Patient Management Flashcards

An elderly patient is found to have a serum sodium of 128 mEq/L with euvolemia. Which is the MOST appropriate initial management?

Answer: Fluid restriction and identify underlying cause (e.g., SIADH)

Euvolemic hyponatremia (SIADH) is managed with fluid restriction and identifying the underlying cause; rapid correction risks osmotic demyelination syndrome.

A 4-year-old is brought in by parents for fever and appears non-toxic. On exam the FNP notes a petechial rash that does NOT blanch with pressure. The PRIORITY action is:

Answer: Emergency transfer to the ED for suspected meningococcemia

Non-blanching petechiae with fever can indicate meningococcemia (Neisseria meningitidis), a rapidly fatal condition requiring immediate emergency evaluation and IV antibiotics.

A patient with bipolar I disorder is started on lithium. Which parameter requires the MOST vigilant monitoring?

Answer: Serum lithium level, renal function (creatinine), and thyroid function

Lithium has a narrow therapeutic index, is renally excreted, and causes hypothyroidism; regular serum levels, renal function, and thyroid function tests are mandatory.

The FNP is counseling a postmenopausal woman on hormone therapy (HT). Which combination is preferred for a woman WITH a uterus?

Answer: Estrogen plus progestogen (combined HT)

Women with an intact uterus must receive progestogen with estrogen to prevent unopposed estrogen stimulation causing endometrial hyperplasia and cancer.

A patient with chronic kidney disease and secondary hyperparathyroidism has low calcium and elevated phosphorus. The FNP should FIRST address:

Answer: Phosphorus restriction and phosphate binders

Hyperphosphatemia drives secondary hyperparathyroidism in CKD; dietary phosphorus restriction combined with phosphate binders is the first-line approach.

A patient newly diagnosed with rheumatoid arthritis has active synovitis. Per ACR guidelines, which is the FIRST-LINE disease-modifying agent (DMARD)?

Answer: Methotrexate

Methotrexate is the anchor DMARD for rheumatoid arthritis, recommended as first-line therapy due to its efficacy, long-term safety profile, and cost-effectiveness.