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FNP BOARD REVIEW QUESTIONS AND ANSWERS LATEST UPDATE 2023/2024,ALL ANSWERS 100% CORRECT AND VERIFIED TO SCORE A+ FOR SUCCESS.
Typology: Exams
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What is the treatment for CAP caused by Mycoplasma pneumoniae? - CORRECT ANSWERS Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - CORRECT ANSWERS Beta- lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond? A) No, it's too soon after your infection B) No, it's not indicated C) Yes, you can get it in about a month D) Yes you can get it today - CORRECT ANSWERS B) No, it's not indicated An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - CORRECT ANSWERS Spirometry (FEV1/FVC ratio < 70%) A 70-year old house painter reports a 4-week history of exertional dyspnea, chest tightness, and cough for the past 3 months. He has never smoked. What diagnoses are included in your differential? Select 4. A) Asthma B) Angina C) COPD D) GERD E) Pneumonia
F) Tuberculosis G) Heart Failure - CORRECT ANSWERS B) Angina C) COPD F) Tuberculosis G) Heart failure How do inhaled anticholinergics work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - CORRECT ANSWERS B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - CORRECT ANSWERS Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - CORRECT ANSWERS Tiotropium (Spiriva) How do inhaled betá-agonists work to treat shortness of breath in COPD? A) They cause bronchodilation in the lungs B) They block the action of acetylcholine and prevent bronchoconstriction - CORRECT ANSWERS A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - CORRECT ANSWERS Albuterol and levalbuterol Name an inhaled long-acting beta agonists (LABAs): - CORRECT ANSWERS Salmeterol (Serevent) What are the side effects associated with anticholinergic medications? - CORRECT ANSWERS Cognitive impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, acute angle glaucoma "Can't see, can't pee, can't spit, can't shit."
Name a inhaled combined short-acting anticholinergic/short-acting beta agonist: - CORRECT ANSWERS Ipratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - CORRECT ANSWERS Fluticasone/salmeterol (Advair) Fluticasone/vilanterol (Breo) Budesonide/formoterol (Symbicort) Mometasone/frmoterol (Dulera) Name an inhaled steroid: - CORRECT ANSWERS Fluticasone (Flovent) Budesonide (Pulmicort) Mometasone (Asmanex) Put the following in the correct order for COPD prescribing strategy: A) Long-acting anticholinergic or LABA, plus rescue med B) Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med C) Short-acting anticholinergic or SABA PRN D) Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med - CORRECT ANSWERS C, A, B, D
A) Medrol dose-pack B) 10-day course of Prednisone 20 mg, followed by a taper C) 5-day course of Prednisone 40 mg - CORRECT ANSWERS C) 5-day course of Prednisone 40 mg Chronic use should be avoided - associated with an unfavorable risk-to-benefit ratio A patient with asthma symptoms daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - CORRECT ANSWERS C) Moderate persistent asthma A patient with asthma symptoms more than twice a week, but not daily with occasional nighttime awakenings has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - CORRECT ANSWERS B) Mild persistent asthma A patient with asthma symptoms less than twice a week has A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - CORRECT ANSWERS A) Intermittent asthma A patient with asthma symptoms multiple times throughout the day and nighttime awakenings on most nights of the week has
A) Intermittent asthma B) Mild persistent asthma C) Moderate persistent asthma D) Severe persistent asthma - CORRECT ANSWERS D) Severe persistent asthma What are the most common side effects of long-term inhaled steroid use? A) Osteoporosis and GERD B) Cataracts and osteopenia C) Hyperkalemia and diabetes D) Hypertension and diabetes - CORRECT ANSWERS B) Cataracts and osteopenia What medication combination is considered unsafe in a patient with asthma? A) Fluticasone and albuterol B) Mometasone, formoterol, albuterol C) Budesonide and levalbuterol D) Salmeterol and levalbuterol Why? - CORRECT ANSWERS D) Salmeterol and levalbuterol Salmeterol is a long-acting beta agonist. LABAs MUST be combined with an inhaled corticosteroid (e.g. Advair, Breo, Symbicort) A 30-year old male has persistent asthma. What daily medication regimen would be appropriate? A) Albuterol B) Low-dose fluticasone, albuterol C) Medium-dose fluticasone
D) Budseonide, salmeterol, albuterol - CORRECT ANSWERS C) Medium-dose fluticasone Albuterol alone is used for intermittent asthma Albuterol should not be used daily (if the patient is using their rescue inhaler more than twice a week --> call the PCM!) Mr. Jones, a 45-year old drug and alcohol counselor, smokes 1 PPD and c/o cough, low-grade fever, and night sweats for the last week. His CXR show bilateral hilar nodes. What should you do next? A) Refer to Pulmonology B) Order a chest CT with contrast C) Order a TB skin test D) Repeat the CXR in 2 weeks - CORRECT ANSWERS C) Order a TB skin test A patient who takes fosinopril for HTN has been diagnosed with ACE-inhibitor cough. Which of the following statements is true? A) He could switch to lisinopril B) This cough is more likely in patients with lower airway disease C) His cough should improve over time D) The cough is related to an inability to break down bradykinin - CORRECT ANSWERS D) The cough is related to an inability to break down bradykinin A 19-year old college student (otherwise healthy, nonsmoker) was diagnosed with community- acquired pneumonia by CXR a couple days ago. She has been taking amoxillin with clavulanate 875 mg BID for the past 48 hours. She returns today for a follow-up appointment. Her vitals 2 days ago: BP 120/72, HR 96, T 103F, RR 24/min, Ó2 sats 92%. Her vitals today: BP 130/80, HR 100, T 102.2, RR 24/min, Ó2 sats 94%. How would you manager her today? A) Repeat CXR, CBC, and start levofloxacin
B) Start azithromycin 5-day pack C) Continue with amoxicillin-clavulanate for another 24 hours D) Stop amoxicillin-clavulanate and start doxcycline 100 mg BID x 7 days - CORRECT ANSWERS D) Stop amoxicillin-clavulanate and start doxycycline 100 mg BID x 7 days She most likely has an atypical pathogen (mycoplasma pneumoniae or chlamydophila pneumoniae), which should be treated with a macrolide or doxycycline If a 19-year old college female diagnosed with community acquired pneumonia was pregnant in her first trimester, how could she be managed? A) Levofloxacin 750 mg PO daily x 5 days B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID C) Cephalexin 500 mg PO BID x 5 days D) Doxycyline 100 mg PO BID x 5 days - CORRECT ANSWERS B) Azithromycin 500 mg on day 1, then 250 mg daily on days 2-5, plus amoxicillin 1000 mg BID Quinolones (e.g. levofloxacin) and tetracyclines (e.g. doxycycline) are teratogenic and should not be given during pregnancy A 63-year old patient w/ COPD c/o a pounding heart after using his inhaler. Which of the following is the least likely culprit? A) Fluticasone B) Albuterol C) Iptratropium D) Salmeterol - CORRECT ANSWERS A) Fluticasone Mr. Smith, an 80-year old smoker, has stage II COPD. Based on his medications, what is the most predictable drug-disease interaction?
Losartan 50 mg, HCTZ 12.5 mg, Amlodipine 5 mg daily, Tamsulosin (Flomax) 0.8 mg daily, Atorvastatin (Lipitor) 10 mg daily, Albuterol inhaler 2 puffs PRN for SOB, tiotropium (Spiriva) once daily A) Glaucoma B) Frequent urination C) Anxiety D) Pruritis E) Hyperglycemia F) Fatigue G) Constipation - CORRECT ANSWERS G) Constipation Amlodipine (CCB) and tiotropium (short-acting anti-cholinergic) An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. How should she be managed today? A) Treat with azithromycin daily for 5 days B) Treat with ciprofloxacin, nebulized albuterol q4-6 hours PRN for wheezing C) Treat with oral steroid and nebulized levalbuterol q8 hours PRN D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing - CORRECT ANSWERS D) Treat with levofloxacin, nebulized albuterol q4-6 PRN for wheezing She is more likely to have Strep pneumoniae and should be treated with a quinolone. Ciprofloxacin is not a respiratory quinolone An obese 55-year old woman with a history of moderate persistent asthma has a temperature of 101F, bilateral wheezes, mild shortness of breath, and purulent sputum. Her med list includes: fluticasone/salmeterol BID, albuterol PRN, amlodipine 5 mg, levothyroxine 99 mcg daily, and metformin 1000 mg BID. She is being treated for pneumonia with levofloxacin and nebulized albuterol q4-6 PRN for wheezing. She develops white plaques on the buccal mucosa, palate, and tongue (thrush). What medications are the most likely cause of this?
A) Levofloxacin and metformin B) Albuterol and levofloxacin C) Metformin and fluticasone D) Fluticasone and levofloxacin - CORRECT ANSWERS D) Fluticasone and levofloxacin Anemia is a reduction in one or more of what RBC measurements? - CORRECT ANSWERS RBC count (4.2-4.9 mil/microL), hemoglobin (12-15 g/dl), or hematocrit (37-51%) The patient has the following CBC results: Is the patient anemic? RBC 4. HGB 11. HCT 35.6% MCV 90 MCH 25. MCHC 33. RDW 14. PLT 265 MPV 7.1 - CORRECT ANSWERS Yes Name 3 causes of anemia. Which is the most common reason in the US? - CORRECT ANSWERS Blood loss (most common), sick bone marrow, increased RBC destruction
Normal = 80- Microcytic < Macrocytic > Which of the RBC indices tells you about the RBC color? What does a low level tell you about the RBC color? - CORRECT ANSWERS Mean corpuscular hemoglobin (MCH) Low MCH = hypochromic (pale) RBC Match the lab with the definition
Blood loss is the most common cause (Patients are usually asymptomatic until H/H < 10/30) A patient's hemoglobin is 10.2 and hematocrit is 30.6%. Which findings are consistent with an iron deficiency anemia? A) MCV 76, MCH 28 B) MCV 84, MCH 26 C) MCV 75, MCH 25 D) MCV 120, MCH 30 - CORRECT ANSWERS C) MCV 75 (low), MCH 25 (low) Microcytic, hypochromic anemia In new onset iron deficiency anemia, the RDW (red cell distribution width) is ___________. - CORRECT ANSWERS > 15% In ____________ iron deficiency anemia, the RDW is < 15%. - CORRECT ANSWERS Longstanding, chronic (all RBCs are small) A 24-year old woman was diagnosed with iron deficiency anemia 4 weeks ago (Hgb 11.5, Hct 34.5%). Today her Hgb is 12.8 and her Hct is 38.4%. How do you proceed? A) Stop iron supplementation since she is no longer anemic B) Order a reticuloctye count C) Order a TIBC D) Consider continued iron supplementation for another 3-5 months - CORRECT ANSWERS D) Consider continued iron supplementation for another 3-5 months (to replace iron stores) In addition to acanthosis nigricans, which of the following is a risk factor for insulin resistance? A) Delivery of infant > 9 lbs B) Severe obesity C) Age > 65 D) Sleep Apnea - CORRECT ANSWERS B) Severe obesity
The ADA recommends annual screening for diabetes for patients with a BMI greater than _______ and one ore more risk factors. - CORRECT ANSWERS 25 The ADA recommends screening for the entire population over the age of _____________ every ____ years if the screening is normal. - CORRECT ANSWERS 45; 3 Mr.Smith is a 75-year old man with an Ā1C of 8.9%. Which of the following should be the provider's first action? A) Start metformin B) Discuss exercise, weight loss C) Establish an Ā1C goal of < 7% D) Establish a target Ā1C goal - CORRECT ANSWERS D) Establish a target Ā1C goal Match the Suggested Ā1C goals for T2DM A) Patient with T1DM B) Most pregnant patients C) Older patients D) Most adults with T2DM
B) eGFR C) LFTs D) Presence of heart failure E) Presence of binge drinking F) Use of CCBs G) Presence of BPH - CORRECT ANSWERS B) eGFR C) LFTs D) Presence of heart failure E) Presence of binge drinking Mr. Johnson is a 72-year old newly diagnosed Type 2 diabetic. Which of the following characteristics increase the likelihood of lactic acidosis? Select 4. A) Concurrent use of contrast dye B) eGFR > 45 C) Dehydration D) Presence of heart failure E) Presence of binge drinking F) Use of CCBs G) Presence of BPH - CORRECT ANSWERS A) Concurrent use of contrast dye C) Dehydration D) Presence of heart failure E) Presence of binge drinking What are the two most common side effects of Metformin? A) Diarrhea B) Weight gain C) Headaches
D) Flatulence - CORRECT ANSWERS A) Diarrhea D) Flatulence Mr. Johnson is a 62-year old T2DM with an Ā1C of 7.3%. He has been started on low-dose Metformin. Over the last few weeks he has tolerated increasing doses and now takes 1000 mg twice daily. What would you expect his Ā1C to be when you recheck it in 3 months? A) 7.0% B) 6.8% C) 6.5% D) 6.0% - CORRECT ANSWERS D) 6.0% Metformin 1000 mg BID can produce a 1-2% drop in Ā1C Based on the primary mechanism of action of Metformin, what lab value must be evaluated and monitored? A) ALT, AST B) BUN, Cre C) eGFR D) Potassium - CORRECT ANSWERS A) AST, ALT Metformin works in the liver to decrease hepatic glucose output 35-year old female with newly diagnosed impaired fasting glucose and Ā1C of 5.9%
A 60-year old mane with T2DM takes Metformin and Glipizide. His Ā1C is 10.2 (goal < 7%). The NP decides to start basal insulin.
L-thyroxine (synthetic T4) is given PO daily in the morning on an empty stomach. The usual replacement dose is based on ideal body weight. How much L-thyroxine would you start a healthy, young adult? - CORRECT ANSWERS 1.6 mcg/kg/day (e.g. 120 lbs = 55 kg --> replacement 88 mcg) Levothyroxine tabs: 25 mcg, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, 300 A 58-year old man has the following lab results. TSH 13.5 (normal 0.4-4.8), T4 1.1 (norm 0.8-1.8) 6 weeks later: TSH 15.6, T4 0. Select the best answer. A) Diagnose as primary hypothyroidism, treat with levothyroxine B) Diagnose as subclinical hypothyroidism, treat with levothyroxine C) Diagnose as subclinical hypothyroidism, do not treat D) Diagnose as subclinical hyperthyroidism, treat with methimazole - CORRECT ANSWERS B) Diagnose as subclinical hypothyroidism, treat with levothyroxine Treatment of subclinical hypothyroidism is controversial.... If patient has subclinical hypothyroidism with TSH > 10 --> Treat to PREVENT conversion to primary hypothyroidism If TSH < 10 --> monitor. Associated with risk of afib (immediate risk), accelarated bone loss (long-term risk, leeches calcium and vit D from the bones) A 45-year old patient has subclinical hypothyroidism. Her TSH is 6.2. What are the major risks of prescribing levothyroxine? A) There are very few risks B) Hyperlipidemia, atrial fibrillation C) Accelerated bone loss, atrial fibrillation D) She may develop hypertension and tachycardia - CORRECT ANSWERS C) Accelerated bone loss, atrial fibrillation
A 45- year old patient was diagnosed with hypothyroidism 12 weeks ago. 12 weeks ago: TSH 14.3 (normal 0.4-4.8). On Levothyroxine 50 mcg 6 weeks ago: TSH 5.4. On 75 Levothyroxine 75 mcg Today: TSH 0. How shoulder her levothyroxine dose be managed today? A) Refer to endocrinology B) Decrease levothyroxine to 50 mcg daily C) Discontinue levothyroxine D) Resume levothyroxine 50 mcg daily and have her take 2 tabs on Saturdays/Sundays - CORRECT ANSWERS D) Resume levothyroxine 50 mcg daily and have her take 2 tabs on Saturdays/Sundays 50 mcg daily x 7 days = 350 mcg weekly (not enough, patient was not at goal after 6 weeks) 75 mcg daily x 7 days = 525 mcg weekly (too much her TSH decreased to 0.4 after 6 weeks) 50 mcg M-F = 250 mcg 100 mcg Sat/Sun = 200 mcg 250+200 = 450 mcg weekly A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine after dinner? - CORRECT ANSWERS TSH will INCREASE (due to decreased absorption of levothyroxine) A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes two pills instead of one? - CORRECT ANSWERS TSH will DECREASE A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine with an OTC PPI? - CORRECT ANSWERS TSH will INCREASE (PPIs increase gastric acid and affect absorption)
A patient has hypothyroidism. Her last TSH was 2.5. She takes her levothyroxine in the AM on an empty stomach. What will happen to her TSH if she takes the levothyroxine with her morning coffee?
Her TSH is normal What class of diabetes medications is considered weight neutral? - CORRECT ANSWERS DPP-4 inhibitors "gliptins" sitagliptin (Januvia), linagrliptin (Tradjenta) Which diabetes medications are associated with weight loss? - CORRECT ANSWERS GLP-1 agonists - exenatide (Byetta, Bydureon), liraglutide (Victoza) -AND- SGLT 2 inhibitors - canagliflozin (Invokana), dapagliflozin (Farxiga) Which diabetes medications are associated with weight gain? - CORRECT ANSWERS Sulfonylureas - glipizide (Glucotrol), glyburide (DiaBeta), glimeperide (Amaryl) -AND- Insulin Which of the following characteristics apply to T1DM? A) significant hyperglycemia and ketoacidosis results from lack of insulin B)T1DM is commonly diagnosed on routine exam or workup for other health problems C) Initial response to oral sulfonylureas is usually favorable D) Insulin resistance is a significant part of the disease - CORRECT ANSWERS A) significant hyperglycemia and ketoacidosis results from lack of insulin Which of the following characteristics apply to T2DM? A) Heredity and obesity are major risk factors B) Pear-shaped body type is common C) Exogenous insulin is needed for control of disease D) Physical activity enhances insulin resistance - CORRECT ANSWERS A) Heredity and obesity are major risk factors
You consider prescribing insulin glargine (Lantus) because of its A) extended duration of action B) rapid onset of action C) ability to prevent diabetic end-organ damage D) ability to preserve pancreatic function - CORRECT ANSWERS A) extended duration of action After use, the onset of action of lispro (Humalog) occurs in A) less than 30 minutes B) approximately 1 hour C) 1-2 hours D) 3-4 hours - CORRECT ANSWERS A) less than 30 minutes Which of the following medications should be used with caution in a person with a known or suspected sulfa allergy? A) metformin B) glyburide C) rosglitazone D) NPH insulin - CORRECT ANSWERS B) glyburide The mechanism of action of metformin (Glucophage) is as A) an insulin-production enhancer B) a product virtually identical in action to sulfonylureas C) a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production D) a facilitator of renal glucose excretion - CORRECT ANSWERS C) a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production
Generally, testing for T2DM in asymptomatic, undiagnosed individuals over the age of 45 years, should be done every ______________. A) year B) 3 years C) 5 years D) 10 years - CORRECT ANSWERS B) 3 years You are seeing a 17-year old girl. All of the following would be considered risk factors for T2DM except: A) obesity B) Native American ancestry C) Family history of T1 DM D) personal history of polycystic ovary syndrome - CORRECT ANSWERS C) family history of T1DM Criteria for the diagnosis of T2DM includes: A) classic symptoms, regardless of fasting plasma glucose measurement B) plasma glucose level of 126 mg/dL as a random measurement C) a 2-hour glucose measurement of 156 mg/dl after a 75-gram anhydrous glucose load D) a plasma glucose level of 126 mg/dl or greater after an 8-hour fast on more than one occasion - CORRECT ANSWERS D) a plasma glucose level of 126 mg/dl or greater after an 8-hour fast on more than one occasion The mechanism of action of pioglitazone is as: A) an insulin-production enhancer B) a reducer of pancreatic glucose output C) an insulin sensititizer
D) a facilitator of renal glucose excretion - CORRECT ANSWERS C) an insulin sensititizer pioglitazone (Actos) is a thiazolidinedione Which of the following should be the goal measurement in a person with DM and hypertension? A) SBP < 140 and DBP < 90 B) Ā1C equal to or greater than 7% C) Triglyceride level 200-300 D) HDL level 35-40 - CORRECT ANSWERS A) SBP < 140 and DBP < 90 In caring for a patient with DM, micoralbuminuria measurement should be obtained A) annually if urine protein is present B) periodically in relation to glycemic control C) yearly D) with every diabetes-related office visit - CORRECT ANSWERS C) yearly The mechanism of action of sulfonylureas is as A) an antagonist of insulin receptor site activity B) a product that enhances insulin release C) a facilitator of renal glucose excretion D) an agent that can reduce hepatic glucose production - CORRECT ANSWERS B) a product that enhances insulin release When caring for a patient with DM, HTN, and persistent proteinuria, the NP should prescribe ___________. A) furosemide B) methyldopa
C) fosinopril D) nifedipine - CORRECT ANSWERS C) fosinopril Clinical presentation of T1DM usually includes all of the following, except A) report of recent unintentional weight gain B) ketosis C) thirst D) polyphagia - CORRECT ANSWERS A) report of recent unintentional weight gain Which of the following should be periodically monitoring when using a thiazolidinedione? A) CK B) ALP C) ALT D) Cr - CORRECT ANSWERS C) ALT Which of the following should be periodically monitoring when using a biguanide? A) CK B) ALP C) ALT D) Cr - CORRECT ANSWERS D) Cr All of the following are risks for lactic acidosis in individuals taking metformin, except A) the presence of chronic renal insufficiency B) acute dehydration C) recent use of radiographic contrast dye