Sarah Michelle FNP Practice Test QUESTIONS & ANSWERS Already GRADED A
1. 1. Question
A 65 year old female patient presents today to the clinic with
worsening back pain over the last week. She appears to be sweating
and states that she is profusely dizzy. Which of the following findings
on her urinalysis would indicate the most immediate need for referral
to the emergency department ?
o Red blood cell (RBC) casts, as they are indicative of possible
cytomegalovirus
o White blood cell (WBC) casts, as they are indicative of
pyelonephritis
o Hyaline casts, as they are indicative of dehydration after exercise
o Glucose, as it confirms a new diagnosis of Diabetes
Correct
With the patient’s presenting symptoms, it appears that the likely
diagnosis is pyelonephritis. WBC casts in conjunction with the
presenting symptoms would warrant an immediate referral as it can be
life threatening. Dehydration does not always warrant an immediate
referral, and glucose in the urine does not confirm a diagnosis of
Diabetes. RBC casts are not indicative of possible Cytomegalovirus
(CMV).
2. 2. Question
A middle aged patient recently started taking Benadryl
(diphenhydramine) for issues with allergic rhinitis symptoms. Which of
the following signs or symptoms would be least likely for the patient to
report after regularly taking this medication?
o Blurred vision
o Dry mouth
o Diarrhea
o Urinary hesitancy
Correct
Benadryl (Diphenhydramine) is a second line treatment for allergic
rhinitis. This drug belongs to the antihistamine drug class which is
notorious for anticholinergic side effects. The typical anticholinergic
side effects that can occur are constipation, vision complaints, dry
mouth, and urinary hesitancy.
3. 3. Question
A patient presented with suspected gallstones, and the ultrasound
results indicate there are no gallstones present. However, the patient
continues to have symptoms of acute cholecystitis. Which of the
following would be the most appropriate next action for this patient?
, o Refer the patient for an MRI
o Repeat the ultrasound as it can take weeks for gallstones to
appear
o Refer the patient for a HIDA scan
o Refer to general surgery to have the gallbladder removed
Correct
An ultrasound is the first line diagnostic test for cholecystitis. If the
ultrasound is negative for gallstones, the next appropriate step would
be to refer the patient for a HIDA scan, which is more sensitive. The
patient does not necessarily need surgery right away, and an MRI is
not as sensitive as a HIDA scan is for cholecystitis. An ultrasound is
used prior to a HIDA scan to rule out gallstones due to safety concerns.
4. 4. Question
A 56-year-old male patient comes into the clinic after falling on ice. He
states he was carrying groceries in one arm and used the other to
break his fall. He is now having pain and tenderness in the hand which
he fell on. Where would the nurse practitioner palpate to examine this
patient for a scaphoid fracture?
o The humeral tuberosity
o The radial head
o The boxer’s anatomical position
o The anatomic snuffbox
Correct
The anatomical snuffbox is a triangle-shaped depression on the lateral
aspect of the back of the hand. It is best seen and palpated when the
thumb is
extended. Tenderness in this area is indicative of a scaphoid fracture,
also known as a navicular fracture.
5. 5. Question
A patient is having excruciating pain in the side of their face and is
placed on carbamazepine (Tegretol) for this condition. The nurse
practitioner understands which cranial nerve is affected?
o CN IV
o CN VII
o CN VI
o CN V
Correct
Trigeminal neuralgia presents as severe, excruciating pain due to the
trigeminal nerve (CN V)
,6. 6. Question
A middle aged patient presents to the clinic requesting hormone
replacement therapy for her menopausal symptoms. Which of the
following in the patient’s history is not a contraindication to starting
hormone replacement therapy?
o 2 pack per day smoker
o Deep vein thrombosis
o New vaginal spotting that began two weeks ago
o Endometriosis
Incorrect
The American Academy of Family Physicians notes that undiagnosed
vaginal bleeding is an absolute contraindication to hormone
replacement therapy (HRT). Endometriosis and previous history of
thromboembolism are relative contraindications. At this time, smoking
is ill advised while taking HRT but is not considered a contraindication.
7. 7. Question
A 68-year-old male presents with complaints of swelling and redness in
his right lower leg. He explains that he has always had veins that
“stuck out” but now his skin itches and looks “leathery”. During the
exam, the nurse practitioner notes a reddish-brown discoloration of the
legs with mild edema present. There are also several varicose veins on
the right lower leg, sparing the foot. What is the most likely diagnosis?
o Deep Vein Thrombosis (DVT)
o Cellulitis
o Lymphedema
o Chronic Venous Insufficiency (CVI)
Correct
Chronic venous insufficiency (CVI) is characterized by lower extremity
edema, varicose veins, pruritus of the skin, discoloration of the skin,
and possible ulcerations or abrasions to the skin. It is due to
inadequate venous circulation caused by a partial vein blockage or
leakage of a venous valve that increases pressure. Although DVTs can
be caused by CVI – it is important to remember that this can happen
from other things as well such as sitting or standing too long, smoking,
obesity, or trauma to the leg.
8. 8. Question
An 82 year old patient presents to the office today with complaints of
severe pain, redness, warmth, and swelling of the distal
interphalangeal joint on her right hand. Which of the following
, diagnoses may be responsible for her acute symptoms? Select all that
apply by choosing two of the following answer choices.
o Carpal tunnel syndrome
o Rheumatoid arthritis
o Gout
o Cellulitis
o Ganglion cyst
Incorrect
Based on the pain, redness, warmth, and swelling this patient is
experiencing in her finger, both gout and cellulitis should be
considered. Gout, although more common in the great toes and knees,
can occur in the fingers. Herberden’s nodes are traditionally associated
with osteoarthritis rather than rheumatoid arthritis. Finally, a ganglion
cyst may present with pain and swelling, but will likely not present with
redness and warmth.
9. 9. Question
A 63 year old patient diagnosed with COPD has a CAT (COPD
Assessment Test) score of 6 and has not had any severe exacerbations
in the last year, placing them in treatment Group A. Which medications
might this patient be on? Select all that apply by choosing two of the
following answer choices.
o Levoalbuterol (Xopenex)
o ipatropium bromide and albuterol (Combivent)
o Budesonide (Pulmicort)
o Theophylline (Theochron)
o Cromolyn sodium (Gastrocom)
o Fomoterol (Perforomist)
Correct
Patients in COPD group A should be prescribed a bronchodilator –
either a short acting or a long acting bronchodilator depending on the
patient’s response. Therefore, this patient could be prescribed
levoalbuterol (a SABA) or fomoterol (a LABA) from the list above.
10. 10. Question
A 46 year old African American patient with a history of GERD presents
to the clinic today with a blood pressure of 134/89 mmHg. Three
months ago his blood pressure was 137/85 and he was educated on
lifestyle modifications like smoking cessation, low sodium diet, and
exercise. According to the JNC 8 hypertension guidelines, what
treatment should the nurse practitioner initiate for this patient?
