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Advanced Nursing Practice FNP Clinical Practicum Q & A w/ Rationales, Exams of Nursing

A series of questions and rationales related to clinical scenarios that an Advanced Nursing Practice Family Nurse Practitioner (FNP) may encounter during a clinical practicum. The questions cover a range of topics, including assessment, diagnosis, treatment, and ethical principles. The rationales provide explanations for the correct answers and highlight key concepts and considerations. intended to serve as a study aid for FNP students preparing for clinical practicum exams or certification exams.

Typology: Exams

2023/2024

Available from 01/23/2024

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NURSING 7268.01
Advanced Nursing
Practice FNP Clinical
Practicum
Q & A w/ Rationales
2024
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NURSING 7 268.

Advanced Nursing

Practice FNP Clinical

Practicum

Q & A w/ Rationales

  1. A 45-year-old male patient presents to the FNP with complaints of chest pain, dyspnea, and palpitations. He has a history of hypertension, diabetes, and smoking. He is currently taking metformin, lisinopril, and aspirin. The FNP suspects that he may have an acute coronary syndrome (ACS) and orders an electrocardiogram (ECG) and cardiac biomarkers. Which of the following ECG findings is most suggestive of an ACS? a) ST-segment elevation in two contiguous leads b) T-wave inversion in leads V1-V c) Q waves in leads II, III, and aVF d) ST-segment depression and/or T-wave inversion in two or more leads Rationale: ST-segment depression and/or T-wave inversion in two or more leads is indicative of ischemia, which is a hallmark of ACS. ST-segment elevation in two contiguous leads suggests a myocardial infarction (MI), which is a type of ACS, but not the only one. T-wave inversion in leads V1-V4 may indicate a right ventricular strain or pulmonary embolism, which are not related to ACS. Q waves in leads II, III, and aVF may indicate an old inferior MI, which is not an acute condition.
  2. A 32-year-old female patient visits the FNP for a routine prenatal check-up at 28 weeks of gestation. She has no significant medical or obstetric history and her pregnancy has been uncomplicated so far. She reports feeling well and has no complaints. The FNP performs a physical examination and measures her blood pressure, which is

action for the FNP to take? a) Decrease the dose of levothyroxine b) Increase the dose of levothyroxine c) Adjust the dose of levothyroxine based on TSH level d) Switch to a combination therapy of levothyroxine and liothyronine Rationale: The patient has symptoms and laboratory results consistent with hypothyroidism, which indicates that her current dose of levothyroxine is insufficient to normalize her thyroid function. The dose of levothyroxine should be adjusted based on TSH level, which is the most sensitive indicator of thyroid status. The goal of therapy is to maintain TSH within the normal range, which may vary depending on the patient's age and comorbidities. Increasing or decreasing the dose of levothyroxine without considering TSH level may result in over- or under- treatment of hypothyroidism, which can have adverse effects on cardiovascular, metabolic, and neuropsychiatric functions. Switching to a combination therapy of levothyroxine and liothyronine, which is a synthetic form of FT3, is not recommended for most patients with hypothyroidism, as there is no clear evidence of superiority over levothyroxine monotherapy and there are potential risks of cardiac arrhythmias and osteoporosis.

  1. A 50-year-old male patient is referred to the FNP by his primary care provider for evaluation of benign prostatic hyperplasia (BPH). He reports having difficulty initiating and maintaining a urinary stream, nocturia, urgency, and incomplete bladder emptying. He has no history of urinary

tract infections, hematuria, or renal stones. He takes no medications and has no allergies. The FNP performs a digital rectal examination and palpates a smooth, firm, and enlarged prostate. The FNP also orders a urinalysis, which is normal, and a prostate-specific antigen (PSA) test, which shows a level of 4.5 ng/mL (normal range: 0-4 ng/mL). Which of the following is the most appropriate next step for the FNP to take? a) Prescribe an alpha-blocker b) Prescribe a 5-alpha-reductase inhibitor c) Refer the patient to a urologist d) Perform a shared decision-making with the patient about treatment options Rationale: The patient has moderate symptoms of BPH, which can be assessed using a validated tool such as the International Prostate Symptom Score (IPSS). His PSA level is slightly elevated, which may indicate BPH or prostate cancer. The FNP should perform a shared decision-making with the patient about treatment options, which include watchful waiting, pharmacotherapy, minimally invasive procedures, or surgery. The choice of treatment depends on the severity of symptoms, the size of the prostate, the risk of complications, the patient's preferences, and the availability of resources. An alpha- blocker, such as tamsulosin or doxazosin, can provide rapid relief of symptoms by relaxing the smooth muscle of the prostate and bladder neck. A 5-alpha-reductase inhibitor, such as finasteride or dutasteride, can reduce the size of the prostate and lower the PSA level by inhibiting the conversion of testosterone to dihydrotestosterone.

creating an inflammatory reaction in the uterus that prevents fertilization and implantation; and a hormonal IUD (Mirena, Skyla, Kyleena, Liletta), which releases a low dose of progestin that thickens the cervical mucus and thins the endometrium. Both types of IUDs have similar efficacy and safety profiles, but may differ in their effects on bleeding patterns, dysmenorrhea, and cost. The copper IUD may cause increased menstrual bleeding and cramping, while the hormonal IUD may cause amenorrhea or irregular spotting. The copper IUD is more cost- effective in the long term, but has a higher upfront cost than the hormonal IUD. The IUD does not protect against STIs and may increase the risk of PID if inserted in the presence of an active infection. Therefore, screening for STIs should be performed before insertion and condom use should be encouraged for dual protection. B:

  1. Which of the following terms best describes the role of an Advanced Nursing Practice Family Nurse Practitioner (FNP) during the clinical practicum? A. Observational B. Supervisory C. Independent D. Assistive

Answer: C. Independent Rationale: The role of an Advanced Nursing Practice FNP during the clinical practicum is focused on applying independent nursing skills and knowledge, making clinical decisions, and providing comprehensive patient care under limited supervision.

  1. During the clinical practicum, an FNP student encounters a patient with multiple chronic conditions. Which intervention should the student prioritize to provide comprehensive care? A. Perform a thorough physical examination B. Develop a comprehensive care plan C. Collaborate with other healthcare providers D. Engage in evidence-based practice Answer: B. Develop a comprehensive care plan Rationale: Prioritizing the development of a comprehensive care plan allows the FNP student to holistically address the patient's multiple chronic conditions, considering all relevant aspects such as physical, psychological, and social factors.
  2. Which of the following activities should be prioritized by an FNP student during the clinical practicum to enhance their interprofessional collaboration skills?

A. Prescribing medications based on personal experience B. Utilizing research findings to guide clinical decision- making C. Implementing interventions based on traditional nursing practices D. Adhering strictly to clinical guidelines provided by the preceptor Answer: B. Utilizing research findings to guide clinical decision-making Rationale: Adhering to evidence-based practice involves utilizing current research findings and best available evidence to guide clinical decision-making, ensuring the delivery of high-quality care.

  1. During the clinical practicum, an FNP student assesses a patient's pain level using a numeric rating scale. Which level of pain would the student consider as within the acceptable range? A. 2/ B. 5/ C. 8/ D. 10/ Answer: A. 2/1 0 Rationale: A pain level of 2/10 indicates mild pain, which

can be considered within the acceptable range for many patients. Higher pain levels may indicate the need for further intervention or pain management strategies.

  1. Which of the following ethical principles should guide the FNP student's decision-making process during the clinical practicum? A. Beneficence B. Autonomy C. Non-maleficence D. Justice Answer: A. Beneficence Rationale: The ethical principle of beneficence emphasizes the FNP student's obligation to promote the well-being and best interests of their patients while providing comprehensive care during the clinical practicum.
  2. When conducting a comprehensive health assessment during the clinical practicum, which technique should the FNP student prioritize to assess heart sounds? A. Percussion B. Inspection C. Palpation D. Auscultation Answer: D. Auscultation

D. Patient identification Answer: C. Hand hygiene Rationale: Hand hygiene is crucial in preventing the transmission of pathogens in healthcare settings, promoting patient safety. It is a fundamental practice that should be prioritized by all healthcare professionals, including FNP students.

  1. Which of the following assessments should an FNP student conduct when suspecting a deep vein thrombosis in a patient? A. Tinel's sign B. Romberg test C. Homan's sign D. Kernig's sign Answer: C. Homan's sign Rationale: Homan's sign is a physical assessment technique aimed at identifying deep vein thrombosis (DVT) by evaluating calf pain and tenderness during dorsiflexion of the foot. This assessment should be conducted if a DVT is suspected.
  2. An FNP student is caring for a patient experiencing status asthmaticus. Which medication would be the most appropriate choice for immediate bronchodilation?

A. Ipratropium bromide (Atrovent) B. Fluticasone propionate (Flovent) C. Montelukast (Singulair) D. Albuterol (Proventil) Answer: D. Albuterol (Proventil) Rationale: Albuterol (Proventil) is a short-acting bronchodilator used for immediate relief of bronchoconstriction in asthma and is therefore the medication of choice in situations such as status asthmaticus.

  1. Which of the following interventions would be most appropriate for an FNP student to implement to establish rapport with a pediatric patient during the clinical practicum? A. Engage in age-appropriate play activities B. Use medical terminology and jargon to establish credibility C. Limit family involvement to ensure the child's independence D. Speak directly and authoritatively to gain the child's respect Answer: A. Engage in age-appropriate play activities Rationale: Engaging in age-appropriate play activities helps

SSRS)

Rationale: The Columbia-Suicide Severity Rating Scale (C- SSRS) is a specifically designed tool used to evaluate and categorize suicidal ideation, providing valuable information to evaluate a patient's suicide risk during mental health assessments. C: Question 1: A 45-year-old female patient presents with complaints of persistent headaches, visual disturbances, and unexplained weight gain. Which of the following assessments should the advanced practice nurse prioritize during the initial evaluation? A. Complete blood count (CBC) B. Thyroid function tests C. Fundoscopic examination D. Magnetic resonance imaging (MRI) of the brain Answer: C Rationale: Visual disturbances and unexplained weight gain are indicative of potential intracranial pathology. Therefore, a fundoscopic examination is crucial to assess for papilledema, which could suggest increased intracranial pressure.

Question 2: When conducting a comprehensive health assessment on an older adult, the nurse practitioner should recognize that age-related changes can affect the interpretation of findings. Which of the following physiological changes should the nurse consider when evaluating the cardiovascular system in older adults? A. Decreased heart rate variability B. Increased maximum heart rate C. Decreased systolic blood pressure D. Increased baroreceptor sensitivity Answer: A Rationale: Age-related changes lead to decreased heart rate variability, which can affect the cardiovascular response to stress and exercise in older adults. Question 3: A 55-year-old male patient with a history of type 2 diabetes presents with a non-healing foot ulcer. Which of the following diagnostic tests would be most appropriate for assessing the perfusion status of the affected limb? A. Ankle-brachial index (ABI) B. Doppler ultrasound C. Venous duplex ultrasound D. Magnetic resonance angiography (MRA) Answer: A Rationale: The ABI is a non-invasive and cost-effective test that provides valuable information about the perfusion status of the lower extremities in patients with diabetes.

Question 6: A 40-year-old female patient presents with symptoms of anxiety and panic attacks. Which of the following psychotherapeutic approaches is recommended as the first- line treatment for generalized anxiety disorder? A. Cognitive-behavioral therapy (CBT) B. Psychodynamic therapy C. Dialectical behavior therapy (DBT) D. Interpersonal therapy Answer: A Rationale: Cognitive-behavioral therapy has the strongest evidence base and is recommended as the first-line treatment for generalized anxiety disorder. Question 7: When managing a patient with chronic kidney disease (CKD), the advanced practice nurse should prioritize interventions to prevent complications associated with CKD. Which of the following interventions is most effective in slowing the progression of CKD and reducing cardiovascular risk? A. Blood pressure control B. Glycemic control C. Protein restriction D. Lipid-lowering therapy Answer: A Rationale: Blood pressure control is crucial in slowing the progression of CKD and reducing cardiovascular risk in patients with CKD.

Question 8: A 60-year-old male patient presents with acute-onset urinary retention and severe lower abdominal pain. The advanced practice nurse suspects acute urinary retention due to benign prostatic hyperplasia (BPH). Which of the following interventions is the initial management approach for this patient? A. Insertion of a Foley catheter B. Alpha-adrenergic antagonist therapy C. Prostate-specific antigen (PSA) testing D. Transurethral resection of the prostate (TURP) Answer: A Rationale: Insertion of a Foley catheter is the initial management approach for acute urinary retention, providing immediate relief of bladder distention. Question 9: A 70-year-old female patient with a history of osteoporosis presents for a follow-up visit. Which of the following pharmacological interventions is recommended as first-line therapy for the prevention of osteoporotic fractures in postmenopausal women? A. Alendronate (Fosamax) B. Raloxifene (Evista) C. Teriparatide (Forteo) D. Denosumab (Prolia) Answer: D Rationale: Denosumab is recommended as first-line therapy for the prevention of osteoporotic fractures in postmenopausal women who are at high risk of fracture.