FNP LEIK UPDATED ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS
●● Pt with GERD abrupt stop of PPI, with Barrett's esophagus
Answer: This patient is having severe rebound symptoms caused by
abrupt cessation of the proton-pump inhibitor (PPI). In addition, he has
Barrett's esophagus, which increases the risk of esophageal cancer.
Neither an antacid nor an H2 blocker is likely to be effective in
controlling his symptoms. This question is a good example of the ethical
concept of beneficence
●● Depo-Provera side effect after 5 years
Answer: Depo-Provera (contraceptive injection) is a progesterone
hormone that causes cessation of periods. One common side effect seen
in women who have been taking Depo-Provera for more than 5 years is
amenorrhea. As women continue using Depo-Provera, fewer experience
irregular bleeding and more experience amenorrhea. By month 12,
amenorrhea was reported by 55% of women, and by month 24,
amenorrhea was reported by 68% of women.
●● NSAIDs affect which systems:
Answer: Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)
is associated with increased risk of ulcers, perforation, and bleeding of
the gastrointestinal tract, heart attacks, cardiovascular damage, strokes,
acute interstitial nephritis and kidney injury, and liver damage. It does
not affect the lungs or the pulmonary system.
,●● Watery diarrhea after hospitalization and Clindamycin therapy
Answer: Important risk factors for CDAD and C. difficile colitis are
antibiotic therapy and hospitalization. Almost any antibiotic can cause
the condition, but the most common are clindamycin, cephalosporins,
and fluoroquinolones. Diarrhea can occur during as well as after therapy
(5-10 days; up to 10 weeks). Pseudomembranous colitis is a
complication of C. difficile colitis.
●● Drug interaction with Levothyroxine
Answer: Levothyroxine does not interact with penicillins. But it does
have numerous drugs it interacts with such as anticoagulants, tricyclic
antidepressants, antacids and calcium, iron, multivitamins, proton-pump
inhibitors, estrogens, statins, metformin, and others. Certain foods
interfere with absorption (calcium-fortified foods, dietary fiber, walnuts,
soy). Patients should avoid taking them together, and should space these
foods and drugs several hours apart. Levothyroxine (Synthroid) is a
synthetic form of T4.
●● First line therapy for pain in acute exacerbation of gout
Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
indomethacin (Indocin), have been used for the treatment of acute gout.
Colchicine may be added to the NSAIDs if relief is not obtained.
Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once they
occur. It may take several months or longer before the full benefit of
allopurinol is felt. Allopurinol may increase the number of gout attacks
,during the first few months that it is taken, although it will eventually
prevent attacks. Systemic steroids are reserved as a second-line option
for patients who cannot take NSAIDs.
●● Atypical Antipsychotic adverse effects
Answer: Orthostatic hypotension and sedation are common side effects
of atypical antipsychotics such as olanzapine (Zyprexa), quetiapine
(Seroquel), and risperidone (Risperdal). It is also a common side effect
of the older antipsychotics like haloperidol (Haldol). Antipsychotics do
not cause severe anxiety and decreased appetite. They lower anxiety and
cause sedation, sleepiness, anorexia, and hypotension, and increase the
risk of sudden death in frail elders.
●● Which medication is contraindicated for bone loss?
Answer: Long-term use (>3 years) of medroxyprogesterone (Depo-
Provera) increases risk of bone loss. Avoid with osteopenia,
osteoporosis, long-term amenorrhea, or in underweight women with
anorexia. First-line treatment of osteoporosis is the biphosphanates.
Lifestyle measures are weight-bearing exercises and adequate calcium
and vitamin D intake.
●● Prophylactic treatment for migraine headaches
Answer: Propranolol (Inderal) is a beta-blocker. Sufficient evidence and
consensus exist to recommend propranolol, timolol, amitriptyline,
divalproex, sodium valproate, and topiramate as first-line agents for
migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and
, duration, and by increasing the responsiveness of acute migraines to
treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen
(Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex) are all
medications used to treat symptoms of migraine headache
●● Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3.
Theophylline 4. Xanax
Answer: Alprazolam (Xanax) and other benzodiazepines cause sedation
and promote sleep. But selective serotonin reuptake inhibitors (SSRIs),
such as sertraline (Zoloft), can cause insomnia in some patients. Other
drug classes with stimulating effects are decongestants, such as
pseudoephedrine (Sudafed), and methylxanthines such as theophylline
(Theo-Dur) and caffeine.
●● Contraindication for Wellbutrin (bupropion)
Answer: Bupropion increases the risk of seizures. Contraindications are
seizures, anorexia nervosa, and bulimia. Avoid with any condition that
increases seizures, such as after abrupt withdrawal of alcohol or
sedatives and with certain head injuries. For peripheral neuropathy,
treatment options are an SNRI (duloxetine/Cymbalta), tricyclic
antidepressants, anticonvulsants, topical capsaicin cream, and others.
●● Recommended treatment for erythema migrans or early Lyme
disease
Answer: Erythema migrans is the rash characteristic of Lyme disease
and it usually appears 7 to 10 days after a tick bite. Lyme disease is
caused by Borrelia burgdorferi, a spirochete. The rash appears either as a
QUESTIONS AND CORRECT ANSWERS
●● Pt with GERD abrupt stop of PPI, with Barrett's esophagus
Answer: This patient is having severe rebound symptoms caused by
abrupt cessation of the proton-pump inhibitor (PPI). In addition, he has
Barrett's esophagus, which increases the risk of esophageal cancer.
Neither an antacid nor an H2 blocker is likely to be effective in
controlling his symptoms. This question is a good example of the ethical
concept of beneficence
●● Depo-Provera side effect after 5 years
Answer: Depo-Provera (contraceptive injection) is a progesterone
hormone that causes cessation of periods. One common side effect seen
in women who have been taking Depo-Provera for more than 5 years is
amenorrhea. As women continue using Depo-Provera, fewer experience
irregular bleeding and more experience amenorrhea. By month 12,
amenorrhea was reported by 55% of women, and by month 24,
amenorrhea was reported by 68% of women.
●● NSAIDs affect which systems:
Answer: Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs)
is associated with increased risk of ulcers, perforation, and bleeding of
the gastrointestinal tract, heart attacks, cardiovascular damage, strokes,
acute interstitial nephritis and kidney injury, and liver damage. It does
not affect the lungs or the pulmonary system.
,●● Watery diarrhea after hospitalization and Clindamycin therapy
Answer: Important risk factors for CDAD and C. difficile colitis are
antibiotic therapy and hospitalization. Almost any antibiotic can cause
the condition, but the most common are clindamycin, cephalosporins,
and fluoroquinolones. Diarrhea can occur during as well as after therapy
(5-10 days; up to 10 weeks). Pseudomembranous colitis is a
complication of C. difficile colitis.
●● Drug interaction with Levothyroxine
Answer: Levothyroxine does not interact with penicillins. But it does
have numerous drugs it interacts with such as anticoagulants, tricyclic
antidepressants, antacids and calcium, iron, multivitamins, proton-pump
inhibitors, estrogens, statins, metformin, and others. Certain foods
interfere with absorption (calcium-fortified foods, dietary fiber, walnuts,
soy). Patients should avoid taking them together, and should space these
foods and drugs several hours apart. Levothyroxine (Synthroid) is a
synthetic form of T4.
●● First line therapy for pain in acute exacerbation of gout
Answer: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
indomethacin (Indocin), have been used for the treatment of acute gout.
Colchicine may be added to the NSAIDs if relief is not obtained.
Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once they
occur. It may take several months or longer before the full benefit of
allopurinol is felt. Allopurinol may increase the number of gout attacks
,during the first few months that it is taken, although it will eventually
prevent attacks. Systemic steroids are reserved as a second-line option
for patients who cannot take NSAIDs.
●● Atypical Antipsychotic adverse effects
Answer: Orthostatic hypotension and sedation are common side effects
of atypical antipsychotics such as olanzapine (Zyprexa), quetiapine
(Seroquel), and risperidone (Risperdal). It is also a common side effect
of the older antipsychotics like haloperidol (Haldol). Antipsychotics do
not cause severe anxiety and decreased appetite. They lower anxiety and
cause sedation, sleepiness, anorexia, and hypotension, and increase the
risk of sudden death in frail elders.
●● Which medication is contraindicated for bone loss?
Answer: Long-term use (>3 years) of medroxyprogesterone (Depo-
Provera) increases risk of bone loss. Avoid with osteopenia,
osteoporosis, long-term amenorrhea, or in underweight women with
anorexia. First-line treatment of osteoporosis is the biphosphanates.
Lifestyle measures are weight-bearing exercises and adequate calcium
and vitamin D intake.
●● Prophylactic treatment for migraine headaches
Answer: Propranolol (Inderal) is a beta-blocker. Sufficient evidence and
consensus exist to recommend propranolol, timolol, amitriptyline,
divalproex, sodium valproate, and topiramate as first-line agents for
migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and
, duration, and by increasing the responsiveness of acute migraines to
treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen
(Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex) are all
medications used to treat symptoms of migraine headache
●● Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3.
Theophylline 4. Xanax
Answer: Alprazolam (Xanax) and other benzodiazepines cause sedation
and promote sleep. But selective serotonin reuptake inhibitors (SSRIs),
such as sertraline (Zoloft), can cause insomnia in some patients. Other
drug classes with stimulating effects are decongestants, such as
pseudoephedrine (Sudafed), and methylxanthines such as theophylline
(Theo-Dur) and caffeine.
●● Contraindication for Wellbutrin (bupropion)
Answer: Bupropion increases the risk of seizures. Contraindications are
seizures, anorexia nervosa, and bulimia. Avoid with any condition that
increases seizures, such as after abrupt withdrawal of alcohol or
sedatives and with certain head injuries. For peripheral neuropathy,
treatment options are an SNRI (duloxetine/Cymbalta), tricyclic
antidepressants, anticonvulsants, topical capsaicin cream, and others.
●● Recommended treatment for erythema migrans or early Lyme
disease
Answer: Erythema migrans is the rash characteristic of Lyme disease
and it usually appears 7 to 10 days after a tick bite. Lyme disease is
caused by Borrelia burgdorferi, a spirochete. The rash appears either as a
