Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
A nurse practitioner working in a community health clinic sees a male patient who expresses
concern about starting a homosexual relationship with a new partner. Which of the following is
the best plan to follow during this visit? (Select all that apply.)
Contact the patient's partner to schedule HIV testing
Educate the patient about using barrier devices during sex
Prescribe daily oral PrEP
Draw a blood sample for a combination HIV antigen/antibody test
Schedule a follow-up appointment in 1 month to review test results and discuss options for
PrEP - correct answer Educate the patient about using barrier devices during sex; draw a blood
sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1
month to review test results and discuss options for PrEP
Education on using barriers during sexual activity (e.g., condom/dental dams) is important.
Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for
sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the
nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule
a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is
not appropriate ethically or legally to contact the partner; however, it would be appropriate for
the patient to encourage his partner to get tested.
An older adult male presents with complaints of sharp flank and back pain. The patient has
difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The
patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which
diagnosis is most likely?
Congestive heart failure
Infective endocarditis
Dissecting abdominal aortic aneurysm
Acute myocardial infarction - correct answer Dissecting abdominal aortic aneurysm.
Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain
located in the abdomen, back, or flank area, accompanied by a distended abdomen and
hypotension. Older male adults with a smoking history and hypertension are at higher risk.
Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and
ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with
the presence of a new murmur. Acute myocardial infarction generally presents with a gradual
,Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy
pressure in the chest.
Mrs. Harris a 67-year-old woman who is in the early stages of Alzheimer disease. She suffers
from mild dementia. In this type of Alzheimer dementia which of the following would you use
as the mainstay treatment?
Vitamin E 1000 IU twice daily
cholinesterase inhibitors
NSAIDS
Selgiline 5 mg twice daily - correct answer cholinesterase inhibitors
The mainstay treatment for mild to moderate stage Alzheimer-type dementia is the use of
cholinesterase inhibitors. These include donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Razadyne). They have a clear, although minor and time-limited benefit.
When listening to your 86-year-old patient's heart murmur, you note that it is so loud that it
can be heard with the stethoscope completely off the chest. How do you grade the murmur?
IV/VI.
I/VI.
V/VI.
VI/VI. - correct answer VI/VI.
Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not
be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon
as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart
murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can
be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can
be heard with the stethoscope completely off the patient's chest.
Which of the following persons would not be a candidate for the antipneumococcal vaccine?
a 65-year-old healthy female living with her family
,Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
a 35-year-old patient with HIV infection
a 58-year-old male resident of a nursing home
a 55-year-old female living alone - correct answer a 55-year-old female living alone
The antipneumococcal vaccine is not indicated for an otherwise healthy person who is under
the age of 65 unless there are other health factors involved. Living alone has no bearing on the
need for the vaccine. The vaccine is indicated for persons with HIV infection, persons living in
nursing homes, and all adults 65 years or older regardless of health status.
Which of the following diseases is more likely to cause chronic pelvic pain rather than acute
pelvic pain?
ectopic pregnancy
PID
ovarian cysts
interstitial cystitis - correct answer interstitial cystitisInterstitial cystitis is more likely to cause
chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic
pelvic pain include: endometriosis, leiomyomas, and malignancy.
You have a 58-year-old male patient with possible pancreatic cancer. You will not order an
abdominal ultrasound for diagnosis because it is limited by which of the following?
previous history of pancreatic disease
patient's age
the presence of intestinal gas
size of tumor - correct answer the presence of intestinal gas
The usefulness of abdominal ultrasound is limited by the presence of intestinal gas. Abdominal
CT scan is more helpful in identifying pancreatic cancer.
A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for
Type II diabetes mellitus. What should be done to manage him FIRST?
, Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
Start insulin
Start metformin plus pioglitazone
Have him return tomorrow to recheck his blood glucose
Start metformin - correct answer Start insulin
Most oral agents will have little effect on his glucose and it should be lowered immediately.
Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a
chance to work. He should return to the clinic the next day for a recheck of the blood glucose
and medication adjustment.
Utilization review can best be described as which of the following?
a system of monitoring and assessing for high-risk areas and procedures
the process of evaluating the appropriateness of inpatient hospitalization
the process used for accreditation
the process used for case management - correct answer the process of evaluating the
appropriateness of inpatient hospitalization
A utilization review is the process of evaluating the appropriateness of inpatient hospitalization.
Proof of the medical necessity for the patient's hospitalization is done mainly through chart
reviews. If the reviewer and payor do not agree, the claim can be denied, resulting in denial of
payment to the health facility.
John is a patient with acute renal failure. His inability to regulate electrolytes might be
evidenced by all but which of the following conditions?
hyperkalemia
hyperlipidemia
hypocalcemia
hypernatremia - correct answer hyperlipidemia
A nurse practitioner working in a community health clinic sees a male patient who expresses
concern about starting a homosexual relationship with a new partner. Which of the following is
the best plan to follow during this visit? (Select all that apply.)
Contact the patient's partner to schedule HIV testing
Educate the patient about using barrier devices during sex
Prescribe daily oral PrEP
Draw a blood sample for a combination HIV antigen/antibody test
Schedule a follow-up appointment in 1 month to review test results and discuss options for
PrEP - correct answer Educate the patient about using barrier devices during sex; draw a blood
sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1
month to review test results and discuss options for PrEP
Education on using barriers during sexual activity (e.g., condom/dental dams) is important.
Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for
sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the
nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule
a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is
not appropriate ethically or legally to contact the partner; however, it would be appropriate for
the patient to encourage his partner to get tested.
An older adult male presents with complaints of sharp flank and back pain. The patient has
difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The
patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which
diagnosis is most likely?
Congestive heart failure
Infective endocarditis
Dissecting abdominal aortic aneurysm
Acute myocardial infarction - correct answer Dissecting abdominal aortic aneurysm.
Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain
located in the abdomen, back, or flank area, accompanied by a distended abdomen and
hypotension. Older male adults with a smoking history and hypertension are at higher risk.
Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and
ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with
the presence of a new murmur. Acute myocardial infarction generally presents with a gradual
,Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy
pressure in the chest.
Mrs. Harris a 67-year-old woman who is in the early stages of Alzheimer disease. She suffers
from mild dementia. In this type of Alzheimer dementia which of the following would you use
as the mainstay treatment?
Vitamin E 1000 IU twice daily
cholinesterase inhibitors
NSAIDS
Selgiline 5 mg twice daily - correct answer cholinesterase inhibitors
The mainstay treatment for mild to moderate stage Alzheimer-type dementia is the use of
cholinesterase inhibitors. These include donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Razadyne). They have a clear, although minor and time-limited benefit.
When listening to your 86-year-old patient's heart murmur, you note that it is so loud that it
can be heard with the stethoscope completely off the chest. How do you grade the murmur?
IV/VI.
I/VI.
V/VI.
VI/VI. - correct answer VI/VI.
Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not
be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon
as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart
murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can
be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can
be heard with the stethoscope completely off the patient's chest.
Which of the following persons would not be a candidate for the antipneumococcal vaccine?
a 65-year-old healthy female living with her family
,Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
a 35-year-old patient with HIV infection
a 58-year-old male resident of a nursing home
a 55-year-old female living alone - correct answer a 55-year-old female living alone
The antipneumococcal vaccine is not indicated for an otherwise healthy person who is under
the age of 65 unless there are other health factors involved. Living alone has no bearing on the
need for the vaccine. The vaccine is indicated for persons with HIV infection, persons living in
nursing homes, and all adults 65 years or older regardless of health status.
Which of the following diseases is more likely to cause chronic pelvic pain rather than acute
pelvic pain?
ectopic pregnancy
PID
ovarian cysts
interstitial cystitis - correct answer interstitial cystitisInterstitial cystitis is more likely to cause
chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic
pelvic pain include: endometriosis, leiomyomas, and malignancy.
You have a 58-year-old male patient with possible pancreatic cancer. You will not order an
abdominal ultrasound for diagnosis because it is limited by which of the following?
previous history of pancreatic disease
patient's age
the presence of intestinal gas
size of tumor - correct answer the presence of intestinal gas
The usefulness of abdominal ultrasound is limited by the presence of intestinal gas. Abdominal
CT scan is more helpful in identifying pancreatic cancer.
A 58-year-old male presents in the office with a glucose of 309 mg/dL and is symptomatic for
Type II diabetes mellitus. What should be done to manage him FIRST?
, Leik /Exam Edge FNP Review, First Exam Edge - ANCC prep test Part 1., PSI FNP Practice
Start insulin
Start metformin plus pioglitazone
Have him return tomorrow to recheck his blood glucose
Start metformin - correct answer Start insulin
Most oral agents will have little effect on his glucose and it should be lowered immediately.
Therefore, insulin is the best agent to reduce the blood sugar so that oral agents will have a
chance to work. He should return to the clinic the next day for a recheck of the blood glucose
and medication adjustment.
Utilization review can best be described as which of the following?
a system of monitoring and assessing for high-risk areas and procedures
the process of evaluating the appropriateness of inpatient hospitalization
the process used for accreditation
the process used for case management - correct answer the process of evaluating the
appropriateness of inpatient hospitalization
A utilization review is the process of evaluating the appropriateness of inpatient hospitalization.
Proof of the medical necessity for the patient's hospitalization is done mainly through chart
reviews. If the reviewer and payor do not agree, the claim can be denied, resulting in denial of
payment to the health facility.
John is a patient with acute renal failure. His inability to regulate electrolytes might be
evidenced by all but which of the following conditions?
hyperkalemia
hyperlipidemia
hypocalcemia
hypernatremia - correct answer hyperlipidemia
