FNP study1
Fnp 545
FNP study1
PC
,You see a 23-year-old gravida 1 para 0 for her prenatal checkup at 38 weeks gestation. She complains of
severe headaches and epigastric pain. She has had an uneventful pregnancy to date and had a normal
prenatal examination 2 weeks ago. Her blood pressure is 140/100 mm Hg. A urinalysis shows 2+ protein;
she has gained 5 lb in the last week, and has 2+ pitting edema of her legs. The most appropriate
management at this point would be: (check one)
A. Strict bed rest at home and reexamination within 48 hours
B. Admitting the patient to the hospital for bed rest and frequent monitoring of blood pressure, weight,
and proteinuria
C. Admitting the patient to the hospital for bed rest and monitoring, and beginning hydralazine
(Apresoline) to maintain blood pressure below 140/90 mm Hg
D. Admitting the patient to the hospital, treating with parenteral magnesium sulfate, and planning
prompt delivery either vaginally or by - correct answer ✔✔D
This patient manifests a rapid onset of preeclampsia at term. The symptoms of epigastric pain and
headache categorize her preeclampsia as severe. These symptoms indicate that the process is well
advanced and that convulsions are imminent. Treatment should focus on rapid control of symptoms and
delivery of the infant. Ref: Cunningham FG, Gant NF, Leveno KJ, et al: Williams Obstetrics, ed 21.
McGraw-Hill, 2001, pp 569-571, 591-592.
Which one of the following is the most common cause of hypertension in children under 6 years of age?
(check one)
A. Essential hypertension
B. Pheochromocytoma
C. Renal parenchymal disease
D. Hyperthyroidism
E. Excessive caffeine use - correct answer ✔✔C
Although essential hypertension is most common in adolescents and adults, it is rarely found in children
less than 10 years old and should be a diagnosis of exclusion. The most common cause of hypertension is
renal parenchymal disease, and a urinalysis, urine culture, and renal ultrasonography should be ordered
for all children presenting with hypertension. Other secondary causes, such as pheochromocytoma,
hyperthyroidism, and excessive caffeine use, are less common, and further testing and/or investigation
should be ordered as clinically indicated. Ref: Luma GB, Spiotta RT: Hypertension in children and
adolescents. Am Fam Physician 2006;73(9):1558-1566.
,A 70-year-old male with a history of hypertension and type 2 diabetes mellitus presents with a 2-month
history of increasing paroxysmal nocturnal dyspnea and shortness of breath with minimal exertion. An
echocardiogram shows an ejection fraction of 25%. Which one of the patients current medications
should be discontinued? (check one)
A. Lisinopril (Zestril)
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL)
E. Repaglinide (Prandin) - correct answer ✔✔B
According to the American Diabetes Association guidelines, thiazolidinediones (TZDs) are associated with
fluid retention, and their use can be complicated by the development of heart failure. Caution is
necessary when prescribing TZDs in patients with known heart failure or other heart diseases, those with
preexisting edema, and those on concurrent insulin therapy (SOR C). Older patients can be treated with
the same drug regimens as younger patients, but special care is required when prescribing and
monitoring drug therapy. Metformin is often contraindicated because of renal insufficiency or heart
failure. Sulfonylureas and other insulin secretagogues can cause hypoglycemia. Insulin can also cause
hypoglycemia, and injecting it requires good visual and motor skills and cognitive ability on the part of
the patient or a caregiver. TZDs should not be used in patients with New York Heart Association class III
or IV heart failure.
Ref: American Diabetes Association: Standards of medical care in diabetes-2007. Diabetes Care
2007;30(Suppl 1):S4-S41.
A 72-year-old African-American male with New York Heart Association Class III heart failure sees you for
follow-up. He has shortness of breath with minimal exertion. The patient is adherent to his medication
regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice daily; carvedilol (Coreg),
25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood pressure is 100/60 mm Hg, and his
pulse rate is 68 beats/min and regular. Findings include a few scattered bibasilar rales on examination of
the lungs, an S3 gallop on examination of the heart, and no edema on examination of the legs. An EKG
reveals a left bundle branch block, and echocardiography reveals an ejection fraction of 25%, but no
other abnormalities. Which one of the following would be most appropriate at this time? (check one)
A. Increase the lisinopril dosage to 80 mg twice daily
B. Increase the carvedilol dosage to 50 mg - correct answer ✔✔E
, This patient is already receiving maximal medical therapy. The 2002 joint guidelines of the American
College of Cardiology, the American Heart Association (AHA), and the North American Society of Pacing
and Electrophysiology endorse the use of cardiac resynchronization therapy (CRT) in patients with
medically refractory, symptomatic, New York Heart Association (NYHA) class III or IV disease with a QRS
interval of at least 130 msec, a left ventricular end-diastolic diameter of at least 55 mm, and a left
ventricular ejection fraction (LVEF) ≤30%. Using a pacemaker-like device, CRT aims to get both ventricles
contracting simultaneously, overcoming the delayed contraction of the left ventricle caused by the left
bundle-branch block. These guidelines were refined by an April 2005 AHA Science Advisory, which stated
that optimal candidates for CRT have a dilated cardiomyopathy on an ischemic or nonischemic basis, an
LVEF ≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV despite
maximal medical therapy for heart failure. Ref: Jarcho JA: Biventricular pacing. N Engl J Med
2006;355(3):288-294.
The American Heart Association recommends a goal blood pressure of ≤130/80 mm Hg for patients with:
(check one)
A. Heart failure
B. Pulmonary hypertension
C. Atrial fibulation
D. Angina pectoris
E. Chronic kidney disease - correct answer ✔✔E
The American Heart Association recommends a goal blood pressure of 130/80 mm Hg or less for the
treatment of hypertension in patients with diabetes mellitus, chronic kidney disease, or coronary artery
disease.
Ref: Pflieger M, Winslow BT, Mills K, Dauber IM: Medical management of stable coronary artery disease.
Am Fam Physician 2011;83(7):819-826.
According to the U.S. Preventive Services Task Force, which one of the following patients should be
screened for an abdominal aortic aneurysm? (check one)
A. A 52-year-old male with type 2 diabetes mellitus
B. An asymptomatic 67-year-old male smoker with no chronic illness
C. A 72-year-old male with a history of chronic renal failure
D. A 69-year-old female with a history of coronary artery disease
Fnp 545
FNP study1
PC
,You see a 23-year-old gravida 1 para 0 for her prenatal checkup at 38 weeks gestation. She complains of
severe headaches and epigastric pain. She has had an uneventful pregnancy to date and had a normal
prenatal examination 2 weeks ago. Her blood pressure is 140/100 mm Hg. A urinalysis shows 2+ protein;
she has gained 5 lb in the last week, and has 2+ pitting edema of her legs. The most appropriate
management at this point would be: (check one)
A. Strict bed rest at home and reexamination within 48 hours
B. Admitting the patient to the hospital for bed rest and frequent monitoring of blood pressure, weight,
and proteinuria
C. Admitting the patient to the hospital for bed rest and monitoring, and beginning hydralazine
(Apresoline) to maintain blood pressure below 140/90 mm Hg
D. Admitting the patient to the hospital, treating with parenteral magnesium sulfate, and planning
prompt delivery either vaginally or by - correct answer ✔✔D
This patient manifests a rapid onset of preeclampsia at term. The symptoms of epigastric pain and
headache categorize her preeclampsia as severe. These symptoms indicate that the process is well
advanced and that convulsions are imminent. Treatment should focus on rapid control of symptoms and
delivery of the infant. Ref: Cunningham FG, Gant NF, Leveno KJ, et al: Williams Obstetrics, ed 21.
McGraw-Hill, 2001, pp 569-571, 591-592.
Which one of the following is the most common cause of hypertension in children under 6 years of age?
(check one)
A. Essential hypertension
B. Pheochromocytoma
C. Renal parenchymal disease
D. Hyperthyroidism
E. Excessive caffeine use - correct answer ✔✔C
Although essential hypertension is most common in adolescents and adults, it is rarely found in children
less than 10 years old and should be a diagnosis of exclusion. The most common cause of hypertension is
renal parenchymal disease, and a urinalysis, urine culture, and renal ultrasonography should be ordered
for all children presenting with hypertension. Other secondary causes, such as pheochromocytoma,
hyperthyroidism, and excessive caffeine use, are less common, and further testing and/or investigation
should be ordered as clinically indicated. Ref: Luma GB, Spiotta RT: Hypertension in children and
adolescents. Am Fam Physician 2006;73(9):1558-1566.
,A 70-year-old male with a history of hypertension and type 2 diabetes mellitus presents with a 2-month
history of increasing paroxysmal nocturnal dyspnea and shortness of breath with minimal exertion. An
echocardiogram shows an ejection fraction of 25%. Which one of the patients current medications
should be discontinued? (check one)
A. Lisinopril (Zestril)
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL)
E. Repaglinide (Prandin) - correct answer ✔✔B
According to the American Diabetes Association guidelines, thiazolidinediones (TZDs) are associated with
fluid retention, and their use can be complicated by the development of heart failure. Caution is
necessary when prescribing TZDs in patients with known heart failure or other heart diseases, those with
preexisting edema, and those on concurrent insulin therapy (SOR C). Older patients can be treated with
the same drug regimens as younger patients, but special care is required when prescribing and
monitoring drug therapy. Metformin is often contraindicated because of renal insufficiency or heart
failure. Sulfonylureas and other insulin secretagogues can cause hypoglycemia. Insulin can also cause
hypoglycemia, and injecting it requires good visual and motor skills and cognitive ability on the part of
the patient or a caregiver. TZDs should not be used in patients with New York Heart Association class III
or IV heart failure.
Ref: American Diabetes Association: Standards of medical care in diabetes-2007. Diabetes Care
2007;30(Suppl 1):S4-S41.
A 72-year-old African-American male with New York Heart Association Class III heart failure sees you for
follow-up. He has shortness of breath with minimal exertion. The patient is adherent to his medication
regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice daily; carvedilol (Coreg),
25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood pressure is 100/60 mm Hg, and his
pulse rate is 68 beats/min and regular. Findings include a few scattered bibasilar rales on examination of
the lungs, an S3 gallop on examination of the heart, and no edema on examination of the legs. An EKG
reveals a left bundle branch block, and echocardiography reveals an ejection fraction of 25%, but no
other abnormalities. Which one of the following would be most appropriate at this time? (check one)
A. Increase the lisinopril dosage to 80 mg twice daily
B. Increase the carvedilol dosage to 50 mg - correct answer ✔✔E
, This patient is already receiving maximal medical therapy. The 2002 joint guidelines of the American
College of Cardiology, the American Heart Association (AHA), and the North American Society of Pacing
and Electrophysiology endorse the use of cardiac resynchronization therapy (CRT) in patients with
medically refractory, symptomatic, New York Heart Association (NYHA) class III or IV disease with a QRS
interval of at least 130 msec, a left ventricular end-diastolic diameter of at least 55 mm, and a left
ventricular ejection fraction (LVEF) ≤30%. Using a pacemaker-like device, CRT aims to get both ventricles
contracting simultaneously, overcoming the delayed contraction of the left ventricle caused by the left
bundle-branch block. These guidelines were refined by an April 2005 AHA Science Advisory, which stated
that optimal candidates for CRT have a dilated cardiomyopathy on an ischemic or nonischemic basis, an
LVEF ≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV despite
maximal medical therapy for heart failure. Ref: Jarcho JA: Biventricular pacing. N Engl J Med
2006;355(3):288-294.
The American Heart Association recommends a goal blood pressure of ≤130/80 mm Hg for patients with:
(check one)
A. Heart failure
B. Pulmonary hypertension
C. Atrial fibulation
D. Angina pectoris
E. Chronic kidney disease - correct answer ✔✔E
The American Heart Association recommends a goal blood pressure of 130/80 mm Hg or less for the
treatment of hypertension in patients with diabetes mellitus, chronic kidney disease, or coronary artery
disease.
Ref: Pflieger M, Winslow BT, Mills K, Dauber IM: Medical management of stable coronary artery disease.
Am Fam Physician 2011;83(7):819-826.
According to the U.S. Preventive Services Task Force, which one of the following patients should be
screened for an abdominal aortic aneurysm? (check one)
A. A 52-year-old male with type 2 diabetes mellitus
B. An asymptomatic 67-year-old male smoker with no chronic illness
C. A 72-year-old male with a history of chronic renal failure
D. A 69-year-old female with a history of coronary artery disease
