NP Certification Q&A

A 28-year-old man presents to an urgent care clinic with approximately 12 hours of abdominal pain accompanied by “feeling warm” with T to 100.4 degree F (38 d C) at home and mild nausea without vomit. He reports that the discomfort began with a feeling of “heartburn that did not get better with taking an antacid like it usually does”.  During the past 6 hours, the pain has become more intense and...

A 78-year-old woman with hypertension controlled with hydrochlorothiazide started taking carbamazepine for trigeminal neuralgia approximately 3 weeks ago. She presents today saying, “I’ve been feeling oddly for the past week.”  Laboratory results are  •Na⁺ 131 mEq/L (normal 135–145 mEq/L) •K⁺ 3.8 mEq/L (normal 3.5–5.0 mEq/L) •Cl⁻ 100 mEq/L (normal 98–106 mEq/L) •HCO₃⁻ 25 mEq/L (normal 22–29 mEq/L)...

A 78-year-old woman who is taking a thiazide diuretic with lisinopril for the treatment of hypertension is started on a therapeutic dose of an SSRI due to a new diagnosis of major depressive disorder. Which of the following is a potential drug induced electrolyte disorder in an older adult taking these medications?  A. Hypokalemia B. Hyperkalemia C. Hyponatremia D. Hypercalcemia --- YouTube: https...

An 81-year-old woman with a 30-year history of hypertension and dyslipidemia, both at treatment goal, presents with a 1-week history of a new-onset headache. She states, “I’ve never had a headache like this before in my life.” She has a history of migraine without aura beginning in her early teens, with only rare episodes since her early 50s. At age 60, she had herpes zoster ophthalmicus, which re...

An 81-year-old woman with a 30 year hx of HTN and dyslipidemia, all at treatment goal, presents with a 1-week history of a new onset left sided headache, scalp tenderness and jaw claudication. Suspecting giant cell arteritis, the clinician orders which of the two following tests?  A. Temporal artery ultrasonography B. C-reactive protein C.  MRI of the brain D. Carotid artery ultrasound.  --- YouTu...

A healthy 30-year-old at 33 weeks' gestation presents for routine prenatal care in late September in the northeast USA. She's not previously received any vaccines. And about the past ten years and states, "I heard there are shots to protect the baby from RSV. My niece had this when she was a month old and got very sick".  Which of the following is the best response? A. Recommen...

A 12-year-old male presents with his father for a routine Whelchel visit. The father asked to speak to you privately, as he's concerned that his son is, quote, showing some body changes. Close quote during the visit, the child is alert, interactive with physical exam findings consistent with Tanner's Stage three sexual maturation. He remains on his growth curve for height and weight.  Wh...

A seven year old with a diagnosis of asthma since age to present with his parents for a new patient visit. He has cough, wheezing and shortness of breath 4 to 5 days per week and awakens with asthma symptoms about once weekly. His parents states when he's playing soccer, sometimes he needs to stop running because of his cough. So last visit with his prior PCP was about seven months ago when h...

A healthy 12 month old child is scheduled for a routine well, child's visit and age appropriate immunizations in three days. The parent message is the nurse practitioner and ask, quote, my mother told me to give her some acetaminophen Tylenol before she gets her shots. That way she won't be uncomfortable afterwards. I want to check with you first. Is this a good idea?  A. Give acetaminop...

According to the latest American College of Cardiology and American Heart Association dyslipidemia guidance, in which of the following patients is it most appropriate to obtain a lipoprotein A level?  A. A twenty-eight-year-old woman with obesity and polyendocrine metabolic ovarian syndrome, formerly known as PCOS, whose father had a myocardial infarction at age 48.  B. A 47-year-old man with well...

A 55-year-old man is seen in follow up six weeks post hospitalization for acute coronary syndrome with drug eluding stent placement, has a 40-pack-year cigarette smoking history and currently smokes two packs of cigarettes per day. His medical history is also significant for stage 3-A CKD, with current estimated GFR of 52. His medications include high-intensity statin therapy and ezetimibe or Zeti...

A 29-year-old patient presents with a genital lesion he first noted five days ago. The patient reports a new sex partner for the past four weeks with infrequent condom use. He denies dysuria, fever, urinary frequency, abdominal or scrotal pain, or penile discharge. Examination reveals a single well-defined ulcer on the shaft of the penis. The lesion is painless with a clear base and no purulent di...

 A 75-year-old woman presents to the urgent care service of her primary care provider's practice for a sick visit with a chief complaint of a two-day history of dysuria, urinary frequency, and urgency. She denies fever, flank pain, nausea, or vomiting. Her past medical history includes hypertension, stage three ACKD, and dyslipidemia. Current medications include an ARB, thiazide diuretic, sta...

A 38-year-old woman presents for a sick visit with a two-day history of, "not feeling right. I've never felt like this before." Approximately four days ago, she self-discontinued a standard dose SSRI after taking this medication for the past 18 months, stating, "I feel like my depression had gotten much better." She denies alcohol or recreational drug use. When considering...

A 25-year-old woman presents for follow-up with a 12-year history of intermittent headache reported as unilateral throbbing pain with nausea, photophobia, phonophobia that usually lasts about 12 to 24 hours. At the onset of her headache, she takes oral high dose ibuprofen with Sumitriptan reporting, "my headache is usually gone within an hour or so." She reports no particular pattern to...

The parents of a four day old infant born at 41.5 weeks gestation via normal spontaneous vaginal delivery after an uneventful pregnancy present with a chief complaint of a "rash" over the baby's face and body that began about 10 hours ago. They report that she is a vigorous nurser, has about six wet diapers and four yellow-green bowel movements in the past 24 hours. For the past 48...

A 50-year-old woman presents for follow-up on recent lab tests obtained at a health maintenance visit. She reports feeling well and denies fatigue, weight changes, constipation, cold intolerance, palpitations, or changes in mood. She was recently diagnosed with subclinical hypothyroidism.  Which of the following would be her expected lab results? A. TSH of 8.6, elevated free T4 of 14, which is nor...

A 29-year-old otherwise healthy adult presents with a five-day history of nasal congestion, clear to white rhinorrhea, sore throat, and dry cough. She also denies dyspnea, pleuritic chest pain, GI upset, or fever. The patient is in no acute distress. Vital signs are temperature 99.2 Fahrenheit or 37.3 degrees centigrade. Respiratory rate is 16. O2 sat is 98 % on room air. Physical exam reveals mil...

A six-month, two-week-old infant who was born at 40.5 weeks gestation after an uneventful pregnancy is brought in for a well child visit. His parents mentioned, “his older sister was a really different baby. I think he's not quite where she was in his development at this age.” Which of the following would not be a red flag requiring further evaluation?  A. Inability to roll in either directio...

Sarah, a healthy infant born at 40.5 weeks gestation after an uncomplicated pregnancy, is brought in for a four-month well child visit. Parents report the infant is feeding well, smiling frequently, and becoming more interactive with family members.  Which of the following is most consistent with a normal developmental exam for an infant of this age? A. Rolls back to abdomen and transfers objects...

A 24-year-old woman presents for a well-adult visit. Her health history includes the diagnosis of mitral valve prolapse without significant mitral regurgitation. She is feeling well, has no chief complaint, and denies activity intolerance, stating she plays tennis or pickleball for about one hour three to four times a week. Her only medication is an oral combined hormonal contraceptive and reports...

A 51 year old woman who works as a real estate agent presents for an office visit with a chief complaint of severe vasomotor symptoms reporting, "I can't sleep through the night without being drenched in sweat. I have at least four hot flashes a day. Sometimes while I'm working with clients. I need some help. What do you think about hormone therapy? " Her LMP was approximately...

Which of the following best describes the use of contraception for a 26 year old woman who has migraine without aura, usually three episodes per month controlled with high dose ibuprofen who is otherwise well states. "I want to get on some birth control that's really reliable for the next three years while I'm in graduate school." A. All combined hormonal contraceptive forms ar...

A 56-year-old man with a 10-year history of hypertension presents for a primary care visit, stating he has not taken his high blood pressure medicines, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the last three months due to, quote, running out of medication and not getting to the pharmacy, close quote. Today's blood pressure is 192 over 120,...

A 56 year old man with a 10 year history of hypertension presents for a primary care visit, stating he's not taking his hypertension med, a calcium channel blocker, an angiotensin converting enzyme inhibitor, and a thiazide diuretic for the past three months due to  "running out of the medication and not getting to the pharmacy." Today, his blood pressure is 192 over 120 and he has...