NP Certification Q&A

A 76 year-old man with a 20-year history of HTN presents for a sick visit in the primary care clinic, stating, “I do not think that new medicine agrees with me.” Until recently, his BP was at goal with an ARB, but about 1 week ago, due to continued elevated readings, a second BP med, a thiazide diuretic, was added. Which of the following is most likely to be reported by this patient?

A. “Since I started on the medicine, I passed out and woke up on the floor 4 times.”
B. “About 2 days after I started the new medicine, I started feeling lightheaded when I stand up quickly.”
C.” After starting the new medication, I feel like the room is spinning around me.”
D. “I’ve had chest pain and sweating off and on since I started the new medication.”

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A 60 year-old man who has a 10 year history of Parkinson disease presents with a chief complaint of “flaking skin that just does not go away, sometimes worse, sometimes better”, stating this problem has been present for > 6 years. Concurrent health issues include HTN, dyslipidemia and generalized anxiety disorder. The affected areas are occasionally itchy and will ache when particularly severe. He has used OTC hydrocortisone cream and skin moisturizers without seeing improvement. Physical exam reveals inflamed patches on the scalp, accompanied by greasy yellow scales. Similar lesions are noted in the nasolabial folds and behind the ears and into the ear canals. Which of the following is the most likely diagnosis?

A. Dandruff
B. Seborrheic dermatitis
C. Psoriasis
D. Atopic dermatitis

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YouTube: https://www.youtube.com/watch?v=VgCO_kpY208&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=39

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A 35-year-old man who is generally well was diagnosed with scabies 3 days ago presents with a chief complaint. “I do not think that skin medicine I was given worked. I am still really itchy and the rash looks the same”. He reports using topical permethrin as advised. Physical exam reveals excoriated papules on the interdigital area and scattered similar areas in the axillary and groin regions. Microscopic examination of skin scrapings supports the scabies diagnosis. He is otherwise without new findings. The NP considers the following:

A. Another course of permethrin is advised, to be used as soon as possible.
B. A skin biopsy should be performed today.
C. Low dose topical corticosteroids and oral antihistamines should be prescribed.
D. A topical antibacterial is advised.

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Youtube: https://www.youtube.com/watch?v=JP9SBmkMSdg&t=1s

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A 28-year-old woman with a longstanding history of injection drug use presents with a 10-day history of malaise, nausea, and fatigue, and a two day “yellow eyes”. Physical exam reveals scleral icterus and mild hepatomegaly with right upper quadrant tenderness. Considering the possibility of acute hepatitis B in the differential, the NP anticipates laboratory results will include.

A. The presence of hepatitis B surface antibody (HBsAb)
B. Thrombocytosis.
C. Leukocytosis.
D. The presence hepatitis B surface antigen (HBsAg).

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YouTube: https://www.youtube.com/watch?v=OGIvOMwCQCU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=37

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A 22-year-old woman presents for follow-up after a recent clinic, requested STI screening. Testing for Chlamydia trachomatis was positive. She states, “I am really surprised, I feel fine.” Her current medications include combined oral contraceptive and her LMP was about 10 days ago, with appropriate timing and a 3 day light flow. The NP considers which of the following is the best option?
A. Given she is asymptomatic, no further intervention is needed
B. Oral azithromycin as a single dose should be offered
C. Testing for C. trachomatis should be repeated today
D. A 7-day course of oral doxycycline is advised

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A 62-year-old woman with T2DM presents 2 days after noticing a “bug bite” on her left lower leg, stating, “I am not sure what bit me.” During this time, the area has increased in size and she reports discomfort in the region. Examination reveals a tender warm, red, erythematous area with poorly demarcated borders, approximately 15 cm at its widest diameter on the anterior lower leg. Calf circumference is equal bilaterally. The patient is with no fever or additional complaints with no additional contributory history. This most likely represents:
A. Deep vein thrombus
B. Erythema migrans
C. Cellulitis
D. Contact dermatitis

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YouTube: https://www.youtube.com/watch?v=JDp6Y1PXtiA&t=5s

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The NP sees a well, 18-month-old with a two-day history of clear nasal discharge, dry cough, intermittent fever to 101.4 or 38.5C, and mild crankiness. She's up to date with all recommended vaccination. Parents report everyone at home has this cold. Testing for RSV, COVID-19, influenza are all negative. She is alert, age appropriately resists the exam, which is consistent with viral URI. Her father states, “We got her fever under control by giving her two different medicines around the clock.” He presents two medication bottles, one with liquid acetaminophen and one with liquid ibuprofen. The NP considers that alternating between ibuprofen and acetaminophen for a child with fever will:

A. Result in additive effect in fever reduction.
B. Is encouraged in order to prevent febrile seizures.
C. Is only recommended in higher fever, such as when the fever is 100 degrees F or 38.8 degrees C or greater.
D. Is not recommended due to higher potential for adverse effects.

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YouTube: https://www.youtube.com/watch?v=3TwWdK5TnbM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=34

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The NP is seeing a 35 year-old well woman for a health promotion and physical exam woman. She has not complaints, is a nonsmoker, a light social drinker with 1-2 glasses of wine per month, and exercises about 30 mins 5 days a week. Her BMI is 22 and vital signs are unremarkable with BP= 110/70. Which of the following is an anticipated finding on her funduscopic exam?

A. Retinal arteries wider than veins
B. Arteriovenous nicking
C. Physiologic cup-to-optic disc ratio of less than 0.5
D. Blurred optic disc margins

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YouTube: https://www.youtube.com/watch?v=Vmb7IXP68m4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=33

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A healthy 1 year old, accompanied by his mother, is in for a well child visit. He is due to receive routine immunizations for a child his age. His mother mentions that she is about 6 weeks pregnant and read that, “I know he should get the chickenpox and German measles vaccines today. Since I am pregnant, is this safe?” The NP considers the following:

A. Neither vaccine contain live virus and both can be given today.

B. Both vaccines contain live virus that the child will not shed, and he can receive these immunizations today.

C. The vaccines contain live virus and should be delayed until the mom is out of the first trimester of pregnancy.

D. Due to the mother’s pregnancy, these vaccines should be delayed until after she gives birth.

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YouTube: https://www.youtube.com/watch?v=HvjCBeUIXlc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=32&t=6s

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A 78 year-old woman with well-controlled hypertension and dyslipidemia presents with a chief complaint of a many month history of pain, described as achiness, and stiffness in the joints both hands, particularly towards the end of the day. A part-time seamstress, she reports this discomfort is worse on work days. She denies redness or heat in the affected regions and has no systemic complaints. Physical exam reveals Heberden and Bouchard nodes bilaterally. These findings are most consistent with a diagnosis of:

A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Osteoporosis
D. Osteoarthritis

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YouTube: https://www.youtube.com/watch?v=LXSE3bE7I30&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=31

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