Free Family Nurse Practitioner Skill Questions and Answers — Questions and Answers
Question 1: Congestive heart failure has recently been diagnosed in Greg, age 68. (CHF). Which medicine should be stopped for him?
- Hydrochlorothiazide (HydroDIURIL) for his hypertension.
- Nifedipine (Procardia XL) for long-term management of his chronic stable angina. (Correct answer)
- Butalbital for his headaches.
- Enalapril (Vasotec) for his hypertension.
Correct answer: Nifedipine (Procardia XL) for long-term management of his chronic stable angina.
Nifedipine, particularly immediate-release formulations, is a dihydropyridine calcium channel blocker that can cause peripheral vasodilation and reflex tachycardia, which can worsen heart failure symptoms or exacerbate myocardial ischemia. While extended-release forms like Procardia XL are safer, non-dihydropyridine CCBs or other anti-anginal agents are generally preferred in CHF patients if a CCB is needed. Beta-blockers (if stable CHF), ACE inhibitors, and diuretics are often beneficial in CHF management, making nifedipine a less suitable choice.
Question 2: What statement about mitral regurgitation is correct?
- It occurs only as a result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps.
- It results in a prolonged PR interval on electrocardiogram.
- It may be noted as a holosystolic murmur. (Correct answer)
- It is caused by stiff leaflets that limit flow from the left atrium to the left ventricle.
Correct answer: It may be noted as a holosystolic murmur.
Mitral regurgitation (MR) is the backflow of blood from the left ventricle into the left atrium during systole due to incomplete closure of the mitral valve. This abnormal flow creates a characteristic heart sound known as a holosystolic (or pansystolic) murmur. This murmur is typically heard throughout the entire systole, distinguishing it from other types of murmurs.
Question 3: Gary, a healthy 16-year-old kid, is getting a sports physical examination. Which question from the past should the doctor ask Kevin or his parent?
- Does anyone in your family have a history of asthma?
- Did anyone in your family ever have sudden cardiac death? (Correct answer)
- Does anyone in your family have elevated cholesterol levels?
- Did you ever have any injury requiring stitches?
Correct answer: Did anyone in your family ever have sudden cardiac death?
When conducting a sports physical for an adolescent, it is crucial to screen for conditions that could lead to sudden cardiac death (SCD) during physical exertion. A family history of sudden cardiac death, especially in young individuals, can indicate underlying genetic cardiac conditions like hypertrophic cardiomyopathy or long QT syndrome. These conditions are significant risks for athletes and require further investigation.
Question 4: Which patient would you recommend getting the HPV vaccine for?
- Sally, age 17, who had a baby 6 months ago and is breastfeeding. (Correct answer)
- Jean, age 25, who is pregnant.
- Cess, age 7.
- Rhea, age 18, who is allergic to yeast.
Correct answer: Sally, age 17, who had a baby 6 months ago and is breastfeeding.
The HPV vaccine is recommended for individuals up to age 26, and it can be safely administered to breastfeeding women. Pregnancy is a contraindication for receiving the vaccine, and while the vaccine can be started as early as age 9, a 7-year-old is generally too young for the standard recommendation. A yeast allergy is not a contraindication for the HPV vaccine.
Question 5: Angelo, age 35, says he recently returned from a business trip and feels strange pressure in his ear, therefore he believes he has an ear infection. Your barotrauma diagnosis. What will you do next?
- Prescribe systemic antibiotics.
- Prescribe nasal steroids and oral decongestants. (Correct answer)
- Refer Max to an ear, nose, and throat specialist.
- Prescribe antibiotic ear drops.
Correct answer: Prescribe nasal steroids and oral decongestants.
Barotrauma, or "ear pressure," often results from pressure differences between the middle ear and the external environment, commonly experienced after air travel or diving. This can cause Eustachian tube dysfunction. Nasal steroids and oral decongestants help reduce inflammation and open the Eustachian tubes, allowing for pressure equalization and symptom relief without the need for antibiotics unless there's evidence of bacterial infection.
Question 6: In parasite infections, hypersensitivity reactions, and autoimmune diseases, which white blood cell type is elevated?
- Eosinophils (Correct answer)
- Monocytes
- Neutrophils
- Basophils
Correct answer: Eosinophils
Eosinophils are a type of white blood cell that plays a key role in the immune response, particularly against parasitic infections and in allergic reactions (hypersensitivity reactions). Elevated eosinophil counts (eosinophilia) are a classic indicator of these conditions, as well as some autoimmune diseases, due to their involvement in mediating inflammatory responses. They help to neutralize allergens and fight off parasites.
Question 7: Leo, a 22-year-old stock boy, is experiencing severe low back pain. If the nurse practitioner prescribes an NSAID, the patient should be taught about which of the following?
- Wearing a Boston brace at night.
- Beginning lower back strengthening exercises depending on pain tolerance. (Correct answer)
- Maintaining moderate bed rest for 3 to 4 days.
- Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours.
Correct answer: Beginning lower back strengthening exercises depending on pain tolerance.
For acute low back pain, current recommendations emphasize early mobilization and activity within pain limits, rather than prolonged bed rest. Strengthening exercises, once acute pain subsides, are crucial for long-term management, preventing recurrence, and improving core stability. NSAIDs help manage pain, allowing the patient to engage in these beneficial activities and promote recovery.
Question 8: An important point to emphasize when teaching Janice, age 77, to use a cane due to osteoarthritis of her left knee, is ______.
- Making sure the cane length equals the height of the iliac crest.
- Carrying the cane in the ipsilateral hand.
- Advancing the cane with the ipsilateral leg. (Correct answer)
- Making sure the cane length equals the height of the iliac crest.
Correct answer: Advancing the cane with the ipsilateral leg.
When using a cane for support due to weakness or pain in one leg (e.g., left knee osteoarthritis), the cane should be held in the hand opposite to the affected leg (contralateral side). The correct gait pattern involves moving the cane forward simultaneously with the *affected* leg (ipsilateral to the affected knee). This provides a wider base of support and stability, allowing the cane to bear weight as the affected leg steps forward, thus reducing stress on the painful joint.
Question 9: Place the tips of your first two fingers in front of each ear and ask the patient to open and close his mouth in order to assess him. Next, check to see if the mandible moves smoothly by placing your fingers into the depressed area over the joint. By doing this, you are trying to ensure _____.
- Temporomandibular joint syndrome. (Correct answer)
- Mastoid inflammation.
- Well-positioned permanent teeth or well-fitting dentures.
- Maxillomandibular integrity.
Correct answer: Temporomandibular joint syndrome.
The described assessment technique, involving placing fingers in front of the ears and having the patient open and close their mouth, is specifically designed to evaluate the temporomandibular joint (TMJ). This maneuver allows the practitioner to feel for smooth movement, clicking, popping, or pain, which are common indicators of temporomandibular joint syndrome (TMJ syndrome) or dysfunction. Therefore, the goal is to ensure the proper functioning and health of this joint.
Question 10: Sharon, 52, has four children and a demanding job. After a normal physical exam, she states that she suffers from insomnia. You suggest several changes to one's daily routine that may improve sleep quality. You know she doesn't understand when she says which of the following?
- I'll try some valerian extract from the health food store.
- I'll exercise in the evening to tire myself out before bed. (Correct answer)
- I'll wind down before bedtime by taking a warm bath or by reading for 10 minutes.
- I'll try some valerian extract from the health food store.
Correct answer: I'll exercise in the evening to tire myself out before bed.
Exercising vigorously in the evening, especially close to bedtime, can stimulate the body and raise core body temperature, making it harder to fall asleep. Good sleep hygiene recommends avoiding strenuous physical activity within a few hours of going to bed. The other options, such as using valerian extract, taking a warm bath, or reading, are generally considered beneficial for promoting relaxation and improving sleep quality.
Question 11: A female patient, age 25, presents to your primary care clinic 18 days after being involved in a car accident, reporting that she has been having trouble focusing on her graduate studies. Due to a concussion and broken ribs, she was hospitalized for one day. Her car was totally destroyed. She is terrified of driving. She also wakes up in the middle of the night with nightmares about getting into a car accident. What is the patient's condition?
- Panic disorder
- Post-traumatic stress disorder
- Phobia of driving
- Acute stress disorder (Correct answer)
Correct answer: Acute stress disorder
The patient's symptoms, including nightmares, avoidance of driving, and difficulty concentrating, developed within one month of a traumatic event (car accident). Acute Stress Disorder is diagnosed when these types of dissociative, intrusive, avoidance, and arousal symptoms occur for a duration of 3 days to 1 month following exposure to a trauma. If these symptoms were to persist beyond one month, the diagnosis would likely change to Post-Traumatic Stress Disorder (PTSD).
Question 12: What is Goodpasture syndrome?
- Typically, the end stage of other glomerular disorders, such as rapidly progressive glomerulonephritis, lupus nephritis, or diabetic nephropathy.
- An inflammatory autoimmune disorder affecting the connective tissue of the body, with inflammatory lesions involving the supportive tissues of the glomeruli.
- Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes. (Correct answer)
- Characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
Correct answer: Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes.
Goodpasture syndrome is a rare autoimmune disease characterized by the presence of antibodies that target the basement membranes of the glomeruli in the kidneys and the alveoli in the lungs. This immune complex damage leads to a distinctive clinical presentation of rapidly progressive glomerulonephritis and pulmonary hemorrhage. The simultaneous involvement of both organs is a hallmark of this specific condition.
Question 13: What breath sound results when the inspiratory rate equals the expiratory rate?
- Bronchovesicular (Correct answer)
- Tracheal
- Bronchial
- Vesicular
Correct answer: Bronchovesicular
Bronchovesicular breath sounds are characterized by an inspiratory phase that is equal in duration to the expiratory phase. These sounds are typically heard over the major bronchi, such as between the scapulae and next to the sternum. This equality in duration distinguishes them from vesicular sounds (longer inspiration) and bronchial/tracheal sounds (longer expiration or very loud and harsh).
Question 14: Which of the following is true when trying to determine the difference between pulmonary and cardiac causes of dyspnea on exertion?
- In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise.
- When the cause is pulmonary, recovery of normal respiration is slow, and dyspnea eventually abates after cessation of exercise.
- Clients with pulmonary dyspnea have minimal dyspnea at rest.
- Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. (Correct answer)
Correct answer: Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise.
Dyspnea from cardiac causes, often due to the heart's inability to meet the body's demands or fluid congestion in the lungs, tends to persist longer after exercise cessation. The cardiovascular system takes more time to recover and normalize function, leading to prolonged shortness of breath. In contrast, dyspnea from purely pulmonary causes might abate more quickly once the immediate demand for increased respiration is removed, assuming no underlying severe lung disease.
Question 15: When teaching smokers about using nicotine gum to help them quit smoking, advise them to _____.
- Chew 1 piece every 4 hours for the first 6 weeks,
- Chew the gum like regular gum.
- Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. (Correct answer)
- Drink a cup of coffee before chewing the gum because it assists the nicotine absorption.
Correct answer: Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa.
The correct way to use nicotine gum involves chewing it slowly until a 'peppery' taste or tingling sensation is felt, which indicates nicotine release. At this point, the gum should be 'parked' or placed between the cheek and gum (buccal mucosa) to allow for gradual absorption of nicotine. This method prevents rapid nicotine release, which can cause side effects, and ensures effective delivery of the medication.
Question 16: Which serotypes of human papillomavirus cause cancer most often?
- Serotypes 6 and 11
- Serotypes 16 and 18 (Correct answer)
- Serotypes 27 and 29
- Serotypes 3 and 10
Correct answer: Serotypes 16 and 18
Human Papillomavirus (HPV) serotypes 16 and 18 are classified as high-risk types and are responsible for the vast majority of HPV-related cancers, particularly cervical cancer. These specific genotypes have oncogenic potential due to their ability to integrate into host DNA and disrupt cell cycle regulation. Other serotypes, like 6 and 11, are typically low-risk and cause benign conditions such as genital warts.
Free Family Nurse Practitioner Skill Questions and Answers
Congestive heart failure has recently been diagnosed in Greg, age 68. (CHF).
Which medicine should be stopped for him?