cancer

Painless gross hematuria in an older smoker is bladder cancer until proven otherwise; urgent cystoscopy and urology referral are indicated.

A 25-year-old woman presents with a painful vesicular rash in a dermatomal distribution on her right thorax. What is the treatment of choice if she presents within 72 hours of rash onset?

Answer: Oral valacyclovir 1000 mg three times daily for 7 days

Oral valacyclovir (or famciclovir) started within 72 hours of rash onset reduces the severity and duration of herpes zoster and lowers postherpetic neuralgia risk.

Which lab finding is most consistent with iron-deficiency anemia?

Answer: Low serum ferritin, elevated TIBC, microcytic hypochromic RBCs

Iron-deficiency anemia is characterized by low ferritin (depleted stores), elevated TIBC, and microcytic hypochromic red cells on CBC.

A 52-year-old woman presents with new-onset headache described as 'the worst headache of my life.' She denies fever or neck stiffness. What is the most critical next step?

Answer: Perform immediate non-contrast CT of the head

A thunderclap 'worst headache of life' requires urgent non-contrast CT head to rule out subarachnoid hemorrhage before any other management.

When counseling an adolescent patient confidentially, which of the following situations legally requires the FNP to breach confidentiality and notify parents or authorities?

Answer: The teen discloses an imminent plan to harm themselves or another person

Imminent risk of harm to self or others is a legally and ethically mandated exception to adolescent confidentiality in all US states.

A patient with COPD has an FEV₁/FVC ratio of 0.62 post-bronchodilator. According to GOLD criteria, what severity of obstruction does this indicate if FEV₁ is 55% predicted?

Answer: GOLD 2 (Moderate)

GOLD 2 (Moderate COPD) is defined by FEV₁/FVC < 0.70 with FEV₁ 50–79% of predicted.

A 35-year-old woman is found to have a blood pressure of 150/95 mmHg on three separate visits. She is pregnant at 22 weeks. Which antihypertensive is safest to initiate?

Answer: Labetalol

Labetalol (and nifedipine or methyldopa) are preferred antihypertensives in pregnancy; ACE inhibitors are contraindicated due to fetal toxicity.