NP Case Studies & Practical Application 5

Question 1

A 78-year-old woman is brought by family for confusion over 2 days. She lives alone, has multiple chronic conditions, and takes 12 medications. Vitals are normal. Urinalysis shows 5–10 WBCs/hpf and bacteria. What is the most appropriate initial approach?

Accepted Answer

Conduct a comprehensive delirium workup before attributing confusion to bacteriuria

Answer

Asymptomatic bacteriuria is common in elderly women and does not explain delirium; a thorough evaluation for other causes (medications, metabolic, CNS) must occur.

Question 2

A 30-year-old man with HIV (CD4 count 45 cells/μL, not on ART) presents with headache, fever, and neck stiffness for 5 days. CSF analysis shows increased opening pressure, low glucose, and India ink stain reveals encapsulated yeast. What is the treatment of choice for induction?

Accepted Answer

Liposomal amphotericin B plus flucytosine for 2 weeks

Answer

Cryptococcal meningitis induction therapy in HIV is liposomal amphotericin B plus flucytosine for 2 weeks, followed by fluconazole consolidation.

Question 3

A 42-year-old woman presents with a 6-month history of episodic severe headache, diaphoresis, palpitations, and hypertension with BP reaching 210/120 during episodes. Between episodes she is normotensive. Which test is most appropriate?

Accepted Answer

24-hour urine fractionated metanephrines and catecholamines

Answer

Episodic hypertension with the classic triad of headache, diaphoresis, and palpitations is highly suspicious for pheochromocytoma; 24-hour urine metanephrines is the preferred screening test.

Question 4

A 16-year-old girl is brought in by her mother for amenorrhea for 8 months and a 20-lb weight loss. BMI is 16.5 kg/m². She exercises 3 hours daily and states she 'feels fat.' Vital signs reveal HR 48 bpm and BP 88/56 mmHg. What is the priority intervention?

Accepted Answer

Assess medical stability and arrange inpatient medical stabilization if criteria are met

Answer

Bradycardia and hypotension in a patient with anorexia nervosa indicate hemodynamic instability requiring inpatient medical stabilization before any outpatient therapy.

Question 5

A 65-year-old man with a history of MI and HFrEF (EF 30%) presents with increasing dyspnea and bilateral leg edema. His medications include carvedilol, lisinopril, and furosemide 40 mg daily. BNP is 920 pg/mL and creatinine is 1.1 mg/dL. What medication addition has the strongest mortality benefit in this patient?

Accepted Answer

Spironolactone 25 mg daily

Answer

Aldosterone antagonists (spironolactone/eplerenone) reduce mortality by ~30% in symptomatic HFrEF and are guideline-directed with strong evidence from the RALES and EMPHASIS-HF trials.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP Case Studies & Practical Application 5