NP Case Studies & Practical Application 4

Question 1

A 26-year-old woman presents requesting contraception. She has migraines with aura, smokes 10 cigarettes/day, and has a family history of DVT. Which contraceptive method is most appropriate?

Accepted Answer

Levonorgestrel IUD

Answer

Migraine with aura and smoking are absolute contraindications to combined hormonal contraceptives (Category 4); progestin-only methods like the LNG-IUD are safe.

Question 2

A 4-year-old boy is brought in for 3 days of fever (39.5°C), bilateral conjunctivitis, cracked red lips, strawberry tongue, and a diffuse polymorphous rash. On day 5, he develops desquamation of the fingertips. What is the most important treatment consideration?

Accepted Answer

Administer IVIG and high-dose aspirin to prevent coronary artery aneurysms

Answer

Kawasaki disease treated within 10 days with IVIG plus aspirin significantly reduces the risk of coronary artery aneurysms.

Question 3

A 48-year-old woman with bipolar disorder is stabilized on lithium. She presents with polyuria, polydipsia, and a fine hand tremor. Serum lithium level is 0.9 mEq/L. What is the most likely cause of her symptoms?

Accepted Answer

Nephrogenic diabetes insipidus as a side effect of lithium

Answer

Lithium commonly causes nephrogenic DI by reducing renal collecting duct responsiveness to ADH, resulting in polyuria and compensatory polydipsia.

Question 4

A 35-year-old man presents with recurrent painful oral ulcers, genital ulcers, and anterior uveitis. He also has pustular skin lesions. He is of Middle Eastern descent. What is the most likely diagnosis?

Accepted Answer

Behçet's disease

Answer

Behçet's disease presents with the triad of recurrent oral ulcers, genital ulcers, and uveitis, with higher prevalence along the Silk Road including the Middle East.

Question 5

A 60-year-old man with a 40 pack-year smoking history presents with hemoptysis, a 20-lb weight loss, and a hilar mass on CXR. He also notes weakness in his proximal leg muscles that improves with repeated use. The most likely paraneoplastic syndrome is:

Accepted Answer

Lambert-Eaton myasthenic syndrome

Answer

Lambert-Eaton myasthenic syndrome is associated with small cell lung cancer; proximal muscle weakness that improves with repetitive activity distinguishes it from myasthenia gravis.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Case Studies & Practical Application 4