lOMoARcPSD|27131152
FAMILY NURSE PRACTITIONER
CERTIFICATION INTENSIVE
REVIEW
, lOMoARcPSD|27131152
32
Answers With Rationales
1. A) Obtain a complete and thorough history Before prescribing medications, a thor-
ough history must be obtained to determine possible causes of hives. The patient denied
difficulty with swallowing and breathing, so there was no medical emergency that
would require calling 911.
2. B) Edema of the face and the upper extremities Common signs and symptoms of
pregnancy-induced hypertension include edema of the face and the upper extremities,
weight gain, blurred vision, elevated blood pressure, proteinuria, and headaches.
3. D) Tingling and numbness of both feet Vitamin B12 deficiency anemia can cause nerve
cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or
numbness in fingers and toes, difficulty walking, mood changes or depression, memory
loss, disorientation, and dementia.
4. A) Order an ultrasound Abnormally low levels of alpha fetoprotein and estriol and
high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultra-
sound should be ordered to further evaluate the fetus for characteristics of Down syn-
drome and/or fetal demise.
5. C) Most diverticula in the colon are infected with gram-negative bacteria Diverticula
in the colon can be infected with both gram-negative and gram-positive bacteria.
6. B) Chlamydia trachomatis When diagnosed with gonorrhea, the patient should also
be treated for Chlamydia trachomatis.
7. C) Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the
back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis)
contributes to this curvature in the spine. Symptoms that may occur with severe cases of
kyphosis include difficulty breathing, fatigue, and back pain.
8. B) Higher than normal Alpha fetoprotein (AFP) is produced in the fetal and maternal
liver. Higher levels of AFP are commonly seen in multiple gestations due to the growing
liver in each fetus, which cumulatively lead to higher AFP levels.
9. D) Thiazide diuretics Thiazide diuretics have a favorable effect in patients with osteo-
penia and osteoporosis by slowing down the kidney’s excretion of calcium and increas-
ing distal tubule calcium reabsorption. This results in decreased bone demineralization.
633
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
, lOMoARcPSD|27131152
634 VII. PRACTICE QUESTIONS AND ANSWERS
Thiazide diuretics are a good choice of therapy for this population because they treat
hypertension and slow bone loss.
10. A) Instability of the knee The Lachman maneuver is a test performed to assess for
knee instability (i.e., damage to the motion of anterior translation [laxity] of the anterior
cruciate ligament [ACL]) or tear of the ACL. The maneuver should be tested on both
knees, comparing the injured and the opposite knee, the uninjured knee is used as the
“control.” The test is positive if the injured knee slips back further (laxity). Perform the
test by bending the knee 30 degrees. Stabilize the femur with one hand. Place the other
hand under the proximal tibia at the level of the joint line and then pull forward. The
laxity is graded on a 0 (normal)-to-3 scale (1.0–1.5 cm of translation).
11. B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the
diuretic Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA)
inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to isch-
emia. NSAIDs can cause acute kidney injury by decreasing renal blood flow. Nonselective
NSAIDs can adversely affect the kidneys, GI tract, liver, cardiovascular system, and the
lungs (bronchospasm).
12. D) Chlamydia trachomatis Infections that commonly affect the labia and vagina
include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis com-
monly affects the cervix, endometrial lining, fallopian tubes, and pelvic cavity.
13. B) Acute appendicitis Signs and symptoms of an acute abdomen include involuntary
guarding, rebound tenderness, boardlike abdomen, and a positive obturator and psoas
sign. A positive obturator sign occurs when pain is elicted by internal rotation of the
right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs
with passive extension of the thigh while the patient is lying on his or her side with
knees extended, or when pain occurs with active flexion of the thigh at the hip.
14. D) A prescription of methyldopa (Aldomet) to control blood pressure Recommended
care for women diagnosed with preeclampsia includes bed rest with bathroom privileges,
weight and blood pressure monitoring, and closely following urine protein and serum pro-
tein, creatinine, and platelet counts. Oral medications are not used as first-line treatment.
15. C) Custodial care Medicare Parts A and B do not cover custodial care or nursing home
care (help with bathing, dressing, using bathroom, and eating). Medicare Part A cover-
age includes inpatient hospitalization, inpatient psychiatric hospitalization, and skilled
care given in a certified skilled nursing facility (SNF).
16. B) Atypical pneumonia The most common organism causing community-acquired
atypical pneumonia is Mycoplasma pneumoniae, an atypical bacterium. The populations
with the highest infection rates are college students, school-aged children, and military
recruits. Respiratory symptoms (cough) are accompanied by pharyngitis, rhinorrhea,
and sometimes ear pain. It is easily spread from aerosol droplets.
17. C) 10 mm The Mantoux tuberculin skin test is administered on the volar aspect of the
lower arm (nondominant arm preferred) and read 48 to 72 hours after the test is given.
An induration of 10 mm or larger is considered as positive among recent immigrants (<5
years) from high-prevalence countries. If the site has erythema but no induration, the
result would be negative. Color is not important.
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
, lOMoARcPSD|27131152
32. ANSWERS WITH RATIONALES 635
18. B) The agent can make decisions in other areas of the patient’s life such as financial
issues The person named in a durable power of attorney (the agent or proxy) is desig-
nated by the patient to make all medical decisions, as well as any decisions regarding the
patient’s private affairs in the event that the patient becomes incompetent and unable to
make his or her own decisions. This is dependent on the type of power of attorney that
is instituted. B) is the right answer only if so stated in the power of attorney. Generally,
a spouse cannot override the power of attorney. Do not confuse with the durable power
of attorney for health care, who legally can only make health-related decisions for the
patient.
19. B) The patient has a medical illness that causes an anxiety reaction and
denial Munchausen syndrome is a psychiatric disorder in which the patient fakes a
medical illness or disorder to gain attention from health care providers. These patients
often use the emergency department to gain attention.
20. C) Beta-blockers Beta-blockers should be avoided in patients with a history of emphy-
sema. Studies have shown evidence of a reduction in forced expiratory volume in 1
second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator
response to beta agonists in patients receiving beta-blockers.
21. A) On deep inspiration by the patient, palpate firmly in the right upper quadrant
of the abdomen below the costovertebral angle Murphy’s sign is tested during an
abdominal examination for biliary disorders. As the patient breathes in, the abdominal
contents are pushed downward as the diaphragm moves down and the lungs expand.
As the patient stops/hold the breath, the gallbladder comes in contact with the exam-
iner’s fingers and may elicit pain. To be considered positive, the same maneuver must
not elicit pain when performed on the left side. A negative Murphy’s test in the elderly
is not useful for ruling out cholecystitis if history and other tests suggest the diagnosis.
22. B) Placenta previa Placenta previa occurs when the placenta implants abnormally,
partially, or wholly, in the lower segment of the uterus or over the internal os. A clas-
sic presentation is painless bright-red vaginal bleeding in the second and/or third tri-
mester. Do not perform digital cervical in any pregnant women with bleeding until the
position of the uterus is known (abdominal ultrasound). Avoid vaginal exam, sexual
intercourse, or rectal exam if placenta previa is suspected.
23. A) Middle-aged to older women Hashimoto’s disease (Hashimoto’s thyroiditis, or
chronic lymphocytic thyroiditis) is an autoimmune disease. An enlarged thyroid is most
often the first sign of the disease. Hashimoto’s disease is about seven times more com-
mon in women than in men. It can occur in teens and young women, but is more com-
mon in middle age.
24. C) Severe vaginal atrophic changes As women reach menopause, changes that may
occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal
changes, such as dryness and thinning, may also begin to occur. Vaginal atrophy (atrophic
vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estro-
gen. Vaginal atrophy occurs most often after menopause and worsens as women get older.
25. B) Arteriovenous (AV) nicking, left ventricular hypertrophy, and stroke AV nicking
and copper wire/silver wire arterioles are signs of hypertensive retinopathy, left
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
FAMILY NURSE PRACTITIONER
CERTIFICATION INTENSIVE
REVIEW
, lOMoARcPSD|27131152
32
Answers With Rationales
1. A) Obtain a complete and thorough history Before prescribing medications, a thor-
ough history must be obtained to determine possible causes of hives. The patient denied
difficulty with swallowing and breathing, so there was no medical emergency that
would require calling 911.
2. B) Edema of the face and the upper extremities Common signs and symptoms of
pregnancy-induced hypertension include edema of the face and the upper extremities,
weight gain, blurred vision, elevated blood pressure, proteinuria, and headaches.
3. D) Tingling and numbness of both feet Vitamin B12 deficiency anemia can cause nerve
cell damage if not treated. Symptoms of B12 deficiency anemia may include tingling or
numbness in fingers and toes, difficulty walking, mood changes or depression, memory
loss, disorientation, and dementia.
4. A) Order an ultrasound Abnormally low levels of alpha fetoprotein and estriol and
high levels of human chorionic gonadotropin are abnormal during pregnancy. An ultra-
sound should be ordered to further evaluate the fetus for characteristics of Down syn-
drome and/or fetal demise.
5. C) Most diverticula in the colon are infected with gram-negative bacteria Diverticula
in the colon can be infected with both gram-negative and gram-positive bacteria.
6. B) Chlamydia trachomatis When diagnosed with gonorrhea, the patient should also
be treated for Chlamydia trachomatis.
7. C) Osteoporosis Kyphosis is a curvature of the spine that causes a rounding of the
back, which leads to a slouching posture. Severe thinning of the bones (osteoporosis)
contributes to this curvature in the spine. Symptoms that may occur with severe cases of
kyphosis include difficulty breathing, fatigue, and back pain.
8. B) Higher than normal Alpha fetoprotein (AFP) is produced in the fetal and maternal
liver. Higher levels of AFP are commonly seen in multiple gestations due to the growing
liver in each fetus, which cumulatively lead to higher AFP levels.
9. D) Thiazide diuretics Thiazide diuretics have a favorable effect in patients with osteo-
penia and osteoporosis by slowing down the kidney’s excretion of calcium and increas-
ing distal tubule calcium reabsorption. This results in decreased bone demineralization.
633
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
, lOMoARcPSD|27131152
634 VII. PRACTICE QUESTIONS AND ANSWERS
Thiazide diuretics are a good choice of therapy for this population because they treat
hypertension and slow bone loss.
10. A) Instability of the knee The Lachman maneuver is a test performed to assess for
knee instability (i.e., damage to the motion of anterior translation [laxity] of the anterior
cruciate ligament [ACL]) or tear of the ACL. The maneuver should be tested on both
knees, comparing the injured and the opposite knee, the uninjured knee is used as the
“control.” The test is positive if the injured knee slips back further (laxity). Perform the
test by bending the knee 30 degrees. Stabilize the femur with one hand. Place the other
hand under the proximal tibia at the level of the joint line and then pull forward. The
laxity is graded on a 0 (normal)-to-3 scale (1.0–1.5 cm of translation).
11. B) It inhibits the effect of renal prostaglandins and blunts the effectiveness of the
diuretic Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA)
inhibit the vasodilatory effects of prostaglandins, which predisposes the kidney to isch-
emia. NSAIDs can cause acute kidney injury by decreasing renal blood flow. Nonselective
NSAIDs can adversely affect the kidneys, GI tract, liver, cardiovascular system, and the
lungs (bronchospasm).
12. D) Chlamydia trachomatis Infections that commonly affect the labia and vagina
include bacterial vaginosis, candidiasis, and trichomoniasis. Chlamydia trachomatis com-
monly affects the cervix, endometrial lining, fallopian tubes, and pelvic cavity.
13. B) Acute appendicitis Signs and symptoms of an acute abdomen include involuntary
guarding, rebound tenderness, boardlike abdomen, and a positive obturator and psoas
sign. A positive obturator sign occurs when pain is elicted by internal rotation of the
right hip from 90 degrees hip/knee flexion. The psoas sign is positive when pain occurs
with passive extension of the thigh while the patient is lying on his or her side with
knees extended, or when pain occurs with active flexion of the thigh at the hip.
14. D) A prescription of methyldopa (Aldomet) to control blood pressure Recommended
care for women diagnosed with preeclampsia includes bed rest with bathroom privileges,
weight and blood pressure monitoring, and closely following urine protein and serum pro-
tein, creatinine, and platelet counts. Oral medications are not used as first-line treatment.
15. C) Custodial care Medicare Parts A and B do not cover custodial care or nursing home
care (help with bathing, dressing, using bathroom, and eating). Medicare Part A cover-
age includes inpatient hospitalization, inpatient psychiatric hospitalization, and skilled
care given in a certified skilled nursing facility (SNF).
16. B) Atypical pneumonia The most common organism causing community-acquired
atypical pneumonia is Mycoplasma pneumoniae, an atypical bacterium. The populations
with the highest infection rates are college students, school-aged children, and military
recruits. Respiratory symptoms (cough) are accompanied by pharyngitis, rhinorrhea,
and sometimes ear pain. It is easily spread from aerosol droplets.
17. C) 10 mm The Mantoux tuberculin skin test is administered on the volar aspect of the
lower arm (nondominant arm preferred) and read 48 to 72 hours after the test is given.
An induration of 10 mm or larger is considered as positive among recent immigrants (<5
years) from high-prevalence countries. If the site has erythema but no induration, the
result would be negative. Color is not important.
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
, lOMoARcPSD|27131152
32. ANSWERS WITH RATIONALES 635
18. B) The agent can make decisions in other areas of the patient’s life such as financial
issues The person named in a durable power of attorney (the agent or proxy) is desig-
nated by the patient to make all medical decisions, as well as any decisions regarding the
patient’s private affairs in the event that the patient becomes incompetent and unable to
make his or her own decisions. This is dependent on the type of power of attorney that
is instituted. B) is the right answer only if so stated in the power of attorney. Generally,
a spouse cannot override the power of attorney. Do not confuse with the durable power
of attorney for health care, who legally can only make health-related decisions for the
patient.
19. B) The patient has a medical illness that causes an anxiety reaction and
denial Munchausen syndrome is a psychiatric disorder in which the patient fakes a
medical illness or disorder to gain attention from health care providers. These patients
often use the emergency department to gain attention.
20. C) Beta-blockers Beta-blockers should be avoided in patients with a history of emphy-
sema. Studies have shown evidence of a reduction in forced expiratory volume in 1
second (FEV1), increased airway hyperresponsiveness, and inhibition of bronchodilator
response to beta agonists in patients receiving beta-blockers.
21. A) On deep inspiration by the patient, palpate firmly in the right upper quadrant
of the abdomen below the costovertebral angle Murphy’s sign is tested during an
abdominal examination for biliary disorders. As the patient breathes in, the abdominal
contents are pushed downward as the diaphragm moves down and the lungs expand.
As the patient stops/hold the breath, the gallbladder comes in contact with the exam-
iner’s fingers and may elicit pain. To be considered positive, the same maneuver must
not elicit pain when performed on the left side. A negative Murphy’s test in the elderly
is not useful for ruling out cholecystitis if history and other tests suggest the diagnosis.
22. B) Placenta previa Placenta previa occurs when the placenta implants abnormally,
partially, or wholly, in the lower segment of the uterus or over the internal os. A clas-
sic presentation is painless bright-red vaginal bleeding in the second and/or third tri-
mester. Do not perform digital cervical in any pregnant women with bleeding until the
position of the uterus is known (abdominal ultrasound). Avoid vaginal exam, sexual
intercourse, or rectal exam if placenta previa is suspected.
23. A) Middle-aged to older women Hashimoto’s disease (Hashimoto’s thyroiditis, or
chronic lymphocytic thyroiditis) is an autoimmune disease. An enlarged thyroid is most
often the first sign of the disease. Hashimoto’s disease is about seven times more com-
mon in women than in men. It can occur in teens and young women, but is more com-
mon in middle age.
24. C) Severe vaginal atrophic changes As women reach menopause, changes that may
occur include hot flashes, irregular menstrual periods, and cyclic mood swings. Vaginal
changes, such as dryness and thinning, may also begin to occur. Vaginal atrophy (atrophic
vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estro-
gen. Vaginal atrophy occurs most often after menopause and worsens as women get older.
25. B) Arteriovenous (AV) nicking, left ventricular hypertrophy, and stroke AV nicking
and copper wire/silver wire arterioles are signs of hypertensive retinopathy, left
Leik, Maria T. Codina, MSN, ARNP, FNP-C, AGPCNP-BC. Family Nurse Practitioner Certification Intensive Review, Third Edition : Fast Facts and
Practice Questions, Springer Publishing Company, 2017..
Created from villanova-ebooks on 2021-10-13 13:07:05.
.
..
