Cumulitive FNP Final
A 56-year-old patient comes in for a routine well visit. He has a history of a previous stroke and
Type 2 Diabetes. Which of the following orders would be appropriate for a patient with a
previous stroke?
A. Initiate statin therapy.
B. EEG.
C. Warfarin therapy with an INR goal of 2-3.
D. MRI.
A. Initiate statin therapy*.
(Patients with a history of an ASCVD should be started on statin therapy regardless of current
LDL. The question did not mention any other symptoms that would warrant additional
diagnostics. Warfarin therapy is only indicated if indicated. AFIB would be the primary indication
for anticoagulation after a stroke.)
A 36-year-old female is being seen in your clinic for left sided facial weakness. In your review of
systems, the patient reports that "certain sounds really bother her and taste buds seem off". She
also reports temporal pain which had subsided. Your physical exam revealed no other
neurological deficits. Which of the following intervention would be most appropriate?
A. Call 911 to activate emergency stroke protocols.
B. Refer the patient to neurology.
C. Order an MRI.
D. Prescribe a course of oral corticosteroids.
D. Prescribe a course of oral corticosteroids*
(Bell's Palsy commonly causes alterations in taste and hyperacusis. This contrasts with stroke.
Corticosteroids increase the chances of recovery complete by 12-15% at nine to twelve months
and are routinely prescribed. The complaint of pain also suggests a possible viral infection such
as herpes simplex or varicella which has been implicated, in some cases, as a trigger for facial
palsy.)
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A 9-year-old female patient presents to your clinic with complaints of a headache. The patients
mother states that the headache started two days ago and has been giving her children's
Tylenol. The child states that the pain is bilateral and worsens when running or standing. The
nurse practitioner should:
A. Treat her for migraine prevention and start topiramate.
B. Order a CT of her head.
C. Educate the parent that children need at least 9 hours of sleep.
D. Refer to a psychologist for cognitive behavioral therapy.
B. Order a CT of her head*
(Table 25-8 lists red flags for pediatric headaches. Headaches that worsen with postural
changes may indicate additional intracranial pathology and should be further investigated.
Depending on the urgency an MRI vs. CT should be considered. A, C, & D are preventative
measures for established migraines or TTH.)
You are educating the parents of a 16-year-old boy who has been newly diagnosed with
epileptic syndrome. Which statement is false?
A. Most states will grant a driver's license if the patient has been deemed seizure free for 6-12
months by his physician.
B. Clinical seizures that last 15 minutes are considered medical emergencies
C. Physical training such as weight training should be restricted due to safety concerns.
D. Depression is a common comorbidity of epilepsy.
C. Physical training such as weight training should be restricted due to safety concerns. *
Physical activity that promote age appropriate socialization and normalcy are highly
recommended. The only activities that come with restrictions are scuba diving, contact sports
(may or may not be allowed depending on the physician), and free climbing. Swimming is
allowed, but preferably under supervision.
A 25-year-old male presents to clinic complaining of a severe, throbbing headache for the past 2
days. The pain increases when exposed to bright lights and is accompanied by nausea. He
,states the headache started after working a 16-hour shift without resting. What type of
headache is the patient suffering from and what medication is appropriate for immediate relief?
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no relief.
B. Migraine headache - Topiramate 50mg BID.
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no
relief.
D. Cluster headache - Sumatriptan 6mg SQ single dose.
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no relief.
(Migraine headaches can be unilateral and are often accompanied by nausea, vomiting, and
photophobia. These headaches can be triggered by lack of sleep and stress. Zolmitriptan is
often effective for immediate relief of migraines. Topiramate is used as a prophylaxis for
migraines. The patient's symptoms are not characteristic of a tension type or cluster headache.
Triptans are not recommended for tension type headaches.)
A 63-year old male presents to clinic with complaints of tremors and muscle spasms. The
patient has a history of Parkinson's disease and has been taking Levodopa 50mg TID. What is
an appropriate treatment plan for this patient?
A. Decrease the amount of levodopa the patient is taking per day.
B. Inform the patient that these side effects are common as Parkinson's disease progresses and
start the patient on amantadine.
C. Refer the patient to a neurologist for further evaluation.
D. Continue to monitor the patient for increase in tremors.
B. Inform the patient that these side effects are common as Parkinson's disease progresses and
start the patient on amantadine.
Levodopa-induced dyskinesias are common in later Parkinson's disease. Dyskinesias can occur
in the form of chorea, tremors, tics, and dystonia. According to Papadakis and McPhee (2018),
although levodopa-induced dyskinesias are dose related, decreasing the dose can alter the
therapeutic benefit of the medication. The patient can begin taking amantadine or levetiracetam
to help decrease the dyskinesias.
An 11-year old presents to clinic with her mother complaining of severe headaches and nausea
when she wakes up in the morning. Headaches have worsened over the past week. The patient
states the headaches are worse when she changes position and is mostly towards the back of
her head. As the nurse practitioner, what is best treatment option for this patient?
A. Tell the mother to buy ibuprofen over the counter and follow-up if no relief.
B. Prescribe topiramate 50mg BID.
C. Refer the patient for a stat CT scan of her head.
D. Prescribe acetaminophen 15mg/kg.
C. *Refer the patient for a stat CT scan of her head.
, Although ibuprofen 10mg/kg and acetaminophen 15mg/kg are first line treatment for acute
headaches in children, this patient's symptoms are red flags and require further evaluation and
workup. Topiramate is prescribed as a preventative medication for headaches in children.
The NP is evaluating a 6-year old child for his annual check-up. After completing his vision
screening the results are 20/20 in the right eye and 20/30 in the left eye. What would be the next
step the NP would take?
A) This is a normal finding, no further steps to take.
B) Repeat the vision screening in 6 months.
C) Refer the child to an ophthalmologist.
D) Advise the mother on importance of hydration and nutrition to improve vision.
C) Refer the child to an ophthalmologist. ***
The results are within the normal limits but any two-line discrepancy during vision screening has
to be referred to an ophthalmologist even if normal.
A 4-month pregnant patient informs the NP that she will be travelling to Belize with her husband
in the following week. What is the best response by the NP to the patient?
A) You may want to post pone your trip to Belize due to high prevalence of the Zika Virus.
B) You should walk around the plane often to prevent blood clots.
C) Make sure you are up to date with the recommended vaccinations for travel to Belize.
D) Enjoy your trip.
A) You may want to post pone your trip to Belize due to high prevalence of the Zika Virus.***
Pregnant women should take into consideration postponing travel to areas where Zika Virus is
prevalent because infected women during pregnancy can led to fetal microcephaly and loss, in
addition to infant and newborn blindness and neurologic problems
When ordering outpatient imaging studies for a patient who has a medical history of Stage IV
renal failure, a nurse practitioner would be wise to avoid which study?
A. 2 view chest XRAY.
B. CT angiography abdomen and pelvis.
C. MRI brain.
D. CT c-spine.
B. CT angiography abdomen and pelvis**
Radiographic contrast media is directly nephrotoxic and is one of the leading causes of acute
kidney injury. Those with preexisting kidney disease pose the greatest risk of significant
nephropathy if given this contrast media. Of the listed imaging options, only the CT angiography
A 56-year-old patient comes in for a routine well visit. He has a history of a previous stroke and
Type 2 Diabetes. Which of the following orders would be appropriate for a patient with a
previous stroke?
A. Initiate statin therapy.
B. EEG.
C. Warfarin therapy with an INR goal of 2-3.
D. MRI.
A. Initiate statin therapy*.
(Patients with a history of an ASCVD should be started on statin therapy regardless of current
LDL. The question did not mention any other symptoms that would warrant additional
diagnostics. Warfarin therapy is only indicated if indicated. AFIB would be the primary indication
for anticoagulation after a stroke.)
A 36-year-old female is being seen in your clinic for left sided facial weakness. In your review of
systems, the patient reports that "certain sounds really bother her and taste buds seem off". She
also reports temporal pain which had subsided. Your physical exam revealed no other
neurological deficits. Which of the following intervention would be most appropriate?
A. Call 911 to activate emergency stroke protocols.
B. Refer the patient to neurology.
C. Order an MRI.
D. Prescribe a course of oral corticosteroids.
D. Prescribe a course of oral corticosteroids*
(Bell's Palsy commonly causes alterations in taste and hyperacusis. This contrasts with stroke.
Corticosteroids increase the chances of recovery complete by 12-15% at nine to twelve months
and are routinely prescribed. The complaint of pain also suggests a possible viral infection such
as herpes simplex or varicella which has been implicated, in some cases, as a trigger for facial
palsy.)
Previous
Play
Next
Rewind 10 seconds
,Move forward 10 seconds
Unmute
0:00
/
0:15
Full screen
Brainpower
Read More
A 9-year-old female patient presents to your clinic with complaints of a headache. The patients
mother states that the headache started two days ago and has been giving her children's
Tylenol. The child states that the pain is bilateral and worsens when running or standing. The
nurse practitioner should:
A. Treat her for migraine prevention and start topiramate.
B. Order a CT of her head.
C. Educate the parent that children need at least 9 hours of sleep.
D. Refer to a psychologist for cognitive behavioral therapy.
B. Order a CT of her head*
(Table 25-8 lists red flags for pediatric headaches. Headaches that worsen with postural
changes may indicate additional intracranial pathology and should be further investigated.
Depending on the urgency an MRI vs. CT should be considered. A, C, & D are preventative
measures for established migraines or TTH.)
You are educating the parents of a 16-year-old boy who has been newly diagnosed with
epileptic syndrome. Which statement is false?
A. Most states will grant a driver's license if the patient has been deemed seizure free for 6-12
months by his physician.
B. Clinical seizures that last 15 minutes are considered medical emergencies
C. Physical training such as weight training should be restricted due to safety concerns.
D. Depression is a common comorbidity of epilepsy.
C. Physical training such as weight training should be restricted due to safety concerns. *
Physical activity that promote age appropriate socialization and normalcy are highly
recommended. The only activities that come with restrictions are scuba diving, contact sports
(may or may not be allowed depending on the physician), and free climbing. Swimming is
allowed, but preferably under supervision.
A 25-year-old male presents to clinic complaining of a severe, throbbing headache for the past 2
days. The pain increases when exposed to bright lights and is accompanied by nausea. He
,states the headache started after working a 16-hour shift without resting. What type of
headache is the patient suffering from and what medication is appropriate for immediate relief?
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no relief.
B. Migraine headache - Topiramate 50mg BID.
C. Tension - Type Headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no
relief.
D. Cluster headache - Sumatriptan 6mg SQ single dose.
A. Migraine headache - Zolmitriptan 5mg PO one dose now, repeat after 2 hours if no relief.
(Migraine headaches can be unilateral and are often accompanied by nausea, vomiting, and
photophobia. These headaches can be triggered by lack of sleep and stress. Zolmitriptan is
often effective for immediate relief of migraines. Topiramate is used as a prophylaxis for
migraines. The patient's symptoms are not characteristic of a tension type or cluster headache.
Triptans are not recommended for tension type headaches.)
A 63-year old male presents to clinic with complaints of tremors and muscle spasms. The
patient has a history of Parkinson's disease and has been taking Levodopa 50mg TID. What is
an appropriate treatment plan for this patient?
A. Decrease the amount of levodopa the patient is taking per day.
B. Inform the patient that these side effects are common as Parkinson's disease progresses and
start the patient on amantadine.
C. Refer the patient to a neurologist for further evaluation.
D. Continue to monitor the patient for increase in tremors.
B. Inform the patient that these side effects are common as Parkinson's disease progresses and
start the patient on amantadine.
Levodopa-induced dyskinesias are common in later Parkinson's disease. Dyskinesias can occur
in the form of chorea, tremors, tics, and dystonia. According to Papadakis and McPhee (2018),
although levodopa-induced dyskinesias are dose related, decreasing the dose can alter the
therapeutic benefit of the medication. The patient can begin taking amantadine or levetiracetam
to help decrease the dyskinesias.
An 11-year old presents to clinic with her mother complaining of severe headaches and nausea
when she wakes up in the morning. Headaches have worsened over the past week. The patient
states the headaches are worse when she changes position and is mostly towards the back of
her head. As the nurse practitioner, what is best treatment option for this patient?
A. Tell the mother to buy ibuprofen over the counter and follow-up if no relief.
B. Prescribe topiramate 50mg BID.
C. Refer the patient for a stat CT scan of her head.
D. Prescribe acetaminophen 15mg/kg.
C. *Refer the patient for a stat CT scan of her head.
, Although ibuprofen 10mg/kg and acetaminophen 15mg/kg are first line treatment for acute
headaches in children, this patient's symptoms are red flags and require further evaluation and
workup. Topiramate is prescribed as a preventative medication for headaches in children.
The NP is evaluating a 6-year old child for his annual check-up. After completing his vision
screening the results are 20/20 in the right eye and 20/30 in the left eye. What would be the next
step the NP would take?
A) This is a normal finding, no further steps to take.
B) Repeat the vision screening in 6 months.
C) Refer the child to an ophthalmologist.
D) Advise the mother on importance of hydration and nutrition to improve vision.
C) Refer the child to an ophthalmologist. ***
The results are within the normal limits but any two-line discrepancy during vision screening has
to be referred to an ophthalmologist even if normal.
A 4-month pregnant patient informs the NP that she will be travelling to Belize with her husband
in the following week. What is the best response by the NP to the patient?
A) You may want to post pone your trip to Belize due to high prevalence of the Zika Virus.
B) You should walk around the plane often to prevent blood clots.
C) Make sure you are up to date with the recommended vaccinations for travel to Belize.
D) Enjoy your trip.
A) You may want to post pone your trip to Belize due to high prevalence of the Zika Virus.***
Pregnant women should take into consideration postponing travel to areas where Zika Virus is
prevalent because infected women during pregnancy can led to fetal microcephaly and loss, in
addition to infant and newborn blindness and neurologic problems
When ordering outpatient imaging studies for a patient who has a medical history of Stage IV
renal failure, a nurse practitioner would be wise to avoid which study?
A. 2 view chest XRAY.
B. CT angiography abdomen and pelvis.
C. MRI brain.
D. CT c-spine.
B. CT angiography abdomen and pelvis**
Radiographic contrast media is directly nephrotoxic and is one of the leading causes of acute
kidney injury. Those with preexisting kidney disease pose the greatest risk of significant
nephropathy if given this contrast media. Of the listed imaging options, only the CT angiography
