WELL DETAILED ANSWERS|LATEST
A 43-year-old male recently underwent three months worth of lifestyle interventions
but only had a moderate change in overall blood pressure readings at home. At
today's visit, his blood pressure is consistent with his home readings, and is 138/85.
The nurse practitioner knows that according to the AHA guidelines, we should begin
initiating medications for a stage 1 hypertensive patient at what ASCVD cutoff point?
- ANSWER 10%
it is appropriate to initiate antihypertensives if their ASCVD risk score is 10% or
greater. (Hint: can think of hyperTENsion to remember!)
A middle-aged female presents to your clinic today. She has a history of smoking,
hypertension, type II diabetes, and osteoporosis. She has been on lisinopril (Prinvil) 10
mg daily for the past five years and metformin (Glucophage) 500 mg twice daily.
Upon your physical exam you notice asymmetric, non-pitting swelling around her
upper lip which the patient states started yesterday night and is painless. She also
reports diffuse abdominal pain and diarrhea. The rest of the physical exam was
benign. Her fasting blood glucose is 130. Her vital signs are as follows: BP: 141/87
mmHg, HR: 92 bpm, RR: 12 breaths per minute, O2: 96% on room air. What is the
most important thing for the nurse practitioner to do? - ANSWER Discontinue
her lisinopril
This patient is experiencing angioedema - ACE Inhibitor induced angioedema can
occur anytime (days, weeks, or years after initiation). In addition to swelling of the
lips, tongue, and face, visceral angioedema due to an ACE inhibitor can occur and
cause symptoms including abdominal pain, diarrhea, and vomiting. She needs to
immediately stop the lisinopril and it needs to be marked as an allergy.
A patient calls the office complaining of a sudden onset of "cobweb like lines"
moving in and out of her central vision in the right eye. She is not in any pain and
is asking if she needs to come in and be seen. What should the nurse practitioner
advise her to do? - ANSWER Refer to opthalmogogy immediately
1
,A group of new nurse practitioners are evaluating the strength of evidence of some
new asthma guidelines. Which of the following would be at the bottom of the
hierarchy of evidence? - ANSWER Editorial
A 55-year-old male patient reports increasing issues with erectile dysfunction over the
last six months. He is requesting to be placed on tadalafil (Cialis) for control of this
condition. Which of the following is critical for the nurse practitioner to order prior
to prescribing this medication? - ANSWER EKG
You are performing an annual exam and pap smear on a 39-year-old woman who
states she has never had a mammogram before. A close friend of hers was just
diagnosed with breast cancer and she is wanting to know more about her risk and
when she should begin screening. What in her history would be considered a risk
factor for breast cancer? - ANSWER Her only child is a step daughter
You recently diagnosed your patient with sciatica. You ask the patient to perform the
squat and rise exam, and you found that there is a diminished knee jerk. Which of
the following is the root cause of his sciatica based on this finding? -
ANSWER L4
The squat and rise exam with a diminished knee jerk links to the L4 nerve. We can
assess L5 with the heel walk and S1 with the toe walk.
You are assessing a patient for acute abdominal pain. With the patient supine and
right knee flexed, you perform inward rotation on the patient's hip. What maneuver
is this and what are you assessing for? - ANSWER Obturator sign to assess for
appendicitis
Obturator- Is inward rOtation of the hip through full ROM and is a pOsitive sign w/
mOvement or flexion of the hip (I think of all the O's). Iliopsoas/psoas sign is
2
, performed by having patients raise their leg against resistance in a supine position,
then while on their left side, extending the right leg from the hip ( When you do leg
raises at the gym, your iliopsoas muscles are sore). Murphy's sign is elicited when
deep palpation on the RUQ under the costal border produces pain during
Midinspiratory arrest (I think M for Murphy's and M for Midinspiratory).
An 85-year-old woman presents to the clinic today for a follow up x-ray. She states
that she had x-rays completed 11 days after a fall at home but the imaging was
negative at that time. Due to the nature of her fall, she was instructed to come in
for an additional set of x-rays if the pain persisted. The nurse practitioner knows that
if this patient has a fracture today, it is most likely which of the following? -
ANSWER Scaphoid fracture
Your 63-year-old male patient with vague abdominal pain has a triglyceride level of
899. Which of the following clinical signs would be most concerning given this lab
value? - ANSWER Cullen's sign
Patients with polycystic ovarian syndrome (PCOS) may develop all of the following
except: - ANSWER Breast CA
Upon a digital rectal examination, the nurse practitioner notes a warm and boggy
prostate. This finding is consistent with which diagnosis? - ANSWER Prostatitis
A 67-year-old male patient is currently being treated for benign prostatic hyperplasia.
He is concerned that his finasteride (Proscar) is not adequately treating his symptoms.
Which of the following questions is most important to ask this patient to do a
further assessment? - ANSWER How long have you been taking this medication?
A 33-year-old female is complaining of dysuria, flank pain and a fever. Her vital signs
are as follows: BP: 112/76, HR: 76, RR: 18, 97% on room air, Temp: 101.6 F. The
patient states she has had a urinary tract infection off and on over the past month
and antibiotics never really helped. Upon your physical exam you elicit CVA
tenderness. What is the best plan for this patient? - ANSWER Referral to the
emergency room
3
A 43-year-old male recently underwent three months worth of lifestyle interventions
but only had a moderate change in overall blood pressure readings at home. At
today's visit, his blood pressure is consistent with his home readings, and is 138/85.
The nurse practitioner knows that according to the AHA guidelines, we should begin
initiating medications for a stage 1 hypertensive patient at what ASCVD cutoff point?
- ANSWER 10%
it is appropriate to initiate antihypertensives if their ASCVD risk score is 10% or
greater. (Hint: can think of hyperTENsion to remember!)
A middle-aged female presents to your clinic today. She has a history of smoking,
hypertension, type II diabetes, and osteoporosis. She has been on lisinopril (Prinvil) 10
mg daily for the past five years and metformin (Glucophage) 500 mg twice daily.
Upon your physical exam you notice asymmetric, non-pitting swelling around her
upper lip which the patient states started yesterday night and is painless. She also
reports diffuse abdominal pain and diarrhea. The rest of the physical exam was
benign. Her fasting blood glucose is 130. Her vital signs are as follows: BP: 141/87
mmHg, HR: 92 bpm, RR: 12 breaths per minute, O2: 96% on room air. What is the
most important thing for the nurse practitioner to do? - ANSWER Discontinue
her lisinopril
This patient is experiencing angioedema - ACE Inhibitor induced angioedema can
occur anytime (days, weeks, or years after initiation). In addition to swelling of the
lips, tongue, and face, visceral angioedema due to an ACE inhibitor can occur and
cause symptoms including abdominal pain, diarrhea, and vomiting. She needs to
immediately stop the lisinopril and it needs to be marked as an allergy.
A patient calls the office complaining of a sudden onset of "cobweb like lines"
moving in and out of her central vision in the right eye. She is not in any pain and
is asking if she needs to come in and be seen. What should the nurse practitioner
advise her to do? - ANSWER Refer to opthalmogogy immediately
1
,A group of new nurse practitioners are evaluating the strength of evidence of some
new asthma guidelines. Which of the following would be at the bottom of the
hierarchy of evidence? - ANSWER Editorial
A 55-year-old male patient reports increasing issues with erectile dysfunction over the
last six months. He is requesting to be placed on tadalafil (Cialis) for control of this
condition. Which of the following is critical for the nurse practitioner to order prior
to prescribing this medication? - ANSWER EKG
You are performing an annual exam and pap smear on a 39-year-old woman who
states she has never had a mammogram before. A close friend of hers was just
diagnosed with breast cancer and she is wanting to know more about her risk and
when she should begin screening. What in her history would be considered a risk
factor for breast cancer? - ANSWER Her only child is a step daughter
You recently diagnosed your patient with sciatica. You ask the patient to perform the
squat and rise exam, and you found that there is a diminished knee jerk. Which of
the following is the root cause of his sciatica based on this finding? -
ANSWER L4
The squat and rise exam with a diminished knee jerk links to the L4 nerve. We can
assess L5 with the heel walk and S1 with the toe walk.
You are assessing a patient for acute abdominal pain. With the patient supine and
right knee flexed, you perform inward rotation on the patient's hip. What maneuver
is this and what are you assessing for? - ANSWER Obturator sign to assess for
appendicitis
Obturator- Is inward rOtation of the hip through full ROM and is a pOsitive sign w/
mOvement or flexion of the hip (I think of all the O's). Iliopsoas/psoas sign is
2
, performed by having patients raise their leg against resistance in a supine position,
then while on their left side, extending the right leg from the hip ( When you do leg
raises at the gym, your iliopsoas muscles are sore). Murphy's sign is elicited when
deep palpation on the RUQ under the costal border produces pain during
Midinspiratory arrest (I think M for Murphy's and M for Midinspiratory).
An 85-year-old woman presents to the clinic today for a follow up x-ray. She states
that she had x-rays completed 11 days after a fall at home but the imaging was
negative at that time. Due to the nature of her fall, she was instructed to come in
for an additional set of x-rays if the pain persisted. The nurse practitioner knows that
if this patient has a fracture today, it is most likely which of the following? -
ANSWER Scaphoid fracture
Your 63-year-old male patient with vague abdominal pain has a triglyceride level of
899. Which of the following clinical signs would be most concerning given this lab
value? - ANSWER Cullen's sign
Patients with polycystic ovarian syndrome (PCOS) may develop all of the following
except: - ANSWER Breast CA
Upon a digital rectal examination, the nurse practitioner notes a warm and boggy
prostate. This finding is consistent with which diagnosis? - ANSWER Prostatitis
A 67-year-old male patient is currently being treated for benign prostatic hyperplasia.
He is concerned that his finasteride (Proscar) is not adequately treating his symptoms.
Which of the following questions is most important to ask this patient to do a
further assessment? - ANSWER How long have you been taking this medication?
A 33-year-old female is complaining of dysuria, flank pain and a fever. Her vital signs
are as follows: BP: 112/76, HR: 76, RR: 18, 97% on room air, Temp: 101.6 F. The
patient states she has had a urinary tract infection off and on over the past month
and antibiotics never really helped. Upon your physical exam you elicit CVA
tenderness. What is the best plan for this patient? - ANSWER Referral to the
emergency room
3
