FNP III 2026 First Exam Complete Study Guide

FNP III 2026 First
Exam Complete
Study Guide

,A 90-year-old woman is diagnosed with isolated systolic hypertension of the elderly. Which of
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the following antihypertensive medications are preferred for the treatment of this condition?
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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
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systolic hypertension of the elderly. There is no preference of one over the other, and therapy
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may be started with either a thiazide diuretic or a CCB. Isolated systolic hypertension of the
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elderly is caused by hardening of the arteries, resulting in increased peripheral vascular
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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
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for orthostatic hypotension (or decrease in systolic blood pressure of >20 mmHg), which is a
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risk factor for falls.
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A 30-year-old woman has right upper quadrant abdominal pain, nausea, and vomiting. Which
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diagnostic test will the provider order? i i i i i




a. Abdominal CT with contrast
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b. Abdominal ultrasound
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c. MRI of the abdomen
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d. Plain abdominal radiographs - correct answer b. Abdominal ultrasound.
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Per UpToDate: Right upper quadrant pain may involve liver or biliary tree and if there is an
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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:
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●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
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flank and L shoulder. These symptoms best describe:
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a. Cholecystitis
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b. Intestinal obstruction
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c. Pancreatitis
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d. Biliary stones - correct answer c. Pancreatitis
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Patients with epigastric pain should be evaluated for pancreatitis as well as gastric etiologies.
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Also consider splenic etiologies such as splenomegaly.
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"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:
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●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
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rapid onset of severe low-back pain accompanied by abdominal pain that is gradually
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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?
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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
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aneurysm is usually asymptomatic and is discovered incidentally during a routine chest x-ray
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or abdominal ultrasound. Although small aneurysms are usually not detectable during
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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
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pain radiating to the back. He has a history of smoking and drinking alcohol for over 20 years.
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Patient states that the pain is relieved if he leans forward with trunk flexed. The patient's
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symptoms are suggestive of what condition? i i i i i




a) Acute pancreatitis
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b) Acute cholecystitis
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c) Appendicitis
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d) Gastric reflux (GERD) - correct answer A (Analysis)
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Sudden knife-like epigastric pain radiating to the back is typical of acute pancreatitis.
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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
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Cullen's sign is most commonly associated with which of the following?
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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
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the pancreatic enzymes that run along the ligament and subcutaneous tissues around the
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umbilicus.