ANCC FNP review (set of 124) questions
Solved 100% Correct
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.
B. |"Bioidentical |hormones" |are |compounded |mixtures |of |multiple |hormones. |There |is |no
|evidence |to |support |their |use |at |this |time, |and |again, |hormone |treatment |would |be
|contraindicated |in |a |patient |with |a |history |of |breast |cancer.
D. |Black |cohosh |is |an |herbal |remedy |marketed |for |use |with |hot |flashes. |However, |it |has
|not |been |demonstrated |to |be |more |effective |than |a |placebo |for |this |use. |In |addition, |it |has
|been |posited |to |have |a |possible |estrogenic |effect |on |breast |tissue, |which |should |be
|avoided |in |patients |with |a |history |of |breast |cancer.
Vital |Concepts:
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.
A |20-year-old |presents |to |the |office |for |a |wellness |check. |What |is |the |prevalence |of
|bulimia |nervosa |in |female |college |students?
A. |1% |
B.2% |
C. |4% |
D. |5% |- |ANSWER-Correct |Answer: |D. |5%
Bulimia |nervosa |occurs |in |approximately |5% |of |female |college |students, |who |are |10x
|more |likely |than |male |college |students |to |develop |this |disorder. |The |prevalence |of
|anorexia |nervosa |is |1.5% |in |teenage |girls |overall.
Incorrect |Answers:
(A), |(B), |(C) |are |the |not |correct |prevalence.
, A |16-year-old |male |presents |because |he |is |concerned |about |acne. |He |first |began |to
|notice |worsening |acne |6 |months |ago |and |began |using |over-the-counter |benzoyl |peroxide
|and, |after |3 |months, |saw |his |primary |care |physician |who |prescribed |tretinoin |and |oral
|tetracycline. |He |states |that |he |has |been |using |both |medications |for |the |last |3 |months |but
|there |is |no |improvement |in |acne. |He |also |states |he |has |noticed |he |is |very |quick |to |anger
|and |moody |over |the |last |few |months |and |wonders |whether |that |is |a |side |effect |of |the |acne
|medications. |He |is |a |football |player |for |his |high |school |and |has |been |participating |in |extra
|practices |to |"bulk |up" |in |the |hopes |of |achieving |a |college |scholarship. |Upon |closer
|inspection, |he |has |gained |30 |pounds |in |the |last |3 |months |but |does |not |appear
|overweight, |rather |has |increased |muscle |mass. |He |states |that |a |friend |on |the |football
|team |has |been |giving |him |pills |to |help |his |performance. |Which |of |the |following |is |most
|likely |to |be |identified?
A. |Increased |serum |luteinizing |hormone |levels
B. |Decreased |prothrombin |time
C. |Lowered |thyroxine |binding |globulin |(TBG) |levels |
D. |Increased |serum |HDL |cholesterol |- |ANSWER-Correct |Answer: |C. |Lowered |thyroxine
|binding |globulin |(TBG) |levels
Anabolic |steroids |can |lower |thyroxine-binding |globulin |(TBG) |levels |which, |in |turn, |can
|decrease |total |T4 |levels, |although |free |T4 |remains |the |same.
Incorrect |Answers:
A. |This |patient |has |multiple |features |that |are |consistent |with |anabolic |steroid |use,
|including |acne, |a |rapid |increase |in |weight |and |muscle |mass, |and |mood |swings. |In |men
|steroid |use |decreases |serum |luteinizing |hormone |and |follicle-stimulating |hormone |levels,
|which |leads |to |decreased |endogenous |testosterone |production, |decreased
|spermatogenesis, |and |testicular |atrophy. |There |is |also |an |increased |estrogen |production
|due |to |the |aromatization |of |circulating |testosterone |which |can |lead |to |gynecomastia.
B. |Anabolic |steroid |use |can |lead |to |increased |prothrombin |time |as |well |as |a |suppression
|of |clotting |factors |II, |V, |VII, |and |X.
D. |Anabolic |steroid |use |can |have |multiple |cardiovascular |effects |including |decreased
|serum |HDL |cholesterol, |increased |serum |LDL |cholesterol, |increased |total |cholesterol,
|and |increased |blood |pressure. |These |effects |appear |to |be |reversible |when |anabolic
|steroid |use |is |discontinued. |The |risk |of |sudden |death |from |cardiovascular |causes |can
|occur |in |an |athlete |abusing |anabolic |steroids |even |when |there |is |no |evidence |of
|atherosclerosis. |This |is |due |to |an |increased |risk |of |thrombus |formation |while |using
|anabolic |steroids.
A |45-year-old |woman |presents |with |abnormal |uterine |bleeding. |You |discuss |your
|recommendation |for |endometrial |sampling |to |rule |out |endometrial |hyperplasia |and
|carcinoma. |What |is |the |most |common |cause |of |endometrial |cancer?
A. |Human |papilloma |virus
B. |Hereditary |nonpolyposis |colorectal |cancer |
C. |Multiple |endocrine |neoplasia
D. |Unopposed |estrogen |- |ANSWER-Correct |Answer: |D. |Unopposed |estrogen
Solved 100% Correct
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.
B. |"Bioidentical |hormones" |are |compounded |mixtures |of |multiple |hormones. |There |is |no
|evidence |to |support |their |use |at |this |time, |and |again, |hormone |treatment |would |be
|contraindicated |in |a |patient |with |a |history |of |breast |cancer.
D. |Black |cohosh |is |an |herbal |remedy |marketed |for |use |with |hot |flashes. |However, |it |has
|not |been |demonstrated |to |be |more |effective |than |a |placebo |for |this |use. |In |addition, |it |has
|been |posited |to |have |a |possible |estrogenic |effect |on |breast |tissue, |which |should |be
|avoided |in |patients |with |a |history |of |breast |cancer.
Vital |Concepts:
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.
A |20-year-old |presents |to |the |office |for |a |wellness |check. |What |is |the |prevalence |of
|bulimia |nervosa |in |female |college |students?
A. |1% |
B.2% |
C. |4% |
D. |5% |- |ANSWER-Correct |Answer: |D. |5%
Bulimia |nervosa |occurs |in |approximately |5% |of |female |college |students, |who |are |10x
|more |likely |than |male |college |students |to |develop |this |disorder. |The |prevalence |of
|anorexia |nervosa |is |1.5% |in |teenage |girls |overall.
Incorrect |Answers:
(A), |(B), |(C) |are |the |not |correct |prevalence.
, A |16-year-old |male |presents |because |he |is |concerned |about |acne. |He |first |began |to
|notice |worsening |acne |6 |months |ago |and |began |using |over-the-counter |benzoyl |peroxide
|and, |after |3 |months, |saw |his |primary |care |physician |who |prescribed |tretinoin |and |oral
|tetracycline. |He |states |that |he |has |been |using |both |medications |for |the |last |3 |months |but
|there |is |no |improvement |in |acne. |He |also |states |he |has |noticed |he |is |very |quick |to |anger
|and |moody |over |the |last |few |months |and |wonders |whether |that |is |a |side |effect |of |the |acne
|medications. |He |is |a |football |player |for |his |high |school |and |has |been |participating |in |extra
|practices |to |"bulk |up" |in |the |hopes |of |achieving |a |college |scholarship. |Upon |closer
|inspection, |he |has |gained |30 |pounds |in |the |last |3 |months |but |does |not |appear
|overweight, |rather |has |increased |muscle |mass. |He |states |that |a |friend |on |the |football
|team |has |been |giving |him |pills |to |help |his |performance. |Which |of |the |following |is |most
|likely |to |be |identified?
A. |Increased |serum |luteinizing |hormone |levels
B. |Decreased |prothrombin |time
C. |Lowered |thyroxine |binding |globulin |(TBG) |levels |
D. |Increased |serum |HDL |cholesterol |- |ANSWER-Correct |Answer: |C. |Lowered |thyroxine
|binding |globulin |(TBG) |levels
Anabolic |steroids |can |lower |thyroxine-binding |globulin |(TBG) |levels |which, |in |turn, |can
|decrease |total |T4 |levels, |although |free |T4 |remains |the |same.
Incorrect |Answers:
A. |This |patient |has |multiple |features |that |are |consistent |with |anabolic |steroid |use,
|including |acne, |a |rapid |increase |in |weight |and |muscle |mass, |and |mood |swings. |In |men
|steroid |use |decreases |serum |luteinizing |hormone |and |follicle-stimulating |hormone |levels,
|which |leads |to |decreased |endogenous |testosterone |production, |decreased
|spermatogenesis, |and |testicular |atrophy. |There |is |also |an |increased |estrogen |production
|due |to |the |aromatization |of |circulating |testosterone |which |can |lead |to |gynecomastia.
B. |Anabolic |steroid |use |can |lead |to |increased |prothrombin |time |as |well |as |a |suppression
|of |clotting |factors |II, |V, |VII, |and |X.
D. |Anabolic |steroid |use |can |have |multiple |cardiovascular |effects |including |decreased
|serum |HDL |cholesterol, |increased |serum |LDL |cholesterol, |increased |total |cholesterol,
|and |increased |blood |pressure. |These |effects |appear |to |be |reversible |when |anabolic
|steroid |use |is |discontinued. |The |risk |of |sudden |death |from |cardiovascular |causes |can
|occur |in |an |athlete |abusing |anabolic |steroids |even |when |there |is |no |evidence |of
|atherosclerosis. |This |is |due |to |an |increased |risk |of |thrombus |formation |while |using
|anabolic |steroids.
A |45-year-old |woman |presents |with |abnormal |uterine |bleeding. |You |discuss |your
|recommendation |for |endometrial |sampling |to |rule |out |endometrial |hyperplasia |and
|carcinoma. |What |is |the |most |common |cause |of |endometrial |cancer?
A. |Human |papilloma |virus
B. |Hereditary |nonpolyposis |colorectal |cancer |
C. |Multiple |endocrine |neoplasia
D. |Unopposed |estrogen |- |ANSWER-Correct |Answer: |D. |Unopposed |estrogen
