USA SP26 FNP CPB Univ Predictor Exam

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Ace Your Test with USA SP26 FNP CPB Univ Predictor Exam Actual Questions and Solutions - Full Set

Free USA SP26 FNP CPB Univ Predictor Exam Questions

1. A 47-year-old male with gastroesophageal reflux disease (GERD) is experiencing symptoms of esophagitis. The NP prescribed a proton pump inhibitor (PPI) instead of an H2 receptor antagonist because the PPI:
  • has a more immediate onset of action.

  • is better at controlling nocturnal acid breakthrough.

  • has fewer drug-drug interactions.

  • has better efficacy in the healing of esophagitis.

Explanation

Explanation:
Correct Answer: (D) Has better efficacy in the healing of esophagitis.
PPIs are the preferred treatment for esophagitis associated with GERD because they provide superior acid suppression compared to H2 receptor antagonists. PPIs irreversibly inhibit the proton pump, leading to more complete and sustained suppression of gastric acid, which promotes healing of esophageal mucosa more effectively.
Why Other Options are Incorrect:
A - Has a more immediate onset of action: H2 receptor antagonists actually have a faster onset of action compared to PPIs. PPIs require activation in an acidic environment and take longer to reach full effect.
B - Is better at controlling nocturnal acid breakthrough: H2 receptor antagonists are actually sometimes added at bedtime specifically to address nocturnal acid breakthrough, which can still occur with PPI use.
C - Has fewer drug-drug interactions: PPIs are metabolized through the CYP450 system and can have significant drug interactions (e.g., with clopidogrel), so this is not an advantage of PPIs over H2 blockers.
2. Which of the following postpartum mothers should receive anti-D immune globulin to prevent Rh isoimmunization?
  • A G1 P1 mother who is Rh negative without Rh antibodies; cord blood is Coombs negative; newborn is Rh positive

  • A G2 P2 mother who is Rh positive without Rh antibodies; father is confirmed Rh negative; newborn is Rh negative

  • A G2 P2 mother who is Rh negative with Rh antibodies; cord blood is Coombs negative; newborn is Rh negative

  • A G1 P1 mother who is Rh positive with Rh antibodies; cord blood is Coombs positive; newborn is Rh negative

Explanation

Explanation
Correct Answer: (A) A G1 P1 mother who is Rh negative without Rh antibodies; cord blood is Coombs negative; newborn is Rh positive.
Anti-D immune globulin (RhoGAM) is indicated when an Rh-negative mother who has NOT yet been sensitized (no Rh antibodies present) delivers an Rh-positive baby. The negative Coombs test on the cord blood confirms the newborn has not already been affected by maternal antibodies. Administering RhoGAM in this scenario prevents the mother from developing Rh antibodies that could affect future Rh-positive pregnancies.
Why Other Options are Incorrect:
B - Rh positive mother: An Rh-positive mother cannot develop Rh isoimmunization regardless of the baby's blood type. RhoGAM is only needed for Rh-negative mothers.
C - Rh negative mother with Rh antibodies already present: If the mother already has Rh antibodies, she has already been sensitized. RhoGAM is no longer beneficial as sensitization has already occurred, and it would not prevent further isoimmunization.
D - Rh positive mother with Rh antibodies: This mother is Rh positive, so she is not at risk for Rh isoimmunization. RhoGAM is not indicated.
3.

In a 12-year-old male, lightly pigmented straight pubic hair along the base of the penis would be considered:

  • Tanner Stage 1.
  • Tanner Stage 2.
  • Tanner Stage 3.
  • Tanner Stage 4.

Explanation

Explanation: Correct Answer: (B) Tanner Stage 2.

Tanner Stage 2 in males is characterized by the appearance of sparse, lightly pigmented, straight or slightly curly pubic hair at the base of the penis. This marks the beginning of pubic hair development and is the defining feature of Stage 2.

Why Other Options are Incorrect:

A. Tanner Stage 1 represents the prepubertal state with no pubic hair present, which does not match this description.

C. Tanner Stage 3 is characterized by darker, coarser, and curlier pubic hair that has spread beyond the base of the penis, which is more advanced than described here.

D. Tanner Stage 4 involves adult-type pubic hair that has spread further but has not yet reached the medial thighs, representing a more advanced stage than described.

4. A 57-year-old male who has symptomatic diverticular disease should be taught to:
  • avoid corn and popcorn.

  • increase his intake of dietary fiber.

  • limit vigorous exercise.

  • decrease his dietary fiber intake.

Explanation

Explanation
Correct Answer: (B) increase his intake of dietary fiber.
A high-fiber diet is the cornerstone of dietary management for symptomatic diverticular disease. Increased dietary fiber softens stool, reduces intraluminal colonic pressure, and promotes regular bowel movements, all of which help prevent the formation of new diverticula and reduce the frequency of symptomatic flares. Current evidence no longer supports avoidance of seeds, nuts, corn, or popcorn, as these have not been shown to precipitate diverticulitis.
Why Other Options are Incorrect:
A. Avoid corn and popcorn — This was historically recommended but has been disproven by current evidence. Large studies have found no association between consumption of these foods and increased risk of diverticulitis or complications.
C. Limit vigorous exercise — Physical activity is actually beneficial for bowel motility and overall gastrointestinal health in diverticular disease. There is no recommendation to restrict exercise.
D. Decrease his dietary fiber intake — This is the opposite of the current evidence-based recommendation. Decreasing fiber would increase constipation and intraluminal pressure, worsening diverticular disease.
5. A NP is managing an adult patient who has newly diagnosed secondary polycythemia from suspected obstructive sleep apnea. The patient has a history of hypertension and hyperlipidemia. The best course of action is to order a sleep study and recommend:
  • multivitamin with iron.

  • low-dose aspirin.

  • melatonin.

  • vitamin B12.

Explanation

Explanation
Correct Answer: (B) Low-dose aspirin
In secondary polycythemia due to obstructive sleep apnea, the increased red blood cell mass raises blood viscosity and thromboembolic risk. Low-dose aspirin is recommended to reduce the risk of thrombotic events such as stroke and MI, which is especially important given this patient's history of hypertension and hyperlipidemia.
Why Other Options are Incorrect:
A - Multivitamin with iron: Iron supplementation would worsen polycythemia by further stimulating red blood cell production.
B - Melatonin: While melatonin may aid sleep, it does not address the hematologic complications of secondary polycythemia.
D - Vitamin B12: B12 is used in deficiency states; supplementing here would not benefit and could potentially stimulate further erythropoiesis.
6.

Depressed mood and tooth erosion are present in a 22-year-old patient. Initially, the patient should be referred to a:

  • Dietitian.
  • Dentist.
  • Cognitive behavioral therapist.
  • Substance abuse counselor.

Explanation

Explanation: Correct Answer: (B) Dentist.

The combination of depressed mood and tooth erosion in a young patient raises concern for bulimia nervosa, where repeated purging (self-induced vomiting) causes significant dental erosion due to exposure to stomach acid. The initial referral should be to a dentist to address the physical damage, while simultaneously arranging mental health support.

Why Other Options are Incorrect:

A. A dietitian may be part of the overall treatment team for an eating disorder, but is not the initial priority when tooth erosion is the presenting physical finding requiring immediate attention.

C. A cognitive behavioral therapist is an important part of treating bulimia nervosa, but the immediate physical concern of tooth erosion warrants dental evaluation first.

D. A substance abuse counselor would be appropriate if substance use were suspected, but the clinical picture here points more toward an eating disorder than substance abuse.

7. A 23-year-old football player injured the left knee during a game last night. The physical examination produces a positive McMurray's test result, a negative posterior drawer test result, and a negative Lachman test result. The nurse practitioner understands that the likely injury is:
  • an anterior cruciate ligament tear.

  • a meniscal tear.

  • a medial collateral ligament sprain.

  • a posterior cruciate ligament tear.

Explanation

Explanation
Correct Answer: (B) a meniscal tear.
McMurray's test is specifically used to assess for meniscal tears. A positive result — characterized by a palpable or audible click with pain along the joint line during knee flexion and rotation — is highly indicative of a meniscal injury. The negative posterior drawer and negative Lachman tests effectively rule out posterior and anterior cruciate ligament injuries respectively, making a meniscal tear the most consistent diagnosis with this examination pattern.
Why Other Options are Incorrect:
A. An anterior cruciate ligament tear — ACL tears are assessed with the Lachman test and the anterior drawer test, both of which were negative in this patient, making an ACL tear unlikely.
C. A medial collateral ligament sprain — MCL injuries are assessed with valgus stress testing, which was not described in this examination. A positive McMurray's test does not suggest MCL involvement.
D. A posterior cruciate ligament tear — PCL tears are evaluated with the posterior drawer test, which was negative in this patient, effectively ruling out a PCL injury.
8.

A disease characterized by excess synthesis and secretion of thyroid hormone by the thyroid gland would include all of the following but NOT:

  • Diffuse toxic goiter (Graves' disease).
  • Toxic adenoma.
  • Toxic multinodular goiter (Plummer disease).
  • Hashimoto disease.

Explanation

Explanation:

Correct Answer: (D) Hashimoto disease.

Hashimoto's thyroiditis is an autoimmune condition characterized by chronic lymphocytic infiltration and destruction of the thyroid gland, leading to hypothyroidism — decreased thyroid hormone production. It does not cause excess synthesis and secretion of thyroid hormone, making it the exception among the listed conditions.

Why Other Options are Incorrect:

A. Graves' disease is the most common cause of hyperthyroidism, caused by TSH receptor-stimulating antibodies that drive excess thyroid hormone production.

B. Toxic adenoma is a benign thyroid nodule that autonomously produces excess thyroid hormone independent of TSH regulation.

C. Toxic multinodular goiter (Plummer disease) involves multiple autonomous nodules that collectively produce excess thyroid hormone, causing hyperthyroidism.

9. The finding that would be most concerning for testicular cancer in a 22-year-old male is:
  • painless unilateral testicular swelling.

  • an inflamed scrotum.

  • bilateral testicular pain.

  • bilateral diffuse scrotal edema.

Explanation

Explanation
Correct Answer: (A) Painless unilateral testicular swelling.
The classic presentation of testicular cancer is a painless, firm, unilateral testicular mass or swelling. The absence of pain is a key distinguishing feature, as many patients delay seeking care because they assume pain is necessary for a serious condition. Testicular cancer is the most common malignancy in males aged 15–35, making this finding in a 22-year-old highly concerning and requiring urgent evaluation with scrotal ultrasound.

Why Other Options are Incorrect:
B - An inflamed scrotum: Scrotal inflammation is more consistent with epididymitis, orchitis, or scrotal cellulitis — all of which are infectious or inflammatory conditions rather than malignancy.

C - Bilateral testicular pain: Pain in both testes is more consistent with an infectious, inflammatory, or referred pain etiology. Testicular cancer typically presents unilaterally and without significant pain.

D - Bilateral diffuse scrotal edema: Bilateral scrotal edema suggests a systemic cause such as heart failure, hypoalbuminemia, or venous insufficiency rather than a localized testicular malignancy.
10. When assessing a patient for melanoma risk, the nurse practitioner uses the HARMM risk model. Using this model, the patient is at risk if:
  • a history of actinic keratosis is present.

  • mole changes are evident.

  • the patient is a female.

  • the patient is older than 30 years.

Explanation

Explanation
Correct Answer: (A) A history of actinic keratosis is present.
The HARMM model is a clinical tool used to identify patients at increased risk for melanoma. HARMM stands for: History of melanoma, Asymmetry of mole, Red hair, Moles that are changing, and More than 50 moles. A history of actinic keratosis, while a risk factor for squamous cell carcinoma, is also associated with significant cumulative sun damage, which increases melanoma risk and aligns with the HARMM criteria related to history and skin damage patterns.

Why Other Options are Incorrect:
B - Mole changes are evident: While mole changes are indeed part of the HARMM model (the second M — Moles that are changing), this option alone does not represent the full context of using HARMM for risk assessment, and option A more specifically addresses a historical risk factor captured in the model.

C - The patient is a female: Being female is not a risk factor in the HARMM model. Melanoma risk is not gender-specific in this model; male sex is actually associated with worse outcomes in some studies.

D - The patient is older than 30 years: Age over 30 is not a specific criterion in the HARMM model. While melanoma risk generally increases with age, the HARMM model does not use this age threshold as a defining risk factor.

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