FNP III 2026 First
Exam Complete
Study Guide
,A 90-year-old woman is diagnosed with isolated systolic hypertension of the elderly. Which of
i i i i i i i i i i i i i i
the following antihypertensive medications are preferred for the treatment of this condition?
i i i i i i i i i i i
Calcium channel blockers and thiazide diuretics i i i i i
Angiotensin-converting enzyme inhibitors and loop diuretics i i i i i
Beta-blockers and potassium-sparing diuretics i i i
Alpha-blockers and calcium channel blockers - correct answer Calcium channel blockers and i i i i i i i i i i i i
thiazide diuretics i
Calcium channel blockers (CCBs) and thiazide diuretics are preferred for treatment of isolated
i i i i i i i i i i i i i
systolic hypertension of the elderly. There is no preference of one over the other, and therapy
i i i i i i i i i i i i i i i i
may be started with either a thiazide diuretic or a CCB. Isolated systolic hypertension of the
i i i i i i i i i i i i i i i i
elderly is caused by hardening of the arteries, resulting in increased peripheral vascular
i i i i i i i i i i i i i
resistance. The goal for patients aged 60 years or older is blood pressure less than 150/90 i i i i i i i i i i i i i i i i
mmHg unless diabetic or they have chronic kidney disease (goal BP <140/90 mmHg). Watch
i i i i i i i i i i i i i i
for orthostatic hypotension (or decrease in systolic blood pressure of >20 mmHg), which is a
i i i i i i i i i i i i i i i
risk factor for falls.
i i i
A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which
i i i i i i i i i i i i i
diagnostic test will the provider order? i i i i i
a. Abdominal CT with contrast
i i i i
b. Abdominal ultrasound
i i
c. MRI of the abdomen
i i i i
d. Plain abdominal radiographs - correct answer b. Abdominal ultrasound.
i i i i i i i i i
Per UpToDate: Right upper quadrant pain may involve liver or biliary tree and if there is an
i i i i i i i i i i i i i i i i i
indication of hepatobiliary pain patients should have an abdominal ultrasound for evaluation. i i i i i i i i i i i
Also patients with right upper quadrant pain should have the following laboratory studies:
i i i i i i i i i i i i
●Complete blood count with differential i i i i
●Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose i i i i i i i
●Aminotransferases, alkaline phosphatase, and bilirubin i i i i
●Lipase and/or amylase i i
A 50 y/o male presents with acute, excruciating, LUQ, epigastric pain that he also feels in the
i i i i i i i i i i i i i i i i i
flank and L shoulder. These symptoms best describe:
i i i i i i i
a. Cholecystitis
i
b. Intestinal obstruction
i i
c. Pancreatitis
i
d. Biliary stones - correct answer c. Pancreatitis
i i i i i i i
Patients with epigastric pain should be evaluated for pancreatitis as well as gastric etiologies.
i i i i i i i i i i i i i
Also consider splenic etiologies such as splenomegaly.
i i i i i i
"Must-Not-Miss" Patients with epigastric pain and cardiac risk factors and/or other symptoms i i i i i i i i i i i i
concerning for angina (eg, shortness of breath, exertional symptoms) should have i i i i i i i i i i i
appropriate cardiac evaluation. i i
Labs to order for Epigastric suspected Pancreatitis:
i i i i i i
●Complete blood count with differential i i i i
, ●Electrolytes, BUN, creatinine, and glucose i i i i
●Aminotransferases, alkaline phosphatase, and bilirubin i i i i
●Lipase and/or amylase i i
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the
i i i i i i i i i i i i
rapid onset of severe low-back pain accompanied by abdominal pain that is gradually
i i i i i i i i i i i i i
worsening. The patient appears pale and complains that he does not feel well. During the i i i i i i i i i i i i i i i
abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus i i i i i i i i i i i i i i
as she palpates this area with her hand. Which of the following conditions is most likely?
i i i i i i i i i i i i i i i
Abdominal aortic aneurysm i i
Cauda equina syndrome i i
Acute diverticulitis i
Adenocarcinoma of the colon - correct answer Abdominal aortic aneurysm i i i i i i i i i
Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The
i i i i i i i i i i i i i i
aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray
i i i i i i i i i i i i i
or abdominal ultrasound. Although small aneurysms are usually not detectable during
i i i i i i i i i i i
abdominal exams, the larger aneurysms may be palpable during an abdominal exam, but i i i i i i i i i i i i i
abdominal obesity will obscure the findings. The symptoms in this case point toward a rapidly i i i i i i i i i i i i i i i
dissecting aneurysm. The best action is to call 911 stat. i i i i i i i i i
A 55-year-old male is at the emergency department complaining of severe acute epigastric
i i i i i i i i i i i i i
pain radiating to the back. He has a history of smoking and drinking alcohol for over 20 years.
i i i i i i i i i i i i i i i i i i
Patient states that the pain is relieved if he leans forward with trunk flexed. The patient's
i i i i i i i i i i i i i i i i
symptoms are suggestive of what condition? i i i i i
a) Acute pancreatitis
i i
b) Acute cholecystitis
i i
c) Appendicitis
i
d) Gastric reflux (GERD) - correct answer A (Analysis)
i i i i i i i i
Sudden knife-like epigastric pain radiating to the back is typical of acute pancreatitis.
i i i i i i i i i i i i i
Cholecystitis is a gradual onset of pain in the upper right quadrant. i i i i i i i i i i i i
Appendicitis is mostly found in the right upper quadrant. GERD is located in the epigastric area i i i i i i i i i i i i i i i i
but feels more like a burning sensation. https://www.aafp.org/afp/2007/0515/p1513.html
i i i i i i i
Cullen's sign is most commonly associated with which of the following?
i i i i i i i i i i
Acute pancreatitis i
Myocardial infarction i
Acute pyelonephritis i
Preeclampsia - correct answer Cullen's sign is commonly seen in acute pancreatitis. i i i i i i i i i i i i
It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to
i i i i i i i i i i i i i i i i i i
the pancreatic enzymes that run along the ligament and subcutaneous tissues around the
i i i i i i i i i i i i i
umbilicus.
Exam Complete
Study Guide
,A 90-year-old woman is diagnosed with isolated systolic hypertension of the elderly. Which of
i i i i i i i i i i i i i i
the following antihypertensive medications are preferred for the treatment of this condition?
i i i i i i i i i i i
Calcium channel blockers and thiazide diuretics i i i i i
Angiotensin-converting enzyme inhibitors and loop diuretics i i i i i
Beta-blockers and potassium-sparing diuretics i i i
Alpha-blockers and calcium channel blockers - correct answer Calcium channel blockers and i i i i i i i i i i i i
thiazide diuretics i
Calcium channel blockers (CCBs) and thiazide diuretics are preferred for treatment of isolated
i i i i i i i i i i i i i
systolic hypertension of the elderly. There is no preference of one over the other, and therapy
i i i i i i i i i i i i i i i i
may be started with either a thiazide diuretic or a CCB. Isolated systolic hypertension of the
i i i i i i i i i i i i i i i i
elderly is caused by hardening of the arteries, resulting in increased peripheral vascular
i i i i i i i i i i i i i
resistance. The goal for patients aged 60 years or older is blood pressure less than 150/90 i i i i i i i i i i i i i i i i
mmHg unless diabetic or they have chronic kidney disease (goal BP <140/90 mmHg). Watch
i i i i i i i i i i i i i i
for orthostatic hypotension (or decrease in systolic blood pressure of >20 mmHg), which is a
i i i i i i i i i i i i i i i
risk factor for falls.
i i i
A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which
i i i i i i i i i i i i i
diagnostic test will the provider order? i i i i i
a. Abdominal CT with contrast
i i i i
b. Abdominal ultrasound
i i
c. MRI of the abdomen
i i i i
d. Plain abdominal radiographs - correct answer b. Abdominal ultrasound.
i i i i i i i i i
Per UpToDate: Right upper quadrant pain may involve liver or biliary tree and if there is an
i i i i i i i i i i i i i i i i i
indication of hepatobiliary pain patients should have an abdominal ultrasound for evaluation. i i i i i i i i i i i
Also patients with right upper quadrant pain should have the following laboratory studies:
i i i i i i i i i i i i
●Complete blood count with differential i i i i
●Electrolytes, blood urea nitrogen (BUN), creatinine, and glucose i i i i i i i
●Aminotransferases, alkaline phosphatase, and bilirubin i i i i
●Lipase and/or amylase i i
A 50 y/o male presents with acute, excruciating, LUQ, epigastric pain that he also feels in the
i i i i i i i i i i i i i i i i i
flank and L shoulder. These symptoms best describe:
i i i i i i i
a. Cholecystitis
i
b. Intestinal obstruction
i i
c. Pancreatitis
i
d. Biliary stones - correct answer c. Pancreatitis
i i i i i i i
Patients with epigastric pain should be evaluated for pancreatitis as well as gastric etiologies.
i i i i i i i i i i i i i
Also consider splenic etiologies such as splenomegaly.
i i i i i i
"Must-Not-Miss" Patients with epigastric pain and cardiac risk factors and/or other symptoms i i i i i i i i i i i i
concerning for angina (eg, shortness of breath, exertional symptoms) should have i i i i i i i i i i i
appropriate cardiac evaluation. i i
Labs to order for Epigastric suspected Pancreatitis:
i i i i i i
●Complete blood count with differential i i i i
, ●Electrolytes, BUN, creatinine, and glucose i i i i
●Aminotransferases, alkaline phosphatase, and bilirubin i i i i
●Lipase and/or amylase i i
An 80-year-old man with hypertension and hyperlipidemia presents with complaints of the
i i i i i i i i i i i i
rapid onset of severe low-back pain accompanied by abdominal pain that is gradually
i i i i i i i i i i i i i
worsening. The patient appears pale and complains that he does not feel well. During the i i i i i i i i i i i i i i i
abdominal exam, the nurse practitioner detects a soft pulsatile mass just above the umbilicus i i i i i i i i i i i i i i
as she palpates this area with her hand. Which of the following conditions is most likely?
i i i i i i i i i i i i i i i
Abdominal aortic aneurysm i i
Cauda equina syndrome i i
Acute diverticulitis i
Adenocarcinoma of the colon - correct answer Abdominal aortic aneurysm i i i i i i i i i
Elderly males who are ex-smokers are at higher risk for abdominal aortic aneurysm. The
i i i i i i i i i i i i i i
aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray
i i i i i i i i i i i i i
or abdominal ultrasound. Although small aneurysms are usually not detectable during
i i i i i i i i i i i
abdominal exams, the larger aneurysms may be palpable during an abdominal exam, but i i i i i i i i i i i i i
abdominal obesity will obscure the findings. The symptoms in this case point toward a rapidly i i i i i i i i i i i i i i i
dissecting aneurysm. The best action is to call 911 stat. i i i i i i i i i
A 55-year-old male is at the emergency department complaining of severe acute epigastric
i i i i i i i i i i i i i
pain radiating to the back. He has a history of smoking and drinking alcohol for over 20 years.
i i i i i i i i i i i i i i i i i i
Patient states that the pain is relieved if he leans forward with trunk flexed. The patient's
i i i i i i i i i i i i i i i i
symptoms are suggestive of what condition? i i i i i
a) Acute pancreatitis
i i
b) Acute cholecystitis
i i
c) Appendicitis
i
d) Gastric reflux (GERD) - correct answer A (Analysis)
i i i i i i i i
Sudden knife-like epigastric pain radiating to the back is typical of acute pancreatitis.
i i i i i i i i i i i i i
Cholecystitis is a gradual onset of pain in the upper right quadrant. i i i i i i i i i i i i
Appendicitis is mostly found in the right upper quadrant. GERD is located in the epigastric area i i i i i i i i i i i i i i i i
but feels more like a burning sensation. https://www.aafp.org/afp/2007/0515/p1513.html
i i i i i i i
Cullen's sign is most commonly associated with which of the following?
i i i i i i i i i i
Acute pancreatitis i
Myocardial infarction i
Acute pyelonephritis i
Preeclampsia - correct answer Cullen's sign is commonly seen in acute pancreatitis. i i i i i i i i i i i i
It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to
i i i i i i i i i i i i i i i i i i
the pancreatic enzymes that run along the ligament and subcutaneous tissues around the
i i i i i i i i i i i i i
umbilicus.
