FNP Board review questions and

FNP Board review questions and answers latest A 24-year old, otherwise healthy college student presents with c/o cough x 6 weeks.She has tried several OTC cough meds with no improvement. What is the most important information to consider when building your differential diagnoses?

• Her age
• Family hx
• Ineffectiveness of OTC cough medicines
• Length of time she has been coughing - Correct Answer D) Length of time she has

been coughing Why? This information helps you build your ddx Acute cough < 3 weeks: bronchitis, sinusitis, PND, exacerbation of COPD/asthma, pneumonia, pulmonary embolism Chronic cough (>8 weeks) GERD and Asthma are most common causes, also consider infection (e.g. pertussis, atypical pneumonia), ACE inhibitors, chronic bronchitis, bronchiectasis, lung ca) According to the CDC, what drug class is considered first-line treatment for pertussis?

• Sulfonamide
• Tetracycline
• Macrolide
• Beta-lactam - Correct Answer C) Macrolide antiobitic (e.g. Azithromycin,

clarithromycin Sulfonamides are second-line

Match the antibiotics with the correct drug class:

• Sulfonamide
• Tetracycline
• Macrolide
• Beta-lactam
• Doxycyline
• Azithromycin
• Penicillins

D.Trimethoprim-Sulfamethoxazole

• Cephalosporin
• Clarithromycin - Correct Answer 1. Sulfonamide - D.Trimethoprim-Sulfamethoxazole

(Bactrim)

• Tetracycline - A. Doxycycline 1 / 4

• Macrolide - B & F, Azithromycin and Clarithromycin
• Beta-lactam - C & E, PCN and cephalosporins

What are the three most common bugs in community-acquired pneumonia? - Correct Answer Streptococcus pneumoniae Mycoplasma pneuomiae (atypical pathogen) Chlamydophila pneumoniae (atypical pathogen) What is the treatment for CAP caused by Strep pneumo? - Correct Answer Respiratory quinolone (e.g. Levofloxacin, moxifloxacin, gemifloxacin) OR high-dose amoxicillin OR amoxicillin with clavulanate What antibiotics are avoided in CAP caused by Strep pneumo due to high rates of resistance? - Correct Answer Macrolides What is the treatment for CAP caused by Mycoplasma pneumoniae? - Correct Answer Macrolide OR doxycycline What antibiotics are avoided in CAP caused by atypical pathogens? - Correct Answer Beta-lactams (ineffective) A 38-year old mother of two teenagers recently recovered from Mycoplasma pneumonia a couple of weeks ago. She asks if she should get the "pneumonia shot." She takes levothyroxine 88 mcg daily for hypothyroidism, but is otherwise healthy. How do you respond?

• No, it's too soon after your infection
• No, it's not indicated
• Yes, you can get it in about a month
• Yes you can get it today - Correct Answer B) No, it's not indicated

An otherwise healthy adult without immunocompromise or multiple comorbid conditions is not a "vulnerable population" The pneumonia vaccine does not prevent mycoplasma pneumonia According to GOLD, what is required to establish the diagnosis of COPD? - Correct Answer Spirometry (FEV1/FVC ratio < 70%) A 70-year old house painter reports a 4-week history of exertional dyspnea, chest tightness, and cough for the past 3 months. He has never smoked. What diagnoses are included in your differential? Select 4.

• Asthma
• Angina

C) COPD 2 / 4

D) GERD

• Pneumonia
• Tuberculosis
• Heart Failure - Correct Answer B) Angina

C) COPD

• Tuberculosis
• Heart failure

How do inhaled anticholinergics work to treat shortness of breath in COPD?

• They cause bronchodilation in the lungs
• They block the action of acetylcholine and prevent bronchoconstriction - Correct

Answer B) They block the action of acetylcholine and prevent bronchconstriction Name a short-acting inhaled anticholinergic: - Correct Answer Ipratropium (Atrovent) Name a long-acting inhaled anticholinergic: - Correct Answer Tiotropium (Spiriva) How do inhaled betá-agonists work to treat shortness of breath in COPD?

• They cause bronchodilation in the lungs
• They block the action of acetylcholine and prevent bronchoconstriction - Correct

Answer A) They cause bronchodilation in the lungs What are the only 2 inhaled short-acting beta agonists (SABAs): - Correct Answer Albuterol and levalbuterol

Name an inhaled long-acting beta agonists (LABAs): - Correct Answer Salmeterol

(Serevent) What are the side effects associated with anticholinergic medications? - Correct Answer Cognitive impairment, confusion, hallucinations, dry mouth, blurry vision, urinary retention, constipation, tachycardia, acute angle glaucoma "Can't see, can't pee, can't spit, can't shit." Name a inhaled combined short-acting anticholinergic/short-acting beta agonist: - Correct Answer Ipratropium/albuterol (Combivent) Name a inhaled combined long-acting beta-agonist/corticosteroid - Correct Answer Fluticasone/salmeterol (Advair) Fluticasone/vilanterol (Breo) Budesonide/formoterol (Symbicort) Mometasone/frmoterol (Dulera)

Name an inhaled steroid: - Correct Answer Fluticasone (Flovent)

Budesonide (Pulmicort) Mometasone (Asmanex) 3 / 4

Put the following in the correct order for COPD prescribing strategy:

• Long-acting anticholinergic or LABA, plus rescue med
• Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med
• Short-acting anticholinergic or SABA PRN
• Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med - Correct

Answer C, A, B, D

• Short-acting anticholinergic or SABA PRN

THEN

• Long-acting anticholinergic or LABA, plus rescue med

THEN

• Inhaled corticosteroid +LABA or LA anticholinergic, plus rescue med

THEN

• Inhaled corticosteroid +LABA and/or LA anticholinergic, plus rescue med

There is good evidence in support of oral steroids for COPD exacerbations to shorten recovery time and improve lung function. What is the correct recommended dose?

• Medrol dose-pack
• 10-day course of Prednisone 20 mg, followed by a taper
• 5-day course of Prednisone 40 mg - Correct Answer C) 5-day course of Prednisone

40 mg Chronic use should be avoided - associated with an unfavorable risk-to-benefit ratio A patient with asthma symptoms daily with occasional nighttime awakenings has

• Intermittent asthma
• Mild persistent asthma
• Moderate persistent asthma
• Severe persistent asthma - Correct Answer C) Moderate persistent asthma

A patient with asthma symptoms more than twice a week, but not daily with occasional nighttime awakenings has

• Intermittent asthma
• Mild persistent asthma
• Moderate persistent asthma
• Severe persistent asthma - Correct Answer B) Mild persistent asthma

A patient with asthma symptoms less than twice a week has

• Intermittent asthma
• Mild persistent asthma
• Moderate persistent asthma
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