NP Certification Q&A

A 35 year old presents with chief complaint of “my sinus infection is not getting better”, with continued nasal and sinus congestion, yellow to white nasal discharge, and a feeling of sinus pressure particularly when he bends over. He denies sore throat headache, and GI symptoms, and previously reported fever prior to treatment is now resolved. The EMR documentation notes a prescription for dose-appropriate amoxicillin with clavulanate written 2 1/2 days ago when seen for a sick visit. Patient states he has taken the antibiotic as advised, staring the medicine on the day of his sick visit, and has not missed any doses. Physical exam reveals a no acute distress, mild tenderness to sinus palpation, and no fever. The next most appropriate step in this patient's treatment plan is to:

A. Advise the patient to continue his current course of therapy.
B. Switch his antimicrobial to moxifloxacin.
C. Order a CT of the sinuses.
D. Perform a posterior pharyngeal culture and sensitivity.
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Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4 days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood. He has been tolerating clear liquids for the past 24 h and voided a small amount around 2 h ago. He feels “a little bit hungry but I am afraid to eat or I might throw up again. I still feel a little bit sick to my stomach.” Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and denies dizziness with position change from supine to sit or stand. His mucous membranes are slightly dry, with intact skin turgor, and mild diffuse abdominal tenderness without rebound. With a working diagnosis of viral gastroenteritis, which of the two following clinical actions should be taken?

A. Obtain stool for culture and sensitivity.
B. Order a chem panel.
C. Provide information about a slowly progressive diet as tolerated.
D. Prescribe an antiemetic.
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Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 4 h ago, last stool was around 2 h ago, reported as yellow brown in color, small volume and without blood. He has been tolerating a sips of clear liquids for the past 3 h and voided a small amount around 2 h ago. Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and his mucous membranes are slightly dry. The most likely cause of Joseph’s clinical condition is:

A. Staphylococcal food poisoning
B. Clostridium difficile (C. diff) enteritis
C. Viral gastroenteritis
D. Gastric ulcer
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Sonia is a 15 year old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents for an urgent care visit with a 6-h history of sudden onset nausea, with multiple episodes of vomiting, abdominal cramping and 2 episodes of diarrhea with stool described as light to dark brown without visible blood. Her VS are within normal limits and mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild exceptional tenderness without rebound. When considering a diagnosis of staphylococcal food poisoning, which would most likely be reported by Sonia?

A. "One after another, the people on my basketball team have been getting sick like this during the past week."

B. "My basketball team stopped at a restaurant today to get something to eat on our way home from a game. Practically all of us who got turkey sandwiches are sick like this.”

C. "I had an ear infection a couple of weeks ago, and I took about 5 days of an antibiotic."

D. "I have really bad cramps during my period, and I take a lot of ibuprofen to help out."
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The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots over the back, and the buttocks. The areas are flat with irregular shape and unclear edges and are noted in the areas that the parents report. The areas of discoloration are 8 to 20 centimeters in diameter. Palpating the areas does not appear to elicit any discomfort in the child and the color does not blanch with pressure. The skin texture is within normal limits, and The physical exam is otherwise within normal limits. These findings are most consistent with:

A. cafe au lait spots
B. Congenital dermal melanocytosis
C. Port wine stain
D. Capillary Hemangioma
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A three year old otherwise well child for a sick visit. Her caregivers report that the child has been well, with the exception of a number of small, new skin lesions on the chin and arms, present for about 3 days. The child will occasionally rub the lesions, but does not complain about pain, has no fever, no other symptoms. Exam is consistent with non bullous impetigo, with approximately 6 lesions, all less than two to three centimeters in diameter, scattered over the chin and both arms. The child is in no acute distress, and age appropriately resist the exam. Which of the following is the preferred treatment option?

A. Topical bacitracin, polymyxin and neomycin cream
B. Mupirocin ointment
C. Oral trimethoprim sulfamethoxazole
D. Triamcinolone cream
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A 5 year-old otherwise well child presents with a 4-day history of “a skin problem”. . She is without fever and in no acute distress. Her parent advises that other children in the child’s playgroup have developed similar skin lesions. Considering the diagnosis of non bullous impetigo, the NP expects to find which of the following?

A : A four-centimeter, round, honey-crusted lesion surrounded by about a 0.5 centimeter area of erythema, localized to the chin.

B: Multiple papular skin lesions about 0.25 centimeters in diameter, with burrow marks in a linear fashion on both arms.

C : A generalized vesicular rash over the trunk and extremities.

D. : Areas of lichenification in the antecubital fossa.
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A 33 year-old who is pregnant with her 2d child presents for prenatal care. She does not have record of her immunizations, but states she has not had any vaccines in more than 1 year. She is without complaint, and exam is consistent with gestational age, with FHT= 140 BPM and visible fetal activity. Today which two vaccines are recommended?

A: Measles, mumps, rubella.
B: Varicella.
C: COVID 19.
D: Tdap or tetanus-diphtheria-acellular pertussis.
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Which of the following is consistent with the clinical presentation of placental abruption?

a. A 38 year-old with primary HTN, who is now 28 weeks pregnant with her 6th child, presents with a 1-h history of sudden onset abdominal pain as well as dark red vaginal bleeding,dizziness, tachycardia and BP= 88/ 55

b. A 32 year old who's pregnant with her eighth child, now 32 weeks pregnant presenting with A2 hour history of bright red vaginal bleeding stating she does not have abdominal pain.

c. 28 year old who states she had a positive home pregnancy test three days ago with last menstrual period six weeks ago. Normal timing and flow with an 8 hour history of intermittent bright red vaginal spot spotting with mild cramping.

d. A 26 year old with a past medical history of pelvic inflammatory disease who's now 8 weeks pregnant by LMP with A2 hour History of sudden onset. Severe left sided abdominal pain radiating to the shoulder, Small amount of bright red bleeding per vagina. Feeling lightheaded. Vital signs reveal tachycardia in ABP of 80 / 45.

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The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots over the back, and the buttocks. The areas are flat with irregular shape and unclear edges and are noted in the areas that the parents report. The areas of discoloration are 8 to 20 centimeters in diameter. Palpating the areas does not appear to elicit any discomfort in the child and the color does not blanch with pressure. The skin texture is within normal limits, and The physical exam is otherwise within normal limits. These findings are most consistent with:

A. Cafe au lait spots
B. Congenital dermal melanocytosis
C. Port wine stain
D. Capillary Hemangioma

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YouTube:https://www.youtube.com/watch?v=CJnbvuB_iO0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=59

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