ANCC FNP EXAM 3 QUESTIONS CORRECT

ANCC FNP EXAM 3 QUESTIONS & CORRECT

ANSWERS GRADED A LATEST EXAM

special considerations for Thiazides - ANSWER-Chlorthalidone is preferred on the basis of prolonged half-life and proven trial reduction of CVD.

Monitor for hyponatremia and hypokalemia, monitor uric acid and calcium levels.

Use with caution in patients with history of acute gout unless patient is on uric acid-lowering therapy.

special considerations for ACE inhibitors - ANSWER-Do not use in combination with ARBs or direct renin inhibitor.

There is an increased risk of hyperkalemia, especially in patients with CKD or in those on K+ supplements or K+-sparing drugs.

There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.

Do not use if patient has history of angioedema with ACE inhibitors.

ACE inhibitor cough is common, in 5 to 20 percent of patients, due to bradykinin production.

Avoid in pregnant females or females of reproductive age without adequate contraception

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special considerations for Angiotensin receptor blockers - ANSWER-Do not use in combination with ACE inhibitors or direct renin inhibitor.

There is an increased risk of hyperkalemia in CKD or in those on K+ supplements or K+-sparing drugs.

There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis.

Do not use if patient has history of angioedema with ARBs. Patients with a history of angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after ACE inhibitor is discontinued.

Avoid in pregnant females or females of reproductive age without adequate contraception.

Lower risk of cough than ACE-Is.

special considerations for Calcium channel blockers - ANSWER-Associated with dose-related pedal edema, which is more common in females than men.

When should you Refer to a Nephrologist or Cardiologist in a hypertensive patient? - ANSWER--signs of end-organ damage -evidence of a secondary cause of hypertension -only on one to two medications

Generally, failure to achieve blood pressure goal in patients who are adhering to full doses of an appropriate three to four drug regimen that includes a diuretic may warrant referral to a nephrologist or cardiologist 2 / 4

Before referring, clinicians should first review other causes of inadequate

hypertension control such as:

-Improper blood pressure measurement -White coat hypertension -Excess sodium intake -Medication issues (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs), illicit drugs, sympathomimetics, oral contraceptives) -Excess alcohol intake -Underlying identifiable causes of hypertension (secondary hypertension)

A researcher is studying potential risk factors for obesity. She sends a questionnaire to 5000 patients who meet the CDC criteria for obesity that asks them about sedentary lifestyle factors, consumption of processed food, and family history of obesity. The researcher sends the same questionnaire to 5000 patients who are not obese. Which of the following best describes the design of the study?

• Cross-sectional study
• Randomized controlled trial
• Meta-analysis

D. Case-control study - ANSWER-Correct Answer: D. Case-control study

This is a retrospective case-control study. In this observational study design, subjects are selected based on an outcome, and their prior exposures are assessed and compared to subjects who do not have the particular outcome. The result of the

study is expressed as an odds ratio: OR = (# exposed with disease / # exposed

without disease) / (# not exposed with disease / # not exposed without disease). A retrospective case-control study does not prove causation but demonstrates an association.Incorrect 3 / 4

Answers:

• A cross-sectional study is used to assess disease status and risk factors at 1 point

in time.

• A randomized controlled trial refers to a study where a group is given a

treatment and outcomes are compared against a control group given a placebo or treated with the standard of care.

• A meta-analysis provides a statistical analysis of the results of multiple studies.

Vital Concepts:

In an observational study design, subjects are selected based on an outcome, and their prior exposures are assessed and compared to subjects who do not have a particular outcome. The result of the study is expressed as an odds ratio: OR = (# exposed with disease / # exposed without disease) / (# not exposed with disease / # not exposed without disease). A retrospective case-control study does not prove causation but demonstrates an association.

A 49-year-old female presents to the office with a history of breast cancer who is having frequent hot flashes who already tried first-line lifestyle changes without improvement? What is the best treatment for this patient?

• Hormonal therapy with estrogen and progesterone
• Bioidentical hormones
• Citalopram

D. Black cohosh - ANSWER-Correct Answer: C. Citalopram

Selective serotonin reuptake inhibitors (SSRI)s are the most effective pharmacologic choice for the vasomotor symptoms of menopause. Citalopram is an SSRI that has good evidence of efficacy against these symptoms and is typically well-tolerated.

Incorrect Answers:

• Women with a history of breast cancer are not candidates for hormone

replacement therapy.

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