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Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Expert Fitzgerald faculty clinicians share their knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So, if you’re ready, let’s jump right in.
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 discharge. Mild non-tender inguinal lymphadenopathy is present. This clinical presentation is most consistent with: A. genital herpes B. primary syphilis C. chancroid D. Secondary syphilis --- YouTube: https://www.youtube.com/watch?v=AcXiEUw94kY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=153 Visit fhea.com to learn more!
75-Year-Old Woman With CKD and UTI
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, statin, and an SGLT2i. Vital signs are stable. Physical exam is unremarkable except for mild suprapubic tenderness. Laboratory results include the following: Urinalysis, positive for leukocyte esterase and nitrites. Reference lab is negative for those substances. Estimated GFR is 48, Serum potassium is 4.8. Which of the following is the most appropriate treatment? A. Trimethoprim sulfamethoxazole DS B. Nitrofurantoin C. Ciprofloxacin D. Amoxicillin --- YouTube: https://www.youtube.com/watch?v=2kWxQiKJo20&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=152 Visit fhea.com to learn more!
Antidepressant Discontinuation Syndrome
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 the diagnosis of antidepressant discontinuation syndrome, which of the following is most likely to be reported? A. tremor, diaphoresis, tachycardia, hypertension, agitation B. yawning, rhinorrhea, abdominal cramping, diarrhea, piloerection C. dizziness, nausea, body aches, sleep disturbance, irritability, brief vibrating sensations D. restlessness, sweating, diarrhea, tremor, fever, and involuntary muscle jerking Visit fhea.com to learn more!
Neuroimaging for Headache
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 headache trigger and denies headache prodrome. Family history is positive for mother and sister with similar headache. She's currently headache free and her neuro exam is within normal limits. Today she asked if she needs, "any tests to find out what causes my headache." The NP considers the following. A. head MRI due to duration of headache B. order a head CT with contrast due to frequency of headache C. discuss the utility of carotid Doppler ultrasonography in confirming the diagnosis of migraine D. advise the patient that neuroimaging is not routinely indicated in this clinical scenario --- YouTube: https://www.youtube.com/watch?v=rT6JNb0yN9Q&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=150 Visit fhea.com to learn more!
Skin Lesions in a Four-Day-Old Infant
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 hours since she came home from the hospital with her mom, skincare has been limited to the use of a mild skin cleanser as needed. Physical exam reveals an alert child without fever and no acute distress with scattered erythematous macules and papules with occasional pinpoint pustules on the face, trunk, and proximal extremities.The rest of the clinical presentation is unremarkable. The most likely diagnosis is: A. Neonatal Acne B. Milia C. Neonatal Herpes Simplex D. Erythema Toxicum Neonatorum --- YouTube: https://www.youtube.com/watch?v=Jvx_eDhKLqw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=149 Visit fhea.com to learn more!
Subclinical Hypothyroidism
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 normal. B. TSH of less than 0.15, undetectable. Free T4 of 79, markedly elevated. C. TSH of 24, elevated. A free T4 of three, markedly reduced. D. TSH of 1.8, which is normal and a free T4 of 14, also normal. --- YouTube: https://www.youtube.com/watch?v=RCXz36twv8k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=148 Visit fhea.com to learn more!
29 Year-Old with Viral URI
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 mild pharyngeal erythema without exudate, no lymphadenopathy and tympanic membranes within normal limits. Lung resam is unremarkable except for occasional cough. The nurse practitioner diagnoses a viral URI or a common cold. The patient states, “I have trip coming up in five days, and I'm really worried that I might have the start of a sinus infection or pneumonia or a strep throat.” The NP considers which of the following in addressing the patient's concerns? A. if you start to cough up phlegm within the next day or so, this could indicate the start of a pneumonia B. If your nasal discharge turns to green or dark yellow, this usually indicates that an antibiotic is needed C. your cough could persist for a couple of weeks, which is quite common in a viral respiratory tract infection D. if your sore throat persists for two to three more days, it means that a strep infection is starting --- YouTube: https://www.youtube.com/watch?v=PaHg61Doc8E&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=147 Visit fhea.com to learn more!
Developmental Red Flags in a 6-Month Old
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 direction B. Unable to transfer objects hand to hand C. Reaches for objects with one hand D. Ability to sit briefly without support --- YouTube: https://www.youtube.com/watch?v=hR4oy4NXV5s&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=146 Visit fhea.com to learn more!
Developmental Milestones in a Well 4-Month Old
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 hand to hand B. brings hands together and laughs out loud C. Lifts head briefly when prone and startles to loud sounds D. Increase babbling and sits without support ---- YouTube: https://youtu.be/TDwbqgwDimw?si=H9VP_6uzlXJbRnsp Visit fhea.com to learn more!
24 Year Old Woman With Heart Murmur Inquiring About Contraception
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 being pleased with her contraceptive method. She states that she read online that “I know I have a heart murmur and I'm worried about whether the birth control pill is safe for me.” The nurse practitioner considers the following when advising this patient A. she should switch to a progestin only contraceptive method B. if no other contraindications are present, she can continue to use combined hormonal contraception C. in this clinical scenario, barrier contraceptive method is advised D. she should be referred to cardiology for advice on contraceptive methods --- YouTube: https://www.youtube.com/watch?v=fkJkZLA1BM8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=144 Visit fhea.com to learn more!
HRT in a 51-Year Old Woman
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 13 months ago and she's without chronic health problems. When considering postmenopause hormone therapy, which of the following is the most accurate statement? A. The use of hormone therapy post menopause is associated with a significant increase in cardiovascular and cancer risk. B. The use of select low dose SSRIs for the management of vasomotor symptoms is as effective as hormone therapy. C. Short duration lower dose hormone therapy offers an effective form of therapy for menopausal vasomotor symptoms. D. Hormone therapy postmenopause offers an effective treatment for osteoporosis. --- YouTube: https://www.youtube.com/watch?v=80j1H7FVrJY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=143 Visit fhea.com to learn more!
Contraceptive Choices in Migraine
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 are contraindicated with any type of migraine. B. Combined hormonal contraception is acceptable for use in this clinical situation. C. Progestin-only contraceptive methods should be avoided in migraine with or without aura due to the increased risk for elevated blood pressure. D. Barrier contraceptive methods are preferred in this situation. --- YouTube: https://www.youtube.com/watch?v=PyCwq8NMkPw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=142 Visit fhea.com to learn more!
HTN Interventions
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 just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a half an hour." His physical exam shows no acute distress, grade one hypertensive retinopathy, and S4 heart sound. His neck veins are within normal limit, chest is clear, no peripheral edema with a resting heart rate of 73. Respiratory rate 16, 12 lead ECG is within normal limits. His BMI is 33. Which of the following is the next best step in the patient's care? A. Administer in-office oral clonidine and reassess blood pressure in 1 hour. B. Activate EMS with prompt transfer to emergency department C. Restart prior blood pressure medications with follow-up within the next month D. Advise restricting dietary sodium and weight loss to help with BP control. --- YouTube: https://www.youtube.com/watch?v=xpsNR1uxO4Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=141 Visit fhea.com to learn more!
HTN Findings
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 no complaint, denying shortness of breath, chest pain or visual changes. He states, "I just came in today for a visit since I ran out of my blood pressure refills. I need to get back to work in a half an hour." When considering the diagnosis of asymptomatic markedly elevated blood pressure, the clinician would predict his physical exam is normal with the exception of which of the following. A. S4 heart sound B. Grade 3 HTN retinopathy C. Neck vein distension D. Murmur of aortic regurgitation --- YouTube: https://www.youtube.com/watch?v=GlnpCn_tg48&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=140 Visit fhea.com to learn more!
Asymptomatic Bacteriuria
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 CFU of mixed flora. C. A 30‑year‑old woman who is 10 weeks pregnant, no urinary symptoms, culture reveals 100,000 CFU per ml of E. coli. D. A 72‑year‑old man scheduled for a transurethral prostate resection, a TURP, next week, no urinary symptoms. His culture reveals 100,000 CFU per ml of E. coli. --- YouTube: https://www.youtube.com/watch?v=n1Ze5rIDf8Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=139 Visit fhea.com to learn more!
Infant Development Question
A healthy seven‑month‑old boy presents with his parents for a well‑child visit. He was born at 39.5 weeks gestation via spontaneous vaginal delivery. After a pregnancy without complication, he and his mother went home after 24 hours. He is primarily breastfed with a small amount of solids and continues to be at the 50th percentile weight and 40th percentile length. The parents voice no concerns. Which of the following is the most appropriate developmental milestone for this child's age? A. sits briefly with support B. is able to pull to stand C. rolls front to back D. uses pincher grasp to pick up a small object --- YouTube: https://www.youtube.com/watch?v=rhH1qyJ5gxw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=138 Visit fhea.com to learn more!
An Adult With a 10 Day History of Cough
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 rate 72, respiratory rate 18, BP 112 over 68, SpO2 is 99%, no acute distress, mild pharyngeal redness, no lymphadenopathy, chest without crackles, occasional dry cough, abdominal exam is within normal limits. Which of the following is the most appropriate next step? A. Prescribe one week of oral amoxicillin. B. Order a chest x-ray C. Prescribe a five-day course of azithromycin D. Provide advice about symptomatic care --- YouTube: https://www.youtube.com/watch?v=RlTB1oBGISY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=137 Visit fhea.com to learn more!
36 Year Old Woman With Thyroid Disorder
A 36 year old woman presents with a three month history of unintended weight loss, sensation of increased anxiety, heat intolerance, and reports, "I feel like my heart is going to beat right out of my chest." In addition, she reports a two-month history of increased frequency and looseness of stools. Physical exam reveals 3-4 plus Achilles and patella reflex response, mild exophthalmosis, bilateral fine tremor, and a diffusely enlarged non-tender thyroid. Heart rate 115 beats per minute at rest without murmur or other cardiac abnormalities. Considering thyroid disorder as her working diagnosis, which of the following would be her anticipated lab results? A. Elevated TSH with normal limit free T4 B. Low TSH with elevated free T4 C. Elevated TSH with a low free T4 D. Normal limit TSH --- YouTube: https://www.youtube.com/watch?v=LCbIl606pHM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=136 Visit fhea.com to learn more!
Assessment in Diagnosis of COPD
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 of progressive dyspnea and chronic productive cough B. 60-pack year cigarette smoking history C. FEV1 to FEC ratio of less than 0.7 post bronchodilator D. FEV1 of less than 50 % of predicted --- YouTube: https://www.youtube.com/watch?v=nzAiWzsDfuM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=135 Visit fhea.com to learn more!
Treatment Choices in Infective Endocarditis Prophylaxis
A 72-year-old with a prosthetic aortic valve presents stating, "I was told I have to take a medicine before I have a deep dental cleaning." Concurrent health issues include hypertension, type 2 diabetes, and dyslipidemia, currently at treatment goals. Medications include metformin, hydrochlorothiazide, telmisartan, and rosuvastatin. She has no drug allergies. Which of the following is the most appropriate next step in her care? A. amoxicillin 2 grams PO 30 to 60 minutes prior to the procedure B. amoxicillin 2 grams PO 1 to 2 hours after the procedure C. cephalexin 2 grams PO 30 to 60 minutes prior to the procedure D. inform the patient that no antimicrobial prophylaxis is needed during dental care. Visit fhea.com to learn more!
