USA SP26 FNP CPB Univ Predictor Exam
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Free USA SP26 FNP CPB Univ Predictor Exam Questions
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Prostatic abscess
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Epididymitis
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Bacteremia
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Erectile dysfunction
Explanation
Correct Answer: (D) Erectile dysfunction.
While erectile dysfunction can be associated with chronic prostatitis or chronic pelvic pain syndrome, it is not considered a classic or well-recognized direct complication of acute bacterial prostatitis. The established complications of acute prostatitis include prostatic abscess, epididymitis, and bacteremia/sepsis.
Why Other Options are Incorrect:
A - Prostatic abscess: This is a recognized complication of acute prostatitis, particularly if treatment is delayed or inadequate, leading to loculated infection within the prostate.
B - Epididymitis: Bacterial spread from the prostate can extend to the epididymis, making epididymitis a known complication of acute prostatitis.
C - Bacteremia: Acute prostatitis is caused by bacterial infection and can lead to bacteremia or urosepsis, especially if not promptly treated, making this a well-recognized and serious complication.
A 41-year-old female presents with multiple painful vesicular lesions in the vulvar area. She has been with the same sexual partner for 21 years and she believes infidelity has not occurred. Which of the following is the MOST likely diagnosis?
- Aphthous ulcers (Bechet's syndrome)
- Human papillomavirus infection
- Herpes simplex infection
- Syphilis
Explanation
Explanation:
Correct Answer: (C) Herpes simplex infection.
Painful vesicular lesions in the vulvar area are the classic presentation of herpes simplex virus (HSV) infection. Importantly, HSV can remain latent for many years after initial infection and reactivate spontaneously, meaning the patient could have been infected long before her current relationship without either partner being aware. This explains the presentation even in a long-term monogamous relationship.
Why Other Options are Incorrect:
A. Aphthous ulcers associated with Bechet's syndrome are painful oral and genital ulcers, but Bechet's syndrome is a rare systemic vasculitis that requires additional systemic criteria for diagnosis and is far less common than HSV.
B. Human papillomavirus (HPV) infection typically causes painless warts (condyloma acuminata) or is associated with cervical dysplasia, not painful vesicular lesions.
D. Syphilis presents with a painless chancre (primary syphilis) or a diffuse rash including the palms and soles (secondary syphilis), not painful vesicular lesions in the vulvar area.
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Hypertension
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Tachypnea
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Hives
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Rhonchi
Explanation
Correct Answer: (B) Tachypnea.
Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction. Tachypnea (rapid breathing) is a hallmark sign of anaphylaxis, resulting from bronchospasm, laryngeal edema, and airway compromise. Respiratory involvement is the most dangerous component of anaphylaxis and a primary cause of death if untreated.
Why Other Options are Incorrect:
A - Hypertension: Anaphylaxis typically causes hypotension, not hypertension, due to massive vasodilation and increased vascular permeability leading to distributive shock.
C - Hives: While urticaria (hives) is a common cutaneous manifestation of allergic reactions, it can also occur in mild allergic reactions that do not progress to anaphylaxis. It is not the most specific or serious symptom of anaphylaxis compared to respiratory compromise.
D - Rhonchi: Rhonchi are low-pitched sounds associated with secretions in larger airways, more characteristic of conditions like bronchitis or COPD exacerbations. In anaphylaxis, wheezing from bronchospasm is more characteristic than rhonchi.
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avoid a chest X-ray and treat empirically with doxycycline (Doryx).
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avoid a chest X-ray and treat empirically with levofloxacin (Levaquin).
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obtain a chest X-ray to confirm pneumonia, and treat with ceftriaxone (Rocephin) and levofloxacin (Levaquin).
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obtain a chest X-ray to confirm pneumonia, and treat with amoxicillin (Amoxil) and azithromycin (Zithromax).
Explanation
Correct Answer: (D) Obtain a chest X-ray to confirm pneumonia, and treat with amoxicillin (Amoxil) and azithromycin (Zithromax).
In a pregnant patient, a chest X-ray can and should be performed when clinically indicated, with appropriate abdominal shielding. The radiation exposure is minimal and the risk of untreated pneumonia to mother and fetus far outweighs the small radiation risk. For treatment, amoxicillin plus azithromycin is the preferred regimen for community-acquired pneumonia in pregnancy, as both are considered safe in pregnancy (Category B). This combination provides adequate coverage for typical and atypical organisms.
Why Other Options are Incorrect:
A - Avoid X-ray and use doxycycline: Doxycycline is contraindicated in pregnancy (Category D) as it can cause fetal tooth discoloration and inhibit bone growth. Additionally, avoiding diagnostic imaging when it is clinically needed is not appropriate.
B - Avoid X-ray and use levofloxacin: Fluoroquinolones such as levofloxacin are generally avoided in pregnancy due to concerns about fetal cartilage and musculoskeletal development. Avoiding the chest X-ray is also not clinically appropriate.
C - Ceftriaxone and levofloxacin: While ceftriaxone is safe in pregnancy, levofloxacin (a fluoroquinolone) is not the preferred choice during pregnancy. The combination of amoxicillin and azithromycin is the safer and guideline-supported regimen for outpatient CAP management in pregnant patients.
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inability to achieve independence in daily living.
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immature social skills.
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an IQ <70.
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general performance 2-3 years behind peers of the same age.
Explanation
Correct Answer: (A) Inability to achieve independence in daily living
Individuals with mild intellectual disability (IQ 50–70) are generally capable of achieving a degree of independence in daily living with appropriate support. They can often learn self-care skills, hold employment, and live semi-independently. Complete inability to achieve independence is more characteristic of moderate to severe intellectual disability.
Why Other Options are Incorrect:
B - Immature social skills: This is a common feature of mild intellectual disability, as social development is often delayed.
C - An IQ <70: This is the defining criterion for intellectual disability, including the mild range (IQ 50–70).
D - General performance 2-3 years behind peers: This is a typical academic and developmental characteristic seen in individuals with mild intellectual disability.
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.
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A short-acting bronchodilator
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An oral leukotriene inhibitor
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An inhaled corticosteroid
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Combination of methylxanthine and a long-acting bronchodilator
Explanation
Correct Answer: (C) An inhaled corticosteroid.
Inhaled corticosteroids (ICS) are the preferred and most effective long-term controller therapy for persistent asthma, including mild persistent asthma with nighttime symptoms. ICS reduce airway inflammation, decrease bronchial hyperresponsiveness, and prevent nocturnal symptoms by addressing the underlying inflammatory process rather than just providing symptomatic relief.
Why Other Options are Incorrect:
A - A short-acting bronchodilator: Short-acting bronchodilators (SABAs) like albuterol are rescue medications used for acute symptom relief. They do not address the underlying airway inflammation and are not appropriate for prevention of recurrent nighttime cough.
B - An oral leukotriene inhibitor: While leukotriene receptor antagonists (e.g., montelukast) can be used as alternative controllers in mild persistent asthma, they are considered less effective than inhaled corticosteroids as first-line preventive therapy.
D - Combination of methylxanthine and a long-acting bronchodilator: This combination is not a standard first-line approach for mild asthma. Methylxanthines (e.g., theophylline) have a narrow therapeutic window and significant side effects, making them less preferred compared to ICS.
A 5-year-old male is repeatedly soiling his underwear after previously being potty trained. The patient is likely to also have:
- Delayed sexual development.
- A urinary tract infection.
- Constipation.
- Laxative overuse.
Explanation
Explanation: Correct Answer: (C) Constipation.
Encopresis — the involuntary soiling of underwear in a previously toilet-trained child — is most commonly caused by chronic constipation with overflow incontinence. A large fecal mass impacted in the rectum causes the internal sphincter to relax, allowing liquid stool to leak around the impaction and soil the underwear without the child's awareness.
Why Other Options are Incorrect:
A. Delayed sexual development is unrelated to encopresis and would not explain fecal soiling in a previously toilet-trained child.
B. A urinary tract infection causes urinary symptoms such as dysuria, frequency, and urgency, not fecal soiling or encopresis.
D. Laxative overuse would cause diarrhea rather than the overflow incontinence pattern seen with constipation-related encopresis, and is not a typical cause in a 5-year-old.
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avoid corn and popcorn.
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increase his intake of dietary fiber.
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limit vigorous exercise.
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decrease his dietary fiber intake.
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.
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decreased functional residual capacity.
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decreased forced vital capacity.
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decreased postbronchodilator FEV1/FVC ratio.
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decreased total lung capacity.
Explanation
Correct Answer: (C) Decreased postbronchodilator FEV1/FVC ratio.
Chronic bronchitis is a form of COPD, an obstructive lung disease. The hallmark spirometric finding in obstructive lung disease is a decreased FEV1/FVC ratio (less than 0.70 post-bronchodilator), which indicates that the patient cannot exhale a normal proportion of their forced vital capacity in the first second due to airway obstruction. This is the defining spirometric criterion for diagnosing COPD, including chronic bronchitis.
Why Other Options are Incorrect:
A - Decreased functional residual capacity: Functional residual capacity (FRC) is actually increased in COPD due to air trapping and hyperinflation of the lungs, not decreased. A decreased FRC is more characteristic of restrictive lung disease.
B - Decreased forced vital capacity: FVC may be normal or only mildly reduced in early obstructive disease. A significantly decreased FVC with a normal or increased FEV1/FVC ratio is more indicative of restrictive lung disease, not chronic bronchitis.
D - Decreased total lung capacity: Total lung capacity (TLC) is increased or normal in COPD due to air trapping and hyperinflation. A decreased TLC is a hallmark of restrictive lung disease, not obstructive conditions like chronic bronchitis.
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