FNP III EXAM 1 QUESTIONS AND
CORRECT ANSWERS
AA290-year-
oldA2womanA2isA2diagnosedA2withA2isolatedA2systolicA2hypertensionA2ofA2theA2elderly.A2Wh
ichA2ofA2theA2followingA2antihypertensiveA2medicationsA2areA2preferredA2forA2theA2treatme
ntA2ofA2thisA2condition?
CalciumA2channelA2blockersA2andA2thiazideA2diuretics
Angiotensin-convertingA2enzymeA2inhibitorsA2andA2loopA2diuretics
Beta-blockersA2andA2potassium-sparingA2diuretics
Alpha-blockersA2andA2calciumA2channelA2blockersA2-A2Ans--
CalciumA2channelA2blockersA2andA2thiazideA2diuretics
CalciumA2channelA2blockersA2(CCBs)A2andA2thiazideA2diureticsA2areA2preferredA2forA2treat
mentA2ofA2isolatedA2systolicA2hypertensionA2ofA2theA2elderly.A2ThereA2isA2noA2preferenceA2
ofA2oneA2overA2theA2other,A2andA2therapyA2mayA2beA2startedA2withA2eitherA2aA2thiazideA2di
ureticA2orA2aA2CCB.A2IsolatedA2systolicA2hypertensionA2ofA2theA2elderlyA2isA2causedA2byA2h
ardeningA2ofA2theA2arteries,A2resultingA2inA2increasedA2peripheralA2vascularA2resistance.A2
TheA2goalA2forA2patientsA2agedA260A2yearsA2orA2olderA2isA2bloodA2pressureA2lessA2thanA21
50/90A2mmHgA2unlessA2diabeticA2orA2theyA2haveA2chronicA2kidneyA2diseaseA2(goalA2BPA2<
140/90A2mmHg).A2WatchA2forA2orthostaticA2hypotensionA2(orA2decreaseA2inA2systolicA2blo
odA2pressureA2ofA2>20A2mmHg),A2whichA2isA2aA2riskA2factorA2forA2falls.
AA230-year-
oldA2womanA2hasA2rightA2upperA2quadrantA2abdominalA2pain,A2nausea,A2andA2vomiting.A2
WhichA2diagnosticA2testA2willA2theA2providerA2order?
a.A2AbdominalA2CTA2withA2contrast
b.A2AbdominalA2ultrasound
c.A2MRIA2ofA2theA2abdomen
d.A2PlainA2abdominalA2radiographsA2-A2Ans--b.A2AbdominalA2ultrasound.
PerA2UpToDate:A2RightA2upperA2quadrantA2painA2mayA2involveA2liverA2orA2biliaryA2treeA2an
dA2ifA2thereA2isA2anA2indicationA2ofA2hepatobiliaryA2painA2patientsA2shouldA2haveA2anA2abd
ominalA2ultrasoundA2forA2evaluation.
AlsoA2patientsA2withA2rightA2upperA2quadrantA2painA2shouldA2haveA2theA2followingA2laborat
oryA2studies:
●CompleteA2bloodA2countA2withA2differential
●Electrolytes,A2bloodA2ureaA2nitrogenA2(BUN),A2creatinine,A2andA2glucose
●Aminotransferases,A2alkalineA2phosphatase,A2andA2bilirubin
●LipaseA2and/orA2amylase
,AA250A2y/
oA2maleA2presentsA2withA2acute,A2excruciating,A2LUQ,A2epigastricA2painA2thatA2heA2alsoA2f
eelsA2inA2theA2flankA2andA2LA2shoulder.A2TheseA2symptomsA2bestA2describe:
a.A2Cholecystitis
b.A2IntestinalA2obstruction
c.A2Pancreatitis
d.A2BiliaryA2stonesA2-A2Ans--c.A2Pancreatitis
PatientsA2withA2epigastricA2painA2shouldA2beA2evaluatedA2forA2pancreatitisA2asA2wellA2asA2
gastricA2etiologies.
AlsoA2considerA2splenicA2etiologiesA2suchA2asA2splenomegaly.
"Must-Not-Miss"A2PatientsA2withA2epigastricA2painA2andA2cardiacA2riskA2factorsA2and/
orA2otherA2symptomsA2concerningA2forA2anginaA2(eg,A2shortnessA2ofA2breath,A2exertionalA2
symptoms)A2shouldA2haveA2appropriateA2cardiacA2evaluation.
LabsA2toA2orderA2forA2EpigastricA2suspectedA2Pancreatitis:
●CompleteA2bloodA2countA2withA2differential
●Electrolytes,A2BUN,A2creatinine,A2andA2glucose
●Aminotransferases,A2alkalineA2phosphatase,A2andA2bilirubin
●LipaseA2and/orA2amylase
AnA280-year-
oldA2manA2withA2hypertensionA2andA2hyperlipidemiaA2presentsA2withA2complaintsA2ofA2the
A2rapidA2onsetA2ofA2severeA2low-
backA2painA2accompaniedA2byA2abdominalA2painA2thatA2isA2graduallyA2worsening.A2TheA2p
atientA2appearsA2paleA2andA2complainsA2thatA2heA2doesA2notA2feelA2well.A2DuringA2theA2ab
dominalA2exam,A2theA2nurseA2practitionerA2detectsA2aA2softA2pulsatileA2massA2justA2above
A2theA2umbilicusA2asA2sheA2palpatesA2thisA2areaA2withA2herA2hand.A2WhichA2ofA2theA2follow
ingA2conditionsA2isA2mostA2likely?
AbdominalA2aorticA2aneurysm
CaudaA2equinaA2syndrome
AcuteA2diverticulitis
AdenocarcinomaA2ofA2theA2colonA2-A2Ans--AbdominalA2aorticA2aneurysm
ElderlyA2malesA2whoA2areA2ex-
smokersA2areA2atA2higherA2riskA2forA2abdominalA2aorticA2aneurysm.A2TheA2aneurysmA2isA2
usuallyA2asymptomaticA2andA2isA2discoveredA2incidentallyA2duringA2aA2routineA2chestA2x-
rayA2orA2abdominalA2ultrasound.A2AlthoughA2smallA2aneurysmsA2areA2usuallyA2notA2detect
ableA2duringA2abdominalA2exams,A2theA2largerA2aneurysmsA2mayA2beA2palpableA2duringA2
anA2abdominalA2exam,A2butA2abdominalA2obesityA2willA2obscureA2theA2findings.A2TheA2sy
mptomsA2inA2thisA2caseA2pointA2towardA2aA2rapidlyA2dissectingA2aneurysm.A2TheA2bestA2a
ctionA2isA2toA2callA2911A2stat.
AA255-year-
oldA2maleA2isA2atA2theA2emergencyA2departmentA2complainingA2ofA2severeA2acuteA2epigas
, tricA2painA2radiatingA2toA2theA2back.A2HeA2hasA2aA2historyA2ofA2smokingA2andA2drinkingA2al
coholA2forA2overA220A2years.A2PatientA2statesA2thatA2theA2painA2isA2relievedA2ifA2heA2leansA2
forwardA2withA2trunkA2flexed.A2TheA2patient'sA2symptomsA2areA2suggestiveA2ofA2whatA2con
dition?
a)A2AcuteA2pancreatitis
b)A2AcuteA2cholecystitis
c)A2Appendicitis
d)A2GastricA2refluxA2(GERD)A2-A2Ans--AA2(Analysis)
SuddenA2knife-
likeA2epigastricA2painA2radiatingA2toA2theA2backA2isA2typicalA2ofA2acuteA2pancreatitis.A2
CholecystitisA2isA2aA2gradualA2onsetA2ofA2painA2inA2theA2upperA2rightA2quadrant.A2
AppendicitisA2isA2mostlyA2foundA2inA2theA2rightA2upperA2quadrant.A2GERDA2isA2locatedA2inA
2theA2epigastricA2areaA2butA2feelsA2moreA2likeA2aA2burningA2sensation.A2https://
www.aafp.org/afp/2007/0515/p1513.html
Cullen'sA2signA2isA2mostA2commonlyA2associatedA2withA2whichA2ofA2theA2following?
AcuteA2pancreatitis
MyocardialA2infarction
AcuteA2pyelonephritis
PreeclampsiaA2-A2Ans--Cullen'sA2signA2isA2commonlyA2seenA2inA2acuteA2pancreatitis.A2
ItA2refersA2toA2aA2yellowish-
blueA2skinA2colorA2changeA2aroundA2theA2umbilicus.A2ItA2isA2thoughtA2toA2occurA2dueA2toA2t
heA2pancreaticA2enzymesA2thatA2runA2alongA2theA2ligamentA2andA2subcutaneousA2tissuesA
2aroundA2theA2umbilicus.
WhatA2typeA2ofA2murmurA2canA2radiateA2toA2theA2leftA2axilla?
AorticA2regurgitation
AorticA2stenosis
MitralA2stenosis
MitralA2regurgitationA2-A2Ans--MitralA2regurgitation
Rationale
TheA2murmurA2ofA2mitralA2regurgitationA2occursA2duringA2systoleA2(holosystolic)A2andA2isA2
locatedA2inA2theA2mitralA2areaA2ofA2theA2chest.A2TheA2locationA2ofA2theA2mitralA2areaA2(fifthA
2intercostalA2spaceA2onA2theA2leftA2sideA2ofA2theA2midclavicularA2line)A2isA2nearA2theA2leftA2
axilla,A2soA2thatA2aA2loudA2murmurA2canA2radiateA2toA2theA2leftA2axilla.A2TheA2causesA2canA
2beA2congenitalA2orA2itA2mayA2aA2beA2sequelaA2ofA2rheumaticA2fever,A2mitralA2valveA2prola
pse,A2orA2papillaryA2muscleA2dysfunctionA2secondaryA2toA2acuteA2orA2priorA2myocardialA2in
farction.
JohnA2isA2aA226-year-
oldA2graduateA2studentA2comesA2intoA2theA2clinicA2complainingA2ofA2abdominalA2painA2forA
24A2days.A2HeA2statesA2theA2painA2startedA2atA2theA2umbilicusA2andA2hasA2frequentA2sympt
omsA2ofA2nausea.A2AA2fewA2hoursA2beforeA2comingA2toA2theA2clinic,A2theA2painA2becameA2
CORRECT ANSWERS
AA290-year-
oldA2womanA2isA2diagnosedA2withA2isolatedA2systolicA2hypertensionA2ofA2theA2elderly.A2Wh
ichA2ofA2theA2followingA2antihypertensiveA2medicationsA2areA2preferredA2forA2theA2treatme
ntA2ofA2thisA2condition?
CalciumA2channelA2blockersA2andA2thiazideA2diuretics
Angiotensin-convertingA2enzymeA2inhibitorsA2andA2loopA2diuretics
Beta-blockersA2andA2potassium-sparingA2diuretics
Alpha-blockersA2andA2calciumA2channelA2blockersA2-A2Ans--
CalciumA2channelA2blockersA2andA2thiazideA2diuretics
CalciumA2channelA2blockersA2(CCBs)A2andA2thiazideA2diureticsA2areA2preferredA2forA2treat
mentA2ofA2isolatedA2systolicA2hypertensionA2ofA2theA2elderly.A2ThereA2isA2noA2preferenceA2
ofA2oneA2overA2theA2other,A2andA2therapyA2mayA2beA2startedA2withA2eitherA2aA2thiazideA2di
ureticA2orA2aA2CCB.A2IsolatedA2systolicA2hypertensionA2ofA2theA2elderlyA2isA2causedA2byA2h
ardeningA2ofA2theA2arteries,A2resultingA2inA2increasedA2peripheralA2vascularA2resistance.A2
TheA2goalA2forA2patientsA2agedA260A2yearsA2orA2olderA2isA2bloodA2pressureA2lessA2thanA21
50/90A2mmHgA2unlessA2diabeticA2orA2theyA2haveA2chronicA2kidneyA2diseaseA2(goalA2BPA2<
140/90A2mmHg).A2WatchA2forA2orthostaticA2hypotensionA2(orA2decreaseA2inA2systolicA2blo
odA2pressureA2ofA2>20A2mmHg),A2whichA2isA2aA2riskA2factorA2forA2falls.
AA230-year-
oldA2womanA2hasA2rightA2upperA2quadrantA2abdominalA2pain,A2nausea,A2andA2vomiting.A2
WhichA2diagnosticA2testA2willA2theA2providerA2order?
a.A2AbdominalA2CTA2withA2contrast
b.A2AbdominalA2ultrasound
c.A2MRIA2ofA2theA2abdomen
d.A2PlainA2abdominalA2radiographsA2-A2Ans--b.A2AbdominalA2ultrasound.
PerA2UpToDate:A2RightA2upperA2quadrantA2painA2mayA2involveA2liverA2orA2biliaryA2treeA2an
dA2ifA2thereA2isA2anA2indicationA2ofA2hepatobiliaryA2painA2patientsA2shouldA2haveA2anA2abd
ominalA2ultrasoundA2forA2evaluation.
AlsoA2patientsA2withA2rightA2upperA2quadrantA2painA2shouldA2haveA2theA2followingA2laborat
oryA2studies:
●CompleteA2bloodA2countA2withA2differential
●Electrolytes,A2bloodA2ureaA2nitrogenA2(BUN),A2creatinine,A2andA2glucose
●Aminotransferases,A2alkalineA2phosphatase,A2andA2bilirubin
●LipaseA2and/orA2amylase
,AA250A2y/
oA2maleA2presentsA2withA2acute,A2excruciating,A2LUQ,A2epigastricA2painA2thatA2heA2alsoA2f
eelsA2inA2theA2flankA2andA2LA2shoulder.A2TheseA2symptomsA2bestA2describe:
a.A2Cholecystitis
b.A2IntestinalA2obstruction
c.A2Pancreatitis
d.A2BiliaryA2stonesA2-A2Ans--c.A2Pancreatitis
PatientsA2withA2epigastricA2painA2shouldA2beA2evaluatedA2forA2pancreatitisA2asA2wellA2asA2
gastricA2etiologies.
AlsoA2considerA2splenicA2etiologiesA2suchA2asA2splenomegaly.
"Must-Not-Miss"A2PatientsA2withA2epigastricA2painA2andA2cardiacA2riskA2factorsA2and/
orA2otherA2symptomsA2concerningA2forA2anginaA2(eg,A2shortnessA2ofA2breath,A2exertionalA2
symptoms)A2shouldA2haveA2appropriateA2cardiacA2evaluation.
LabsA2toA2orderA2forA2EpigastricA2suspectedA2Pancreatitis:
●CompleteA2bloodA2countA2withA2differential
●Electrolytes,A2BUN,A2creatinine,A2andA2glucose
●Aminotransferases,A2alkalineA2phosphatase,A2andA2bilirubin
●LipaseA2and/orA2amylase
AnA280-year-
oldA2manA2withA2hypertensionA2andA2hyperlipidemiaA2presentsA2withA2complaintsA2ofA2the
A2rapidA2onsetA2ofA2severeA2low-
backA2painA2accompaniedA2byA2abdominalA2painA2thatA2isA2graduallyA2worsening.A2TheA2p
atientA2appearsA2paleA2andA2complainsA2thatA2heA2doesA2notA2feelA2well.A2DuringA2theA2ab
dominalA2exam,A2theA2nurseA2practitionerA2detectsA2aA2softA2pulsatileA2massA2justA2above
A2theA2umbilicusA2asA2sheA2palpatesA2thisA2areaA2withA2herA2hand.A2WhichA2ofA2theA2follow
ingA2conditionsA2isA2mostA2likely?
AbdominalA2aorticA2aneurysm
CaudaA2equinaA2syndrome
AcuteA2diverticulitis
AdenocarcinomaA2ofA2theA2colonA2-A2Ans--AbdominalA2aorticA2aneurysm
ElderlyA2malesA2whoA2areA2ex-
smokersA2areA2atA2higherA2riskA2forA2abdominalA2aorticA2aneurysm.A2TheA2aneurysmA2isA2
usuallyA2asymptomaticA2andA2isA2discoveredA2incidentallyA2duringA2aA2routineA2chestA2x-
rayA2orA2abdominalA2ultrasound.A2AlthoughA2smallA2aneurysmsA2areA2usuallyA2notA2detect
ableA2duringA2abdominalA2exams,A2theA2largerA2aneurysmsA2mayA2beA2palpableA2duringA2
anA2abdominalA2exam,A2butA2abdominalA2obesityA2willA2obscureA2theA2findings.A2TheA2sy
mptomsA2inA2thisA2caseA2pointA2towardA2aA2rapidlyA2dissectingA2aneurysm.A2TheA2bestA2a
ctionA2isA2toA2callA2911A2stat.
AA255-year-
oldA2maleA2isA2atA2theA2emergencyA2departmentA2complainingA2ofA2severeA2acuteA2epigas
, tricA2painA2radiatingA2toA2theA2back.A2HeA2hasA2aA2historyA2ofA2smokingA2andA2drinkingA2al
coholA2forA2overA220A2years.A2PatientA2statesA2thatA2theA2painA2isA2relievedA2ifA2heA2leansA2
forwardA2withA2trunkA2flexed.A2TheA2patient'sA2symptomsA2areA2suggestiveA2ofA2whatA2con
dition?
a)A2AcuteA2pancreatitis
b)A2AcuteA2cholecystitis
c)A2Appendicitis
d)A2GastricA2refluxA2(GERD)A2-A2Ans--AA2(Analysis)
SuddenA2knife-
likeA2epigastricA2painA2radiatingA2toA2theA2backA2isA2typicalA2ofA2acuteA2pancreatitis.A2
CholecystitisA2isA2aA2gradualA2onsetA2ofA2painA2inA2theA2upperA2rightA2quadrant.A2
AppendicitisA2isA2mostlyA2foundA2inA2theA2rightA2upperA2quadrant.A2GERDA2isA2locatedA2inA
2theA2epigastricA2areaA2butA2feelsA2moreA2likeA2aA2burningA2sensation.A2https://
www.aafp.org/afp/2007/0515/p1513.html
Cullen'sA2signA2isA2mostA2commonlyA2associatedA2withA2whichA2ofA2theA2following?
AcuteA2pancreatitis
MyocardialA2infarction
AcuteA2pyelonephritis
PreeclampsiaA2-A2Ans--Cullen'sA2signA2isA2commonlyA2seenA2inA2acuteA2pancreatitis.A2
ItA2refersA2toA2aA2yellowish-
blueA2skinA2colorA2changeA2aroundA2theA2umbilicus.A2ItA2isA2thoughtA2toA2occurA2dueA2toA2t
heA2pancreaticA2enzymesA2thatA2runA2alongA2theA2ligamentA2andA2subcutaneousA2tissuesA
2aroundA2theA2umbilicus.
WhatA2typeA2ofA2murmurA2canA2radiateA2toA2theA2leftA2axilla?
AorticA2regurgitation
AorticA2stenosis
MitralA2stenosis
MitralA2regurgitationA2-A2Ans--MitralA2regurgitation
Rationale
TheA2murmurA2ofA2mitralA2regurgitationA2occursA2duringA2systoleA2(holosystolic)A2andA2isA2
locatedA2inA2theA2mitralA2areaA2ofA2theA2chest.A2TheA2locationA2ofA2theA2mitralA2areaA2(fifthA
2intercostalA2spaceA2onA2theA2leftA2sideA2ofA2theA2midclavicularA2line)A2isA2nearA2theA2leftA2
axilla,A2soA2thatA2aA2loudA2murmurA2canA2radiateA2toA2theA2leftA2axilla.A2TheA2causesA2canA
2beA2congenitalA2orA2itA2mayA2aA2beA2sequelaA2ofA2rheumaticA2fever,A2mitralA2valveA2prola
pse,A2orA2papillaryA2muscleA2dysfunctionA2secondaryA2toA2acuteA2orA2priorA2myocardialA2in
farction.
JohnA2isA2aA226-year-
oldA2graduateA2studentA2comesA2intoA2theA2clinicA2complainingA2ofA2abdominalA2painA2forA
24A2days.A2HeA2statesA2theA2painA2startedA2atA2theA2umbilicusA2andA2hasA2frequentA2sympt
omsA2ofA2nausea.A2AA2fewA2hoursA2beforeA2comingA2toA2theA2clinic,A2theA2painA2becameA2
