NP Certification Q&A

Latest Episodes:

Viral Hepatitis Assessment Sep 25, 2023

Show notes

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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STI Plan/ Intervention Sep 18, 2023

Show notes

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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YouTube: https://www.youtube.com/watch?v=nptqU5aDxqs&t=2s

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Insect Bite in Older Adult with T2DM Sep 11, 2023

Show notes

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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Child Sick Visit Sep 04, 2023

Show notes

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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Health Assessment Aug 28, 2023

Show notes

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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Immunization Intervention and Plan Aug 21, 2023

Show notes

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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Older Adult Joint Pain Differential Diagnosis Aug 14, 2023

Show notes

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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Acute Bacterial Prostatitis Assessment Aug 07, 2023

Show notes

A 67-year-old man who is diagnosed with acute bacterial prostatitis presents with a chief complaint of a one-week history of constant perineal pain, arthralgia, irritative voiding symptoms, and intermittent fever. Which of the following is most consistent with anticipated findings on prostatic digital rectal exam (DRE) with this condition?
A. An enlarged prostate with obliterated median sulcus
B. A prostatic exam that reveals multiple firm, non tender nodular lesions
C. A tender, boggy prostate
D. A firm, non tender prostate
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YouTube: https://www.youtube.com/watch?v=fPoH6HNHh1U&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=30&t=302s

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Bacterial Vaginosis Diagnosis Jul 31, 2023

Show notes

Which of the following is most likely to be reported as part of the HPI in a woman presenting with bacterial vaginosis?
A. A 19-year-old woman with a 3-day history of vaginal and perineal itch, clumping white vaginal discharge that has a slight “musty” odor.
B. A 24-year-old woman with a 1-week history of mild perineal irritation, thin, grey-green vaginal discharge with a strong “fishy” odor.
C. A 68 year-old with chief complaint of vaginal irritation, discomfort on vaginal sexual activity, and denies unusual vaginal discharge or odor.
D. A 28 year-old woman with 10-day history of copious purulent yellow vaginal discharge without unusual odor, perineal irritation and mild dysuria.
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YouTube: https://www.youtube.com/watch?v=7rGFpDUuzo4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=29

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Statin Therapy Evaluation Jul 24, 2023

Show notes

A 67-year-old man has been recently diagnosed with HTN, dyslipidemia and T2DM. As part of his medication treatment plan, he agrees to start statin therapy. The NP appreciates that which of the following laboratory tests should be conducted about 4-12 weeks after starting statin therapy?
A. AST and ALT
B. CK and potassium
C. Lipid profile
D. CBC with WBC differential and platelet count
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YouTube: https://www.youtube.com/watch?v=EwQBD3z6rQs&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=28

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