NP Case Studies & Practical Application 2

Question 1

A 58-year-old male with type 2 diabetes presents with a painless, non-healing ulcer on the plantar aspect of his right foot for 3 weeks. ABI is 0.95, HbA1c is 10.2%, and the wound base is pink with no purulence. Which is the most appropriate next step?

Accepted Answer

Optimize glycemic control and begin offloading with a total contact cast

Answer

Neuropathic diabetic foot ulcers without infection require offloading (total contact cast is gold standard) and glycemic optimization as first-line management.

Question 2

A 34-year-old woman at 28 weeks gestation presents with sudden-onset right upper quadrant pain, nausea, and vomiting. BP is 158/102 mmHg, platelets 88,000/μL, AST 210 U/L. What is the most likely diagnosis?

Accepted Answer

HELLP syndrome

Answer

HELLP syndrome presents with hemolysis, elevated liver enzymes, and low platelets in the setting of preeclampsia, often with RUQ pain.

Question 3

A 72-year-old woman is started on lisinopril for heart failure with reduced ejection fraction. Two weeks later she returns with a persistent dry cough. What is the best management?

Accepted Answer

Switch to an ARB such as losartan

Answer

ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB provides equivalent HFrEF benefit without this side effect.

Question 4

A 45-year-old man presents with sudden severe headache described as 'the worst of my life,' neck stiffness, and photophobia. CT head is negative. What must be done next?

Accepted Answer

Perform lumbar puncture to evaluate for xanthochromia

Answer

A thunderclap headache with negative CT requires lumbar puncture to rule out subarachnoid hemorrhage, as CT misses up to 5% of cases.

Question 5

A 62-year-old woman with COPD GOLD stage 3 is on dual bronchodilator therapy. She has had 2 exacerbations requiring oral steroids in the past year and her eosinophil count is 320 cells/μL. What is the best next step in therapy?

Accepted Answer

Add an inhaled corticosteroid (ICS) to her regimen

Answer

GOLD guidelines recommend adding ICS to LABA/LAMA in COPD patients with frequent exacerbations and elevated eosinophils (≥300 cells/μL).

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Case Studies & Practical Application 2