ANCC FNP Exam Review Questions LEIK part 1
Key Concepts in Clinical Assessment and
Management
1. The Lachman Maneuver
Indication: Detects instability of the knee.
Incorrect Options:
o Nerve damage of the knee due to past injuries.
o Integrity of the patellar tendon.
o Tears of the meniscus.
2. Third Trimester Bleeding
Clinical Presentation: A 28-year-old multipara at 32 weeks gestation with
sudden onset of small amounts of bright-red vaginal bleeding and a soft
uterus on palpation.
Most Likely Diagnosis: Placenta previa.
Differential Diagnoses (Less Likely):
o Placenta abruptio (typically presents with pain and a firm uterus).
o Acute cervicitis (usually associated with inflammation and discharge).
o Molar Pregnancy (hydatidiform mole) (typically presents earlier in
pregnancy with other signs).
3. Vaginal Discharge Analysis
Key Findings:
o Large amount of milk-like vaginal discharge.
o Microscopy reveals numerous cells with blurred margins.
o Very few white blood cells.
o Vaginal pH of 6.0.
Most Likely Diagnosis: Bacterial Vaginosis.
Distinguishing Features (Incorrect Options):
o Trichomonas infections: Often present with motile trichomonads on
microscopy and a higher pH.
, o Candidal infection: Typically shows budding yeast and hyphae on
KOH prep, often with itching and a normal pH.
o Normal finding: The large amount of discharge and elevated pH are
not typical.
4. Signs and Symptoms of Depression
Core Symptoms:
o Anhedonia (loss of interest or pleasure).
o Low Self-esteem.
o Apathy (lack of motivation or interest).
Incorrect Option:
o Apraxia: A neurological disorder characterized by the inability to
perform learned (familiar) movements on command, even though the
command is understood and there is a willingness to perform the
movement.
5. Medicare Part B Coverage
Covered Services:
o Persons aged 65 years or older.
o Durable medical equipment.
o Mammograms annually starting at age 50.
o Outpatient anesthesiologist services.
Exception (Not Covered Under Part B): This question requires identifying
something not covered, which isn't explicitly listed in the correct options.
However, Part A primarily covers inpatient hospital stays, skilled nursing
facility care, hospice care, and some home health care.
6. Complications of Severe Preeclampsia
Severe Preeclampsia Complications:
o Liver Failure.
o Hypertensive Encephalopathy.
o Pulmonary Edema.
Incorrect Option:
o Placenta Previa: A condition where the placenta implants in the lower
part of the uterus, potentially covering the cervix. It is a risk factor for
, bleeding during pregnancy but not a direct complication of severe
preeclampsia.
7. Koplik's Spots
Association: Rubeola (measles).
Description: Small, white spots with bluish-white centers on an
erythematous background, found on the buccal mucosa.
Incorrect Options:
o Poxvirus infections (e.g., smallpox, molluscum contagiosum).
o Kawasaki's disease (associated with fever, rash, conjunctivitis, etc.).
o Rubella (German measles, associated with a maculopapular rash
starting on the face).
8. Needlestick Injury Management
Scenario: A middle-aged housekeeping worker sustains a needlestick injury
from an ER garbage bag.
Next Step: Order an enzyme-linked immunosorbent assay (ELISA) test
as soon as possible to establish a baseline for potential bloodborne pathogen
exposure (HIV, Hepatitis B, Hepatitis C).
Other Considerations:
o A tetanus booster should be considered based on the patient's
immunization history, but it's not the immediate next step for
bloodborne pathogen risk assessment.
o Hepatitis B immunoglobulin (HBIG) would be considered if the
source patient was known to be HBsAg positive or if the worker was
not vaccinated against Hepatitis B.
o A chest X-ray is not indicated for a needlestick injury.
9. Migraine Triggers - Incorrect Advice
Common Migraine Triggers (Should Be Avoided):
o Foods high in tyramine content (e.g., aged cheeses, cured meats,
fermented foods).
o Get enough sleep (irregular sleep patterns can be a trigger).
o Fermented foods (often high in tyramine).
Incorrect Advice (Should NOT Be Avoided):
Key Concepts in Clinical Assessment and
Management
1. The Lachman Maneuver
Indication: Detects instability of the knee.
Incorrect Options:
o Nerve damage of the knee due to past injuries.
o Integrity of the patellar tendon.
o Tears of the meniscus.
2. Third Trimester Bleeding
Clinical Presentation: A 28-year-old multipara at 32 weeks gestation with
sudden onset of small amounts of bright-red vaginal bleeding and a soft
uterus on palpation.
Most Likely Diagnosis: Placenta previa.
Differential Diagnoses (Less Likely):
o Placenta abruptio (typically presents with pain and a firm uterus).
o Acute cervicitis (usually associated with inflammation and discharge).
o Molar Pregnancy (hydatidiform mole) (typically presents earlier in
pregnancy with other signs).
3. Vaginal Discharge Analysis
Key Findings:
o Large amount of milk-like vaginal discharge.
o Microscopy reveals numerous cells with blurred margins.
o Very few white blood cells.
o Vaginal pH of 6.0.
Most Likely Diagnosis: Bacterial Vaginosis.
Distinguishing Features (Incorrect Options):
o Trichomonas infections: Often present with motile trichomonads on
microscopy and a higher pH.
, o Candidal infection: Typically shows budding yeast and hyphae on
KOH prep, often with itching and a normal pH.
o Normal finding: The large amount of discharge and elevated pH are
not typical.
4. Signs and Symptoms of Depression
Core Symptoms:
o Anhedonia (loss of interest or pleasure).
o Low Self-esteem.
o Apathy (lack of motivation or interest).
Incorrect Option:
o Apraxia: A neurological disorder characterized by the inability to
perform learned (familiar) movements on command, even though the
command is understood and there is a willingness to perform the
movement.
5. Medicare Part B Coverage
Covered Services:
o Persons aged 65 years or older.
o Durable medical equipment.
o Mammograms annually starting at age 50.
o Outpatient anesthesiologist services.
Exception (Not Covered Under Part B): This question requires identifying
something not covered, which isn't explicitly listed in the correct options.
However, Part A primarily covers inpatient hospital stays, skilled nursing
facility care, hospice care, and some home health care.
6. Complications of Severe Preeclampsia
Severe Preeclampsia Complications:
o Liver Failure.
o Hypertensive Encephalopathy.
o Pulmonary Edema.
Incorrect Option:
o Placenta Previa: A condition where the placenta implants in the lower
part of the uterus, potentially covering the cervix. It is a risk factor for
, bleeding during pregnancy but not a direct complication of severe
preeclampsia.
7. Koplik's Spots
Association: Rubeola (measles).
Description: Small, white spots with bluish-white centers on an
erythematous background, found on the buccal mucosa.
Incorrect Options:
o Poxvirus infections (e.g., smallpox, molluscum contagiosum).
o Kawasaki's disease (associated with fever, rash, conjunctivitis, etc.).
o Rubella (German measles, associated with a maculopapular rash
starting on the face).
8. Needlestick Injury Management
Scenario: A middle-aged housekeeping worker sustains a needlestick injury
from an ER garbage bag.
Next Step: Order an enzyme-linked immunosorbent assay (ELISA) test
as soon as possible to establish a baseline for potential bloodborne pathogen
exposure (HIV, Hepatitis B, Hepatitis C).
Other Considerations:
o A tetanus booster should be considered based on the patient's
immunization history, but it's not the immediate next step for
bloodborne pathogen risk assessment.
o Hepatitis B immunoglobulin (HBIG) would be considered if the
source patient was known to be HBsAg positive or if the worker was
not vaccinated against Hepatitis B.
o A chest X-ray is not indicated for a needlestick injury.
9. Migraine Triggers - Incorrect Advice
Common Migraine Triggers (Should Be Avoided):
o Foods high in tyramine content (e.g., aged cheeses, cured meats,
fermented foods).
o Get enough sleep (irregular sleep patterns can be a trigger).
o Fermented foods (often high in tyramine).
Incorrect Advice (Should NOT Be Avoided):
