Patient Management Flashcards

A pregnant patient at 28 weeks is found to have a 1-hour glucose challenge test result of 155 mg/dL. The NEXT step is:

Answer: Order a 3-hour 100g oral glucose tolerance test (OGTT)

A 1-hour GCT ≥140 mg/dL is a positive screen requiring confirmatory 3-hour OGTT to diagnose or exclude gestational diabetes.

The FNP is managing a patient with newly diagnosed stage 1 hypertension (130–139/80–89 mmHg) with no comorbidities. The FIRST-LINE intervention is:

Answer: Lifestyle modification for 3–6 months before initiating medication

ACC/AHA guidelines recommend 3–6 months of lifestyle modification (diet, exercise, weight loss, sodium reduction) as initial therapy for stage 1 hypertension without cardiovascular risk.

A 2-year-old with fever of 39.5°C and left ear pain is diagnosed with acute otitis media. Per AAP guidelines, the PREFERRED management is:

Answer: Amoxicillin 80–90 mg/kg/day for 10 days

Children under 2 years with AOM and fever ≥39°C should receive immediate antibiotic therapy with high-dose amoxicillin per AAP guidelines.

A 68-year-old woman with osteoporosis has a T-score of -2.7 at the lumbar spine. The FNP initiates bisphosphonate therapy and counsels the patient to:

Answer: Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes

Bisphosphonates must be taken fasting with a full glass of water, and patients must remain upright for 30 minutes to prevent esophageal irritation and ensure absorption.

An FNP is managing a patient after an acute MI. Which medication has MOST clearly demonstrated mortality reduction post-MI?

Answer: Beta-blocker (e.g., metoprolol succinate)

Beta-blockers reduce sympathetic stimulation and cardiac remodeling after MI and are associated with significant reduction in mortality.

A patient with GERD fails PPI therapy. The FNP considers referral to gastroenterology for which procedure?

Answer: Upper endoscopy (EGD) to assess for Barrett's esophagus or other pathology

PPI-refractory GERD requires upper endoscopy to evaluate for Barrett's esophagus, esophagitis, strictures, or other conditions requiring intervention.