NP Risk Assessment & Management 4 — Questions and Answers
Question 1: A 50-year-old African American male has a blood pressure of 138/88 mmHg at two separate visits. Per JNC 8/ACC/AHA guidelines, what is the appropriate threshold for initiating pharmacologic treatment in this patient?
- 130/80 mmHg (Correct answer)
- 140/90 mmHg
- 150/90 mmHg
- 160/100 mmHg
Correct answer: 130/80 mmHg
ACC/AHA 2017 guidelines recommend initiating antihypertensive therapy in adults with stage 1 hypertension (≥130/80 mmHg) who have 10-year ASCVD risk ≥10%.
Question 2: Which factor is MOST associated with increased risk of opioid misuse when initiating opioid therapy for chronic pain?
- Age over 65
- History of substance use disorder (Correct answer)
- Female sex
- Concurrent NSAID use
Correct answer: History of substance use disorder
A personal history of substance use disorder is the strongest predictor of opioid misuse risk and should be carefully weighed using validated tools such as the ORT before prescribing.
Question 3: A nurse practitioner uses the STOP-BANG questionnaire and a patient scores 5. What is the appropriate next step in management?
- Reassure the patient and rescreen in one year
- Recommend weight loss as definitive treatment
- Refer for polysomnography (sleep study) (Correct answer)
- Prescribe auto-CPAP empirically without testing
Correct answer: Refer for polysomnography (sleep study)
A STOP-BANG score ≥3 indicates high risk for obstructive sleep apnea (OSA), and a score of 5 warrants referral for polysomnography to confirm the diagnosis.
Question 4: When performing a skin cancer risk assessment, which patient characteristic carries the HIGHEST independent risk for melanoma?
- Fitzpatrick skin type III
- History of 5 or more blistering sunburns
- Use of indoor tanning beds before age 35 (Correct answer)
- Having more than 50 common nevi
Correct answer: Use of indoor tanning beds before age 35
Indoor tanning bed use before age 35 increases melanoma risk by 59–75% and is classified as a Group 1 carcinogen by the IARC.
Question 5: A 60-year-old male is prescribed warfarin for atrial fibrillation. Which tool BEST assesses his bleeding risk?
- CHADS2-VASc
- HAS-BLED (Correct answer)
- HEMORR2HAGES
- ORBIT
Correct answer: HAS-BLED
The HAS-BLED score is the most widely used and validated tool to estimate major bleeding risk in patients on anticoagulation for atrial fibrillation.
Question 6: A nurse practitioner is seeing a 28-year-old female patient who discloses intimate partner violence. Which action is the HIGHEST priority?
- Document the disclosure and file a mandatory report immediately
- Assess immediate safety and provide referrals to local resources (Correct answer)
- Advise the patient to leave the relationship
- Contact the partner to discuss the situation
Correct answer: Assess immediate safety and provide referrals to local resources
The immediate priority in IPV disclosure is assessing the patient's current safety and connecting her with resources; mandatory reporting of adult IPV is NOT required in most US states.
Question 7: Which laboratory finding MOST strongly suggests an increased perioperative cardiac risk in a patient undergoing elective non-cardiac surgery?
- Serum creatinine 1.6 mg/dL
- BNP level of 350 pg/mL (Correct answer)
- Hemoglobin of 10.5 g/dL
- Fasting glucose of 145 mg/dL
Correct answer: BNP level of 350 pg/mL
Elevated preoperative BNP (>92 pg/mL) is a strong independent predictor of major adverse cardiac events (MACE) after non-cardiac surgery per the ACC/AHA guidelines.
NP Risk Assessment & Management 4
A 50-year-old African American male has a blood pressure of 138/88 mmHg at two separate visits.
Per JNC 8/ACC/AHA guidelines, what is the appropriate threshold for initiating pharmacologic treatment in this patient?