ANCC FNP EXAM 3 QUESTIONS & CORRECT
ANSWERS GRADED A LATEST EXAM
special considerations for Thiazides - ANSWER-Chlorthalidone is preferred on the
basis of prolonged half-life and proven trial reduction of CVD.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric
acid-lowering therapy.
special considerations for ACE inhibitors - ANSWER-Do not use in combination
with ARBs or direct renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with CKD or in
those on K+ supplements or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ACE inhibitors.
ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin
production.
Avoid in pregnant females or females of reproductive age without adequate
contraception
,special considerations for Angiotensin receptor blockers - ANSWER-Do not use in
combination with ACE inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in CKD or in those on K+ supplements
or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ARBs. Patients with a history
of angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after
ACE inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate
contraception.
Lower risk of cough than ACE-Is.
special considerations for Calcium channel blockers - ANSWER-Associated with
dose-related pedal edema, which is more common in females than men.
When should you Refer to a Nephrologist or Cardiologist in a hypertensive
patient? - ANSWER--signs of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to
full doses of an appropriate three to four drug regimen that includes a diuretic may
warrant referral to a nephrologist or cardiologist
,Before referring, clinicians should first review other causes of inadequate
hypertension control such as:
-Improper blood pressure measurement
-White coat hypertension
-Excess sodium intake
-Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit
drugs, sympathomimetics, oral contraceptives)
-Excess alcohol intake
-Underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a
questionnaire to 5000 patients who meet the CDC criteria for obesity that asks
them about sedentary lifestyle factors, consumption of processed food, and family
history of obesity. The researcher sends the same questionnaire to 5000 patients
who are not obese. Which of the following best describes the design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
D. Case-control study - ANSWER-Correct Answer: D. Case-control study
This is a retrospective case-control study. In this observational study design,
subjects are selected based on an outcome, and their prior exposures are assessed
and compared to subjects who do not have the particular outcome. The result of the
study is expressed as an odds ratio: OR = (# exposed with disease / # exposed
without disease) / (# not exposed with disease / # not exposed without disease). A
retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
, Answers:
A. A cross-sectional study is used to assess disease status and risk factors at 1 point
in time.
B. A randomized controlled trial refers to a study where a group is given a
treatment and outcomes are compared against a control group given a placebo or
treated with the standard of care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital Concepts:
In an observational study design, subjects are selected based on an outcome, and
their prior exposures are assessed and compared to subjects who do not have a
particular outcome. The result of the study is expressed as an odds ratio: OR = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / #
not exposed without disease). A retrospective case-control study does not prove
causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is
having frequent hot flashes who already tried first-line lifestyle changes without
improvement? What is the best treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - ANSWER-Correct Answer: C. Citalopram
Selective serotonin reuptake inhibitors (SSRI)s are the most effective
pharmacologic choice for the vasomotor symptoms of menopause. Citalopram is
an SSRI that has good evidence of efficacy against these symptoms and is typically
well-tolerated.
Incorrect Answers:
A. Women with a history of breast cancer are not candidates for hormone
replacement therapy.
ANSWERS GRADED A LATEST EXAM
special considerations for Thiazides - ANSWER-Chlorthalidone is preferred on the
basis of prolonged half-life and proven trial reduction of CVD.
Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.
Use with caution in patients with history of acute gout unless patient is on uric
acid-lowering therapy.
special considerations for ACE inhibitors - ANSWER-Do not use in combination
with ARBs or direct renin inhibitor.
There is an increased risk of hyperkalemia, especially in patients with CKD or in
those on K+ supplements or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ACE inhibitors.
ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin
production.
Avoid in pregnant females or females of reproductive age without adequate
contraception
,special considerations for Angiotensin receptor blockers - ANSWER-Do not use in
combination with ACE inhibitors or direct renin inhibitor.
There is an increased risk of hyperkalemia in CKD or in those on K+ supplements
or K+-sparing drugs.
There is a risk of acute renal failure in patients with severe bilateral renal artery
stenosis.
Do not use if patient has history of angioedema with ARBs. Patients with a history
of angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after
ACE inhibitor is discontinued.
Avoid in pregnant females or females of reproductive age without adequate
contraception.
Lower risk of cough than ACE-Is.
special considerations for Calcium channel blockers - ANSWER-Associated with
dose-related pedal edema, which is more common in females than men.
When should you Refer to a Nephrologist or Cardiologist in a hypertensive
patient? - ANSWER--signs of end-organ damage
-evidence of a secondary cause of hypertension
-only on one to two medications
Generally, failure to achieve blood pressure goal in patients who are adhering to
full doses of an appropriate three to four drug regimen that includes a diuretic may
warrant referral to a nephrologist or cardiologist
,Before referring, clinicians should first review other causes of inadequate
hypertension control such as:
-Improper blood pressure measurement
-White coat hypertension
-Excess sodium intake
-Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit
drugs, sympathomimetics, oral contraceptives)
-Excess alcohol intake
-Underlying identifiable causes of hypertension (secondary hypertension)
A researcher is studying potential risk factors for obesity. She sends a
questionnaire to 5000 patients who meet the CDC criteria for obesity that asks
them about sedentary lifestyle factors, consumption of processed food, and family
history of obesity. The researcher sends the same questionnaire to 5000 patients
who are not obese. Which of the following best describes the design of the study?
A. Cross-sectional study
B. Randomized controlled trial
C. Meta-analysis
D. Case-control study - ANSWER-Correct Answer: D. Case-control study
This is a retrospective case-control study. In this observational study design,
subjects are selected based on an outcome, and their prior exposures are assessed
and compared to subjects who do not have the particular outcome. The result of the
study is expressed as an odds ratio: OR = (# exposed with disease / # exposed
without disease) / (# not exposed with disease / # not exposed without disease). A
retrospective case-control study does not prove causation but demonstrates an
association.
Incorrect
, Answers:
A. A cross-sectional study is used to assess disease status and risk factors at 1 point
in time.
B. A randomized controlled trial refers to a study where a group is given a
treatment and outcomes are compared against a control group given a placebo or
treated with the standard of care.
C. A meta-analysis provides a statistical analysis of the results of multiple studies.
Vital Concepts:
In an observational study design, subjects are selected based on an outcome, and
their prior exposures are assessed and compared to subjects who do not have a
particular outcome. The result of the study is expressed as an odds ratio: OR = (#
exposed with disease / # exposed without disease) / (# not exposed with disease / #
not exposed without disease). A retrospective case-control study does not prove
causation but demonstrates an association.
A 49-year-old female presents to the office with a history of breast cancer who is
having frequent hot flashes who already tried first-line lifestyle changes without
improvement? What is the best treatment for this patient?
A. Hormonal therapy with estrogen and progesterone
B. Bioidentical hormones
C. Citalopram
D. Black cohosh - ANSWER-Correct Answer: C. Citalopram
Selective serotonin reuptake inhibitors (SSRI)s are the most effective
pharmacologic choice for the vasomotor symptoms of menopause. Citalopram is
an SSRI that has good evidence of efficacy against these symptoms and is typically
well-tolerated.
Incorrect Answers:
A. Women with a history of breast cancer are not candidates for hormone
replacement therapy.
