NP Family Nurse Practitioner 4 — Questions and Answers
Question 1: A 62-year-old woman with osteoporosis (T-score -2.8) and a 10-year FRAX hip fracture probability of 4.5% should be treated with:
- Calcium and vitamin D supplementation only
- Bisphosphonate therapy plus calcium/vitamin D (Correct answer)
- Hormone replacement therapy
- Denosumab only
Correct answer: Bisphosphonate therapy plus calcium/vitamin D
A T-score ≤-2.5 (osteoporosis) meets the threshold for pharmacologic treatment; bisphosphonates are first-line with calcium/vitamin D supplementation.
Question 2: Which physical exam finding is most specific for appendicitis?
- McBurney's point tenderness
- Rovsing's sign
- Rebound tenderness at any site
- Psoas sign (Correct answer)
Correct answer: Psoas sign
The psoas sign (pain with hip extension) is highly specific for retrocecal appendicitis, indicating inflammation adjacent to the psoas muscle.
Question 3: A 50-year-old woman reports hot flashes, night sweats, and vaginal dryness. She has a uterus. The safest hormone therapy regimen is:
- Estrogen alone (conjugated equine estrogen)
- Combined estrogen plus progestogen (Correct answer)
- Progestogen alone
- Testosterone only
Correct answer: Combined estrogen plus progestogen
Women with an intact uterus must receive combined estrogen-progestogen therapy to protect against endometrial hyperplasia and cancer caused by unopposed estrogen.
Question 4: A 9-month-old infant has not yet achieved the developmental milestone of sitting without support. At what age should this milestone normally be achieved?
- 4 months
- 6 months (Correct answer)
- 8 months
- 12 months
Correct answer: 6 months
Most infants can sit without support by 6 months; failure to achieve this by 9 months warrants developmental evaluation.
Question 5: A 40-year-old male presents with episodic severe unilateral periorbital pain lasting 45–90 minutes, ipsilateral lacrimation, and nasal congestion occurring nightly for 6 weeks. The diagnosis is:
- Migraine with aura
- Cluster headache (Correct answer)
- Trigeminal neuralgia
- Paroxysmal hemicrania
Correct answer: Cluster headache
Cluster headaches present with severe unilateral orbital pain with autonomic features (lacrimation, nasal congestion), occurring in clusters over weeks, often nocturnally.
Question 6: A 55-year-old male with hypertension, dyslipidemia, and no prior cardiovascular events has a 10-year ASCVD risk of 8%. The recommended management is:
- Statin therapy is mandatory regardless of patient preference
- Discuss statin therapy with shared decision-making (Correct answer)
- No statin indicated below 10% risk
- Start high-intensity statin immediately
Correct answer: Discuss statin therapy with shared decision-making
For borderline ASCVD risk (7.5–20%), ACC/AHA guidelines recommend shared decision-making about statin therapy, considering risk-enhancing factors and patient values.
Question 7: A 35-year-old woman at 36 weeks gestation presents with blood pressure of 162/108 mmHg, headache, and 3+ proteinuria. Initial pharmacologic treatment should be:
- Oral labetalol 200mg
- IV hydralazine or IV labetalol (Correct answer)
- Oral nifedipine XL 30mg
- IV magnesium sulfate alone
Correct answer: IV hydralazine or IV labetalol
Severe-range blood pressure in preeclampsia (≥160/110) requires urgent IV antihypertensive therapy to prevent maternal stroke, with IV labetalol or hydralazine as first-line.
NP Family Nurse Practitioner 4
A 62-year-old woman with osteoporosis (T-score -2.8) and a 10-year FRAX hip fracture probability of 4.5% should be treated with: