NP Family Nurse Practitioner 5 — Questions and Answers
Question 1: A 6-year-old child is brought in for enuresis. He was previously dry at night but began wetting the bed 3 months ago after starting school. This is best classified as:
- Primary nocturnal enuresis
- Secondary nocturnal enuresis (Correct answer)
- Diurnal enuresis
- Neurogenic bladder
Correct answer: Secondary nocturnal enuresis
Secondary enuresis refers to bedwetting that recurs after a dry period of at least 6 months, often triggered by psychosocial stressors like starting school.
Question 2: Which finding is most consistent with iron deficiency anemia rather than anemia of chronic disease?
- Elevated ferritin
- Low serum iron with high TIBC (Correct answer)
- Low serum iron with low TIBC
- Normal RBC morphology
Correct answer: Low serum iron with high TIBC
Iron deficiency anemia shows low serum iron with elevated TIBC (transferrin is upregulated), whereas anemia of chronic disease shows low iron with low or normal TIBC.
Question 3: A patient presents with palpitations, dyspnea, and an irregularly irregular pulse. ECG shows no discernible P waves and a ventricular rate of 130 bpm. Initial management should include:
- Immediate synchronized cardioversion
- Rate control with IV metoprolol or diltiazem (Correct answer)
- IV adenosine 6mg rapid push
- Amiodarone 300mg IV bolus
Correct answer: Rate control with IV metoprolol or diltiazem
For hemodynamically stable atrial fibrillation with rapid ventricular rate, rate control with AV nodal blocking agents (beta-blockers or non-dihydropyridine CCBs) is the priority.
Question 4: A 22-year-old female presents with dyspareunia, mucopurulent cervical discharge, and cervical motion tenderness. The most appropriate empiric treatment is:
- Azithromycin 1g single dose only
- Ceftriaxone 500mg IM plus doxycycline 100mg BID x 14 days (Correct answer)
- Metronidazole 500mg BID x 7 days only
- Fluconazole 150mg single dose
Correct answer: Ceftriaxone 500mg IM plus doxycycline 100mg BID x 14 days
Pelvic inflammatory disease is treated with ceftriaxone (for gonorrhea) plus doxycycline with or without metronidazole, per CDC guidelines.
Question 5: During a routine visit, a 75-year-old patient reports falling twice in the past 6 months. The most evidence-based intervention to reduce fall risk is:
- Prescribe a walker immediately
- Refer for balance and strength exercise program (Correct answer)
- Order CT brain to rule out subdural hematoma
- Start vitamin D 50,000 IU weekly
Correct answer: Refer for balance and strength exercise program
Multifactorial fall prevention programs emphasizing balance and strength training (e.g., Tai Chi, physical therapy) have the strongest evidence for reducing falls in older adults.
Question 6: A 48-year-old male with no cardiac history presents with new-onset chest pain radiating to the jaw, diaphoresis, and ST elevations in leads V1–V4. After aspirin, the next most critical intervention is:
- IV morphine 4mg
- Urgent PCI (percutaneous coronary intervention) (Correct answer)
- IV nitroglycerin drip
- Thrombolytics if PCI unavailable within 2 hours
Correct answer: Urgent PCI (percutaneous coronary intervention)
STEMI requires immediate reperfusion; primary PCI is the gold standard when available within 90 minutes (door-to-balloon time).
Question 7: A 5-year-old child with a 4-day history of fever, strawberry tongue, cracked lips, bilateral conjunctival injection, rash, and cervical lymphadenopathy (1.5 cm node) is diagnosed with Kawasaki disease. First-line treatment is:
- High-dose aspirin alone
- IVIG 2g/kg single infusion plus high-dose aspirin (Correct answer)
- Corticosteroids plus aspirin
- Amoxicillin plus ibuprofen
Correct answer: IVIG 2g/kg single infusion plus high-dose aspirin
IVIG 2g/kg plus high-dose aspirin is the standard treatment for Kawasaki disease to reduce fever duration and prevent coronary artery aneurysms.
NP Family Nurse Practitioner 5
A 6-year-old child is brought in for enuresis.
He was previously dry at night but began wetting the bed 3 months ago after starting school.
This is best classified as: