NP Risk Assessment & Management 5 — Questions and Answers
Question 1: A 55-year-old patient with a 30-pack-year smoking history currently smokes. Per USPSTF guidelines, which lung cancer screening protocol is recommended?
- Annual chest X-ray starting now
- Annual low-dose CT (LDCT) scan for ages 50–80 with ≥20 pack-year history (Correct answer)
- CT scan every 2 years for ages 55–74 with ≥30 pack-year history
- Annual LDCT only if symptomatic
Correct answer: Annual low-dose CT (LDCT) scan for ages 50–80 with ≥20 pack-year history
The 2021 USPSTF guideline recommends annual LDCT for lung cancer screening in adults aged 50–80 with a ≥20 pack-year smoking history who currently smoke or quit within the past 15 years.
Question 2: Which scoring system is used to stratify risk for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis?
- Child-Pugh score
- MELD score (Correct answer)
- APACHE II score
- MELD-Na score
Correct answer: MELD score
The MELD (Model for End-Stage Liver Disease) score is the primary validated tool used to assess severity and prognosis in cirrhosis, informing SBP prophylaxis decisions and transplant prioritization.
Question 3: A nurse practitioner is assessing a pediatric patient for developmental delay. At what age should a child definitively be referred for evaluation if they are not yet walking independently?
- 12 months
- 15 months
- 18 months (Correct answer)
- 24 months
Correct answer: 18 months
Independent walking is an expected milestone by 12–15 months; failure to walk by 18 months is a red flag that warrants formal developmental evaluation.
Question 4: A patient on long-term corticosteroid therapy presents for a risk assessment. Which complication requires BOTH baseline and ongoing monitoring with a validated tool?
- Adrenal suppression via ACTH stimulation test
- Bone loss via DEXA scan (Correct answer)
- Infection risk via CBC with differential
- Fluid retention via daily weights
Correct answer: Bone loss via DEXA scan
Long-term corticosteroid use causes glucocorticoid-induced osteoporosis (GIOP); baseline DEXA scan and periodic follow-up are recommended to monitor bone mineral density and guide bisphosphonate therapy.
Question 5: A nurse practitioner is risk-stratifying a patient newly diagnosed with community-acquired pneumonia (CAP). Which validated tool should be used to determine the need for hospitalization?
- CURB-65 (Correct answer)
- APACHE II
- SOFA score
- Pneumonia Severity Index (PSI) alone is sufficient
Correct answer: CURB-65
The CURB-65 score (Confusion, Urea, Respiratory rate, Blood pressure, age ≥65) is the most practical validated tool for outpatient NPs to quickly risk-stratify CAP and guide disposition decisions.
Question 6: Which genetic risk factor assessment should be prioritized for a 35-year-old woman whose mother and maternal aunt both had breast cancer diagnosed before age 50?
- Order BRCA1/BRCA2 testing without referral
- Use the Tyrer-Cuzick or Gail model to calculate lifetime risk before referral
- Refer directly to genetic counseling for hereditary cancer evaluation (Correct answer)
- Reassure and schedule routine annual mammography at age 40
Correct answer: Refer directly to genetic counseling for hereditary cancer evaluation
A strong family history suggesting hereditary breast cancer syndrome warrants direct referral to genetic counseling for comprehensive risk assessment and appropriate BRCA testing.
Question 7: A 62-year-old male with type 2 diabetes and CKD stage 3 (eGFR 42) asks about his cardiovascular risk. Which tool provides the MOST accurate 10-year ASCVD risk estimate for this patient?
- Framingham Risk Score
- ACC/AHA Pooled Cohort Equations
- Reynolds Risk Score
- QRISK3 (Correct answer)
Correct answer: QRISK3
QRISK3 includes CKD, type 2 diabetes with eGFR/HbA1c inputs, and other comorbidities that improve accuracy in patients with complex risk profiles compared to the standard Pooled Cohort Equations.
NP Risk Assessment & Management 5
A 55-year-old patient with a 30-pack-year smoking history currently smokes.
Per USPSTF guidelines, which lung cancer screening protocol is recommended?