NP Certification Q&A

Latest Episodes:

Atrial Fibrillation/INR Dec 11, 2023

Show notes

A 68-year-old with atrial fibrillation is taking warfarin as part of therapy for the prevention of thromboembolic event. His goal INR is 2-3, which is checked monthly and has been within acceptable range for the past 6 months. Today he presents with an INR=3.8. He denies bleeding events and reports, “I am taking my medicine just like I was told.” The NP considers that:
A. The INR should be repeated today.
B. A single dose of injectable vitamin K should be ordered.
C. His health history should be reviewed carefully, with a focus on interacting with medications and/or foods.
D. His weekly warfarin dose should be increased by 15%.
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YouTube: https://www.youtube.com/watch?v=GNOlaFUosp0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=47

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Heart Murmur Diagnostic Evaluation Dec 04, 2023

Show notes

A 35-year-old woman presents for a well-woman exam. She is without complaint, with BMI=22, and reports that she runs about 28 miles per week, 4-5 miles with each run, and has excellent exercise tolerance. She states, “I am in great health.” On physical examination, the NP notes a faint mid-systolic click followed by a grade 2/6 mid- to late-systolic murmur, best heard at the apex. No other abnormalities are noted. These findings are most suggestive of
A. aortic stenosis
B. mitral stenosis
C. mitral regurgitation
D. mitral valve prolapse
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YouTube: https://www.youtube.com/watch?v=etnHh0ST5XY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=46

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Lactation Mastitis Treatment Nov 20, 2023

Show notes

A 28-year-old woman who is breastfeeding her healthy 3-month-old term infant presents with a 48-hour history of generalized body aches, intermittent fever to 101.2 F, and localized pain on the upper aspect of her left breast. Nursing her child worsens the breast pain, while putting a cool compress on the area helps with pain control. She denies cough, GI symptoms or other skin alterations and does not have allergies to any medication. Physical exam is consistent with the diagnosis of lactation mastitis. Which of the following represents the two best treatment options?
A. Discontinue breastfeeding on the affected side.
B. Prescribe an appropriate course of antimicrobial therapy.
C. Ensure that milk flow through the breast is encouraged via nursing as is tolerated or pumping.
D. Discard the milk from the affected breast.
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YouTube: https://www.youtube.com/watch?v=JravIOgsQm0&t=4s

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Professional Role: Controlled Substance Prescribing Nov 13, 2023

Show notes

A nurse practitioner is newly licensed to practice. Which of the following best describes the NP’s ability to prescribe controlled substances?
A. Any NP who meets state-level requirements for a license to practice is able to prescribe controlled substances.
B. NPs are significantly restricted nationally from prescribing controlled substances.
C. NPs are able to prescribe controlled substances with significant physician oversight.
D. Controlled substance prescribing authority for NPs is regulated at the state and national level.
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YouTube: https://www.youtube.com/watch?v=I69XvssB_1k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=44

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Delirium Assessment Nov 06, 2023

Show notes

Mrs. Parr, an 82-year-old woman with a 30-year history HTN and dyslipidemia, treated and at EBP goals, presents with a 3-day history of weakness and urinary incontinence. She was seen in urgent care yesterday, diagnosed with a UTI, and appropriately treated. She resides with her adult daughter who states, “The last two days, Mom kept saying she needed to get to work. She retired 15 years ago. She’s never been confused like this.” The NP understands that, with delirium, the changes in mental status usually:
A. Occur rapidly and are associated with an acute illness.
B. Are noted over a number of weeks and typically progressive.
C. Irreversible and usually slowly advancing.
D. Without a predictable pattern and often noted in the absence of an acute illness.
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YouTube: https://www.youtube.com/watch?v=nQ6JtFvWZeg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=43

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T2DM Evaluation Oct 30, 2023

Show notes

The NP is seeing a 60-year-old woman with a 10 year history of T2DM. Her current medications include oral metformin and an oral SGLT2-I, and states she is feeling well, without report of blurred vision, excessive thirst or polyuria. She has not had any laboratory tests done in the past 6 months. Which of the following represents the best choice of test to determine her overall glucose control?
A. Fasting plasma glucose
B. Serum creatinine/ e GFR (estimated glomerular filtration rate)
C. Hemoglobin A1c
D. Random blood glucose
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YouTube: https://www.youtube.com/watch?v=yz94zsqABG8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=42

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ABRS Antimicrobial Therapy Oct 23, 2023

Show notes

A 21 year-old woman with a 15 year history of asthma. presents with acute bacterial rhinosinusitis; she is without fever and in no acute distress. Her current medications include an ICS/LABA inhaler for reliever and prevention asthma therapy, and a LNG-IUD for contraception. She also reports being told by her parents that she has penicillin allergy, and states, “I had a pink rash on my face and body for a few days when I took penicillin at around 3 or 4 years-old.” In considering ABRS antimicrobial therapy for this patient, the preferred treatment option would be:
A. Cefpodoxime
B. Azithromycin
C. Amoxicillin
D. Trimethoprim-sulfamethoxazole
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YouTube: https://www.youtube.com/watch?v=V6a_DYT3KEg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD

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Sick visit from patient with 20-year history of HTN Oct 16, 2023

Show notes

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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YouTube: https://www.youtube.com/watch?v=Tt0iVD7ohAM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=40

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Differential diagnosis: Skin condition in patient with 10-year history of Parkinson Disease Oct 09, 2023

Show notes

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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Scabies Evaluation Oct 02, 2023

Show notes

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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