AANPCB FNPFree Family Nurse Practitioner practice test

Correct answer: D. Order a fasting lipid panel to screen for dyslipidemia

Children aged 2 years and older with obesity and a family history of dyslipidemia or premature cardiovascular disease should be screened with a fasting lipid panel. Early lipid abnormalities are common in this population, and identifying them enables timely lifestyle-based interventions to reduce long-term cardiovascular risk. Diabetes screening with hemoglobin A1c is recommended starting at age 10 years or onset of puberty in at-risk children, making it inappropriate for this 2-year-old. A nutrition and activity log may support counseling but does not address the recommended medical screening for obesity-related comorbidities. Pharmacologic management of obesity is not indicated in toddlers and is not part of standard care at this age.

Correct answer: C. Scoliosis

In otherwise healthy individuals, mitral valve prolapse is often an incidental finding related to elongated mitral valve leaflets without significant regurgitation or systemic disease. These patients are frequently asymptomatic and may have associated musculoskeletal findings such as scoliosis or chest wall deformities, even without an underlying connective tissue disorder. Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta are connective tissue disorders that can be associated with mitral valve prolapse, but patients with these conditions typically have additional systemic features and more severe valvular involvement. These diagnoses are less likely in an asymptomatic patient with isolated findings on routine examination.

Correct answer: C. Intraspinal surgery performed two months ago

Intracranial or intraspinal surgery within the preceding two months is an absolute contraindication to fibrinolysis. Before administering a thrombolytic agent, prescribers must assess for absolute and relative contraindications. Other absolute contraindications include any prior intracranial hemorrhage, known structural cerebrovascular lesion, malignant intracranial neoplasm, ischemic stroke within 3 months (except acute ischemic stroke within 4.5 hours), suspected aortic dissection, active bleeding or bleeding diathesis excluding menses, significant closed-head or facial trauma within 3 months, severe uncontrolled hypertension unresponsive to emergency therapy, and prior streptokinase use within 6 months. Chronic poorly controlled hypertension, major surgery within the past three weeks, and pregnancy (indicated by a positive hCG test) are all relative, not absolute, contraindications.

Correct answer: D. The plan should include monitored fluid resuscitation.

Fluid resuscitation in heatstroke should be aggressive but carefully monitored given the risk of pulmonary edema from reduced cardiac output. Hyperkalemia, not hypokalemia, is common in heatstroke due to creatine kinase release from tissue damage, so potassium supplementation is not indicated. Rapid cooling is discouraged because it triggers cutaneous vasoconstriction that impairs heat dissipation; controlled cooling using tepid water spray, fanning, or cold packs applied to the groin, neck, and axillae is preferred. Fluid restriction is contraindicated, as rehydration is a core element of heatstroke management.

Correct answer: A. Secondary Raynaud phenomenon

Secondary Raynaud phenomenon is not a complication of varicose veins. It occurs in the context of underlying conditions such as atherosclerosis, collagen vascular disease, or autoimmune disorders such as scleroderma. Contributing factors can include vibrating tool use, repetitive finger movements, frostbite, tobacco use, ergotamine, or beta-blocker use. Recognized complications of varicose veins include superficial thrombophlebitis and secondary lower extremity changes such as chronic edema, skin hyperpigmentation, and the development of chronic venous insufficiency.

Correct answer: A. Cardiac troponin I (cTnI) is more sensitive and specific than electrocardiography in diagnosing non-Q-wave myocardial infarction.

Cardiac troponin I (cTnI) is more sensitive and specific than electrocardiography and CK-MB for diagnosing unstable angina and non-Q-wave myocardial infarction. Rapid assay availability also makes cTnI results quickly actionable. CK-MB is less sensitive and specific than cTnI for unstable angina. CK-MB typically rises within 6 to 12 hours after MI and returns to baseline within about 60 hours. In contrast, cTnI rises sharply in the first 12 hours and remains elevated for approximately 192 hours, not 60 hours.

Correct answer: A. Cardiac troponin I (cTnI)

Mild baseline elevations in cardiac troponin are common in chronic kidney disease due to reduced clearance and chronic myocardial strain. However, serial cardiac troponin I (cTnI) measurements remain the most specific and reliable indicator of acute myocardial infarction. Troponin I is preferred over troponin T in renal disease because it is less affected by chronic elevation. CK-MB can rise from skeletal muscle injury and lacks specificity for myocardial damage. Myoglobin rises early but normalizes rapidly and is nonspecific. hs-CRP reflects systemic inflammation and is not diagnostic for acute MI.

Correct answer: A. 30% but less than 50%

The ACC/AHA recommends moderate-intensity statin therapy as primary prevention for patients aged 40 to 75 years with one or more cardiovascular risk factors and a 10-year CVD event risk exceeding 7.5%. Atorvastatin 20 mg is classified as a moderate-intensity statin. Moderate-intensity statins lower LDL-C by 30% to less than 50%. High-intensity statins achieve reductions of 50% or more. Low-intensity statins produce reductions of less than 30%.

Correct answer: C. Acute coronary syndrome

The presentation is characteristic of acute coronary syndrome (ACS) as it manifests in women. Women with ACS often delay seeking care and more frequently present with atypical symptoms—such as nausea, fatigue, shortness of breath, and insomnia—rather than classic chest pain. Chest pain may or may not be present but remains a common initial feature of coronary heart disease. Heart failure can cause similar symptoms but typically also includes a persistent cough and extremity edema. Infective endocarditis commonly presents with fever, chills, unexplained weight loss, hematuria, splenic tenderness, Osler's nodes, petechiae, and joint or muscle aching. Aortic stenosis has a long asymptomatic period followed by rapid deterioration, manifesting as dyspnea, syncope, chest pain, and heart failure.

Correct answer: B. Decreased insulin resistance

Regular aerobic exercise combined with dietary modification improves the lipid profile primarily by reducing insulin resistance. Improved insulin sensitivity enhances lipoprotein lipase activity, facilitating more efficient triglyceride clearance and increased HDL production. These changes are most apparent when diet and exercise are maintained consistently. Soluble fiber and plant stanols lower LDL by reducing intestinal cholesterol absorption but have limited effects on HDL or triglycerides. The improvement in HDL and triglyceride levels is therefore best attributed to enhanced insulin sensitivity driven by exercise and metabolic conditioning.