SOLUTION TO FNP Final Exam.pdf, Exams of Nursing

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SOLUTION TO FNP Final Exam

A patient has recurrent cluster headaches and asks about abortive therapy. Which therapy is effective for a majority of patients with cluster headaches? a. Lithium b. NSAIDs c. Oxygen d. Verapamil - ans-C. Oxygen A patient reports recurrent headaches occurring 1 or 2 times per month that generally occur with weather changes or when sleep patterns are disrupted and describes them as severe, with throbbing on one side of the head and sometimes accompanied by nausea. What is the recommended treatment for this type of headache? a. Gabapentin b. Propranolol c. Rizatriptan d. Topiramate - ans-c. Rizatriptan Which medication is NOT useful in treating tension-type headaches? a. Antiemetics

b. Lithium c. Muscle relaxants d. NSAIDse. Oxygen - ans-b. Lithium A patient reports two episodes of visual disturbances and eye pain that lasted 1 to 2 days each about 2 months apart. Which diagnostic testing will the provider order initially? a. Lumbar puncture b. Magnetic resonance imaging c. Optical Coherence Tomography d. Visual evoked potential - ans-b. Magnetic resonance imaging A patient with Parkinson's disease (PD) has been taking carbidopa-levodopa (Sinemet) with good results but develops increased dyskinesia. Which drug will be added to this patient's regimen to help control this symptom? a. Amantadine b. Benztropine c. Ropinirole d. Tolcapone - ans-a. Amantadine All of the following are common symptoms seen in patients with Parkinson's disease except: a. Bradykinesia b. Festination c. Hyperphonia d. Rigidity e. Symmetric tremor - ans-c. Hyperphonia Which drug is used to treat patients with focal epilepsy and complex partial seizures? a. Carbamazepine

During a well child examination on a 4monthold infant, the primary care pediatric nurse practitioner evaluates mental health issues. Which statement by the parent indicates a potential problem with the parent infant relationship? a. "I can sense a difference in my baby's cries." b. "I let my baby cry a while to learn to be patient." c. "My baby prefers to nurse in a darkened room." d. "My baby seems very sensitive to loud noises." - ans-b. "I let my baby cry a while to learn to be patient." The primary care pediatric nurse practitioner attempts to learn more about the emotional health of an 18monthold child through which assessment strategy? a. Asking the child to tell a story using dolls and other props b. Asking the child to draw a picture of him or herself and other family members c. Interviewing the child separately from caretakers and parents d. Observation of the child with caretakers in structured and unstructured situations - ans-d. Observation of the child with caretakers in structured and unstructured situations The parent of a 4 year old child reports that the child seems to be having trouble adjusting to a new day care and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do? a. Ask the parent if the child is slow to warm up to other new situations. b. Reassure the parent that parallel play is common among preschool age children. c. Recommend that the parent spend time encouraging the child to play with others. d. Suggest that the day care center may be neglecting the child. - ans-a. Ask the parent if the child is slow to warm up to other new situations.

The parent of a school age child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child? a. Generalized anxiety disorder (GAD) b. obsessive-compulsive disorder (OCD) c. Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) d. Separation anxiety disorder (SAD) - ans-a. Generalized anxiety disorder (GAD) A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner do initially? a. Ask the mother about the child's relationship with the father. b. Consult with a child psychiatrist to prescribe medications. c. Recommend cognitive behavioral or psychodynamic therapy. d. Refer the family to a child behavioral specialist for counseling. - ans-a. Ask the mother about the child's relationship with the father. An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk? a. Addition of risperidone therapy b. Cognitive behavioral therapy c. Family therapy d. Hospitalization - ans-b. Cognitive behavioral therapy

The spouse of a patient newly diagnosed with amyotrophic lateral sclerosis (ALS) asks about long-term care. What will the provider include when teaching the family about this disease? a. Bowel and bladder function will eventually be lost b. Positive-pressure ventilation can prolong life. c. Preventing malnutrition is a key element in care. d. The nerves affecting sensation will die initially. - ans-c. Preventing malnutrition is a key element in care. What is recommended to prevent ophthalmic complications in patients with Bell's palsy? a. Acupuncture b. Lubricating eye drops c. Patching of the eye d. Sunglasses - ans-b. Lubricating eye drops A patient with dementia experiences agitation and visual hallucinations and is given haloperidol with a subsequent worsening of symptoms. Based on this response, what is the likely cause of this patient's symptoms? a. Alzheimer's disease b. Lewy body dementia c. Pseudodementia d. Vascular neurocognitive disorder - ans-b. Lewy body dementia A patient with Alzheimer's disease (AD) is taking donepezil to treat cognitive symptoms. The patient's son reports noting increased social withdrawal and sleep impairment. What is the initial step to manage these symptoms? a. Encourage activity and exercise

b. Prescribe a selective serotonin reuptake inhibitor c. Recommend risperidone d. Referral to a neurologist for evaluation - ans-a. Encourage activity and exercise What is an important purpose of conducting an interview prior to beginning neuropsychological testing on an older adult suspected of having dementia? a. To assess the patient's ability to cooperate with the testing b. To determine the patient's degree of dementia c. To evaluate the patient's feelings about family members' concerns d. To find out whether a referral to a specialist is needed - ans-a. To assess the patient's ability to cooperate with the testing An elderly patient has symptoms of depression and the patient's daughter asks about possible Alzheimer's disease since there is a family history of this disease. A screening evaluation shows no memory loss. What is the initial step in managing this patient? a. Order brain imaging studies such as CT or MRI b. Perform genetic testing to identify true risk c. Prescribe a trial of an antidepressant medication d. Recommend a trial of a cholinesterase inhibitor drug - ans-c. Prescribe a trial of an antidepressant medication A patient being treated with for caner has had chemotherapy within the past two weeks and comes to the primary care clinic with a fever of 38.5. What is the initial action? a. Order blood and urine cultures b. Obtain a STAT CBC with diff c. Prescribe empiric antibiotics

a. Bone specific alkaline phosphate b. Bone densitometry of the hip and posteroanterior lumbar spine c. Plain radiographs of the hips and lumbar and thoracic spine d. Serum calcium and serum 25-hydroxyvitamin D - ans-b. Bone densitometry of the hip and posteroanterior lumbar spine A patient with normal renal function has a potassium level of 6.0 mEq/L. Which underlying cause is possible in this patient? a. Adrenocortical deficiency b. Malabsorption syndrome c. Alcoholism d. Hypertension - ans-a. Adrenocortical deficiency A patient with cancer is expected to require long-term pain medication to manage cancer pain. Which agent will be best for this patient? a. Naloxone b. Ibuprofen c. Meperidine d. Morphine - ans-d. Morphine A woman has stopped having menstrual periods has vasomotor symptoms but does not want to use HRT. What measure will the provider recommend? a. Increase caffeine intake b. Keeping the house cold

c. Trying herbal remedies d. Keeping the house cool, use of personal fans e. Having a glass of wine or two each evening - ans-d. Keeping the house cool, use of personal fans A woman who is taking oral contraceptives to prevent pregnancy calls the provider to report forgetting to take the pills for 4 days. She has not had sex. What will the provider recommend? a. Use a morning after pill today and resume the OCP's b. Resume the pills and use a back up method the remainder of the cycle c. Stop the OCP and use alternative method and resume OCP at the next cycle d. Take 2 pills daily for 4 days and use an alternate method for 4 days - ans-b. Resume the pills and use a back up method the remainder of the cycle An adolescent female reports moderate dysmenorrhea with periods and tells the provider that 400mg of ibuprofen Q6-8 hours does not control her pain. What will the provider recommend? a. Using extended-release naproxen 500 mg Q b. Increasing the ibuprofen does to 600 to 800 mg Q 6-8 hours c. Taking extra strength Tylenol 1000mg Q4-6 hours d. Taking naproxen 500 mg initially and then 250 mg Q6-8 hours - ans-d. Taking naproxen 500 mg initially and then 250 mg Q6-8 hours An obsess adolescent female patient reports irregular periods and excessive acne. The provider notes an increased amount of hair on her upper back, shoulders, and upper abdomen. What will the provider do? a. Counsel her about diet, exercise, and weight loss b. Consider treatment with oral contraceptives

A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0. mg/dL above the normal without signs of nephrolithiasis. What is the recommended treatment for this patient? a. Annual monitoring of calcium, creatinine, and bone density b. Avoidance of weight bearing exercises c. Decreasing calcium and vitamin D intake until values are normal Parathyroidectomy - ans-a. Annual monitoring of calcium, creatinine, and bone density A patient has new-onset hypertension with a systolic BP of 180 mm Hg. Which test will the provider order to diagnose this patient? a. ACTH suppression testing b. Cortisol excretion studies c. Fractionated metanephrine levels Adrenal antibody tests - ans-c. Fractionated metanephrine levels A woman has history of migraines with aura and request oral contraception to prevent pregnancy. Which type of contraceptive will the provider recommend? a. Transdermal combination patch b. Combination oral contraceptive c. Progestin-only contraception d. Contraceptive implant - ans-c. Progestin-only contraception A patient has unexplained weight loss and the provider notes increased skin pigmentation on light exposed skin folds along with darkened palmar creases. Which laboratory test will the provider NOT order?

a. Serum cortisol b. TB skin testing c. Serum electrolytes d. Serum ACTH - ans-a. Serum cortisol A patient has carpal spasm when a blood pressure cuff is inflated. Which diagnostic testing will the provider consider evaluating the cause of this finding? A. Magnesium and vitamin D B. Calcitriol level C. C-reactive protein Protein electrophoresis - ans-A. Magnesium and vitamin D A patient has a low serum calcium associated with low albumin. What is the recommended treatment for this patient? a. Thiazide diuretics and sodium restriction b. Correction of other serum electrolytes c. Calcium supplementation only d. Vitamin D and calcium supplementation - ans-b. Correction of other serum electrolytes What is the most important role of the primary care provider in cancer management? a. Performing regular screenings to detect cancer b. Referring patients for genetic testing to identify those at risk c. Counseling about healthy practices to reduce risk factors d. Teaching patients about cancer management once diagnosed - ans-c. Counseling about healthy practices to reduce risk factors

a. Neuropathic pain b. Chronic pain c. Somatic pain d. Visceral pain - ans-a. Neuropathic pain Which underlying causes are related to chronic pelvic pain in women? a. Age under 25 years b. Recurrent pneumonia c. Interstitial cystitis d. Hepatitis e. Menopause - ans-c. Interstitial cystitis What is a possible cause of decreased arousal, libido, and orgasm in postmenopausal women? a. Low estrogen levels b. Diminished testosterone c. Uterine prolapse d. Endometriosis - ans-b. Diminished testosterone A female patient is identified as having the BRCA mutation and she asks which intervention will reduce the risk of breast cancer the most? What will the provider tell her? a. Prophylactic mastectomy and oophorectomy b. Early childbearing and breastfeeding c. Clinical breast examination every 6 months Breast MRI - ans-a. Prophylactic mastectomy and oophorectomy

A 17-year-old patient has undergone surgical incision and drainage of a Bartholin's gland cyst with insertion of a drain. What is an important aspect of care for this patient? a. Education about long term dyspareunia b. Teaching about reproductive sequelae c. Weekly follow-up monitoring d. Administration of antibiotics - ans-c. Weekly follow-up monitoring An asymptomatic female learns that her boyfriend has gonorrhea and asks about antibiotics. What will the provider recommend? a. Amoxicillin-clavulanate for 10 days b. Cultures and treatment if symptoms appear c. Trimethoprim-sulfamethoxazole d. Empiric ceftriaxone and azithromycin - ans-d. Empiric ceftriaxone and azithromycin A 50-year-old man reports having erectile dysfunction. What is an important response by the provider when developing a plan of care for this patient? a. Considering testosterone hormone replacement therapy b. Prescribing an oral phosphodiesterase type 5 inhibitor c. Evaluating the patient for cardiovascular disease d. Referring the patient for psychotherapy and counseling - ans-c. Evaluating the patient for cardiovascular disease A previously healthy 22-year-old female reports pain in the rectovaginal area that occurs with sexual intercourse. What is the most likely cause of this patient's discomfort?

d. Men with hypoactive sexual desire may have normal excitement and orgasm - ans-d. Men with hypoactive sexual desire may have normal excitement and orgasm A patient diagnosed with MS and began disease modulating therapy drugs. As part of the counseling about this therapy, the provider will tell the patient that this regimen will? a. Decrease the need for other medications b. Reduce the exacerbation rate c. Induce long-term remission d. Stop progression of the disability - ans-b. Reduce the exacerbation rate A woman who has had routine pap tests all of her life has an abnormal pap with low-grade intraepithelial lesion. What will the provider tell her about this result? a. The result most likely indicates HPV infection b. Colposcopy with biopsy is necessary c. She most likely has early cervical cancer d. She may have vaginal cancer - ans-b. Colposcopy with biopsy is necessary An adolescent takes ibuprofen, acetaminophen, and a tricyclic antidepressant (TCA) to treat phantom limb pain and reports that the medications are no longer effective. What will the primary care provider care nurse do? a. Increase the TCA dose and reevaluate in 2-3 weeks b. Change the TCA to a SSRI c. Refer the adolescent to a pain management specialist d. Evaluate the adolescent for drug-seeking behavior - ans-c. Refer the adolescent to a pain management specialist

A 16-year-old female has primary amenorrhea. A pregnancy test is negative. Further testing reveals a normal TSH and an elevated prolactin level. Which test will the provider order next? a. Progesterone challenge test b. MRI c. Serum dehydroepiandrosterone d. Clomiphene challenge test - ans-b. MRI A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the family practioner manage this situation? a. Prescribe short-term antidepressants for this situational problem b. Suggest that the child have close follow-up by a school counselor c. Refer the child to a mental health specialist for evaluation and treatment d. Schedule extended appointments for counseling and mental health intervention - ans-c. Refer the child to a mental health specialist for evaluation and treatment A 69-year-old patient with cancer is reluctant to take an opioid agonist medication because of the side effects. What will the primary care provider recommend? a. Using opioids on an as needed basis only b. Taking a stool softener with the opioid c. Adding an NSAID to the pain regimen d. Using diphenhydramine to prevent itching - ans-b. Taking a stool softener with the opioid What is the medical diagnostic term used to identify transgender patients? a. Gender expression disorder