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FNP BOARD STUDY QUESTIONS AND ANSWERS
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FNP BOARD STUDY QUESTIONS AND ANSWERS
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FNP BOARD STUDY QUESTIONS AND ANSWERSThe nurse practitioner assesses an older adult patient who smokes a half pack per day
and presents to the clinic with reports of abdominal pain that is worse 2-3 hours after
eating and frequently wakes the patient from sleep at night. Stool for occult blood is
positive. Which diagnosis is most likely? - answer- Duodenal ulcer
Duodenal ulcers occur in the lining of the small intestine (duodenum). Symptoms
include abdominal pain that is worse within 2-3 hours of eating, nocturnal pain, bloating,
nausea, heartburn, and bloody or dark stools.
(Peptic ulcers may occur in the lining of the stomach (gastric) or the lining of the small
intestine (duodenal). Epigastric pain is the most common presenting symptom in both
types of ulcers. The pain is usually described as gnawing or burning and typically
occurs shortly after meals with gastric ulcers and 2-3 hours after meals with duodenal
ulcers.
The pain of duodenal ulcers wakes the patient up at night in about 50%-80% of cases,
with only 20%-40% incidence of nocturnal pain in patients with a gastric ulcer.
Complications of gastric ulcers include bleeding with anemia, early satiety, unexplained
weight loss, progressive dysphagia or odynophagia, recurrent vomiting, and
gastrointestinal cancer.
Risk factors for the development of peptic ulcers include age >70, regular use of
NSAIDs, regular use of corticosteroids or drugs to increase bone mass, drinking
alcohol, or smoking. Smoking can impair the healing of ulcers, and smokers are urged
to quit.
Peptic ulcers are diagnosed with an upper endoscopy and occasionally can be
diagnosed with an upper GI series. The presence of Helicobacter pylori bacteria should
be ruled out after diagnosis, and this is generally)
Of these, which step is final? - answer- Evaluate the change in outcomes after
implementation
Evaluation is the fifth and final step in evidence integration.
(The final step of evidence-based practice implementation is an evaluation of the
outcome. Outcome measures are best defined prior to implementation and can include
physiologic changes, psychosocial factors, or functional improvements. Evaluation can
be completed through qualitative, quantitative, or both types of measures and can be
completed on a personal, local, regional, national, or international level.
,Examples of large scale outcome evaluation include performance measures required by
The Joint Commission and quality measures in the Affordable Care Act.
Outcome evaluation is important to determine if the change achieved the intended
purpose and if it should be continued or modified.)
While working in a well-child clinic, the nurse practitioner examines and evaluates
several children. Which child needs further evaluation for a possible developmental
delay? - answer- The 9-month-old who cannot stand holding on
By 9 months of age, a child should be able to pull to stand and stand holding on to
something.
(By a certain age, most children can do certain things. These are known as
developmental milestones and should be evaluated by the nurse practitioner at each
encounter. How the child moves, communicates, learns, and acts offer important
parameters about the child's development.
By 9 months of age, the child begins to be more independent in his or her movement
and physical development. At this age, the child may begin to crawl, is able to get into a
sitting position, sit well without support, is able to pull to standing and stand holding on.
Concerns for physical developmental delay at this age include not bearing weight on
legs with support, inability to sit without support, and the inability to use hands to
transfer objects from one hand to the other.
Learning the signs of normal and delayed developmental milestones is important for
nurse practitioners. Nurse practitioners should also provide anticipatory guidance to
parents regarding the child's expected development. Acting early when there are
concerns is important to provide early intervention services.)
A four-year-old child is brought to the clinic for a wellness visit. The nurse practitioner is
assessing the child's development. Which is an expected developmental milestone for
this child? - answer- Names some colors and numbers
A four-year-old child should be able to identify some colors and numbers. Parents can
help the child develop these cognitive skills by counting common items and naming
colors aloud.
(A four-year-old child should be able to name some colors and numbers, play board
games, understand time, and use scissors.
, A detailed assessment of developmental milestones is very important in pediatric
primary care. Observing these behaviors and asking about the child's actions at home
can help the provider gauge the child's growth and development. Catching delays early
can help diagnose diseases and potential disorders. Education can also be provided at
these visits to assist the parents and caregivers in teaching and encouraging the child's
development. They should be educated about what milestones to expect within the next
year.)
An adult patient with a past medical history of myocardial infarction (MI) 3 years ago
presents to the primary care nurse practitioner. The patient's most recent HbA1c level is
9.3%, prompting a diagnosis of type 2 diabetes.
According to the American Diabetes Association (ADA), which treatment is best for this
patient? - answer- Start metformin and canagliflozin.
This patient has a known history of atherosclerotic cardiovascular disease; the second
medication the patient is treated with should be one that reduces cardiovascular events,
like canagliflozin (Invokana).
(According to the American Diabetes Association guidelines for medical care in
diabetes, metformin (Glucophage) is the initial medication used to treat patients with
type 2 diabetes who have an HbA1c level less than 9% at diagnosis unless there is a
contraindication or the patient cannot tolerate this medication. Other oral or injectable
medications to treat type 2 diabetes should be added to metformin as needed to bring
the patient's HbA1c level into the goal range.
Dual therapy (metformin plus another medication) is recommended for patients with an
HbA1c level between 9% and 10%. In patients with a known history of atherosclerotic
cardiovascular disease, the second agent should be one that has evidence for reducing
cardiovascular events, such as the SGLT-2 inhibitor class of medications.
Insulin therapy is recommended initially for the treatment of patients with type 2
diabetes who have an HbA1c of 10% or higher.)
An older adult patient with type 2 diabetes mellitus and a BMI of 32.4 kg/m2 presents to
the clinic for a follow-up visit. Three months ago, the patient's HbA1c level was 8.4%
and the patient was started on metformin. Today, the patient's HbA1c level is 7.3%.
The nurse practitioner recommends starting another medication for glucose control that
does not increase the risk of weight gain. Which drug is weight neutral? - answer-
Sitagliptin
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