Free Family Nurse Practitioner Knowledge Questions and Answers — Questions and Answers
Question 1: Jerry, 35, has dermatosis and uses a high-potency corticosteroid cream. He also has tinea corporis. Tell him about the cream:
- Be sure to use it daily.
- You must use this for an extended period of time for it to be effective.
- It will work better if you occlude the area.
- It may exacerbate your concurrent tinea corporis. (Correct answer)
Correct answer: It may exacerbate your concurrent tinea corporis.
High-potency corticosteroid creams suppress the immune response, which can worsen fungal infections like tinea corporis. Using corticosteroids on a fungal infection can mask symptoms and allow the infection to spread or become more severe. Therefore, it's crucial to warn the patient about this potential exacerbation.
Question 2: When your thyroid-stimulating hormone (TSH) is low, it can cause ______.
- Weight gain
- Brittle hair
- Osteoporosis (Correct answer)
- Weight gain
Correct answer: Osteoporosis
A low TSH indicates hyperthyroidism (overactive thyroid), not hypothyroidism. Hyperthyroidism accelerates bone turnover, leading to increased bone loss and a higher risk of osteoporosis. Weight gain and brittle hair are typically associated with hypothyroidism, while osteoporosis is a known complication of chronic hyperthyroidism.
Question 3: Two days ago, a 21-year-old woman presented to the clinic for evaluation of urine frequency and urgency. She has also observed little vaginal discharge. Symptoms are new to the patient. Urinalysis and culture are done on a urine sample. Which further results suggest pyelonephritis?
- White blood cell casts (Correct answer)
- Microscopic hematuria
- Bacteriuria
- Leukocytosis
Correct answer: White blood cell casts
White blood cell casts in a urinalysis are highly indicative of pyelonephritis (kidney infection) because they form in the renal tubules and signify inflammation within the kidney itself. While bacteriuria, leukocytosis, and microscopic hematuria can be present in UTIs, WBC casts specifically point to an upper urinary tract infection.
Question 4: In the middle of the night, after having a steak meal with friends, a 55-year-old man with type 2 diabetes mellitus appears with significant right foot discomfort. The first metatarsophalangeal joint is swollen and painful during physical examination. During a joint aspiration, monosodium urate crystals were seen in the synovial fluid under a microscope. Which of the following offers the most effective first care?
- Prednisone
- Allopurinol
- Probenecid
- Non-steroidal anti-inflammatory drugs (NSAIDs) (Correct answer)
Correct answer: Non-steroidal anti-inflammatory drugs (NSAIDs)
The patient's symptoms (acute, severe right foot pain, swollen MTP joint after a steak meal, monosodium urate crystals) are classic for an acute gout attack. NSAIDs are typically the first-line treatment for acute gout due to their rapid anti-inflammatory and analgesic effects. Prednisone is an alternative if NSAIDs are contraindicated, while allopurinol and probenecid are for long-term prevention, not acute attacks.
Question 5: A 50-year-old guy arrives for a hypersomnolence assessment. The patient routinely nods off while watching TV at home and has even fallen asleep at his desk at work. He regularly gets 8 hours of sleep each night while working a standard 40-hour workweek as a systems analyst. The patient claims to have a daily cup of coffee to help him "wake up" on his way to work in the morning and another in the late afternoon. Hypertension is present in the medical past. BMI is 38 kg/m2, and blood pressure is 160/100 mm Hg. Normal results from heart, lung, and neurological exams. Which of the following is the ideal course of management to take next?
- CT scan of the head
- Nocturnal polysomnography (Correct answer)
- Sleep hygiene education
- Ambulatory ECG monitoring
Correct answer: Nocturnal polysomnography
The patient presents with significant hypersomnolence despite adequate sleep, along with risk factors like obesity and hypertension, strongly suggesting obstructive sleep apnea. Nocturnal polysomnography (a sleep study) is the gold standard for diagnosing sleep apnea and other sleep disorders. It is the ideal next step to determine the underlying cause of his excessive daytime sleepiness.
Question 6: A 45-year-old man visits the clinic for a regular preventive checkup. Although he claims to be in good health, he does admit to having some dark spots on his back. On the back, a physical examination reveals numerous pigmented lesions, including a single, flat, dark, 9-mm lesion with wavy borders. Which of the following is the ideal next move in treating the skin lesion on this patient?
- Incisional biopsy
- Reassurance and routine follow up only
- Excisional biopsy (Correct answer)
- Photographic documentation and comparison in 6-12 months
Correct answer: Excisional biopsy
The description of the lesion (single, flat, dark, 9-mm with wavy borders) raises strong suspicion for melanoma, especially given the irregular borders. When melanoma is suspected, an excisional biopsy with narrow margins is the preferred diagnostic and initial therapeutic step. This allows for complete removal of the lesion for pathological examination.
Question 7: A 50-year-old man is examined for a severe headache, motion sickness, and discomfort in his left eye. His symptoms began abruptly few hours ago, and despite rest and ibuprofen, his headache has not gone. He took an over-the-counter oral decongestant this morning due to a little cold he had. Physical examination reveals a nonreactive, mid-dilated left pupil. Conjunctival flushing makes the eye look red. In terms of management, which option below is more appropriate?
- Tonometry (Correct answer)
- No additional management indicated
- Eye patch placement and follow up in 3 days
- Fluorescein staining of the eye
Correct answer: Tonometry
The patient's symptoms (severe headache, motion sickness, left eye discomfort, abrupt onset, mid-dilated nonreactive pupil, conjunctival flushing) are highly suggestive of acute angle-closure glaucoma. This is a medical emergency characterized by a sudden increase in intraocular pressure. Tonometry is the diagnostic test used to measure intraocular pressure, which is crucial for confirming the diagnosis and guiding immediate treatment.
Question 8: A 62-year-old lady arrives at the office complaining of leg heaviness, particularly while standing for lengthy periods of time. The patient has spent the previous 20 years working as a cashier at a department store, and she reports that her symptoms are at their worst when her job ends. The calves and ankles of both lower limbs have bilaterally dilated, tortuous veins without erythema or edema upon examination. Examination of the upper extremities is unremarkable. Which of the following outcomes is at higher risk due to this patient's present condition?
- Myocardial infarction
- Pulmonary embolism
- Venous stasis ulcers (Correct answer)
- Intermittent claudication
Correct answer: Venous stasis ulcers
The patient's symptoms (leg heaviness, bilaterally dilated, tortuous veins, prolonged standing occupation) are consistent with varicose veins and chronic venous insufficiency. Over time, impaired venous return and increased pressure in the veins can lead to skin changes, inflammation, and ultimately, the development of venous stasis ulcers, particularly around the ankles.
Question 9: A 36-year-old healthy guy arrives with 2 months' worth of sporadic episodes of rectal bleeding. When he first started noticing blood on the tissue after wiping, it was only in small streaks. However, after defecating yesterday, he dripped bright red blood and the stool was coated with blood. No anal or abdominal discomfort, anorexia, weight loss, or changes in bowel habits have been reported in the patient. No anomalies may be seen in the perianal skin. A digital rectal exam reveals no palpable masses or pain. Bulges in the mucosa are purple, as seen on anoscopy. The ideal next step in management is which of the following?
- High-fiber diet and follow-up (Correct answer)
- Biopsy of the anal lesions
- Referral for surgical evaluation
- Referral for colonoscopy
Correct answer: High-fiber diet and follow-up
The patient's symptoms (sporadic bright red rectal bleeding, blood on tissue/coating stool, purple bulges on anoscopy) without pain, weight loss, or changes in bowel habits are classic for internal hemorrhoids. Initial management for hemorrhoids typically involves conservative measures like a high-fiber diet, increased fluid intake, and stool softeners to reduce straining, often followed by observation.
Question 10: In active labor at 37 weeks along, a 26-year-old woman is diagnosed as gravida 2 para 1. She has an epidural and is slowly dilated to a full cervical opening. The fetal head is delivered, immediately retracts into the perineum, and the anterior shoulder is not delivered despite the patient pushing for two hours. Which of the following best describes the clinical presentation of this patient at risk?
- Maternal chronic hypertension
- Fetal gestational age
- Maternal type 2 diabetes mellitus (Correct answer)
- Maternal age at delivery
Correct answer: Maternal type 2 diabetes mellitus
The clinical presentation describes shoulder dystocia, where the fetal head delivers but the anterior shoulder gets stuck. Maternal type 2 diabetes mellitus is a significant risk factor for shoulder dystocia because it often leads to macrosomia (large baby), which increases the likelihood of the baby's shoulders being too wide to pass through the maternal pelvis.
Question 11: All of the following are used to treat mild preeclampsia, except for ______.
- a prescription of methyldopa (Aldomet) to control blood pressure (Correct answer)
- close follow-up of urinary protein, serum creatinine, and platelet count
- close monitoring of weight and blood pressure
- bed rest except for bathroom privileges
Correct answer: a prescription of methyldopa (Aldomet) to control blood pressure
For *mild preeclampsia*, the primary management focuses on close monitoring and conservative measures rather than immediate antihypertensive medication. Antihypertensives are typically reserved for severe preeclampsia to prevent complications like stroke. Close follow-up of urinary protein, serum creatinine, platelet count, weight, blood pressure, and bed rest are standard for mild cases.
Question 12: B12 deficiency anemia causes which of these symptoms?
- A vegan diet
- Spoon-shaped nails and pica
- Tingling and numbness of both feet (Correct answer)
- An abnormal neurological exam
Correct answer: Tingling and numbness of both feet
Vitamin B12 deficiency anemia often manifests with neurological symptoms due to its role in nerve health. Peripheral neuropathy, characterized by tingling, numbness, and paresthesias (often in the feet and hands), is a classic neurological symptom of B12 deficiency. A vegan diet is a *cause*, not a symptom, and spoon-shaped nails/pica are associated with iron deficiency.
Question 13: Which of the following can be detected with the Lachman maneuver?
- Tears on the meniscus of the knee
- Knee instability (Correct answer)
- Nerve damage of the knee due to past knee injuries
- The integrity of the patellar tendon
Correct answer: Knee instability
The Lachman maneuver is a clinical test specifically used to assess the integrity of the anterior cruciate ligament (ACL) in the knee. A positive Lachman test (excessive anterior tibial translation without a firm endpoint) indicates ACL laxity or a tear, which directly contributes to knee instability. It helps diagnose ACL injuries.
Question 14: In primary care, which of the following laboratory tests is used to assess renal function?
- Creatinine (Correct answer)
- Electrolyte panel
- Blood urea nitrogen (BUN) to creatinine ratio
- Alkaline phosphatase
Correct answer: Creatinine
Serum creatinine is the most commonly used and reliable single laboratory test in primary care to assess renal function. Creatinine is a waste product produced by muscle metabolism and is filtered by the kidneys; elevated levels indicate impaired kidney function. While BUN and electrolyte panels provide additional information, creatinine is the primary marker for estimating glomerular filtration rate (GFR).
Question 15: A 28-year-old woman with a history of multiple pregnancies comes to your office at 32 weeks pregnant, saying she started bleeding bright red blood suddenly. She has had a few episodes and seems to be worried. On a physical exam, her uterus feels soft. The most likely is which?
- Molar pregnancy (hydatidiform mole)
- Placenta abruptio
- Placenta previa (Correct answer)
- Acute cervicitis
Correct answer: Placenta previa
The classic presentation of placenta previa is painless, bright red vaginal bleeding in the third trimester, often described as sudden and recurrent. The uterus typically remains soft and non-tender. Placenta abruptio usually presents with painful bleeding and a firm, tender uterus, while molar pregnancy is usually diagnosed earlier and acute cervicitis typically causes less significant bleeding.
Question 16: Which of the following vaccinations is not recommended for young children with acquired immunodeficiency syndrome (AIDS)?
- Hepatitis B and mumps
- Td and oral polio
- Diphtheria and tetanus (Td)
- Varicella (Correct answer)
Correct answer: Varicella
Live attenuated vaccines, such as the Varicella (chickenpox) vaccine, are generally contraindicated in individuals with severe immunocompromise, including young children with AIDS, due to the risk of vaccine-induced disease. The weakened virus in these vaccines could cause serious infection in a compromised immune system. Inactivated vaccines (like Hepatitis B, Td) are generally safe.
Free Family Nurse Practitioner Knowledge Questions and Answers
Jerry, 35, has dermatosis and uses a high-potency corticosteroid cream.
He also has tinea corporis.
Tell him about the cream: