ANCC FNP review questions Latest Update -

ANCC FNP review questions Latest Update - 125 Questions with 100% Verified Correct Answers Guaranteed A+ Verified by Professor 43-year-old patient with past medical history of mild asthma in his childhood presents for management of hypertension. He has heard that some antihypertensive medications can worsen breathing in asthmatic patients. Which of the following medications would be most likely to cause bronchospasm in a patient with asthma?

• Metoprolol
• Atenolol
• Propranolol
• Bisoprolol - CORRECT ANSWER: Correct Answer: C. Propranolol

Propranolol is the only beta-blocker listed with is non-selective. Beta-blockers can be cardioselective, or non- selective. Cardioselectivity refers to the ability to affect predominantly beta 1 receptors rather than beta 2 receptors. Beta 1 receptors are located mainly in the heart and mediate the sympathetic nervous system's direct effects on the heart. Beta 2 receptors are located predominantly in the peripheral vascular system and other organs like the lungs. Although all beta-blockers affect beta receptors, some affect subsets of receptors differently. This has significant consequences in terms of side effects, as beta-blockers are known to cause extra-cardiac symptoms such as worsened bronchospasms in asthmatics. Although beta-1 selective blockers are safer than nonselective beta blockers, and would be preferred in patients with asthma, they should still be used with caution in patients with asthma, particularly in those with severe obstruction or markedly reduced pulmonary function at baseline.

Incorrect Answers:

• B. and D. These are all cardioselective beta-blockers.

A 10-month-old girl with no prior medical history presents to the emergency room with signs of bronchiolitis. The patient's parents report that she developed a cough 3 days ago, and today she developed rhinorrhea, wheezing, and a fever of 100.4°F. Physical 1 / 4

examination reveals a temperature of 100.5°F, and wheezing is evident on pulmonary exam. Physical examination also reveals right tympanic membrane fullness, with loss of light reflex and erythema. The patient keeps pulling on her ear. It is December, and this is the 10th patient this month who has presented with the same symptoms. Which of the following is the most appropriate therapy for this patient?

• Amoxicillin with analgesics
• Bronchodilators
• Corticosteroids
• Ribavirin - CORRECT ANSWER: Correct Answer: A. Amoxicillin with analgesics

The patient's age, lower respiratory tract symptoms, and the spike in cases seen during this time of year indicate that the patient most likely has respiratory syncytial virus (RSV). RSV is a viral infection that attacks the lower respiratory tract, causing bronchiolitis or pneumonia. While RSV commonly affects young children, it can be seen in adults. While uncomplicated RSV is treated with supportive therapy, the patient also has evidence of otitis media. The 2013 AAP/AAFP guideline recommends either immediate treatment or observation (with pain control) for children between 6 and 24 months with unilateral nonsevere AOM and for children ≥24 months with unilateral or bilateral nonsevere AOM. Since this child has evidence of unilateral AOM, either observation or treatment with antibiotics are appropriate. Individually randomized trials that used stringent diagnostic criteria demonstrated that children under the age of two benefits from antibiotic therapy, including those with nonsevere unilateral AOM.

Incorrect Answers:

• Bronchodilators are not recommended for the routine treatment of RSV bronchiolitis.

While bronchodilators may provide modest short-term improvement, they do not improve long-term outcomes and may have adverse effects. Bronchodilators also increase the cost of care and should only be used if a single trial leads to a prompt favorable response.

• Corticosteroids are not recommended for the routine treatment of RSV bronchiolitis

in infants. However, corticosteroids may be helpful in older children and adults who have RSV-associated bronchial reactivity, especially those who have a history of asthma that may have been exacerbated by the recent RSV infection. Corticosteroids can potentially decrease bronchial swelling and airway obstruction through their inh

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A 12-year-old 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 red and swollen and the right testicle is higher than the left. When you stroke the inner thigh on the right, there is no movement of the testicle. Which of the following is an indicated treatment for this condition?

• Manual reduction
• Antibiotics
• Topical azole cream
• Chemotherapy - CORRECT ANSWER: Correct Answer: A. Manual reduction

The patient, in this case, has a presentation consistent with testicular torsion. Patients with testicular torsion are usually young men between the ages of 10 and 20. They will complain of sudden onset of scrotal pain, usually in the middle of the night or upon awakening. The scrotum will be red and swollen and the affected testicle is usually positioned higher than the unaffected testicle, often closer to the body. The cremasteric reflex refers to elevation of the testicle when the ipsilateral thigh is stroked. This reflex is absent in testicular torsion. Testicular torsion is a urologic emergency. Torsion interrupts the blood supply to the testicle and permanent damage ensues if not reduced within 6 hours. After 24 hours, the testicle will become gangrenous and must be surgically removed. The nurse practitioner should call 911 and the patient should undergo Doppler ultrasound in the ED. Manual detorsion can be accomplished in the ED by the "open book" maneuver, but a surgical reduction is necessary if a manual reduction is unsuccessful.

Incorrect Answers:

• Antibiotics would be appropriate for the treatment of epididymitis.C. Topical azole

creams are used to treat balanitis, which is candida infection of the glans penis.

• Chemotherapy is appropriate for testicular cancer, which usually presents in young

male adults who complain of a sensation of heaviness or aching a nodule or testicular enlargement, or testicular tenderness.

A 12-year-old male patient present for evaluation of a painful pimple on his eyelid. On exam, you find a 3 mm fluctuant pustule on the margin his right eyelid with no exudate.What is this likely to be?

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• Chalazion
• Molluscum contagiosum
• Hordeolum
• Blepharitis - CORRECT ANSWER: Correct Answer: C. Hordeolum

A hordeolum is also known as a stye. It is a painful infection of the meibomian gland, so located at the margin of the eyelid. It is treated with warm compresses for 10 minutes TID and erythromycin ointment may also be added.

Incorrect Answers:

• A chalazion is a subcutaneous nodule that results from blockage of the meibomian

gland, but are generally not due to infection. May be associated with a hordeolum.

• Molluscum contagiosum are small nodules with a central umbilication that may

appear on the face or eyelids. They are caused by a virus and should not be painful.

• Blepharitis is inflammation of the eyelid margin.

Vital Concepts:

A hordeolum is also known as a stye. It is a painful infection of the meibomian gland, so located at the margin of the eyelid. It is treated with warm compresses for 10 minutes TID and erythromycin ointment may also be added.

A 14-year-old female basketball player presents with anterior knee pain that is exacerbated by jumping. She denies any specific injury. There is no effusion, joint-line tenderness, or instability. She has tenderness to palpation over the tibial tubercle. What is the most likely diagnosis, and what is the appropriate management?

• Meniscal tear and arthroscopic surgery
• Osgood-Schlatter disease and rest, ice, and anti-inflammatories
• Anterior cruciate ligament tear and physical therapy

D. Patellofemoral pain syndrome and realignment surgery - CORRECT ANSWER:

Correct Answer: B. Osgood-Schlatter disease and rest, ice, and anti-inflammatories Osgood-Schlatter is the eponym used for anterior knee pain that is often found in adolescents. As they grow, their bones lengthen faster than their tendons, which can lead to apophysitis of the tibial tubercle. Management is rest from activity, stretching,

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