NP Certification Q&A

A 35 year old presents with chief complaint of “my sinus infection is not getting better”, with continued nasal and sinus congestion, yellow to white nasal discharge, and a feeling of sinus pressure particularly when he bends over. He denies sore throat headache, and GI symptoms, and previously reported fever prior to treatment is now resolved. The EMR documentation notes a prescription for dose-appropriate amoxicillin with clavulanate written 2 1/2 days ago when seen for a sick visit. Patient states he has taken the antibiotic as advised, staring the medicine on the day of his sick visit, and has not missed any doses. Physical exam reveals a no acute distress, mild tenderness to sinus palpation, and no fever. The next most appropriate step in this patient's treatment plan is to: A. Advise the patient to continue his current course of therapy. B. Switch his antimicrobial to moxifloxacin. C. Order a CT of the sinuses. D. Perform a posterior pharyngeal culture and sensitivity. --- YouTube: https://www.youtube.com/watch?v=U328N8YjNs8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=68 Visit fhea.com to learn more!

Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4 days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood. He has been tolerating clear liquids for the past 24 h and voided a small amount around 2 h ago. He feels “a little bit hungry but I am afraid to eat or I might throw up again. I still feel a little bit sick to my stomach.” Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and denies dizziness with position change from supine to sit or stand. His mucous membranes are slightly dry, with intact skin turgor, and mild diffuse abdominal tenderness without rebound. With a working diagnosis of viral gastroenteritis, which of the two following clinical actions should be taken? A. Obtain stool for culture and sensitivity. B. Order a chem panel. C. Provide information about a slowly progressive diet as tolerated. D. Prescribe an antiemetic. --- YouTube: https://www.youtube.com/watch?v=_P1Ff1fWzJI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=67 Visit fhea.com to learn more!

Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 4 h ago, last stool was around 2 h ago, reported as yellow brown in color, small volume and without blood. He has been tolerating a sips of clear liquids for the past 3 h and voided a small amount around 2 h ago. Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and his mucous membranes are slightly dry. The most likely cause of Joseph’s clinical condition is: A. Staphylococcal food poisoning B. Clostridium difficile (C. diff) enteritis C. Viral gastroenteritis D. Gastric ulcer --- YouTube: https://www.youtube.com/watch?v=_n_b1BfwfUc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=66 Visit fhea.com to learn more!

Sonia is a 15 year old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents for an urgent care visit with a 6-h history of sudden onset nausea, with multiple episodes of vomiting, abdominal cramping and 2 episodes of diarrhea with stool described as light to dark brown without visible blood. Her VS are within normal limits and mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild exceptional tenderness without rebound. When considering a diagnosis of staphylococcal food poisoning, which would most likely be reported by Sonia? A. "One after another, the people on my basketball team have been getting sick like this during the past week." B. "My basketball team stopped at a restaurant today to get something to eat on our way home from a game. Practically all of us who got turkey sandwiches are sick like this.” C. "I had an ear infection a couple of weeks ago, and I took about 5 days of an antibiotic." D. "I have really bad cramps during my period, and I take a lot of ibuprofen to help out." --- YouTube: https://www.youtube.com/watch?v=_UylkKk9VkY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=66 Visit fhea.com to learn more!

The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots over the back, and the buttocks. The areas are flat with irregular shape and unclear edges and are noted in the areas that the parents report. The areas of discoloration are 8 to 20 centimeters in diameter. Palpating the areas does not appear to elicit any discomfort in the child and the color does not blanch with pressure. The skin texture is within normal limits, and The physical exam is otherwise within normal limits. These findings are most consistent with: A. cafe au lait spots B. Congenital dermal melanocytosis C. Port wine stain D. Capillary Hemangioma --- YouTube: https://www.youtube.com/watch?v=Ah8roYSQQqg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=64 Visit fhea.com to learn more!

A three year old otherwise well child for a sick visit. Her caregivers report that the child has been well, with the exception of a number of small, new skin lesions on the chin and arms, present for about 3 days. The child will occasionally rub the lesions, but does not complain about pain, has no fever, no other symptoms. Exam is consistent with non bullous impetigo, with approximately 6 lesions, all less than two to three centimeters in diameter, scattered over the chin and both arms. The child is in no acute distress, and age appropriately resist the exam. Which of the following is the preferred treatment option? A. Topical bacitracin, polymyxin and neomycin cream B. Mupirocin ointment C. Oral trimethoprim sulfamethoxazole D. Triamcinolone cream --- YouTube: https://www.youtube.com/watch?v=1Pepu_wBoLk&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=63 Visit fhea.com to learn more!

A 5 year-old otherwise well child presents with a 4-day history of “a skin problem”. . She is without fever and in no acute distress. Her parent advises that other children in the child’s playgroup have developed similar skin lesions. Considering the diagnosis of non bullous impetigo, the NP expects to find which of the following? A : A four-centimeter, round, honey-crusted lesion surrounded by about a 0.5 centimeter area of erythema, localized to the chin. B: Multiple papular skin lesions about 0.25 centimeters in diameter, with burrow marks in a linear fashion on both arms. C : A generalized vesicular rash over the trunk and extremities. D. : Areas of lichenification in the antecubital fossa. --- YouTube: https://www.youtube.com/watch?v=SbzgllyYvi8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=62 Visit fhea.com to learn more!

A 33 year-old who is pregnant with her 2d child presents for prenatal care. She does not have record of her immunizations, but states she has not had any vaccines in more than 1 year. She is without complaint, and exam is consistent with gestational age, with FHT= 140 BPM and visible fetal activity. Today which two vaccines are recommended? A: Measles, mumps, rubella. B: Varicella. C: COVID 19. D: Tdap or tetanus-diphtheria-acellular pertussis. --- YouTube: https://www.youtube.com/watch?v=_toUpFEGKaE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=61 Visit fhea.com to learn more!

Which of the following is consistent with the clinical presentation of placental abruption? a. A 38 year-old with primary HTN, who is now 28 weeks pregnant with her 6th child, presents with a 1-h history of sudden onset abdominal pain as well as dark red vaginal bleeding,dizziness, tachycardia and BP= 88/ 55 b. A 32 year old who's pregnant with her eighth child, now 32 weeks pregnant presenting with A2 hour history of bright red vaginal bleeding stating she does not have abdominal pain. c. 28 year old who states she had a positive home pregnancy test three days ago with last menstrual period six weeks ago. Normal timing and flow with an 8 hour history of intermittent bright red vaginal spot spotting with mild cramping. d. A 26 year old with a past medical history of pelvic inflammatory disease who's now 8 weeks pregnant by LMP with A2 hour History of sudden onset. Severe left sided abdominal pain radiating to the shoulder, Small amount of bright red bleeding per vagina. Feeling lightheaded. Vital signs reveal tachycardia in ABP of 80 / 45. --- YouTube: https://www.youtube.com/watch?v=WlRlHSKphHQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=60 Visit fhea.com to learn more!

The nurse practitioner sees a six week old with her parents for an urgent care visit. The family is of southeast Asian ancestry. They voiced concern about “dark spots” over her lower back and buttocks that have developed over the past three weeks. The child was born after a full term pregnancy, went home with parents in 24 hours, has had an appropriate weight gain, and is meeting developmental milestones. On physical exam, the infant appears in no acute distress, and has blue to blue gray spots over the back, and the buttocks. The areas are flat with irregular shape and unclear edges and are noted in the areas that the parents report. The areas of discoloration are 8 to 20 centimeters in diameter. Palpating the areas does not appear to elicit any discomfort in the child and the color does not blanch with pressure. The skin texture is within normal limits, and The physical exam is otherwise within normal limits. These findings are most consistent with: A. Cafe au lait spots B. Congenital dermal melanocytosis C. Port wine stain D. Capillary Hemangioma --- YouTube: https://www.youtube.com/watch?v=CJnbvuB_iO0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=59 Visit fhea.com to learn more!

A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of breath, chest pain or visual changes. He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.” His physical examination shows no acute distress, grade 1 HTN retinopathy, and S4 heart sound, neck veins WNL, chest is clear, no peripheral edema with resting HR= 73, RR=16. 12-lead ECG is WNL. BMI= 33. Which of the following is the next best step in this patient’s care? A. Administer in-office oral clonidine and reassess blood pressure in 1 hour. B. Activate EMS with prompt transfer to emergency department C. Restart prior blood pressure medications with follow-up within the next month D. Advise restricting dietary sodium and weight loss to help with BP control. --- YouTube: https://www.youtube.com/watch?v=QCT8CPoBb7w&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=58 Visit fhea.com to learn more!

A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of breath, chest pain or visual changes. He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.” His physical examination is normal with the exception of which of the following? A. S4 heart sound B. Grade 3 HTN retinopathy C. Neck vein distension D. Murmur of aortic regurgitation --- Youtube: https://www.youtube.com/watch?v=tkfqvPOo8Cg&t=69s Visit fhea.com to learn more!

A 12-month-old is seen for well child care. He has been walking solo since age 11 months, and now waves “bye-bye”, searches for an item under a blanket as well as using “mama” and “dada” specifically. His physical examination is within normal limits. Laboratory evaluation reveals a mild microcytic hypochromic anemia with an elevated RDW. The NP considers which of the following two are the most likely contributing causes of this anemia. A. Vitamin B 12 deficiency B. Plumbism C. Iron deficiency D. Beta thalassemia minor --- YouTube: https://www.youtube.com/watch?v=650oKqmbEgk&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=56 Visit fhea.com to learn more!

Ariel is a 7 month old infant, born at 40 weeks gestation, with Apgar scores of 9 and 10. The baby is up-to-date for well child care and immunizations and has had 2 minor episodic illnesses at aged 4 and 6 months with full recovery. Ariel rolled tummy to back, started to purposely bring hands together, and babble at around age 4 months, and has had a social smile since age 2 months. Ariel is the youngest of three children, and today, parents mention that they are concerned that, “She’s not sitting up by herself yet. Our older kids were all sitting by now. She tries but then falls over.” Physical exam reveals a highly interactive healthy appearing infant with excellent muscle tone, who age appropriately resists exam. The NP considers which of the following? A. Refer the infant to an early intervention program for additional evaluation. B. Discuss a referral for genetic counseling with the child’s parents. C. Advise that the child’s clinical presentation is consistent with normal parameters for an infant of this age. D. Order testing for plumbism and iron-deficiency anemia. --- https://www.youtube.com/watch?v=650oKqmbEgk&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=56 Visit fhea.com to learn more!

A 22-year-old woman presents with a chief complaint of a 4-day history of mild dysuria, described as, “It burns a bit when I urinate.” She denies fever, GI upset, urinary urgency and frequency. About 1 month ago, she entered a relationship with a male partner who is currently without symptoms. Clinical assessment reveals a friable cervix covered by a thick yellow discharge. Suprapubic, CVA and cervical motion tenderness are absent. UA is positive for leukocytes and negative for nitrites, and microscopic examination of vaginal discharge reveals a large number of white blood cells (WBCs). She is in no acute distress. Thie presentation is most consistent with: A. Pelvic inflammatory disease B. Lower urinary tract infection C. Genital herpes D. Chlamydia trachomatis cervicitis. --- Youtube: https://www.youtube.com/watch?v=7X1T771b9ac&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=54 Visit fhea.com to learn more!

Which of the following applies when considering issues in clinical testing in a target disease? A. A false negative result identifies a person with the target disease B. A true positive result identifies a person with the target disease. C. A true negative result allows for the patient and clinician to discuss treatment options for the target disease. D. A false positive result supports a patient and clinician to discussion on the impact of the target disease on the patient’s overall health. --- Youtube: https://www.youtube.com/watch?v=85m02XdQeXE&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=53 Visit fhea.com to learn more!

A 68-year-old woman presents for follow-up at her primary care provider with a chief complaint of “another urine infection”, stating she was seen 4 days ago at urgent care with new onset dysuria and urinary frequency. A review of her clinical record reveals that she has had 3 symptomatic, culture-confirmed UTIs in the past 8 months. She is currently on day 4 of 5 of the antimicrobial prescribed and is without symptoms. Her concomitant health issues include HTN and dyslipidemia, both at treatment goals with lifestyle modification and medication. When discussing with the patient efforts to prevent future UTIs, the NP considers which of the following will be appropriate? A. Adding cranberry juice supplements to her diet daily. B. Avoiding tub baths. C. Initiating long-term antimicrobial prophylaxis D. Regular use of a vaginal estrogen. --- YouTube: https://www.youtube.com/watch?v=LxjF5uUuSHg&t=4s Visit fhea.com to learn more!

A 28 year-old woman presents with a 2-day history of urinary frequency, urgency and dysuria, stating, “This feels like when I had a urine infection 4 years ago.” She denies fever or GI upset and otherwise feels well. In consideration of the diagnosis of lower UTI/cystitis, a urinalysis is ordered. Which of the following is the most sensitive and specific finding for UTI caused by a Gram-negative organism? A. Positive leukocyte esterase B. Presence of bacteriuria C. Proteinuria D. Positive nitrite --- YouTube: https://www.youtube.com/watch?v=LxjF5uUuSHg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=51 Visit fhea.com to learn more!

Which of the following examples represents a potential medical malpractice scenario? A. A 25-year-old who is being treated for acute otitis media, reports penicillin allergy to the healthcare provider. An amoxicillin prescription is advised. The patient takes prescribed amoxicillin without adverse reaction. B. A 40-year-old patient with acute bacterial sinusitis reports to his healthcare provider that his symptoms have not improved after 2 days of a dose-appropriate prescription for amox with clavulanate. C. Before taking a medication, a 28-year-old patient realizes the wrong drug was dispensed at the pharmacy. She returned the prescription and the correct medication was dispensed. D. A 50-year-old patient has an abnormal mammogram and was not advised by her healthcare providers about appropriate follow-up. A mammogram 1 year later confirmed the prior findings, the HCP shared the findings and the patient was referred for further evaluation and breast biopsy. ---YouTube: https://www.youtube.com/watch?v=41Ee5brI-N0 Visit fhea.com to learn more!

A 67-year-old man with a five-year history of heart failure with reduced ejection fraction presented to the ER approximately 7 days ago with worsening shortness of breath, and new onset orthopnea. He was hospitalized for two days, with medications adjusted, and states at that time his symptoms were significantly improved. The nurse practitioner now sees him in follow up. The patient states today that, “For the past day, I feel just like I did the day I was admitted to the hospital. I might even feel worse.” The patient reports a 5 lb weight gain since arriving home from the hospital. He denies dietary indiscretion with high sodium foods and states he is taking all medications prescribed at hospital discharge as advised On physical exam, he is sitting upright, slightly labored breathing, BP=165/92, his resting heart rate=110 with S3 heart sound present, respiratory rate 26, neck veins to 8 cm, and bilateral crackles through the lung fields. The most appropriate next step in his care is to: A. Perform medication reconciliation. B. Obtain a detailed 48-hour dietary and fluid intake history. C. Advise on the need for evaluation and treatment in the emergency department. D. Ensure he has a cardiology follow-up within the next week. --- YouTube: https://www.youtube.com/watch?v=bFdd4tB96hQ Visit fhea.com to learn more!