USA SP26 FNP CPB Univ Predictor Exam
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A patient complains of a dry, hacking cough that is aggravating. He has a history of hypertension that has been well controlled on benazepril (Lotensin) for the past 3 months. The nurse practitioner informs the patient that:
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the cough is likely related to the ACE inhibitor and a bronchodilator will help control this side effect.
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the cough is likely related to the ACE inhibitor. This medication should be discontinued, and an angiotensin receptor blocker should be started.
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the cough is NOT likely related to the ACE inhibitor and a pulmonary function test is needed.
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the cough is NOT likely related to the ACE inhibitor, but if the cough resolves with a reduced dose of benazepril (Lotensin), it will confirm that the ACE inhibitor is the cause.
Explanation
Correct Answer: (B) the cough is likely related to the ACE inhibitor. This medication should be discontinued, and an angiotensin receptor blocker should be started.
A dry, persistent cough is a well-known and common side effect of ACE inhibitors, occurring in approximately 10–15% of patients, caused by the accumulation of bradykinin in the respiratory tract. The appropriate clinical response is to discontinue the ACE inhibitor and switch to an angiotensin receptor blocker (ARB), which provides equivalent antihypertensive and cardioprotective benefits without causing bradykinin accumulation and the associated cough.
Why Other Options are Incorrect:
A. A bronchodilator will help control this side effect — Bronchodilators do not address the bradykinin-mediated mechanism of ACE inhibitor cough and are not an appropriate management strategy for this side effect.
C. The cough is NOT likely related to the ACE inhibitor — Given the temporal relationship between starting benazepril and the onset of a dry, hacking cough, ACE inhibitor-induced cough is the most likely diagnosis and should not be dismissed.
D. A reduced dose will confirm the cause — Dose reduction does not reliably resolve ACE inhibitor cough, as the reaction is a class effect. The appropriate action is medication discontinuation and substitution with an ARB.
Precautions should be taken if a 65-year-old patient who wishes to receive the inactivated influenza vaccine (IIV):
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is receiving warfarin.
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has symptoms of bronchitis with a fever.
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has COPD.
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has stage 3 chronic kidney disease.
Explanation
Correct Answer: (B) Has symptoms of bronchitis with a fever.
Vaccination should be deferred in patients with a moderate to severe acute illness with or without fever. Administering the vaccine during an acute febrile illness can make it difficult to distinguish vaccine side effects from illness symptoms and may potentially compromise the immune response. The patient should be rescheduled once they have recovered.
Why Other Options are Incorrect:
A - Is receiving warfarin: Warfarin use is not a contraindication to the inactivated influenza vaccine. The injection site should be chosen carefully (e.g., using a fine-gauge needle and applying firm pressure), but the vaccine can safely be administered.
C - Has COPD: COPD is actually an indication, not a contraindication, for annual influenza vaccination. Patients with chronic respiratory conditions are at higher risk for complications from influenza and should be prioritized for vaccination.
D - Has stage 3 chronic kidney disease: CKD is not a contraindication to the inactivated influenza vaccine. In fact, patients with CKD are recommended to receive the influenza vaccine annually due to their increased vulnerability to infectious complications.
A 33-year-old female presents with central facial redness that is persistent. She reports that the redness worsens when she is in the sun. These symptoms are most likely associated with:
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systemic lupus erythematosus.
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seborrheic dermatitis.
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dermatomyositis.
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rosacea.
Explanation
Correct Answer: (D) Rosacea.
Rosacea is a chronic inflammatory skin condition that characteristically presents with persistent central facial redness (erythema), flushing, and sensitivity to sun exposure. It most commonly affects the cheeks, nose, chin, and forehead. Sun exposure is one of the most well-known triggers for rosacea flares, making this the most consistent diagnosis with the presentation described.
Why Other Options are Incorrect:
A - Systemic lupus erythematosus: SLE can present with a malar (butterfly) rash that is also sun-sensitive, which makes it a reasonable consideration. However, SLE is a systemic disease with additional features such as joint pain, fatigue, serositis, and abnormal lab findings. In the absence of systemic symptoms, rosacea is the more likely diagnosis.
B - Seborrheic dermatitis: Seborrheic dermatitis typically presents with greasy, scaly patches on the scalp, nasolabial folds, eyebrows, and behind the ears. It is not primarily characterized by central facial redness or sun sensitivity.
C - Dermatomyositis: Dermatomyositis can cause a heliotrope rash around the eyes and Gottron's papules over the knuckles, along with proximal muscle weakness. It does not typically cause the pattern of persistent central facial redness described here.
A patient presents with sore throat and has a diffuse erythematous rash that blanches with pressure. The rash is concentrated in the groin and axilla. Numerous small (1 to 2 mm) papular sandpaper-like elevations are present. To confirm diagnosis, the nurse practitioner should obtain:
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a complete blood count (CBC).
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a monospot test.
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allergy testing.
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a throat culture.
Explanation
Correct Answer: (D) A throat culture.
The clinical presentation describes scarlet fever — a Group A Streptococcal (GAS) infection characterized by sore throat, a diffuse erythematous blanching rash with a sandpaper-like texture, and accentuation in the skin folds (Pastia's lines in the groin and axilla). The gold standard for confirming GAS pharyngitis, which is the source of the streptococcal toxin causing the rash, is a throat culture. A rapid strep test may also be used, but throat culture remains the definitive confirmatory test.
Why Other Options are Incorrect:
A - A complete blood count: A CBC may show elevated white blood cells consistent with infection but is nonspecific and does not confirm the diagnosis of scarlet fever or streptococcal pharyngitis.
B - A monospot test: The monospot test is used to diagnose infectious mononucleosis (Epstein-Barr virus). While mono can present with pharyngitis and rash, the sandpaper-like texture and distribution described are classic for scarlet fever, not mononucleosis.
C - Allergy testing: The rash of scarlet fever is caused by streptococcal erythrogenic toxin, not an allergic mechanism. Allergy testing is not appropriate here.
Which of the following statements about generalized anxiety disorder (GAD) is true?
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GAD occurs twice as often in men as it does in women.
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A patient with GAD is likely to have at least one concurrent disorder (e.g., obsessive compulsive disorder).
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There is no genetic link between major depression and GAD.
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GAD is less likely to occur after the age of 50.
Explanation
Correct Answer: (B) A patient with GAD is likely to have at least one concurrent disorder.
GAD has a very high rate of psychiatric comorbidity. The majority of patients diagnosed with GAD also meet criteria for at least one other mental health disorder, most commonly major depressive disorder, other anxiety disorders, or somatic symptom disorders. This comorbidity is important to recognize as it affects treatment planning and outcomes.
Why Other Options are Incorrect:
A - GAD occurs twice as often in men as in women: This is incorrect. GAD is actually twice as common in women as in men. The female-to-male ratio is approximately 2:1, consistent with most anxiety disorders.
C - There is no genetic link between major depression and GAD: Research has demonstrated a significant genetic overlap between GAD and major depressive disorder. Studies suggest they share common genetic risk factors, which helps explain their frequent co-occurrence.
D - GAD is less likely to occur after the age of 50: GAD can occur at any age, including in older adults. In fact, anxiety disorders including GAD are among the most common psychiatric conditions in the elderly population and should not be dismissed based on age.
In a patient with altered mental status and suspected hyperosmolar hyperglycemic state, the electrolyte that is used to calculate serum plasma osmolality is:
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magnesium.
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chloride.
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potassium.
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sodium.
Explanation
Correct Answer: (D) Sodium.
Serum plasma osmolality is calculated using the formula: 2(sodium) + glucose/18 + BUN/2.8. Sodium is the primary extracellular cation and the most important determinant of serum osmolality. In hyperosmolar hyperglycemic state (HHS), both elevated sodium and markedly elevated glucose contribute to the dangerously high osmolality that causes the altered mental status seen in these patients.
Why Other Options are Incorrect:
A - Magnesium: Magnesium is an intracellular cation that plays roles in enzyme function and neuromuscular activity, but it is not part of the serum osmolality calculation formula.
B - Chloride: While chloride is the primary extracellular anion and follows sodium closely, it is not directly included in the standard osmolality calculation formula.
C - Potassium: Potassium is the primary intracellular cation and is critical for cardiac and neuromuscular function, but it is not included in the standard serum osmolality calculation formula.
A 7-year-old child has had a "slapped cheek" rash for the last 24 hours. During the physical exam, the NP identifies a bright red lacy-appearing rash on the upper trunk, back, and buttocks. The patient is afebrile and states that the rash does not itch. The nurse practitioner should instruct the mother to:
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Keep the child home from school until the rash disappears.
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Send the child to school; they are no longer contagious.
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Make sure the child is not exposed to pregnant women for the next 2 weeks.
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Allow the child to play outside, but avoid getting overheated.
Explanation
Explanation: Correct Answer: (D) Allow the child to play outside, but avoid getting overheated.
The presentation describes erythema infectiosum (Fifth disease), caused by Parvovirus B19. By the time the characteristic slapped cheek rash and lacy rash appear, the child is no longer contagious and is afebrile. The child may return to normal activities including playing outside, but should avoid overheating as heat can worsen the rash.
Why Other Options are Incorrect:
A. Keeping the child home from school is unnecessary because by the time the rash appears, the infectious period has already passed.
B. While it is correct that the child is no longer contagious, this answer is incomplete as it does not address the important precaution regarding heat worsening the rash.
C. The 2-week exposure warning for pregnant women is overstated at this stage; the child is no longer shedding the virus once the rash appears, so isolation from pregnant women is not required at this point.
Examination of a 53-year-old female identifies a scaly, erythematous, crusty, thickened plaque on the left nipple. It is spreading to the surrounding areolar areas. These findings are most characteristic of:
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impetigo of the left breast.
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a psoriatic lesion.
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inflammatory breast cancer.
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mammary Paget disease.
Explanation
Correct Answer: (D) Mammary Paget disease.
Mammary Paget disease is a rare form of breast cancer that presents as a scaly, erythematous, crusty, thickened plaque on the nipple that progressively extends to the surrounding areola. It is caused by Paget cells (adenocarcinoma cells) infiltrating the epidermis of the nipple. This characteristic nipple-areolar presentation in a postmenopausal woman requires urgent biopsy and evaluation for underlying breast malignancy.
Why Other Options are Incorrect:
A - Impetigo of the left breast: Impetigo is a superficial bacterial skin infection typically presenting with honey-colored crusted lesions in children. It does not produce the chronic, progressive, thickened plaque on the nipple described here.
B - A psoriatic lesion: Psoriasis can affect the breast skin, but it typically presents as well-demarcated silvery scaly plaques on extensor surfaces and does not specifically target the nipple-areolar complex in the progressive manner described.
C - Inflammatory breast cancer: Inflammatory breast cancer presents with rapid breast enlargement, erythema, warmth, and peau d'orange skin changes affecting the breast skin diffusely. It does not typically present as a scaly plaque specifically localized to the nipple and areola.
A 57-year-old patient presents with intermittent complaints of tinnitus, middle frequency hearing loss in the left ear, vertigo, and a sense of fullness in the left ear. These presenting symptoms are MOST suggestive of:
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benign paroxysmal vertigo.
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Meniere's disease.
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vestibular migraine.
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presbycusis.
Explanation
Correct Answer: (B) Meniere's disease.
Meniere's disease is characterized by the classic tetrad of episodic vertigo, unilateral sensorineural hearing loss (typically low to middle frequencies), tinnitus, and aural fullness (a sense of pressure or fullness in the affected ear). This patient's presentation perfectly matches all four hallmark features of Meniere's disease, making it the most appropriate diagnosis.
Why Other Options are Incorrect:
A - Benign paroxysmal positional vertigo (BPPV): BPPV presents with brief episodes of vertigo triggered by changes in head position. It does not cause hearing loss, tinnitus, or aural fullness, which distinguishes it clearly from Meniere's disease.
C - Vestibular migraine: Vestibular migraine can cause episodic vertigo and may be associated with auditory symptoms, but the full tetrad of tinnitus, unilateral hearing loss, vertigo, and ear fullness as described here is more characteristic of Meniere's disease.
D - Presbycusis: Presbycusis is age-related sensorineural hearing loss that affects high frequencies bilaterally and progresses gradually. It does not cause episodic vertigo, tinnitus, or aural fullness, and is therefore inconsistent with this presentation.
When counseling the sex partner of a symptomatic patient with gonorrhea, the NP should advise that to prevent reinfection, unprotected sexual intercourse should be avoided for:
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The next 24 hours.
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3 days.
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7 days.
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1 month.
Explanation
Explanation: Correct Answer: (C) 7 days.
After treatment for gonorrhea, both the patient and their sex partner should avoid unprotected sexual intercourse for 7 days following completion of treatment and until all symptoms have resolved. This ensures the infection is fully cleared and prevents reinfection or transmission.
Why Other Options are Incorrect:
A. 24 hours is far too short a period to ensure the infection has been adequately treated and transmission risk eliminated.
B. 3 days is insufficient time to confirm complete treatment response and eliminate transmission risk.
D. 1 month is unnecessarily long; the standard recommendation is 7 days post-treatment before resuming unprotected intercourse.
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