FNP LEIK SYSTEM PRACTICE PAPER 2026
COMPLETE SOLUTIONS
◉ Pt with GERD abrupt stop of PPI, with Barrett's esophagus
Answer: This patient is having severe rebound symptoms caused by
abrupt cessation of the proton-pump inhibitor (PPI). In addition, he
has Barrett's esophagus, which increases the risk of esophageal
cancer. Neither an antacid nor an H2 blocker is likely to be effective
in controlling his symptoms. This question is a good example of the
ethical concept of beneficence
◉ Depo-Provera side effect after 5 years Answer: Depo-Provera
(contraceptive injection) is a progesterone hormone that causes
cessation of periods. One common side effect seen in women who
have been taking Depo-Provera for more than 5 years is
amenorrhea. As women continue using Depo-Provera, fewer
experience irregular bleeding and more experience amenorrhea. By
month 12, amenorrhea was reported by 55% of women, and by
month 24, amenorrhea was reported by 68% of women.
◉ NSAIDs affect which systems: Answer: Chronic use of nonsteroidal
anti-inflammatory drugs (NSAIDs) is associated with increased risk
of ulcers, perforation, and bleeding of the gastrointestinal tract,
heart attacks, cardiovascular damage, strokes, acute interstitial
nephritis and kidney injury, and liver damage. It does not affect the
lungs or the pulmonary system.
,◉ Watery diarrhea after hospitalization and Clindamycin therapy
Answer: Important risk factors for CDAD and C. difficile colitis are
antibiotic therapy and hospitalization. Almost any antibiotic can
cause the condition, but the most common are clindamycin,
cephalosporins, and fluoroquinolones. Diarrhea can occur during as
well as after therapy (5-10 days; up to 10 weeks).
Pseudomembranous colitis is a complication of C. difficile colitis.
◉ Drug interaction with Levothyroxine Answer: Levothyroxine does
not interact with penicillins. But it does have numerous drugs it
interacts with such as anticoagulants, tricyclic antidepressants,
antacids and calcium, iron, multivitamins, proton-pump inhibitors,
estrogens, statins, metformin, and others. Certain foods interfere
with absorption (calcium-fortified foods, dietary fiber, walnuts, soy).
Patients should avoid taking them together, and should space these
foods and drugs several hours apart. Levothyroxine (Synthroid) is a
synthetic form of T4.
◉ First line therapy for pain in acute exacerbation of gout Answer:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
indomethacin (Indocin), have been used for the treatment of acute
gout. Colchicine may be added to the NSAIDs if relief is not obtained.
Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once
they occur. It may take several months or longer before the full
benefit of allopurinol is felt. Allopurinol may increase the number of
gout attacks during the first few months that it is taken, although it
,will eventually prevent attacks. Systemic steroids are reserved as a
second-line option for patients who cannot take NSAIDs.
◉ Atypical Antipsychotic adverse effects Answer: Orthostatic
hypotension and sedation are common side effects of atypical
antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel),
and risperidone (Risperdal). It is also a common side effect of the
older antipsychotics like haloperidol (Haldol). Antipsychotics do not
cause severe anxiety and decreased appetite. They lower anxiety
and cause sedation, sleepiness, anorexia, and hypotension, and
increase the risk of sudden death in frail elders.
◉ Which medication is contraindicated for bone loss? Answer: Long-
term use (>3 years) of medroxyprogesterone (Depo-Provera)
increases risk of bone loss. Avoid with osteopenia, osteoporosis,
long-term amenorrhea, or in underweight women with anorexia.
First-line treatment of osteoporosis is the biphosphanates. Lifestyle
measures are weight-bearing exercises and adequate calcium and
vitamin D intake.
◉ Prophylactic treatment for migraine headaches Answer:
Propranolol (Inderal) is a beta-blocker. Sufficient evidence and
consensus exist to recommend propranolol, timolol, amitriptyline,
divalproex, sodium valproate, and topiramate as first-line agents for
migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and
duration, and by increasing the responsiveness of acute migraines to
, treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen
(Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex)
are all medications used to treat symptoms of migraine headache
◉ Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3.
Theophylline 4. Xanax Answer: Alprazolam (Xanax) and other
benzodiazepines cause sedation and promote sleep. But selective
serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), can
cause insomnia in some patients. Other drug classes with
stimulating effects are decongestants, such as pseudoephedrine
(Sudafed), and methylxanthines such as theophylline (Theo-Dur)
and caffeine.
◉ Contraindication for Wellbutrin (bupropion) Answer: Bupropion
increases the risk of seizures. Contraindications are seizures,
anorexia nervosa, and bulimia. Avoid with any condition that
increases seizures, such as after abrupt withdrawal of alcohol or
sedatives and with certain head injuries. For peripheral neuropathy,
treatment options are an SNRI (duloxetine/Cymbalta), tricyclic
antidepressants, anticonvulsants, topical capsaicin cream, and
others.
◉ Recommended treatment for erythema migrans or early Lyme
disease Answer: Erythema migrans is the rash characteristic of Lyme
disease and it usually appears 7 to 10 days after a tick bite. Lyme
disease is caused by Borrelia burgdorferi, a spirochete. The rash
appears either as a single expanding red patch or a central spot
COMPLETE SOLUTIONS
◉ Pt with GERD abrupt stop of PPI, with Barrett's esophagus
Answer: This patient is having severe rebound symptoms caused by
abrupt cessation of the proton-pump inhibitor (PPI). In addition, he
has Barrett's esophagus, which increases the risk of esophageal
cancer. Neither an antacid nor an H2 blocker is likely to be effective
in controlling his symptoms. This question is a good example of the
ethical concept of beneficence
◉ Depo-Provera side effect after 5 years Answer: Depo-Provera
(contraceptive injection) is a progesterone hormone that causes
cessation of periods. One common side effect seen in women who
have been taking Depo-Provera for more than 5 years is
amenorrhea. As women continue using Depo-Provera, fewer
experience irregular bleeding and more experience amenorrhea. By
month 12, amenorrhea was reported by 55% of women, and by
month 24, amenorrhea was reported by 68% of women.
◉ NSAIDs affect which systems: Answer: Chronic use of nonsteroidal
anti-inflammatory drugs (NSAIDs) is associated with increased risk
of ulcers, perforation, and bleeding of the gastrointestinal tract,
heart attacks, cardiovascular damage, strokes, acute interstitial
nephritis and kidney injury, and liver damage. It does not affect the
lungs or the pulmonary system.
,◉ Watery diarrhea after hospitalization and Clindamycin therapy
Answer: Important risk factors for CDAD and C. difficile colitis are
antibiotic therapy and hospitalization. Almost any antibiotic can
cause the condition, but the most common are clindamycin,
cephalosporins, and fluoroquinolones. Diarrhea can occur during as
well as after therapy (5-10 days; up to 10 weeks).
Pseudomembranous colitis is a complication of C. difficile colitis.
◉ Drug interaction with Levothyroxine Answer: Levothyroxine does
not interact with penicillins. But it does have numerous drugs it
interacts with such as anticoagulants, tricyclic antidepressants,
antacids and calcium, iron, multivitamins, proton-pump inhibitors,
estrogens, statins, metformin, and others. Certain foods interfere
with absorption (calcium-fortified foods, dietary fiber, walnuts, soy).
Patients should avoid taking them together, and should space these
foods and drugs several hours apart. Levothyroxine (Synthroid) is a
synthetic form of T4.
◉ First line therapy for pain in acute exacerbation of gout Answer:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as
indomethacin (Indocin), have been used for the treatment of acute
gout. Colchicine may be added to the NSAIDs if relief is not obtained.
Maintenance therapy consists of allopurinol and/or probenecid.
Allopurinol is used to prevent gout attacks, not to treat them once
they occur. It may take several months or longer before the full
benefit of allopurinol is felt. Allopurinol may increase the number of
gout attacks during the first few months that it is taken, although it
,will eventually prevent attacks. Systemic steroids are reserved as a
second-line option for patients who cannot take NSAIDs.
◉ Atypical Antipsychotic adverse effects Answer: Orthostatic
hypotension and sedation are common side effects of atypical
antipsychotics such as olanzapine (Zyprexa), quetiapine (Seroquel),
and risperidone (Risperdal). It is also a common side effect of the
older antipsychotics like haloperidol (Haldol). Antipsychotics do not
cause severe anxiety and decreased appetite. They lower anxiety
and cause sedation, sleepiness, anorexia, and hypotension, and
increase the risk of sudden death in frail elders.
◉ Which medication is contraindicated for bone loss? Answer: Long-
term use (>3 years) of medroxyprogesterone (Depo-Provera)
increases risk of bone loss. Avoid with osteopenia, osteoporosis,
long-term amenorrhea, or in underweight women with anorexia.
First-line treatment of osteoporosis is the biphosphanates. Lifestyle
measures are weight-bearing exercises and adequate calcium and
vitamin D intake.
◉ Prophylactic treatment for migraine headaches Answer:
Propranolol (Inderal) is a beta-blocker. Sufficient evidence and
consensus exist to recommend propranolol, timolol, amitriptyline,
divalproex, sodium valproate, and topiramate as first-line agents for
migraine prevention. The goal of preventive therapy is to improve
patients' quality of life by reducing migraine frequency, severity, and
duration, and by increasing the responsiveness of acute migraines to
, treatment. A full therapeutic trial may take 2 to 6 months. Ibuprofen
(Motrin), naproxen sodium (Anaprox), and sumatriptan (Imitrex)
are all medications used to treat symptoms of migraine headache
◉ Which medication does not cause insomnia? 1. Zoloft 2. Sudafed 3.
Theophylline 4. Xanax Answer: Alprazolam (Xanax) and other
benzodiazepines cause sedation and promote sleep. But selective
serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft), can
cause insomnia in some patients. Other drug classes with
stimulating effects are decongestants, such as pseudoephedrine
(Sudafed), and methylxanthines such as theophylline (Theo-Dur)
and caffeine.
◉ Contraindication for Wellbutrin (bupropion) Answer: Bupropion
increases the risk of seizures. Contraindications are seizures,
anorexia nervosa, and bulimia. Avoid with any condition that
increases seizures, such as after abrupt withdrawal of alcohol or
sedatives and with certain head injuries. For peripheral neuropathy,
treatment options are an SNRI (duloxetine/Cymbalta), tricyclic
antidepressants, anticonvulsants, topical capsaicin cream, and
others.
◉ Recommended treatment for erythema migrans or early Lyme
disease Answer: Erythema migrans is the rash characteristic of Lyme
disease and it usually appears 7 to 10 days after a tick bite. Lyme
disease is caused by Borrelia burgdorferi, a spirochete. The rash
appears either as a single expanding red patch or a central spot
