FREE Family Nurse Practitioner Knowledge Questions and Answers
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?
Acute angle-closure glaucoma is characterized by a rapid increase in intraocular pressure caused by blocked trabecular meshwork, which manifests clinically as a painful, red eye, a headache, and a fixed, mid-dilated pupil. Tonometry and emergency ophthalmology referral are the recommended next steps for individuals with suspected angle-closure glaucoma.
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?
When the placenta implants abnormally, it is called placenta previa. Painless, bright crimson bleeding is a typical sign of placenta previa.
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?
Pyelonephritis can be confirmed by a positive urine for WBC casts, which also help distinguish between upper and lower UTIs. In renal tubules, where WBCs precipitate with a protein generated by tubular epithelial cells, WBC casts are the only type of WBC cast that may be found. Other intrarenal illnesses (such acute interstitial nephritis) can also cause WBC casts, although these conditions don't frequently include frequent or urgent urination.
Which of the following vaccinations is not recommended for young children with acquired immunodeficiency syndrome (AIDS)?
Since there isn't enough information about how well the varicella vaccine works, it shouldn't be given to people with HIV.
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?
Obesity and comorbid hypertension are risk factors for obstructive sleep apnea and are frequently associated with hypersomnolence (excessive daytime sleepiness); nocturnal polysomnography should be requested to confirm the diagnosis.
Which of the following can be detected with the Lachman maneuver?
To check for knee instability, the Lachman maneuver is often used. A tear in the anterior cruciate ligament is the most common cause of instability in the knee.
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?
The superficial veins of the leg are where varicose veins, which are dilated, convoluted veins, are most frequently observed. They result from ineffective venous valves brought on by persistently elevated intraluminal pressure and/or vessel wall tensile strength loss. Edema, stasis dermatitis, venous stasis ulcers, inadequate wound healing, and infections are typical side effects.
When your thyroid-stimulating hormone (TSH) is low, it can cause ______.
Due to hyperthyroidism's increased metabolic state.
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?
Patients with skin lesions that look like they might be melanoma should get an excisional biopsy that takes out the whole lesion and 1 to 3 mm of skin and fat around it.
All of the following are used to treat mild preeclampsia, except for ______.
Bed rest with bathing privileges, weight and blood pressure monitoring, and thorough monitoring of urine protein and serum protein, creatinine, and platelet counts are all recommended treatments for women diagnosed with preeclampsia. Oral medications are not recommended as first-line therapy.
In primary care, which of the following laboratory tests is used to assess renal function?
Serum creatinine is used to assess renal function. The end product of creatine metabolism is creatinine. The fluid or dietary intake of meat has no effect on creatinine clearance.
B12 deficiency anemia causes which of these symptoms?
If not treated, vitamin B12 deficiency anemia can cause nerve cell damage. Tingling or numbness in the fingers and toes, difficulty walking, mood changes or depression, memory loss, disorientation, and dementia are all symptoms of B12 deficiency anemia.
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?
After delivery, the fetal head retracts into the mother's perineum, indicating shoulder dystocia, the impaction of the fetal shoulder behind the pubic symphysis. Conditions such as maternal diabetes mellitus, maternal obesity, and gestational age greater than 42 weeks are risk factors for fetal macrosomia.
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?
Initial treatment for uncomplicated hemorrhoids entails increasing fluid and fiber intake, lowering fat and alcohol consumption, and engaging in regular exercise. Only patients with prolapsed hemorrhoids that cannot be reduced manually and those who are experiencing refractory symptoms should consider rubber band ligation or surgical hemorrhoidectomy.
Jerry, 35, has dermatosis and uses a high-potency corticosteroid cream. He also has tinea corporis. Tell him about the cream:
Tell your client that using a potent corticosteroid cream to treat their dermatosis may make their other skin problems, like acne and tinea corporis, worse. Not all cutaneous eruptions should be treated with topical corticosteroids.
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?
For acute gouty arthritis, nonsteroidal anti-inflammatory drugs are the primary line of treatment. They have a comprehensive anti-inflammatory action that includes inhibiting neutrophils via inhibiting cyclooxygenase, which reduces prostaglandin generation.