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Explore every episode of the podcast NP Certification Q&A

Dive into the complete episode list for NP Certification Q&A. Each episode is cataloged with detailed descriptions, making it easy to find and explore specific topics. Keep track of all episodes from your favorite podcast and never miss a moment of insightful content.

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TitlePub. DateDuration
Sliding Scale Insulin12 Jan 202600:17:11

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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YouTube: https://www.youtube.com/watch?v=Pig89cLdQ5k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=125

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Treating Type 2 Diabetes with ASCVD06 Jan 202600:15:30

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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Cancer Screening Recommendation19 May 202500:11:30

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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YouTube: https://www.youtube.com/watch?v=qnKPe2EHgl4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=115










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UTI During Pregnancy03 Jul 202300:12:15

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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YouTube: https://www.youtube.com/watch?v=77fa2ryzovQ&feature=youtu.be

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Professional Issues: NP Practice26 Jun 202300:10:34

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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YouTube: https://www.youtube.com/watch?v=mVCynsSUwPo&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=24

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Joint Pain Differential Diagnosis19 Jun 202300:10:10

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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YouTube: https://www.youtube.com/watch?v=-OeTKUMeBBo&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=23

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Infectious Diseases12 Jun 202300:09:37

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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YouTube: https://www.youtube.com/watch?v=ESd2oFc-RIE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=22

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Clinical Assessment05 Jun 202300:12:49

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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YouTube: https://www.youtube.com/watch?v=-UP92_9MHc8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=21

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Family Planning29 May 202300:11:19

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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Eczema Treatment22 May 202300:10:58

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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YouTube: https://www.youtube.com/watch?v=ety4RjgHP9Q&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=19

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COPD Exacerbation15 May 202300:15:20

A 72-year-old woman with severe COPD, who uses an inhaled LAMA/ LAMA daily on a set schedule and SABA via MDI as needed for symptom relief, presents with a 4-day history of URI symptoms, starting with sore throat and clear nasal discharge, without fever. She denies N, V, or other GI upset. She now reports a 2-day history of increasing shortness of breath and production of clear to white sputum. SaO2= 97% and she is no acute distress. In considering the diagnosis of COPD exacerbation, which of the following best describes the role of imaging in the evaluation of COPD exacerbation?

A. A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia.

B.  A chest x-ray should be ordered routinely in the evaluation of a person with COPD exacerbation.

C. Given the frequency of COPD exacerbations that typically occur in a person with COPD, chest x-ray use should be limited due to radiation exposure risk.

D. A thoracic ultrasound is the preferred imaging study to order in a COPD exacerbation.

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YouTube: https://www.youtube.com/watch?v=kNKRn-wvg4I&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=18

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Community-Acquired Pneumonia (CAP) Assessment08 May 202300:09:56

The NP is seeing a 65-year-old woman who is a former smoker, having quit at age 40, with a 20 pack-year cigarette smoking history, and has been diagnosed with community-acquired pneumonia (CAP). Which of the following is most often noted CAP finding in an adult who is deemed to be appropriate for outpatient treatment? 

A. Pleuritic chest pain

B. Dyspnea

C. Purulent sputum production

D. Cough

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YouTube: https://www.youtube.com/watch?v=lQDnrmJjOLw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=17

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Headache Diagnosis01 May 202300:10:03

A 27-year-old, otherwise well, woman complains of recurrent headache that occurs every 1‒2 weeks and lasts up to 24 hours. During headache, she reports sudden onset of unilateral pulsating pain, nearly always on the left side that is accompanied by photophobia, phonophobia and mild nausea without vomiting. Her first headache occurred when she was approximately 12-years-old.  Her neurological exam is within normal limits. What is this clinical scenario most consistent with?

A. Cluster headache 
B. Tension-type headache 
C. Intracranial lesion 
D. Migraine without aura

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YouTube: https://www.youtube.com/watch?v=ZukohMkD4IA&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=16

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Adolescent Anemia Evaluation12 May 202500:08:29

A 10-year-old of Middle Eastern ancestry , assigned female at birth, is seen for routine well child care. 

She is generally healthy and plays soccer, reporting excellent exercise tolerance, stating, “I’m the fastest midfield on the team.” Physical examination is within normal limits with Tanner stage 2. Height and weight are at 40% tile, consistent with previous measures. Laboratory evaluation reveals a mild microcytic hypochromic anemia with a NL RDW. This likely represents which of the following?

A. Vitamin B 12 deficiency

B. G6PD deficiency

C. Iron deficiency

D. Beta thalassemia minor

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YouTube: https://www.youtube.com/watch?v=ch5dbCqkPTM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=114

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Emergency Contraception24 Apr 202300:08:16

When advising a patient on the use of emergency contraception (EC) with levonorgestrel (LNG), which of the following is correct?

A. If pregnancy does occur post LNG EC use, a teratogenic pattern in the offspring has been noted

B. EC LNG must be used within 12 hours after unprotected heterosexual vaginal intercourse to provide EC benefit. 

C. LNG EC’s use is limited due to a number of common contraindications. 

D. LNG EC use does not result in the interruption of an established pregnancy.

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YouTube: https://www.youtube.com/watch?v=VYFUPNbwpqo&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=15

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Therapy Evaluation: T2DM, HTN, Dyslipidaemia, CKD17 Apr 202300:10:44

The NP is caring for a 68 year-old man with a 20 year-history of  type 2 DM, HTN, dyslipidaemia, obesity (BMI=32 kg/m2) stage 3a CKD who is currently taking all of the following medications at optimized doses and with adherence, ACEI, thiazide diuretic, statin, and metformin. His current A1c= 8.2%. (NL= <5-6%)  and states he is feeling well. Which of the following should be considered as next step therapy?

A. A sulfonylurea

B. Basal insulin

C. A SGLT2- inhibitor 

D. No additional therapy as he is feeling well.

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YouTube: https://www.youtube.com/watch?v=SF_ztpgR_Tw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=14

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Professional Issues: Parental Consent10 Apr 202300:06:20

In which of the following situations is parental consent usually needed prior to treatment? 

A. A 16-year-old requesting information about contraception. 

B. A 17-year-old who wants help with smoking cessation. 

C.A 16-year-old requesting treatment for acne vulgaris. 

D. An 18-year-old who requests treatment for a sexually transmitted infection.

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YouTube: https://www.youtube.com/watch?v=4o47mBHN5t8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=13

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Professional Issues: NP Regulation03 Apr 202300:06:32

The legal authority of a nurse practitioner’s scope of practice is defined by:

A. The organization that grants NP certification. 

B. The NP’s employer. 

C. The law of the state where the NP practices.    

D. Federal law.

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YouTube: https://www.youtube.com/watch?v=1hF-FgAfKdw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=12

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Allergic Rhinitis Therapy Evaluation27 Mar 202300:07:47

The nurse practitioner is seeing a 24-year-old man in follow-up visit.  Three weeks ago, he was diagnosed with allergic rhinitis,  reporting that, “ for years, every spring when the pollen count is high, I get a runny, stuffy nose, and itchy throat”.  He started on a regimen of daily use of an intranasal corticosteroid as a controller medication with PRN use of an oral second-generation antihistamine for more severe symptoms. Which statement indicates that the patient understands his medication instructions from the initial visit?

A.“I take my antihistamine every day and am saving the nasal spray for really bad pollen days.”

B. “I use my antihistamine every day and my prescribed nasal spray only when I have a really bad runny or stuffy nose.”

C. "I use my prescribed nasal spray as advised every day, but I notice I haven’t had to use the antihistamine for a week.”  

D."I can use either the antihistamine pills or the nasal spray since both work the same way.” 

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YouTube: https://www.youtube.com/watch?v=LzFdJOhQHDU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=11

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Antimicrobial Prescribing20 Mar 202300:07:54

A 34-year-old woman presents with uncomplicated UTI. Her last menstrual period ended approximately 5 days ago and has a history of bilateral tubal ligation approximately 5 years ago. She is otherwise healthy, has not received a systemic antimicrobial in the past year, denies drug allergies, and is not taking any medications. Per local antibiogram,  E. coli resistance rate to TMP/SMX is about 25%. Which of the following is the best choice for her therapy? 

A. Prescribe a course of 3-day oral trimethoprim-sulfamethoxazole
B. Order a single dose of IM ceftriaxone
C. Prescribe a 5-day course of oral nitrofurantoin
D. Advise that a 1-week course of oral ciprofloxacin therapy is needed

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YouTube: https://www.youtube.com/watch?v=lJA8_3zR5Ls&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=10

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Cardiac13 Mar 202300:06:33

In evaluating a 66-year-old man with dilated cardiomyopathy and heart failure, the NP notes a grade 3/6 medium-pitched blowing systolic murmur that radiates to the axillae. What do these findings most likely represent?

A.Innocent murmur

B. Mitral stenosis

C. Aortic regurgitation

D. Mitral regurgitation

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YouTube: https://www.youtube.com/watch?v=b9XlXNKk04U&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=9

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Panic Disorder Therapy06 Mar 202300:05:31

In treating a 26-year-old man with panic disorder who is otherwise healthy, you consider prescribing:

A. Bupropion.

B. Alprazolam.

C. Citalopram

D. Risperidone

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YouTube: https://www.youtube.com/watch?v=dDYv02H0iDI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=8

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Osteoarthritis Assessment27 Feb 202300:05:49

Which of the following is a most often noted in a 65-year-old woman with osteoarthritis?

A. Anemia of chronic disease is often noted. 

B. Usually presents as a systemic polyarthritis.

C. Constitutional signs and symptoms, including fatigue and unintended weight loss are reported 

D. Typically impacts weight-bearing joints, particularly in early disease

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YouTube: https://www.youtube.com/watch?v=FXL1JYclKTg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=7

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Hypertension Therapy Evaluation20 Feb 202300:05:41

A 55-year-old woman with recently diagnosed hypertension was started on a standard dose of or a thiazide diuretic daily 6 weeks ago. Today her blood pressure is 128/78 mm Hg and the patient is feeling well, and clinical exam fails to reveal abnormal heart sounds or hypertensive retinopathy.  The appropriate action at this time would be to?

A. Consider switching her HTN medication to a calcium channel blocker

B. Continue on her current medication regimen 

C. Add an ACEI to enhance HTN control

D. Advise patient she needs to take her HBP for at least 1 more month prior to evaluating its effectiveness

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YouTube: https://www.youtube.com/watch?v=dXpwpEaXsXc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=6

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Clinical Findings in Heart Failure24 Mar 202500:11:30

A 70 year old man with a 35 year history of hypertension, dyslipidemia, and a 20 year history of type 2 diabetes presents. He was recently diagnosed with systolic heart failure, presenting with dyspnea on exertion and orthopnea. Prior clinical assessment revealed the murmur of mitral regurgitation. Which of the following would the NP anticipate finding on today’s physical exam?  

A. A mid to late systolic murmur that follows a mid systolic click. 

B. In early to mid systolic murmur harsh in quality, that radiates to the neck. 

C. A holosystolic murmur that radiates to the axilla.

D. A localized mid to late diastolic murmur.

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YouTube: https://www.youtube.com/watch?v=jN29-on3tn8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=113

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Laboratory Data Interpretation13 Feb 202300:08:50

A  45-year-old woman with no chronic health problems presents a 6-month history increasing fatigue despite adequate opportunity for rest , worsening dry skin and increased menstrual flow volume. In analyzing the laboratory data below, which is most consistent with the diagnosis of hypothyroidism? 

A. TSH <0.15 mIU/L (0.4–4.0 mIU/L), free T4=79 pmol/L (10–27 pmol/L)

B. TSH=8.9 mIU/L (0.4–4.0 mIU/L), free T4=15 pmol/L (10–27 pmol/L)

C. TSH=1.9 mIU/L (0.4–4.0 mIU/L), free T4=22 pmol/L (10–27 pmol/L)

D. TSH=64 mIU/L (0.4–4.0 mIU/L), free T4=3 pmol/L (10–27 pmol/L)

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YouTube: https://www.youtube.com/watch?v=GRTO-JwQiQs&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=5

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Hypertension Therapy06 Feb 202300:09:23

Saundra is a 72-year-old with hypertension who is on an appropriate dose of an ACE inhibitor with adherence. Today’s BP= 152/96 and is without HTN-related complaint.  Physical exam is unremarkable.She has a history of well-controlled asthma and is using ICS/LABA therapy.  Due to osteoarthritis, she reports, “I get up slowly. Sometimes I do not get the bathroom on time and I lose my urine control.” Which of the following represents the next best step in Saundra’s HTN therapy? 

A.Advise that her BP is in an acceptable range

B. Thiazide diuretic therapy should be initiated

C. Add a CCB to her current therapy

D. A beta blocker represents the optimal additional therapy

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YouTube: https://www.youtube.com/watch?v=-1Xaag9qsrQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=4

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Antimicrobial Therapy30 Jan 202300:08:59

Josh is a well 16-year-old male who presents with a reporting a 4-day history of moderate left-sided otalgia with intermittent fever.  Clinical assessment is consistent with acute otitis media (AOM).  No drug allergy or recent (within the past month) antimicrobial use is reported.  Which of the following represents the most appropriate first-line antimicrobial therapy?

A. Oral moxifloxacin

B. Oral amoxicillin 

C. Oral trimethoprim-sulfamethoxazole

D. Oral azithromycin

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YouTube: https://www.youtube.com/watch?v=MEtQfkXgZXo&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=3

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Differential Diagnosis23 Jan 202300:09:20

A 35-year-old w presents complaining of a 15+ year history of recurrent cramping abdominal pain that is often relieved with defecation that occurs intermittently. Symptom onset is often accompanied by bloating and a change in stool frequency and form, particularly when “I eat certain foods.” She denies bloody or tarry stools, nausea, vomiting or fever. The NP notes the patient’s weight is stable, and there is no evidence of anemia. The most likely diagnosis is?

A. Irritable bowel syndrome

B. Paralytic ileus

C. Peptic ulcer disease

D. Ulcerative colitis

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YouTube: https://www.youtube.com/watch?v=9rTwmoMMBvg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=2

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Anemia Assessment16 Jan 202300:06:56

The NP sees a 34-year-old woman with a chief complaint of 6-month history of increasing fatigue despite adequate opportunity to sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW. You expect to find which of the following upon review of the patient’s health history?

A. Report that she has been eaten a plant-based diet since age 18

B. History of prolonged menses with the need for =8 pads per day

C. Report of drinking 5 or more 5 oz glasses of wine daily

D. A prior diagnosis of rheumatoid arthritis

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YouTube: https://www.youtube.com/watch?v=V6a_DYT3KEg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=1

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Funduscopic Exam Findings17 Mar 202500:09:09

Which of the two following findings would be anticipated in the normal funduscopic exam of a healthy 40-year-old woman who is normotensive, generally in good health and without ocular complaint?  

A. Arteriovenous nicking

B. Optic cup to disc ratio < .0.5

C. Retinal arteries are brighter and narrower than veins  

D. Slight bulging of the optic disk

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YouTube: https://www.youtube.com/watch?v=VchTtrKTmfw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=112

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Common Clinical Presentation 10 Mar 202500:14:12

Which of the following is most consistent with the clinical presentation of a person with folate-deficiency anemia? 

A. A 45-year-old woman with uterine fibroids, menorrhagia and a microcytic, hypochromic anemia with elevated RDW 

B. A 35-year-old woman with newly diagnosed systemic lupus and a normocytic, normochromic anemia with NL RDW 

C. A 40-year-old woman with alcohol use disorder who drinks 5-6 glasses of wine per day and a macrocytic normocytic anemia with an elevated RDW 

D. A 65 yo woman with a 20 year-history of hypothyroidism presenting with a 6-month history of stocking-glove neuropathy and a macrocytic, normochromic anemia with an elevated RDW.  

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YouTube: https://www.youtube.com/watch?v=VsxbJMBLd4U&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=111

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Acute Bacterial Prostatitis Treatment03 Mar 202500:11:37

A 70 year old man with a history of BPH, HTN and dyslipidemia presents with a 3-day history of perineal pain, intermittent fever, dysuria, and difficulty initiating urine stream. He denies GI upset and is taking fluids without difficulty. He denies sexual activity with others for the past three years. He is alert, oriented and appears slightly uncomfortable while seated. Abdominal and scrotal exam are WNL, there is no penile discharge and digital rectal exam reveals a tender, enlarged prostate. UA reveals positive leukocyte esterase and > 10 WBCs per HPF. With a working diagnosis of acute bacterial prostatitis, which of the following is the most appropriate antimicrobial option in this clinical scenario?  

A. Ciprofloxacin PO x 10 days 

B. IM Ceftriaxone as a one-time dose with doxycycline PO BID X 10 days 

C. IV piperacillin with tazobactam for 5 days 

D. Nitrofurantoin PO BID x 5 days.  

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YouTube: https://www.youtube.com/watch?v=gS2EITYZ1ps&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=110

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Diagnosing Acute Bacterial Prostatitis24 Feb 202500:14:35

Which of the following clinical scenarios is most consistent with an older adult presenting with acute bacterial prostatitis?  

A. A 65  year old male who presents with a 6 month history of urinary frequency, occasional difficulty initiating urine stream, without dysuria or fever. GU exam within normal limits with the exception of prostate enlargement.  

B. A 50-year-old male with a 4 day history of increased urinary frequency, end-void dysuria, and intermittent fever. GU exam reveals suprapubic tenderness,  without  prostatic enlargement or scrotal abnormalities.  

C. A 70 year old man with a 3-day history of perineal pain, intermittent fever, dysuria, and difficulty initiating urine stream. Scrotal exam WNL and digital rectal exam reveals a tender, enlarged prostate.  

D. A 78 year old man with a 3 month history of intermittent gross hematuria and urinary frequency without dysuria. GU exam is WNL with the exam of a nontender enlarged prostate with multiple nodular lesions.  

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YouTube: https://www.youtube.com/watch?v=tHiLger_l68&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=109

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Managing Type 2 Diabetes 17 Feb 202500:14:01

The NP sees a 74-year-old woman with a BMI=30 kg/m2 who has a 30-year history of type 2 diabetes, HTN, and dyslipidemia. Pertinent social history includes the following: a retired elementary school teacher who lives in a 1-story home with her spouse and adult child, nonsmoker, drinks approximately 2, 5 oz glasses of wine per month, and walks approximately 2 miles per day. Her current medications include telmisartan, HCTZ, rosuvastatin, metformin, semaglutide and canagliflozin at optimized doses, and current A1c=9.2%. Her current A1c= 9.2% and is at HTN and lipid goal. Prior mediations have included sitagliptin, with patient stating, “That medication did not help my sugar at all.” She states she is adherent to her medications and dietary advice. Her eGFR is within acceptable parameters and she is feeling well. Physical exams are unremarkable. 

Which of the following is the most appropriate next step? 

A. Advise that her A1c is at an age-acceptable level.  

B. Add post-meal sliding scale rapid acting insulin 

C. Prescribe basal and pre meal insulin. 

D. Add oral glipizide.  

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YouTube: https://www.youtube.com/watch?v=uZqb0nZpa8k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=108

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Evaluation Of Glycemic Control10 Feb 202500:14:11

Mrs. Mahem is a 68-year-old patient with a 25-year history of type 2 diabetes mellitus. In the past year, her A1c remains at around 8.5% with the use of the following medications: metformin, sitagliptin, and canagliflozin, at optimized doses and with adherence.  She states, “ I haven’t changed the way I eat and I walk about ½ h a day, just like I have for years”. Additional health issues include HTN and dyslipidemia, treated with medications and at therapeutic goal, and obesity with a BMI= 33. Her eGFR is 65. 

Which of the following is the most appropriate next step in the pharmacologic management of her diabetes?  

A. Add glyburide to enhance glycemic control.

B. Consider discontinuing metformin due to age and renal function.

C. Advise that her glycemic control is adequate for an older adult. 

D. Prescribe semaglutide to help her achieve A1c goal.  

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YouTube: https://www.youtube.com/watch?v=CBH6MbYUIBQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=107

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Vision Changes03 Feb 202500:09:11

A patient presents with a chief complaint of a gradual onset vision change, present for the past 6 months, while denying eye pain, redness or trauma. The funduscopic exam, extraocular movements and pupillary reactions are within normal limits. When considering a diagnosis of presbyopia, which of the following best describes patient presentation? 

A. A 50-year-old who states, "I need to hold what I'm reading really far away in order to see it clearly". 

B. A 75-year-old who states,"When I look at a bright light, I see a colored halo around it".

C. An 80-year-old who states, "I have a blurry spot in the middle of my eyesight". 

D. A 17-year-old who states, "I went to get my driver’s license, but failed the distance vision exam".

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YouTube: https://www.youtube.com/watch?v=KYfi3O-ZMEc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=106


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Exertional Syncope Evaluation18 Aug 202500:16:37

A 17 yo male presents for follow up on a “fainting” episode that occurred during football practice at the end of a running exercise. He states, “I do not know what happened. We finished a set of running sprints and next thing I knew, I was on the ground.” He denies injury from the event and history of prior episodes. His physical examination reveals a crescendo-decrescendo systolic murmur heart best at the apex, increasing in intensity with position change from supine to standing position.  

This most likely represents: 

A. Mitral regurgitation 

B. Physiologic murmur 

C. Hypertrophic cardiomyopathy

D. Aortic stenosis 



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Murmur Evaluation 27 Jan 202500:12:49

A 27-year-old woman presents as a new patient to your practice.  She is without chief complaint. She asks to, “get a refill on my birth control pills” , having used combined oral contraceptives for the past 12 years without adverse effects.  Social history reveals she is a nonsmoker, without recreational drug use, drinks approximately 1-2 mixed drinks per week, and runs 2-3 miles 5 days a week with reported excellent activity tolerance. Her health history is generally unremarkable, but with patient report of a “mild heart murmur that was picked up when I was a teenager during a physical I needed so I could run track. I was told not to worry about it.” Physical exam is unremarkable with the exception of a mid-systolic click followed by a grade II mid to late systolic murmur without radiation. The remainder of the cardiac exam is within normal limits. 

These findings most likely represent which type of murmur?

A. Physiologic

B. Aortic stenosis

C. Mitral regurgitation

D. Mitral valve prolapse
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YouTube: https://www.youtube.com/watch?v=wmGI7v_DPMY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=105

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Managing N&V in Pregnancy20 Jan 202500:11:30

A 29-year-old who is 8 weeks pregnant presents with a chief complaint of nausea and vomiting. She states, “I’ve been like this for three weeks. I don’t know why this is called morning sickness since I feel sick to my stomach almost all the time”, reporting that she vomits 2-3 times nearly every day, stating, “I was worse 2-3 weeks ago, when I was throwing up 4-5 times a day. I figured out what food really bothers my stomach and cut those out.” A 24-h dietary recall reveals frequent low-fat meals and consistent sipping of liquids. She denies thirst or infrequent urination, and reports, “I’m just tired of feeling this way. I’ve missed so much work and can hardly keep up with my 3-year-old.”  Physical exam reveals the following; Alert, appears fatigued, with moist mucous membranes,  a 1 lb. weight loss since last visit 4 weeks ago, and minimal epigastric tenderness without rebound.  

 The NP considers advising on the following:

A.  Initiate therapy with an oral  5HT-3 antagonist such as ondansetron (Zofran®).

B.  Referral to high-risk for advise on further management. 

C.  Advise on the use of daily dose of oral  vitamin B6  with doxylamine. 

D. Increase fluid and fiber intake.
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YouTube: https://www.youtube.com/watch?v=bh8EQsz8QnI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=104

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Medication management in T2DM 13 Jan 202500:13:02

The NP sees  a 44-year-old male of African ancestry with a BMI=34 kg/m2 and recently diagnosed  type 2 diabetes mellitus. He works on a rotating shift in healthcare and reports eating irregularly. He was started on metformin therapy 4 months ago, is at maximum recommended dose, and states he is tolerating the medication well. His initial A1c was 9.8%, with today’s A1c=8.7%. eGFR is within acceptable parameters and he is feeling well, stating, 

“I was so thirsty and needed to urinate all the time before I started that pill”. Physical exam reveals extensive acanthosis nigricans.  He mentions that his health insurance. “Does not pay for all that much. I’m OK with paying for the pill I am taking now, but really cannot afford expensive medicines. “ Which of the following is the most appropriate next step?

A. Prescribe weekly injectable semaglutide. 

B. Adding post-meal sliding scale rapid acting insulin.

C. Add a daily dose of pioglitazone.

D. Add glipizide on days when his eating schedule is predictable. 
---
YouTube: https://www.youtube.com/watch?v=xyh0ld2l9_M&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=103

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[Fan Favorite] Cardiac 06 Jan 202500:06:33

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

In evaluating a 66-year-old man with dilated cardiomyopathy and heart failure, the NP notes a grade 3/6 medium-pitched blowing systolic murmur that radiates to the axillae. What do these findings most likely represent?

A.Innocent murmur

B. Mitral stenosis

C. Aortic regurgitation

D. Mitral regurgitation
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YouTube: https://www.youtube.com/watch?v=jhrYmC-kq6Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=102

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[Fan Favorite] COPD Exacerbation30 Dec 202400:15:20

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

A 72-year-old woman with severe COPD, who uses an inhaled LAMA/ LAMA daily on a set schedule and SABA via MDI as needed for symptom relief, presents with a 4-day history of URI symptoms, starting with sore throat and clear nasal discharge, without fever. She denies N, V, or other GI upset. She now reports a 2-day history of increasing shortness of breath and production of clear to white sputum. SaO2= 97% and she is no acute distress. In considering the diagnosis of COPD exacerbation, which of the following best describes the role of imaging in the evaluation of COPD exacerbation?

A. A chest x-ray should be ordered in COPD exacerbation in the patient with fever and/or low SaO2 to help rule out concomitant pneumonia.

B.  A chest x-ray should be ordered routinely in the evaluation of a person with COPD exacerbation.

C. Given the frequency of COPD exacerbations that typically occur in a person with COPD, chest x-ray use should be limited due to radiation exposure risk.

D. A thoracic ultrasound is the preferred imaging study to order in a COPD exacerbation.
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YouTube: https://www.youtube.com/watch?v=B3LrB-m6Q7g&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=101

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[Fan Favorite] Laboratory Data Interpretation23 Dec 202400:08:50

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

A  45-year-old woman with no chronic health problems presents a 6-month history increasing fatigue despite adequate opportunity for rest , worsening dry skin and increased menstrual flow volume. In analyzing the laboratory data below, which is most consistent with the diagnosis of hypothyroidism?

A. TSH <0.15 mIU/L (0.4–4.0 mIU/L), free T4=79 pmol/L (10–27 pmol/L)

B. TSH=8.9 mIU/L (0.4–4.0 mIU/L), free T4=15 pmol/L (10–27 pmol/L)

C. TSH=1.9 mIU/L (0.4–4.0 mIU/L), free T4=22 pmol/L (10–27 pmol/L)

D. TSH=64 mIU/L (0.4–4.0 mIU/L), free T4=3 pmol/L (10–27 pmol/L)
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YouTube: https://www.youtube.com/watch?v=vPaY65eXMwU&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=100

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[Fan Favorite] Hypertension Therapy16 Dec 202400:09:23

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

Saundra is a 72-year-old with hypertension who is on an appropriate dose of an ACE inhibitor with adherence. Today’s BP= 152/96 and is without HTN-related complaint.  Physical exam is unremarkable.She has a history of well-controlled asthma and is using ICS/LABA therapy.  Due to osteoarthritis, she reports, “I get up slowly. Sometimes I do not get the bathroom on time and I lose my urine control.” Which of the following represents the next best step in Saundra’s HTN therapy?

A.Advise that her BP is in an acceptable range

B. Thiazide diuretic therapy should be initiated

C. Add a CCB to her current therapy

D. A beta blocker represents the optimal additional therapy
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YouTube: https://www.youtube.com/watch?v=JRjErXhuqpY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=99

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[Fan Favorite] Antimicrobial Therapy09 Dec 202400:08:59

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

Josh is a well 16-year-old male who presents with a reporting a 4-day history of moderate left-sided otalgia with intermittent fever.  Clinical assessment is consistent with acute otitis media (AOM).  No drug allergy or recent (within the past month) antimicrobial use is reported.  Which of the following represents the most appropriate first-line antimicrobial therapy?

A. Oral moxifloxacin

B. Oral amoxicillin

C. Oral trimethoprim-sulfamethoxazole

D. Oral azithromycin
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YouTube: https://www.youtube.com/watch?v=8qSpIir5ht4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=98

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[Fan Favorite] Differential Diagnosis02 Dec 202400:09:17

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

A 35-year-old w presents complaining of a 15+ year history of recurrent cramping abdominal pain that is often relieved with defecation that occurs intermittently. Symptom onset is often accompanied by bloating and a change in stool frequency and form, particularly when “I eat certain foods.” She denies bloody or tarry stools, nausea, vomiting or fever. The NP notes the patient’s weight is stable, and there is no evidence of anemia. The most likely diagnosis is?

A. Irritable bowel syndrome

B. Paralytic ileus

C. Peptic ulcer disease

D. Ulcerative colitis
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YouTube: https://www.youtube.com/watch?v=2exovTbGVvI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=97

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[Fan Favorite] Anemia Assessment25 Nov 202400:06:56

As we step away for a holiday break, we’re excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!

The NP sees a 34-year-old woman with a chief complaint of 6-month history of increasing fatigue despite adequate opportunity to sleep and rest. Laboratory results reveal a microcytic, hypochromic anemia with elevated RDW. You expect to find which of the following upon review of the patient’s health history?

A. Report that she has been eaten a plant-based diet since age 18

B. History of prolonged menses with the need for =8 pads per day

C. Report of drinking 5 or more 5 oz glasses of wine daily

D. A prior diagnosis of rheumatoid arthritis
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YouTube: https://www.youtube.com/watch?v=bXell7YIQKE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=96

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Measles Exposure Assessment11 Aug 202500:13:28

A 40 year-old accountant presents for advice on measles prevention. He reports disembarking from an airplane approximately 40 hours ago, and now being notified that one of the passengers on the plane has been diagnosed with measles today. He denies any chronic health problems, states he received “all the shots I should have” when he was a child. However, he is unable to produce documentation of childhood vaccinations. 

Which of the following represents the most appropriate action? 

A. This is an example of a low risk rubeola exposure without need for specific prophylactic action.  

B. Obtain rubeola IgG titers and provide appropriate prophylaxis based on results.  

C. Administer a single dose of MMR vaccine now with advice to contact the practice if there are concerning signs and symptoms.  

D. Order a dose of immunoglobulin and arrange for MMR vaccination update.

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YouTube: https://www.youtube.com/watch?v=C-y2Ihr76nY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=122



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NP Scope Of Practice18 Nov 202400:08:35

Which of the following is most accurate about nurse practitioner’s scope of practice?

A. The organization that grants NP certification dictates a profession scope of practice.

B. The employer is able to require the NP to provide services that are beyond what regulatory bodies outline.

C. The law of the state where the NP practices provides regulatory guidance on scope of practice.

D. Federal law advises on NP scope of practice.
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YouTube: https://www.youtube.com/watch?v=jNdOys7R_Qs&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=95

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