ANCC FNP review questions
Forty three-yr-old affected person with past medical records of mild bronchial asthma in his
adolescence affords for control of high blood pressure. He has heard that some
antihypertensive medicinal drugs can worsen inhaling asthmatic patients. Which of the following
medicinal drugs could be maximum probable to purpose bronchospasm in a patient with
allergies?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Bisoprolol - ANS-Correct Answer: C. Propranolol
Propranolol is the only beta-blocker indexed with is non-selective. Beta-blockers can be
cardioselective, or non- selective. Cardioselectivity refers back to the potential to affect
predominantly beta 1 receptors in place of beta 2 receptors. Beta 1 receptors are placed mainly
in the coronary heart and mediate the sympathetic frightened device's direct effects on the
coronary heart. Beta 2 receptors are placed predominantly inside the peripheral vascular
system and different organs like the lungs. Although all beta-blockers have an effect on beta
receptors, some have an effect on subsets of receptors otherwise. This has substantial
consequences in phrases of side consequences, as beta-blockers are recognised to cause
extra-cardiac signs which include worsened bronchospasms in asthmatics. Although beta-1
selective blockers are more secure than nonselective beta blockers, and might be favored in
patients with bronchial asthma, they ought to nevertheless be used with caution in sufferers with
asthma, specifically in people with intense obstruction or markedly reduced pulmonary
characteristic at baseline.
Incorrect Answers:
A. B. And D. These are all cardioselective beta-blockers.
A 10-month-old girl with no previous scientific records presents to the emergency room with
signs of bronchiolitis. The patient's mother and father document that she developed a cough 3
days ago, and nowadays she evolved rhinorrhea, wheezing, and a fever of a hundred.4°F.
Physical exam reveals a temperature of a hundred.5°F, and wheezing is evident on pulmonary
examination. Physical examination also reveals proper tympanic membrane fullness, with lack
of mild reflex and erythema. The patient keeps pulling on her ear. It is December, and this is the
tenth affected person this month who has provided with the identical signs. Which of the
subsequent is the most suitable remedy for this patient?
A. Amoxicillin with analgesics
B. Bronchodilators
C. Corticosteroids
D. Ribavirin - ANS-Correct Answer: A. Amoxicillin with analgesics
,The affected person's age, decrease respiration tract signs and symptoms, and the spike in
instances seen in the course of this time of year imply that the affected person most probably
has respiratory syncytial virus (RSV). RSV is a viral contamination that attacks the decrease
respiratory tract, causing bronchiolitis or pneumonia. While RSV generally influences young
kids, it may be seen in adults. While clear-cut RSV is dealt with with supportive therapy, the
affected person also has proof of otitis media. The 2013 AAP/AAFP guiding principle
recommends both immediate treatment or observation (with ache manipulate) for youngsters
between 6 and 24 months with unilateral nonsevere AOM and for kids ≥24 months with
unilateral or bilateral nonsevere AOM. Since this infant has proof of unilateral AOM, either
statement or treatment with antibiotics are appropriate. Individually randomized trials that used
stringent diagnostic criteria verified that kids below the age of blessings from antibiotic therapy,
inclusive of people with nonsevere unilateral AOM.
Incorrect Answers:
B. Bronchodilators aren't advocated for the recurring treatment of RSV bronchiolitis. While
bronchodilators may offer modest short-term improvement, they do now not improve
lengthy-time period consequences and may have unfavorable consequences. Bronchodilators
additionally boom the fee of care and ought to best be used if a unmarried trial ends in a spark
off favorable response.
C. Corticosteroids are not endorsed for the recurring remedy of RSV bronchiolitis in infants.
However, corticosteroids can be beneficial in older kids and adults who have RSV-associated
bronchial reactivity, especially the ones who've a history of asthma that could were exacerbated
by the recent RSV infection. Corticosteroids can probably lower bronchial swelling and airway
obstruction through their inh
A 12-12 months-vintage boy complains of abrupt onset of scrotal pain upon awakening this
morning. He has had nausea and vomiting for the past hour. He is afebrile and his heart rate is
100/minute. His scrotum is purple and swollen and the proper testicle is higher than the left.
When you stroke the internal thigh at the proper, there is no movement of the testicle. Which of
the subsequent is an indicated treatment for this condition?
A. Manual reduction
B. Antibiotics
C. Topical azole cream
D. Chemotherapy - ANS-Correct Answer: A. Manual reduction
The patient, in this example, has a presentation constant with testicular torsion. Patients with
testicular torsion are usually younger men among the a while of 10 and 20. They will bitch of
unexpected onset of scrotal ache, usually inside the middle of the night or upon awakening. The
scrotum could be pink and swollen and the affected testicle is usually positioned better than the
unaffected testicle, regularly closer to the body. The cremasteric reflex refers to elevation of the
testicle whilst the ipsilateral thigh is stroked. This reflex is absent in testicular torsion. Testicular
torsion is a urologic emergency. Torsion interrupts the blood deliver to the testicle and
everlasting harm ensues if no longer decreased inside 6 hours. After 24 hours, the testicle turns
into gangrenous and need to be surgically removed. The nurse practitioner ought to call 911 and
the affected person should go through Doppler ultrasound inside the ED. Manual detorsion can
,be achieved within the ED through the "open e book" maneuver, but a surgical reduction is vital
if a guide reduction is unsuccessful.
Incorrect Answers:
B. Antibiotics would be appropriate for the treatment of epididymitis.C. Topical azole creams are
used to deal with balanitis, which is candida infection of the glans penis.
D. Chemotherapy is appropriate for testicular cancer, which generally offers in young male
adults who complain of a sensation of heaviness or aching a nodule or testicular expansion, or
testicular tenderness.
A 12-year-vintage male patient present for assessment of a painful pimple on his eyelid. On
exam, you find a 3 mm fluctuant pustule on the margin his right eyelid without a exudate. What
is that this possibly to be?
A. Chalazion
B. Molluscum contagiosum
C. Hordeolum
D. Blepharitis - ANS-Correct Answer: C. Hordeolum
A hordeolum is likewise called a stye. It is a painful contamination of the meibomian gland, so
located at the margin of the eyelid. It is treated with warm compresses for 10 mins TID and
erythromycin ointment will also be delivered.
Incorrect Answers:
A. A chalazion is a subcutaneous nodule that results from blockage of the meibomian gland, but
are commonly not due to contamination. May be associated with a hordeolum.
B. Molluscum contagiosum are small nodules with a primary umbilication that could seem at the
face or eyelids. They are due to a pandemic and must no longer be painful.
D. Blepharitis is infection of the eyelid margin.
Vital Concepts:
A hordeolum is also referred to as a stye. It is a painful infection of the meibomian gland, so
located at the margin of the eyelid. It is handled with warm compresses for 10 minutes TID and
erythromycin ointment will also be delivered.
A 14-year-old lady basketball player affords with anterior knee ache this is exacerbated via
leaping. She denies any particular injury. There is not any effusion, joint-line tenderness, or
instability. She has tenderness to palpation over the tibial tubercle. What is the maximum
probable prognosis, and what's the perfect management?
A. Meniscal tear and arthroscopic surgical operation
B. Osgood-Schlatter disorder and relaxation, ice, and anti-inflammatories
C. Anterior cruciate ligament tear and physical therapy
D. Patellofemoral pain syndrome and realignment surgical operation - ANS-Correct Answer: B.
Osgood-Schlatter disorder and rest, ice, and anti-inflammatories
Osgood-Schlatter is the eponym used for anterior knee pain this is regularly determined in
adolescents. As they develop, their bones prolong faster than their tendons, that may result in
apophysitis of the tibial tubercle. Management is rest from activity, stretching, and
, anti-inflammatories. Pain often resolves as soon as growth has ceased. Occasionally, surgical
procedure is required if the apophysis will become avulsed.
Incorrect Answers:
A. Effusions are common in meniscal accidents. There is no records of twisting or precise
damage. She has no joint-line tenderness. In addition, no longer all meniscal accidents require
surgical procedure.
C. Effusions are common with ACL tears. The standard treatment is reconstructive surgical
procedure if there are continual signs of instability.
D. PFPS signs encompass tenderness at the patellar sides and a effective grind check. While a
number of the signs are comparable in PFPS and Osgood-Schlatter disease, an appropriate
treatment for PFPS is physical therapy, now not realignment surgical treatment.
A 14-yr-antique woman affords for a pre-sports activities bodily. She complains of back
soreness while she "sits at college for a long term." Her exam well-knownshows scoliosis with a
left-sided curve. An MRI of the spine is indicated to rule out which of the subsequent situations?
A. Intraspinal syrinx
B. Narrowing of disk space
C. Schmorl nodes
D. Irregularities in vertebral endplates - ANS-Correct Answer: A. Intraspinal syrinx
About 80% of scoliosis cases seem as a proper thoracic curve. A left-sided pattern is related to
danger for intraspinal syrinx or tumor, which can be detected on MRI. The the rest of findings
are associated with Schneurmann kyphosis, the 2nd-maximum common cause of spinal
deformities in pediatrics. A scoliotic curve must degree greater than or same to ten ranges on a
spinal radiograph via the Cobb method (a unique tool that measures the attitude on radiograph)
to meet the criteria for diagnosing scoliosis, however most patients do now not show off
clinically large respiration symptoms until the curves degree 60 to a hundred degrees.
The USPSTF states that treating idiopathic scoliosis during early life ends in fitness blessings in
simplest a small fraction of sufferers. Most of the instances detected through screening do now
not come to be clinically giant, and scoliosis that requires competitive treatment/operative
remedy is likely to be detected with out screening because these patients are ultimately
symptomatic.
Incorrect Answers:
(B) Narrowing of disk space may be evaluated with an x-ray. Given this affected person's
left-sided curve, the intraspinal syrinx is extra critical to rule out with an MRI.
(C) Schmorl nodes are intervertebral disc herniations that motive protrusion into another
vertebra. While this may cause the affected person's back discomfort, it would no longer lead to
a left-sided sample which became determined at the bodily exam.
(D) Irregularities in vertebral endplates are related to degenerative disc sickness.While this
could motive the affected person's back discomfort, it'd now not cause a left-sided pattern which
became determined on the bodily examination.
Forty three-yr-old affected person with past medical records of mild bronchial asthma in his
adolescence affords for control of high blood pressure. He has heard that some
antihypertensive medicinal drugs can worsen inhaling asthmatic patients. Which of the following
medicinal drugs could be maximum probable to purpose bronchospasm in a patient with
allergies?
A. Metoprolol
B. Atenolol
C. Propranolol
D. Bisoprolol - ANS-Correct Answer: C. Propranolol
Propranolol is the only beta-blocker indexed with is non-selective. Beta-blockers can be
cardioselective, or non- selective. Cardioselectivity refers back to the potential to affect
predominantly beta 1 receptors in place of beta 2 receptors. Beta 1 receptors are placed mainly
in the coronary heart and mediate the sympathetic frightened device's direct effects on the
coronary heart. Beta 2 receptors are placed predominantly inside the peripheral vascular
system and different organs like the lungs. Although all beta-blockers have an effect on beta
receptors, some have an effect on subsets of receptors otherwise. This has substantial
consequences in phrases of side consequences, as beta-blockers are recognised to cause
extra-cardiac signs which include worsened bronchospasms in asthmatics. Although beta-1
selective blockers are more secure than nonselective beta blockers, and might be favored in
patients with bronchial asthma, they ought to nevertheless be used with caution in sufferers with
asthma, specifically in people with intense obstruction or markedly reduced pulmonary
characteristic at baseline.
Incorrect Answers:
A. B. And D. These are all cardioselective beta-blockers.
A 10-month-old girl with no previous scientific records presents to the emergency room with
signs of bronchiolitis. The patient's mother and father document that she developed a cough 3
days ago, and nowadays she evolved rhinorrhea, wheezing, and a fever of a hundred.4°F.
Physical exam reveals a temperature of a hundred.5°F, and wheezing is evident on pulmonary
examination. Physical examination also reveals proper tympanic membrane fullness, with lack
of mild reflex and erythema. The patient keeps pulling on her ear. It is December, and this is the
tenth affected person this month who has provided with the identical signs. Which of the
subsequent is the most suitable remedy for this patient?
A. Amoxicillin with analgesics
B. Bronchodilators
C. Corticosteroids
D. Ribavirin - ANS-Correct Answer: A. Amoxicillin with analgesics
,The affected person's age, decrease respiration tract signs and symptoms, and the spike in
instances seen in the course of this time of year imply that the affected person most probably
has respiratory syncytial virus (RSV). RSV is a viral contamination that attacks the decrease
respiratory tract, causing bronchiolitis or pneumonia. While RSV generally influences young
kids, it may be seen in adults. While clear-cut RSV is dealt with with supportive therapy, the
affected person also has proof of otitis media. The 2013 AAP/AAFP guiding principle
recommends both immediate treatment or observation (with ache manipulate) for youngsters
between 6 and 24 months with unilateral nonsevere AOM and for kids ≥24 months with
unilateral or bilateral nonsevere AOM. Since this infant has proof of unilateral AOM, either
statement or treatment with antibiotics are appropriate. Individually randomized trials that used
stringent diagnostic criteria verified that kids below the age of blessings from antibiotic therapy,
inclusive of people with nonsevere unilateral AOM.
Incorrect Answers:
B. Bronchodilators aren't advocated for the recurring treatment of RSV bronchiolitis. While
bronchodilators may offer modest short-term improvement, they do now not improve
lengthy-time period consequences and may have unfavorable consequences. Bronchodilators
additionally boom the fee of care and ought to best be used if a unmarried trial ends in a spark
off favorable response.
C. Corticosteroids are not endorsed for the recurring remedy of RSV bronchiolitis in infants.
However, corticosteroids can be beneficial in older kids and adults who have RSV-associated
bronchial reactivity, especially the ones who've a history of asthma that could were exacerbated
by the recent RSV infection. Corticosteroids can probably lower bronchial swelling and airway
obstruction through their inh
A 12-12 months-vintage boy complains of abrupt onset of scrotal pain upon awakening this
morning. He has had nausea and vomiting for the past hour. He is afebrile and his heart rate is
100/minute. His scrotum is purple and swollen and the proper testicle is higher than the left.
When you stroke the internal thigh at the proper, there is no movement of the testicle. Which of
the subsequent is an indicated treatment for this condition?
A. Manual reduction
B. Antibiotics
C. Topical azole cream
D. Chemotherapy - ANS-Correct Answer: A. Manual reduction
The patient, in this example, has a presentation constant with testicular torsion. Patients with
testicular torsion are usually younger men among the a while of 10 and 20. They will bitch of
unexpected onset of scrotal ache, usually inside the middle of the night or upon awakening. The
scrotum could be pink and swollen and the affected testicle is usually positioned better than the
unaffected testicle, regularly closer to the body. The cremasteric reflex refers to elevation of the
testicle whilst the ipsilateral thigh is stroked. This reflex is absent in testicular torsion. Testicular
torsion is a urologic emergency. Torsion interrupts the blood deliver to the testicle and
everlasting harm ensues if no longer decreased inside 6 hours. After 24 hours, the testicle turns
into gangrenous and need to be surgically removed. The nurse practitioner ought to call 911 and
the affected person should go through Doppler ultrasound inside the ED. Manual detorsion can
,be achieved within the ED through the "open e book" maneuver, but a surgical reduction is vital
if a guide reduction is unsuccessful.
Incorrect Answers:
B. Antibiotics would be appropriate for the treatment of epididymitis.C. Topical azole creams are
used to deal with balanitis, which is candida infection of the glans penis.
D. Chemotherapy is appropriate for testicular cancer, which generally offers in young male
adults who complain of a sensation of heaviness or aching a nodule or testicular expansion, or
testicular tenderness.
A 12-year-vintage male patient present for assessment of a painful pimple on his eyelid. On
exam, you find a 3 mm fluctuant pustule on the margin his right eyelid without a exudate. What
is that this possibly to be?
A. Chalazion
B. Molluscum contagiosum
C. Hordeolum
D. Blepharitis - ANS-Correct Answer: C. Hordeolum
A hordeolum is likewise called a stye. It is a painful contamination of the meibomian gland, so
located at the margin of the eyelid. It is treated with warm compresses for 10 mins TID and
erythromycin ointment will also be delivered.
Incorrect Answers:
A. A chalazion is a subcutaneous nodule that results from blockage of the meibomian gland, but
are commonly not due to contamination. May be associated with a hordeolum.
B. Molluscum contagiosum are small nodules with a primary umbilication that could seem at the
face or eyelids. They are due to a pandemic and must no longer be painful.
D. Blepharitis is infection of the eyelid margin.
Vital Concepts:
A hordeolum is also referred to as a stye. It is a painful infection of the meibomian gland, so
located at the margin of the eyelid. It is handled with warm compresses for 10 minutes TID and
erythromycin ointment will also be delivered.
A 14-year-old lady basketball player affords with anterior knee ache this is exacerbated via
leaping. She denies any particular injury. There is not any effusion, joint-line tenderness, or
instability. She has tenderness to palpation over the tibial tubercle. What is the maximum
probable prognosis, and what's the perfect management?
A. Meniscal tear and arthroscopic surgical operation
B. Osgood-Schlatter disorder and relaxation, ice, and anti-inflammatories
C. Anterior cruciate ligament tear and physical therapy
D. Patellofemoral pain syndrome and realignment surgical operation - ANS-Correct Answer: B.
Osgood-Schlatter disorder and rest, ice, and anti-inflammatories
Osgood-Schlatter is the eponym used for anterior knee pain this is regularly determined in
adolescents. As they develop, their bones prolong faster than their tendons, that may result in
apophysitis of the tibial tubercle. Management is rest from activity, stretching, and
, anti-inflammatories. Pain often resolves as soon as growth has ceased. Occasionally, surgical
procedure is required if the apophysis will become avulsed.
Incorrect Answers:
A. Effusions are common in meniscal accidents. There is no records of twisting or precise
damage. She has no joint-line tenderness. In addition, no longer all meniscal accidents require
surgical procedure.
C. Effusions are common with ACL tears. The standard treatment is reconstructive surgical
procedure if there are continual signs of instability.
D. PFPS signs encompass tenderness at the patellar sides and a effective grind check. While a
number of the signs are comparable in PFPS and Osgood-Schlatter disease, an appropriate
treatment for PFPS is physical therapy, now not realignment surgical treatment.
A 14-yr-antique woman affords for a pre-sports activities bodily. She complains of back
soreness while she "sits at college for a long term." Her exam well-knownshows scoliosis with a
left-sided curve. An MRI of the spine is indicated to rule out which of the subsequent situations?
A. Intraspinal syrinx
B. Narrowing of disk space
C. Schmorl nodes
D. Irregularities in vertebral endplates - ANS-Correct Answer: A. Intraspinal syrinx
About 80% of scoliosis cases seem as a proper thoracic curve. A left-sided pattern is related to
danger for intraspinal syrinx or tumor, which can be detected on MRI. The the rest of findings
are associated with Schneurmann kyphosis, the 2nd-maximum common cause of spinal
deformities in pediatrics. A scoliotic curve must degree greater than or same to ten ranges on a
spinal radiograph via the Cobb method (a unique tool that measures the attitude on radiograph)
to meet the criteria for diagnosing scoliosis, however most patients do now not show off
clinically large respiration symptoms until the curves degree 60 to a hundred degrees.
The USPSTF states that treating idiopathic scoliosis during early life ends in fitness blessings in
simplest a small fraction of sufferers. Most of the instances detected through screening do now
not come to be clinically giant, and scoliosis that requires competitive treatment/operative
remedy is likely to be detected with out screening because these patients are ultimately
symptomatic.
Incorrect Answers:
(B) Narrowing of disk space may be evaluated with an x-ray. Given this affected person's
left-sided curve, the intraspinal syrinx is extra critical to rule out with an MRI.
(C) Schmorl nodes are intervertebral disc herniations that motive protrusion into another
vertebra. While this may cause the affected person's back discomfort, it would no longer lead to
a left-sided sample which became determined at the bodily exam.
(D) Irregularities in vertebral endplates are related to degenerative disc sickness.While this
could motive the affected person's back discomfort, it'd now not cause a left-sided pattern which
became determined on the bodily examination.
