FNP Board Review Questions & Answers 2023 A+

FNP Board Review Questions & Answers 2023 A+ A 24-year old, otherwise healthy college student presents with c/o cough x 6 weeks. She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses? A) Her age B) Family hx C) Ineffectiveness of OTC cough medicines D) Length of time she has been coughing - ANS-D) Length of time she has been coughing Why? This information helps you build your ddx Acute cough < 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (>8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis? A) Sulfonamide B) Tetracycline C) Macrolide D) Beta-lactam - ANS-C) Macrolide antiobitic (e.g. Azithromycin, clarithromycin Sulfonamides are second-line Match the antibiotics with the correct drug class: 1. Sulfonamide 2. Tetracycline 3. Macrolide 4. Beta-lactam A. Doxycyline B. Azithromycin C. Penicillins D.Trimethoprim-Sulfamethoxazole E. Cephalosporin F. Clarithromycin - ANS-1. Sulfonamide - D.Trimethoprim-Sulfamethoxazole (Bactrim) 2. Tetracycline - A. Doxycycline 3. Macrolide - B & F, Azithromycin and Clarithromycin 4. Beta-lactam - C & E, PCN and cephalosporins What are the three most common bugs in community-acquired pneumonia? - ANSStreptococcus pneumoniae Mycoplasma pneuomiae (atypical pathogen) Chlamydophila pneumoniae (atypical pathogen) What is the treatment for CAP caused by Strep pneumo? - ANS-Respiratory quinolone (e.g. Levofloxacin, moxifloxacin, gemifloxacin) OR high-dose amoxicillin OR amoxicillin with clavulanate What antibiotics are avoided in CAP caused by Strep pneumo due to high rates of resistance? - ANS-Macrolides What is the treatment for CAP caused by Mycoplasma pneumoniae? - ANS-Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - ANS-Betalactams (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 - ANS-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? - ANSSpirometry (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 - ANS-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 - ANS-B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - ANS-Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - ANS-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 - ANS-A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - ANS-Albuterol and levalbuterol Name an inhaled long-acting beta agonists (LABAs): - ANS-Salmeterol (Serevent) What are the side effects associated with anticholinergic medications? - ANS-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: - ANSIpratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - ANSFluticasone/salmeterol (Advair) Fluticasone/vilanterol (Breo) Budesonide/formoterol (Symbicort) Mometasone/frmoterol (Dulera) Name an inhaled steroid: - ANS-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 - ANS-C, A, B, D 1. Short-acting anticholinergic or SABA PRN THEN 2. Long-acting anticholinergic or LABA, plus rescue med THEN 3. Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med THEN 4. Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med There is good evidence in support of oral steroids for COPD exacerbations to shorten recovery time and improve lung function. What is the correct recommended dose? A) Medrol dose-pack B) 10-day course of Prednisone 20 mg, followed by a taper C) 5-day course of Prednisone 40 mg - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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? - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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? CONTINUES....