NP Certification Q&A

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Back Pain Diagnosis Jul 29, 2024

Show notes

A 55-year-old man with a BMI of 40%, with the chief complaint of low back pain for the past two weeks. He describes the pain as originating in the lumbar sacral region, with radiation across the left buttock associated with numbness and tingling sensation in his left leg. The pain is worse with sitting and somewhat better with standing. He denies lower extremity weakness or a change in bowel or bladder function. He states, “I've tried ice, heat and ibuprofen and these just take the edge off. I've had back pain like this in the past. Usually just lasts a couple of days and it's not that bad. I'm going to try that again and it's not this bad.” This history of present illness is most consistent with:
A. Lumbar Radiculopathy
B. Spinal Stenosis
C. Vertebral Fracture
D. Lumbar Sacral Strain
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YouTube:https://www.youtube.com/watch?v=RayHhiD23iU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=79

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Low Back Pain Jul 22, 2024

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A 45-year-old adult presents for a sick visit, with the chief complaint of three-day history of low back pain. Clinical assessment is consistent with lumbar sacral strain. Which of the following represents the most appropriate next step in this person's care?
A. Advised three days of bed rest on a firm surface.
B. Apply ice or heat to the affected area based on clinical response.
C. Refer to neurology for further advice.
D. Order a lumbar sacral x ray to help confirm the diagnosis.
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YouTube: https://www.youtube.com/watch?v=bNQp-Vq4jds&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=78

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Anemic Lab Findings Jul 15, 2024

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You see a 44-year-old woman with a 6-month history of increasing fatigue despite adequate opportunity for sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW as well as TSH within normal limits. You expect to find which of the following upon review of the patient’s health history?
A. Report that she has been consuming a plant-based diet since age 18
B. Report of menorrhagia
C. A history of alcohol use disorder
D. A diagnosis of rheumatoid arthritis
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YouTube: https://www.youtube.com/watch?v=fSmpWW2doHE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=77

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HIPAA Jul 08, 2024

Show notes

A 48-year-old woman presents for follow up on T2DM and HTN. As part of today’s visit, routine labs are ordered. Which of the following is an appropriate form of electronic communication for sharing these results with the patient?
A. Private message through Facebook® or similar social media website with patient permission
B. Electronic fax or scan uploaded to the patient’s personal account for a third-party file sharing service (e.g., DropBox®)
C. Using encrypted email or other messaging service that is part of the patient’s electronic medical record (EMR) system
D. Text message using the patient’s personal mobile phone number
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YouTube: https://www.youtube.com/watch?v=MH2-1Wi0NWQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=76

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Pneumonia Treatment Jul 01, 2024

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A 72-year-old man presents to primary care for a sick visit, with the chief complaint of a one day history of fever, productive cough with yellow sputum and increasing shortness of breath. His vital signs are as follows, temp 99.8 °F (37.6 °C) , BP 140/85, heart rate 98 beats per minute, and respiratory rate 22 at rest period O2 saturation is 94% on room air. He has a history hypertension and type 2 diabetes, at guideline-based goals. He is a former smoker, quitting about 35 years ago with approximately a 25-pack year history. On physical exam, he has crackles in his right lower lung fields, no wheezing, and can speak in complete sentences. He answers questions appropriately, has moist mucous membranes, and reports voiding approximately 1 hour ago. He denies GI distress but states his appetite’s not what it usually is. He lives in a single-story home with his spouse and adult child, both of whom are with him for today's visit. His laboratory results include a mild leukocytosis and renal function is within normal limits. There is no evidence of anemia, and chest X-ray confirms a right lower lobe infiltrate consisted with pneumonia. Which of the following is the most appropriate treatment location for this patient?
A. Intensive care unit
B. At home with careful follow up
C. Inpatient medical ward
D. Long-term care facility
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YouTube: https://www.youtube.com/watch?v=4tM6zLePTkM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=75

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HTN & T2DM Jun 24, 2024

Show notes

A 49-year-old woman with type 2 diabetes mellitus was started on a standard dose of an ARB daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg, stating she is taking the medication without difficulty and is feeling well. The appropriate action at this time would be to:
A. Order a white blood cell count to assess for neutropenia.
B. Continue her current medication regimen.
C. Add HCTZ to enhance HTN control.
D. Obtain a 12-lead ECG
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YouTube: https://www.youtube.com/watch?v=7Qai4U4zO5o&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=74

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Treating AOM in toddler Jun 17, 2024

Show notes

Esteban is an 18-month-old child who presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations and has no drug allergies, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6 °F (39.2 °C), with father stating, “This is how he acted a few months ago when he had an ear infection.” Physical exam confirms the diagnosis of bilateral AOM. When prescribing an antimicrobial for this child, which of the following represents the first-line treatment option?
A. Oral azithromycin
B. Oral cefpodoxime
C. IM ceftriaxone
D. Oral amoxicillin
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YouTube: https://www.youtube.com/watch?v=PRQHo531djY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=73

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Diagnosing AOM In Toddler Jun 10, 2024

Show notes

An 18-month-old toddler, Estaban, presents with his father for a sick visit. The child, who is typically healthy and UTD with immunizations, has had URI-like symptoms for the past 6 days with congested cough and clear to yellow nasal discharge. Per parental report, Esteban is drinking fluids without difficulty and has a slightly reduced appetite and had a single episode of post tussive vomiting 3 days ago. For the past 36 hours, his father reports increased crankiness and intermittent fever to 102.6°F (39.2°C), with the father stating, “This is how he acted a few months ago when he had an ear infection.” Which of the two following findings are most suggestive in the diagnosis of acute otitis media in a toddler?
A. Bulging tympanic membrane
B. Cough
C. Evidence of ear discomfort
D. Bilateral cervical lymphadenopathy
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YouTube: https://www.youtube.com/watch?v=IrdfBpjYODQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=72

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Lab & Physical Findings In Older Male Jun 03, 2024

Show notes

A 60 year old man presents with a chief complaint of a 6 month history of increasing fatigue despite adequate rest and sleep. He denies chest pain or difficulty breathing, and reports he is a non smoker. Concurrent history includes a 25 year history of alcohol used disorder, with daily intake of 5-7, occasionally more, 1.5 oz shots of whiskey, and chronic poor nutrition, reporting, “I eat chips and crackers a lot, I do not have the time to make a meal and I cannot afford to eat out. He is currently employed as a warehouse working, and states, “I get to work every day. The booze is really not problem.” On physical exam, mild pharyngeal redness without exudate, conjunctival pallor, and epigastric tenderness are present. The following lab results are noted.

Hgb = 9 g/dL (normal 14 to 16 g/dL)

Hct = 28.5% (normal 42% to 48%)

RBC = 3.4 million mm3 (normal 4.7 to 6.1 million mm3)

MCV = 108 fL (normal 81 to 96 fL)

MCHC = 33.2 g/dL (normal 31 to 37 g/dL)

RDW = 18.4% (normal 11-15%)

These findings are most likely caused by:
A. iron deficiency anemia

B. Vitamin B12 deficiency anemia

C. Folic acid deficiency anemia

D. Anemia of chronic disease.
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YouTube: https://www.youtube.com/watch?v=vU-JuuCQT18&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=71

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Hypothyroidism & Fatigue May 27, 2024

Show notes

A 45 year old woman with a 10 year history of hypothyroidism presents for follow up care. She's been taking levothyroxine 100 micrograms per day with excellent adherence. Stating "I take the medicine every morning on an empty stomach with a big glass of water.” She states she's generally feeling well, but notices increased fatigue over the past four months, which she attributes to the stress of starting her graduate studies while working full time. The results of today's laboratory testing include the following:

TSH is 2.3, the norm being .4 to 4, pre T4 15 with norm being 10 to 27.
The next step in her care is to:
A. continue on the same levothyroxine dose and obtain a repeat TSH in one year.
B. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in one month.
C. increase the levothyroxine dose by 25 micrograms per day and repeated TSH in two months.
D. Repeat the TSH and free T4 today and provide counseling about taking the medication with breakfast.
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YouTube: https://www.youtube.com/watch?v=NOXdT0E5oFM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=70

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