NP Risk Assessment & Management 3 — Questions and Answers
Question 1: A 45-year-old patient presents with hypertension, obesity (BMI 34), and a family history of type 2 diabetes. Using the ADA risk assessment, what is the MOST appropriate next step?
- Begin metformin empirically
- Order fasting plasma glucose and HbA1c (Correct answer)
- Refer to endocrinology immediately
- Advise weight loss and recheck in 5 years
Correct answer: Order fasting plasma glucose and HbA1c
Adults with risk factors for type 2 diabetes should be screened with fasting plasma glucose or HbA1c per ADA guidelines, as early detection enables timely intervention.
Question 2: Which clinical feature MOST increases the pretest probability for pulmonary embolism when using the Wells PE scoring system?
- Heart rate 95 bpm
- Leg swelling and tenderness
- Recent 4-hour car ride
- Clinical signs and symptoms of DVT (Correct answer)
Correct answer: Clinical signs and symptoms of DVT
Clinical signs and symptoms of DVT (objective leg swelling and pain on palpation) contribute 3 points—the highest single-item score—on the Wells PE criteria.
Question 3: A nurse practitioner is using the CHADS2-VASc score for a 70-year-old female with hypertension and heart failure but no prior stroke. What is her score?
- 2
- 3
- 4 (Correct answer)
- 5
Correct answer: 4
She earns: 1 for heart failure, 1 for hypertension, 1 for age 65–74, 1 for female sex = CHA2DS2-VASc score of 4, indicating anticoagulation is warranted.
Question 4: When assessing a patient for elder abuse, which screening tool is MOST recommended for use in primary care?
- CAGE questionnaire
- Elder Assessment Instrument (EAI) (Correct answer)
- HITS screening tool
- SLUMS examination
Correct answer: Elder Assessment Instrument (EAI)
The Elder Assessment Instrument (EAI) is a validated, widely recommended tool for systematically screening for signs and symptoms of elder abuse, neglect, and exploitation.
Question 5: A 32-year-old pregnant woman at 28 weeks is found to have a blood pressure of 148/96 mmHg on two readings 4 hours apart with no proteinuria. What is the MOST likely diagnosis?
- Chronic hypertension
- Gestational hypertension (Correct answer)
- Preeclampsia without severe features
- White coat hypertension
Correct answer: Gestational hypertension
Gestational hypertension is defined as new-onset BP ≥140/90 mmHg after 20 weeks of gestation without proteinuria or other systemic features of preeclampsia.
Question 6: A nurse practitioner calculates a patient's Framingham Risk Score at 18%. Which medication class should be discussed in addition to lifestyle modification?
- ACE inhibitor
- Statin therapy (Correct answer)
- Aspirin only
- Beta-blocker
Correct answer: Statin therapy
A 10-year Framingham cardiovascular risk ≥10% (high risk) warrants statin therapy discussion in addition to lifestyle changes per primary prevention guidelines.
Question 7: Which validated tool is MOST appropriate for assessing delirium risk in a hospitalized elderly patient?
- Mini-Cog assessment
- Confusion Assessment Method (CAM) (Correct answer)
- Montreal Cognitive Assessment (MoCA)
- Saint Louis University Mental Status (SLUMS)
Correct answer: Confusion Assessment Method (CAM)
The Confusion Assessment Method (CAM) is the most widely validated and used bedside tool for identifying delirium in hospitalized patients.
NP Risk Assessment & Management 3
A 45-year-old patient presents with hypertension, obesity (BMI 34), and a family history of type 2 diabetes.
Using the ADA risk assessment, what is the MOST appropriate next step?