NP Certification Q&A

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, and he's without complaint, denying shortness of breath, chest pain, or visual changes. He states, "I ...

Which of the following two patients with asymptomatic bacteria, or abbreviated ABS, should receive antimicrobial therapy? A. An 84‑year‑old woman who is a resident of a long‑term care facility with dementia, no new urinary symptoms, her urine is positive for nitrites, leukocytes, and culture reveals 100,000 colony forming units per ml of E. coli. B. A 70‑year‑old man with an indwelling Foley catheter, no new urinary symptoms. His urine appears cloudy and foul‑smelling. His culture is 100,000 ...

A 28‑year‑old male non‑smoker with no chronic health problems presents with a 10‑day history of persistent cough that's worse at night, stating, "I started with a head cold about two weeks ago. The cold moved into my chest." He reports mild chest discomfort with deep cough, rare production of small amounts of clear to white sputum, and feels tired because, "the cough keeps waking me up." He denies sore throat, fever, ear pain, shortness of breath, or GI symptoms. Objective temp 97.6, heart ra...

A 62 year old man with a 60 pack year cigarette smoking history presents with a chief complaint of progressive dyspnea on exertion and a chronic productive cough over the past eight years. Significant contributing history include two episodes of being seen in urgent care in the past year for "bronchitis" and being told he should follow up with primary care. When considering the diagnosis of COPD, which of the following is the most important diagnostic parameter? A. patient report ...

A patient presents stating, "I've been told I need to take a medicine before I have a deep dental cleaning." Which of the following patients requires antimicrobial prophylaxis prior to this dental visit? A. A 28-year-old female taking combined oral contraceptives with a history of the murmur of mitral valve prolapse B. An 18 year old with a physiologic murmur and a history of ACL repair C. A 64 year old male with hypertension, type 2 diabetes, dyslipidemia, and an A1c of 9.5% D. A 72-year-old...

A 45 year old woman who works as a professional baker, with a specialty in birthday and wedding cakes, is diagnosed today with carpal tunnel syndrome. Her history of present illness include a four month history of numbness and tingling of the thumb, index and middle finger of her dominant hand. Physical exam reveals normal grip strength and decreased sensation along the median nerve distribution. Thenar atrophy is absent. Which of the following is the most appropriate next step? A. refe...

A 28-year-old woman who is breastfeeding her healthy six-week-old term infant presents with a four-day history of generalized body aches, intermittent fever to 101.2 degrees Fahrenheit, and localized pain on the upper aspect of her left breast. She states that she's been attempting to nurse her infant as tolerated and pumps the affected breast when unable to nurse. Physical exam is consistent with lactation-associated mastitis. Which of the following is the most appropriate next steps?&...

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A 73-year-old female with a 20-year history of hypertension, type 2 diabetes, dyslipidemia, and stage 3B CKD, typically at treatment goals with oral medications, is being seen. She was discharged yesterday after being hospitalized for three days with community-acquired pneumonia and is here for a follow-up visit. She states she's feeling much better with less shortness of breath, diminished cough, and sputum production, and is without fever. She mentions that while she was in the hospital tha...

A 17 yo male presents for follow up on a “fainting” episode that occurred during football practice at the end of a running exercise. He states, “I do not know what happened. We finished a set of running sprints and next thing I knew, I was on the ground.” He denies injury from the event and history of prior episodes. His physical examination reveals a crescendo-decrescendo systolic murmur heart best at the apex, increasing in intensity with position change from supine to standing position. &n...

A nurse practitioner receives a message from a neighbor, a 35-year-old woman who is asking for a prescription to treat a “urine infection”. The neighbor states she's had this condition occur in the past and does quite well if she gets on an antimicrobial quickly. The neighbor also mentions that she's going out of town on a business trip the next day and is unable to contact her personal healthcare provider nor get to urgent care. The NP considers the following in prescribing a medicatio...

A 6-year-old presents with his parents, with a chief complaint of a 3 day history of sore throat, intermittent frontal headache and fever with a 1 day history of a non pruritic fine, raised rash, without N, V, D or C. He is able to take fluids without difficulty but has diminished appetite. The parents report that other children in their son’s kindergarten class have been sick with similar signs and symptoms. A rapid strep screen is positive. Clinical evaluation is consistent with scarlet fev...

An 18-month-old toddler presents for a sick visit with a chief complaint of recent onset of fever and skin lesions. Which of the following is most consistent with the presentation of measles (rubeola)? A. A 3-day history of anterior cervical lymphadenopathy, significant sore throat, fever with a 1-day history of a fine erythematous skin eruption. B. A 3-day history of fever, mild nasal congestion, and crankiness followed by resolution of elevated temperature and erupt...