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PRIMARY CARE FNP BOARD REVIEW EXAM QUESTIONS(LATEST 2022 UPDATE)
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PRIMARY CARE FNP BOARD REVIEW EXAM QUESTIONS(LATEST 2022 UPDATE)
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PRIMARY CARE FNP BOARD REVIEW EXAMQUESTIONS
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Board Reviewed Questions
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You see a 23-year-old gravida 1 para 0 for her prenatal checkup at 38 weeks gestation. She complains of
severe headaches and epigastric pain. She has had an uneventful pregnancy to date and had a normal
prenatal examination 2 weeks ago. Her blood pressure is 140/100 mm Hg. A urinalysis shows 2+ protein;
she has gained 5 lb in the last week, and has 2+ pitting edema of her legs. The most appropriate
management at this point would be: (check one)
A. Strict bed rest at home and reexamination within 48 hours
B. Admitting the patient to the hospital for bed rest and frequent monitoring of blood pressure, weight,
and proteinuria
C. Admitting the patient to the hospital for bed rest and monitoring, and beginning hydralazine
(Apresoline) to maintain blood pressure below 140/90 mm Hg
D. Admitting the patient to the hospital, treating with parenteral magnesium sulfate, and planning
prompt delivery either vaginally or by cesarean section (correct answers)D. Admitting the patient to the
hospital, treating with parenteral magnesium sulfate, and planning prompt delivery either vaginally or
by cesarean section. This patient manifests a rapid onset of preeclampsia at term. The symptoms of
epigastric pain and headache categorize her preeclampsia as severe. These symptoms indicate that the
process is well advanced and that convulsions are imminent. Treatment should focus on rapid control of
symptoms and delivery of the infant.
Which one of the following is the most common cause of hypertension in children under 6 years of age?
(check one)
A. Essential hypertension
,B. Pheochromocytoma
C. Renal parenchymal disease
D. Hyperthyroidism
E. Excessive caffeine use (correct answers)C. Renal parenchymal disease. Although essential
hypertension is most common in adolescents and adults, it is rarely found in children less than 10 years
old and should be a diagnosis of exclusion. The most common cause of hypertension is renal
parenchymal disease, and a urinalysis, urine culture, and renal ultrasonography should be ordered for all
children presenting with hypertension. Other secondary causes, such as pheochromocytoma,
hyperthyroidism, and excessive caffeine use, are less common, and further testing and/or investigation
should be ordered as clinically indicated.
A 70-year-old male with a history of hypertension and type 2 diabetes mellitus presents with a 2-month
history of increasing paroxysmal nocturnal dyspnea and shortness of breath with minimal exertion. An
echocardiogram shows an ejection fraction of 25%. Which one of the patients current medications
should be discontinued? (check one)
A. Lisinopril (Zestril)
B. Pioglitazone (Actos)
C. Glipizide (Glucotrol)
D. Metoprolol (Toprol-XL)
E. Repaglinide (Prandin) (correct answers)B. Pioglitazone (Actos). According to the American Diabetes
Association guidelines, thiazolidinediones (TZDs) are associated with fluid retention, and their use can
be complicated by the development of heart failure. Caution is necessary when prescribing TZDs in
patients with known heart failure or other heart diseases, those with preexisting edema, and those on
concurrent insulin therapy (SOR C). Older patients can be treated with the same drug regimens as
younger patients, but special care is required when prescribing and monitoring drug therapy. Metformin
is often contraindicated because of renal insufficiency or heart failure. Sulfonylureas and other insulin
secretagogues can cause hypoglycemia. Insulin can also cause hypoglycemia, and injecting it requires
good visual and motor skills and cognitive ability on the part of the patient or a caregiver. TZDs should
not be used in patients with New York Heart Association class III or IV heart failure.
,A 72-year-old African-American male with New York Heart Association Class III heart failure sees you for
follow-up. He has shortness of breath with minimal exertion. The patient is adherent to his medication
regimen. His current medications include lisinopril (Prinivil, Zestril), 40 mg twice daily; carvedilol (Coreg),
25 mg twice daily; and furosemide (Lasix), 80 mg daily. His blood pressure is 100/60 mm Hg, and his
pulse rate is 68 beats/min and regular. Findings include a few scattered bibasilar rales on examination of
the lungs, an S3 gallop on examination of the heart, and no edema on examination of the legs. An EKG
reveals a left bundle branch block, and echocardiography reveals an ejection fraction of 25%, but no
other abnormalities. Which one of the following would be most appropriate at this time? (check one)
A. Increase the lisinopril dosage to 80 mg twice daily
B. Increase the carvedilol dosage to 50 mg twice daily
C. Increase the furosemide dosage to 160 mg daily
D. Refer for coronary angiography
E. Refer for cardiac resynchronization therapy (correct answers)E. Refer for cardiac resynchronization
therapy. This patient is already receiving maximal medical therapy. The 2002 joint guidelines of the
American College of Cardiology, the American Heart Association (AHA), and the North American Society
of Pacing and Electrophysiology endorse the use of cardiac resynchronization therapy (CRT) in patients
with medically refractory, symptomatic, New York Heart Association (NYHA) class III or IV disease with a
QRS interval of at least 130 msec, a left ventricular end-diastolic diameter of at least 55 mm, and a left
ventricular ejection fraction (LVEF) ≤30%. Using a pacemaker-like device, CRT aims to get both ventricles
contracting simultaneously, overcoming the delayed contraction of the left ventricle caused by the left
bundle-branch block. These guidelines were refined by an April 2005 AHA Science Advisory, which stated
that optimal candidates for CRT have a dilated cardiomyopathy on an ischemic or nonischemic basis, an
LVEF ≤0.35, a QRS complex ≥120 msec, and sinus rhythm, and are NYHA functional class III or IV despite
maximal medical therapy for heart failure.
Of the following dietary factors recommended for the prevention and treatment of cardiovascular
disease, which one has been shown to decrease the rate of sudden death? (check one)
A. Increased intake of plant protein
B. Increased intake of omega-3 fats
C. Increased intake of dietary fiber and whole grains
, D. Increased intake of monounsaturated oils
E. Moderate alcohol consumption (1 or 2 standard drinks per day) (correct answers)B. Increased intake
of omega-3 fats. Omega-3 fats contribute to the production of eicosapentaenoic acid (EPA) and
docosahexaenoic acid (DHA), which inhibit the inflammatory immune response and platelet aggregation,
are mild vasodilators, and may have antiarrhythmic properties. The American Heart Association
guidelines state that omega-3 supplements may be recommended to patients with preexisting disease, a
high risk of disease, or high triglyceride levels, as well as to patients who do not like or are allergic to
fish. The Italian GISSI study found that the use of 850 mg of EPA and DHA daily resulted in decreased
rates of mortality, nonfatal myocardial infarction, and stroke, with particular decreases in the rate of
sudden death.
A 75-year-old male presents to the emergency department with a several-hour history of back pain in
the interscapular region. His medical history includes a previous myocardial infarction (MI) several years
ago, a history of cigarette smoking until the time of the MI, and hypertension that is well controlled with
hydrochlorothiazide and lisinopril (Prinivil, Zestril). The patient appears anxious, but all pulses are intact.
His blood pressure is 170/110 mm Hg and his pulse rate is 110 beats/min. An EKG shows evidence of an
old inferior wall MI but no acute changes. A chest radiograph shows a widened mediastinum and a
normal aortic arch, and CT of the chest shows a dissecting aneurysm of the descending aorta that is
distal to the proximal abdominal aorta but does not involve the renal arteries. Which one of the
following would be the most appropriate next step in the management of this patient? (check one)
A. Immediate surgical intervention
B. Arteriography of the aorta
C. Intravenous nitroprusside (Nipride)
D. A nitroglycerin drip
E. Intravenous labetalol (Normodyne, Trandate) (correct answers)E. Intravenous labetalol (Normodyne,
Trandate). Patients with thoracic aneurysms often present without symptoms. With dissecting
aneurysms, however, the presenting symptom depends on the location of the aneurysm. Aneurysms can
compress or distort nearby structures, resulting in branch vessel compression or embolization of
peripheral arteries from a thrombus within the aneurysm. Leakage of the aneurysm will cause pain, and
rupture can occur with catastrophic results, including severe pain, hypotension, shock, and death.
Aneurysms in the ascending aorta may present with acute heart failure brought about by aortic
regurgitation from aortic root dilatation and distortion of the annulus. Other presenting findings may
include hoarseness, myocardial ischemia, paralysis of a hemidiaphragm, wheezing, coughing,
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