FNP ANCC EXAM ACTUAL EXAM | QUESTIONS
AND CORRECT ANSWERS (DETAILED
ANSWERS) | GRADED A+ | LATEST VERSION |
VERIFIED ANSWERS
A 62-year-old man with a past medical history of hypertension, chronic
obstructive pulmonary disease (COPD), and diabetes mellitus type II (DM
II) presents to the primary care clinic for a 2-week follow-up after being
discharged from the hospital for a COPD exacerbation. He has no
complaints and is compliant with his home medications. His vitals are
temperature 98.8 degrees Fahrenheit, heart rate 88 beats per minute,
respiratory rate 18 breaths per minute, and blood pressure 138/92 mmHg.
Physical exam is unremarkable. The patient received vaccines through his
20s but not since then.
Which of the following vaccinations is indicated at this visit?
A. Pneumococcal conjugate (PCV13) vaccine
B. Pneumococcal polysaccharide (PPSV23) vaccine
C. Meningococcal vaccine
D. Hepatitis A vaccine ---------CORRECT ANSWER-----------------Correct
Answer: B. Pneumococcal polysaccharide (PPSV23) vaccine
There are two types of pneumococcal vaccine, a 13-valent conjugate
vaccine (PCV13) and a 23-valent polysaccharide vaccine (PPSV23), with
13 and 23 corresponding to the number of pneumococcal strains covered.
PPSV23 is indicated for all adults ages 65 years or older. It is also
indicated for adults <65 years old (like this patient) with chronic lung
conditions (e.g. COPD, emphysema, asthma), chronic cardiovascular
diseases, DM II, chronic renal disease, chronic liver diseases, and chronic
alcohol use disorder, as well as immunocompromising conditions (e.g. HIV,
nephrotic syndrome). This patient is <65 years old and has COPD, DM II,
and hypertension. Both COPD and DM II qualify him for early (<65 years
old) PPSV23. When indicated, it is also recommended to administer
PPSV23 to patients without a reliable immunization record.
Incorrect Answers:
A. For anyone ages 19-65 with asplenia, an immunocompromising
condition (e.g. chronic renal failure, nephrotic syndrome), cerebrospinal
,fluid leaks, or cochlear implants, PCV13 is recommended. When indicated,
also administer PCV13 to patients without a reliable vaccination record. For
all patients over 65 years old without the aforementioned conditions,
PCV13 administration should be decided based on shared decision making
between the patient and provider.
A 6-year-old boy arrives at the office with his parents for a wellness check.
What are the three most common types of fractures in children?
A. Metaphyseal, epiphyseal, apophyseal
B. Comminuted, epiphyseal, spiral
C. Transverse, metaphyseal, apophyseal
D. Comminuted, spiral, transverse ---------CORRECT ANSWER----------------
-Correct Answer: A. Metaphyseal, epiphyseal, apophyseal
Children are different from adults in that they have a metaphysis and a
physis which is also known as the growth plate. This is the area of bone
where it lengthens. Salter-Harris fractures are epiphyseal-metaphyseal
fractures. Children also have apophyses in many locations in the body,
including the heel (Sever's disease) and knee (Osgood-Schlatter's
disease).
Incorrect Answers:
B. A comminuted fracture is a fracture that involves more than 2 bone
components. A spiral fracture is a torsion fracture; when observed in long
bones of young children, child abuse must be considered.
C. A transverse fracture can occur in children, but epiphysis fractures are
more common. A transverse fracture is perpendicular to the axis of the
bone.
D. These are all types of fractures that occur in children, but they are less
common.
The McMurray's test is performed by having the patient lie supine, flexing
the knee and hip to 45 degree angles. While one hand holds the knee, the
other holds the ankle. Then externally rotate the leg and assess for any
audible clicks or pain. This is testing for:
A. Tenosynovitis
,B. Knee osteophytes
C. Arthritis
D. Meniscal injury Correct ---------CORRECT ANSWER-----------------Correct
Answer: D. Meniscal injury
A positive McMurray's test indicates a meniscal injury.
Incorrect Answers:
A. Tenosynovitis would not have a positive McMurray's test. Tenosynovitis
is inflammation of the sheath surrounding a tendon. You would use
Finklestein's test to assess for tenosynovitis.
B. Knee osteophytes would not elicit a positive McMurray's test.
Osteophytes are suggestive of arthritis. C. This test does not assess for
arthritis.
A 24-year-old tennis player complains of knee pain upon presentation to
the orthopedic clinic. She claims that during one of her games a month
ago, she quickly changed direction in order to return a served ball from her
opponent. She felt an uncomfortable painful twisting motion as she reached
for the ball. After the incident, she was able to put weight on her knee and
felt fine walking. However, recently she has felt increasing knee pain when
walking, joint-line tenderness, and difficulty putting weight on her knee. The
patient's temperature = 98.3°F, HR = 70, RR = 16, and BP = 120/80. Her
BMI is 24. A McMurray test is performed: the patient feels pain in the knee
when it is flexed completely and the examiner provides a valgus stress.
Which of the following is the most likely diagnosis?
A. ACL tear
B. MCL tear
C. LCL tear
D. Medial meniscus tear ---------CORRECT ANSWER-----------------Correct
Answer: D. Medial meniscus tear
Meniscus tears occur when the knee is twisted while flexed with the foot
planted on the ground. Unlike ACL, MCL, or LCL tears, there is typically no
trauma involved and no immediate pain following the injury. Patients can
walk and bear weight on the knee following the injury, In the days that
follow, they present with symptoms of joint-line tenderness, difficulty
squatting, joint effusion, and loss of smooth motion of the knee. Meniscus
tears are diagnosed by the McMurray test: the knee is held by one hand,
which is placed along the joint line, and the knee is flexed completely while
, the foot is held by the sole with the other hand. The examiner then places
one hand on the lateral side of the knee to stabilize the joint and provides a
valgus stress. The other hand rotates the leg externally while extending the
knee. If pain is felt, this indicates a tear in the medial meniscus. Our
patient's pain 1 month after the incident followed by a positive valgus stress
on McMurray test confirm the diagnosis of a medial meniscus tear.
Incorrect Answers:
A. Tearing of the anterior cruciate ligament (ACL) presents with immediate
pain at the moment of impact from either a direct blunt trauma to the knee
or hard planting of the knee on the ground when changing directions,
especially in sports such as basketball, football, or soccer. Patients present
with immediate severe pain, swelling, and sometimes hemarthrosis.
Patients also have difficulty in putting weight on their knees and patellar
tenderness. Diagnosis is made using a variety of tests such as the
Lachman, anterior drawer, or pivot tests. The lack of immediate pain
following the incident make this diagnosis unlikely.
B. Tearing of the medial collateral ligament (MCL) typically occurs when a
direct, blunt trauma is dealt to the lateral po
A 55-year-old environmental service worker reports twisting his knee at
work yesterday. Upon examination his knee is swollen and tender to
palpation. His exam is otherwise negative. He is diagnosed with a Grade II
sprain. Your initial treatment plan would include which of the following?
A. Protecting and elevating the knee from further injury, use of ice
intermittently for 48 hours
B. Alternate heat and ice application for 48 hours
C. Application of Ace bandage to knee for support
D. Isometric exercises, recheck knee in 24 hours ---------CORRECT
ANSWER-----------------Correct Answer: A.
Protecting and elevating the knee from further injury, use of ice
intermittently for 48 hours
PRICE: Protect, rest, ice, compress and elevate is the acronym used for
minor musculoskeletal injuries. Elevation will help decrease swelling to the
knee. Application of ice will also minimize tissue swelling if done in the first
48 hours.
Incorrect Answers:
