NP Certification Q&A – Details, episodes & analysis

A 73-year-old female with a 20-year history of hypertension, type 2 diabetes, dyslipidemia, and stage 3B CKD, typically at treatment goals with oral medications, is being seen. She was discharged yesterday after being hospitalized for three days with community-acquired pneumonia and is here for a follow-up visit.

She states she's feeling much better with less shortness of breath, diminished cough, and sputum production, and is without fever. She mentions that while she was in the hospital that, quote, they changed my diabetes medicine and gave me insulin four times a day to keep my sugar controlled, close quote. A review of her discharge note reveals that rapid acting insulin was given according to blood glucose levels without scheduled basal insulin and this was used from admission to discharge. 

Random glucose today is at 220. The patient asks, should I start back up on those insulin shots? I've never used them before. The NP considers with which of the following.

A. given her random blood glucose is elevated, the use of a sliding scale insulin should be continued for the next week

B. the use of a sliding scale insulin potentially results in wide glucose excursions

C. sliding scale insulin is helpful as it mimics physiologic insulin secretion

D. the sliding scale insulin regimen should now be replaced with a basal insulin

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A 60-year-old male with documented ASCVD, obesity with BMI of 34, and type 2 diabetes presents for care. The patient reports he's currently feeling well without episodes of hypoglycemia. Current laboratory assessment includes the following. A1C is 8.6 % and his estimated GFR is at 62. Current medications include metformin at optimized dose and a sulfonyl urea.

Which of the following represents the nurse practitioner's next best action?

A. continue on current therapy and arrange for a three month follow up

B. discontinue the metformin and add a DPP4 inhibitor

C. add a GLP-1 inhibitor and discontinue the sulfonyl urea

D. add basal insulin and titrate to fasting glycemic goals

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YouTube: https://www.youtube.com/watch?v=8ybH1qcskq8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=124

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A 52-year-old man presents for an initial primary care visit at the nurse practitioners practice period he has not seen any health care providers since age 38, stating that he has been in good health. Social history, drinking approximately 2 beers per night over the weekend, two nights per week, has a 5 pack year cigarette smoking history, having taken up smoking when he was in college, and quit at age 22. He reports feeling well and without chief complaint or chronic health problems.  He asks about what kind of cancer screening he should have. The NP advisors which of the following?

A. Colonoscopy 

B. Prostate specific antigen (PSA) 

C. Low dose chest CT

D. Given his history, no routine cancer screening is advised. 

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A 28-year-old woman G2P1LC1AB0, currently 22-weeks pregnant, presents with a 3-day history of urinary frequency and dysuria.  She is in no acute distress, without fever or vaginal discharge, reports “The baby is really moving around a lot” and denies GI symptoms. Fundal height is consistent with gestational age and FHT= 140 BPM and regular. UA dip in office is positive for leukocyte esterase and nitrites, yielding a working diagnosis of lower UTI.   Which of the following antimicrobials is preferred for the treatment of a UTI during pregnancy?

A. Doxycycline

B. Levofloxacin

C. Cephalexin

D. Azithromycin

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Robert has recently graduated from a NP program. During a job interview for an organization that has clinical sites in multiple states, he is asked questions about NP practice issues. Which of the following is accurate?

A.   Once I am nationally certified, I am also licensed to practice as an NP.

B. Once I am a certified NP and licensed to practice in one state, I will be able to practice in every state.

C. From state to state, NP practice acts are largely standardized.

D. NPs must obtain state-level prescriptive authority as well as a federal Drug Enforcement Agency (DEA) registration number in order to prescribe controlled substance.

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A 45-year-old woman presents for a sick visit with a chief complaint of 2–3-day sudden onset right elbow swelling with pain, stating, “I’ve never had pain like this. It looks like I have a swollen ball hanging from my elbow”.  She denies recent or remote injury to the area, fever, pain in other joints or skin lesions, and does report recently spending an extensive period of time on her computer due to a major work project. Physical exam reveals an area of painful sac-like swelling behind the right elbow, slightly warm, without redness or evidence of trauma. Joint range of motion (ROM) elicits discomfort but is largely intact. This clinical presentation is most consistent with: 

A. Rheumatoid arthritis 

B. Tendonitis 

C. Olecranon bursitis

D. Septic arthritis

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A 37-year-old adult was diagnosed with dyspepsia with documented H. pylori infection. An appropriate course of antimicrobial and proton pump inhibitor (PPI) therapy was prescribed and completed approximately 4 weeks ago. The patient states that the presenting symptoms have resolved and, “My stomach feels much better.” Which of the following is the most appropriate next step in care?

A.  Serologic test for H. pylori antibodies should be checked today.

B. The patient should be referred to gastroenterology for biopsy via endoscopy.

C. No further testing is needed as the patient’s symptoms have resolved.

D. Urea breath test should be conducted to confirm H. pylori eradication.

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Sarah is a 75 year-old woman with a 40 year history of HTN and a 30 year history of T2DM and dyslipidemia who was recently diagnosed with stage 4 chronic kidney disease (CKD). Given this history, which of the following hemograms would be expected? 

A. Hb = 9.7 g/dL (12 to 14 g/dL); MCV = 69 fL (80 to 96 fL); RDW=18% (11.5-15%)

B. Hb = 7.2 g/dL (12 to 14 g/dL); MCV = 122 fL (80 to 96 fL); RDW= 18.1% (11.5-15%)

C. Hb = 9.4 g/dL (12 to 14 g/dL); MCV = 83 fL (80 to 96 fL);  RDW= 13% (11.5-15%)

D. Hb = 10.4 g/dL (12 to 14 g/dL); MCV = 82 fL (80 to 96 fL); RDW= 18% (11.5-15%)

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Which of the following is a MEC Category 4 (use represents unacceptable health risk) to the use of a CHC (combined hormonal contraception method such as combined oral contraception [COC])?

A.  Mother with a history of breast cancer.

B. Personal history of hepatitis A at age 10 years.

C. Presence of factor V Leiden mutation.

D. Cigarette smoking one pack per day in a 22-year-old.

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YouTube: https://www.youtube.com/watch?v=PI9_QBQGxFU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=20

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You see a  17-year-old  woman with a long-standing history  of eczema and allergic rhinitis. Today she presents with worsening symptoms of skin lesions with itch for the past 2 months, now affecting the antecubital fossa of both arms, stating, “I get like this every winter but I am much better during warm weather. “  She is otherwise healthy. The most important aspects of skin care for this scenario is:

A.Daily use of medium to higher potency topical corticosteroids.

B. Twice-daily application of an antifungal cream.

C. Use of a topical antibiotic until skin lesions are clear.

D. Maintaining skin lubrication.

E. The use of low to medium potency topical corticosteroids to treat layers. 

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