NP Certification Q&A

A 28-year-old man presents to an urgent care clinic with approximately 12 hours of abdominal pain accompanied by “feeling warm” with T to 100.4 degree F (38 d C) at home and mild nausea without vomit. He reports that the discomfort began with a feeling of “heartburn that did not get better with taking an antacid like it usually does”. During the past 6 hours, the pain has become more intense and has moved more to the lower right side of his abdomen, stating, “It’s hard to show you exactly where it hurts.” Walking makes the discomfort worse, and rest makes it somewhat better. He also reports little appetite and denies contact with individuals with similar symptom. He reports having two small soft stools earlier today. He denies dysuria, penile discharge, or scrotal pain.

Physical examination is unremarkable except for localized tenderness at McBurney's point with mild involuntary guarding. Genital exam WNL Vital signs: T 100.4°F (38°C), HR 96 beats/min, BP 122/76 mmHg.

This clinical presentation is most suggestive of:

A. Viral gastroenteritis

B. Acute appendicitis

C. Acute diverticulitis

D. Testicular torsion

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A 78-year-old woman with hypertension controlled with hydrochlorothiazide started taking carbamazepine for trigeminal neuralgia approximately 3 weeks ago. She presents today saying, “I’ve been feeling oddly for the past week.”

Laboratory results are

•Na⁺ 131 mEq/L (normal 135–145 mEq/L)

•K⁺ 3.8 mEq/L (normal 3.5–5.0 mEq/L)

•Cl⁻ 100 mEq/L (normal 98–106 mEq/L)

•HCO₃⁻ 25 mEq/L (normal 22–29 mEq/L)

•Creatinine 0.9 mg/dL (approximately normal 0.6–1.3 mg/dL)

•eGFR 65 mL/min/1.73 m² (≥60 mL/min/1.73 m² generally considered preserved for medication/lab interpretation in this context) (Stage 3A CKD

Given her lab results, which of the following are the most likely clinical findings in this patient?

A. Mild fatigue, difficulty concentrating, intermittent nausea, and mild unsteadiness when walking

B. Marked confusion, repeated vomiting, seizures, and decreased level of consciousnes

C. Muscle weakness, muscle cramps, constipation, and palpitations

D. Perioral and fingertip tingling, painful muscle spasms, and carpopedal spasm

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A 78-year-old woman who is taking a thiazide diuretic with lisinopril for the treatment of hypertension is started on a therapeutic dose of an SSRI due to a new diagnosis of major depressive disorder. Which of the following is a potential drug induced electrolyte disorder in an older adult taking these medications?

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypercalcemia

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An 81-year-old woman with a 30-year history of hypertension and dyslipidemia, both at treatment goal, presents with a 1-week history of a new-onset headache. She states, “I’ve never had a headache like this before in my life.”

She has a history of migraine without aura beginning in her early teens, with only rare episodes since her early 50s. At age 60, she had herpes zoster ophthalmicus, which resolved without visual changes or neurologic sequelae.

Her current symptoms include right-sided scalp tenderness that worsens when she brushes her hair, unusual fatigue, and pain in the right jaw that develops with chewing and is promptly relieved when she stops moving her jaw. She is drinking fluids without difficulty but is eating less because chewing precipitates the jaw pain. She denies dysphagia, fever, diarrhea, constipation, or visual changes. She reports mild nausea associated with the headache.

Physical examination is at her previous baseline except for right-sided scalp tenderness and a thickened, tender right temporal artery area. Vital signs are unremarkable except for BP 155/82 mm Hg.

Which diagnosis best explains this patient's current clinical presentation?

A. Giant cell arteritis

B. Headache secondary to elevated blood pressure

C. Migraine without aura

D. Trigeminal neuralgia

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An 81-year-old woman with a 30 year hx of HTN and dyslipidemia, all at treatment goal, presents with a 1-week history of a new onset left sided headache, scalp tenderness and jaw claudication. Suspecting giant cell arteritis, the clinician orders which of the two following tests?

A. Temporal artery ultrasonography

B. C-reactive protein

C. MRI of the brain

D. Carotid artery ultrasound.

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A healthy 30-year-old at 33 weeks' gestation presents for routine prenatal care in late September in the northeast USA. She's not previously received any vaccines. And about the past ten years and states, "I heard there are shots to protect the baby from RSV. My niece had this when she was a month old and got very sick".

Which of the following is the best response?

A. Recommend a single dose of an FDA approved RSV vaccine as soon as possible.

B. The maternal RSV vaccine is recommended with each pregnancy, preferably given in the first trimester.

C. Given that her baby will be born outside of the typical RSV season, the use of maternal RSV vaccine is not recommended.

D. The maternal RSV vaccine is given to provide protection to the mother but not the baby.

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A 12-year-old male presents with his father for a routine Whelchel visit. The father asked to speak to you privately, as he's concerned that his son is, quote, showing some body changes. Close quote during the visit, the child is alert, interactive with physical exam findings consistent with Tanner's Stage three sexual maturation. He remains on his growth curve for height and weight.

When discussing these findings with the father, which of the following is the most accurate statement?

A. These findings are normal for his age.

B. This is an unusual finding in a 12-year-old.

C. This signals he is likely nearly his adult height.

D. He just started puberty changes.

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A seven year old with a diagnosis of asthma since age to present with his parents for a new patient visit. He has cough, wheezing and shortness of breath 4 to 5 days per week and awakens with asthma symptoms about once weekly. His parents states when he's playing soccer, sometimes he needs to stop running because of his cough. So last visit with his prior PCP was about seven months ago when he was prescribed, according to his parents quote, "a pill to take every day to help control his cough". His last dose of this medication was about two months ago because the medication had no refills.

He's currently using albuterol as needed. Two puffs, about 3 to 4 times a day. About. Five days per week to help control his cough and shortness of breath. The medication, per his parent quote, "works pretty well most times". The child is currently feeling well without evidence of acute asthma exacerbation. He is alert oriented, talkative, and able to demonstrate adequate inhaler technique. Peak expiratory flow rate is approximately 60% a predictor.

Which of the following is an appropriate preferred treatment option for this child?

A. Continue current therapy as it is providing adequate symptom control.

B. They begin low dose ICS formoterol therapy, as maintenance and reliever therapy or marked therapy.

C. Begin daily montelukast albuterol as needed.

D. Begin nebulizer budesonide twice daily with nebulizer albuterol as needed.

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A healthy 12 month old child is scheduled for a routine well, child's visit and age appropriate immunizations in three days. The parent message is the nurse practitioner and ask, quote, my mother told me to give her some acetaminophen Tylenol before she gets her shots. That way she won't be uncomfortable afterwards. I want to check with you first. Is this a good idea?

A. Give acetaminophen about one hour before the appointment to relieve to prevent fever and injection site discomfort.

B. If she develops a fever or discomfort after the vaccines, you can give her an age and weight appropriate dose of acetaminophen as needed.

C. Give ibuprofen at the time of the vaccinations and continue it every six hours for the first 24 hours.

D. Try to avoid acetaminophen and ibuprofen for at least 48 hours after the vaccines, so that they can work as well as possible.

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According to the latest American College of Cardiology and American Heart Association dyslipidemia guidance, in which of the following patients is it most appropriate to obtain a lipoprotein A level?

A. A twenty-eight-year-old woman with obesity and polyendocrine metabolic ovarian syndrome, formerly known as PCOS, whose father had a myocardial infarction at age 48.

B. A 47-year-old man with well-controlled hypertension for the past five years, without a family history of early cardiovascular disease and an LDL cholesterol of 92

C. A 35-year-old woman with episodic migraine since age 12 and an LDL of 72 who exercises regularly.

D. A 52-year-old man with triglycerides of 320 related to uncontrolled type 2 diabetes.

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A 55-year-old man is seen in follow up six weeks post hospitalization for acute coronary syndrome with drug eluding stent placement, has a 40-pack-year cigarette smoking history and currently smokes two packs of cigarettes per day. His medical history is also significant for stage 3-A CKD, with current estimated GFR of 52. His medications include high-intensity statin therapy and ezetimibe or Zetia, along with standard post ACS and CKD therapies. He states he's feeling well and taking all his medications as advised without adverse effects. Laboratory results today reveal an LDL cholesterol of 98, HDL of 35, triglycerides of 154.

Which of the following is the most appropriate next step in lipid management?

A. As he is feeling well, an LDL cholesterol is post ACS goal. Continue current therapy.

B. Due to his GFR, discontinue Zetia and substitute with bempedoic acid.

C. Add a PCSK9 inhibitor to current regimen.

D. Advise that moderate intensity statin therapy is preferred in stage 3-A CKD.

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A 29-year-old patient presents with a genital lesion he first noted five days ago. The patient reports a new sex partner for the past four weeks with infrequent condom use. He denies dysuria, fever, urinary frequency, abdominal or scrotal pain, or penile discharge. Examination reveals a single well-defined ulcer on the shaft of the penis. The lesion is painless with a clear base and no purulent discharge. Mild non-tender inguinal lymphadenopathy is present. This clinical presentation is most consistent with:

A. genital herpes

B. primary syphilis

C. chancroid

D. Secondary syphilis

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A 75-year-old woman presents to the urgent care service of her primary care provider's practice for a sick visit with a chief complaint of a two-day history of dysuria, urinary frequency, and urgency. She denies fever, flank pain, nausea, or vomiting. Her past medical history includes hypertension, stage three ACKD, and dyslipidemia. Current medications include an ARB, thiazide diuretic, statin, and an SGLT2i. Vital signs are stable. Physical exam is unremarkable except for mild suprapubic tenderness. Laboratory results include the following: Urinalysis, positive for leukocyte esterase and nitrites. Reference lab is negative for those substances. Estimated GFR is 48, Serum potassium is 4.8.

Which of the following is the most appropriate treatment?

A. Trimethoprim sulfamethoxazole DS

B. Nitrofurantoin

C. Ciprofloxacin

D. Amoxicillin

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A 38-year-old woman presents for a sick visit with a two-day history of, "not feeling right. I've never felt like this before." Approximately four days ago, she self-discontinued a standard dose SSRI after taking this medication for the past 18 months, stating, "I feel like my depression had gotten much better." She denies alcohol or recreational drug use. When considering the diagnosis of antidepressant discontinuation syndrome, which of the following is most likely to be reported?

A. tremor, diaphoresis, tachycardia, hypertension, agitation

B. yawning, rhinorrhea, abdominal cramping, diarrhea, piloerection

C. dizziness, nausea, body aches, sleep disturbance, irritability, brief vibrating sensations

D. restlessness, sweating, diarrhea, tremor, fever, and involuntary muscle jerking

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A 25-year-old woman presents for follow-up with a 12-year history of intermittent headache reported as unilateral throbbing pain with nausea, photophobia, phonophobia that usually lasts about 12 to 24 hours. At the onset of her headache, she takes oral high dose ibuprofen with Sumitriptan reporting, "my headache is usually gone within an hour or so." She reports no particular pattern to the headache trigger and denies headache prodrome. Family history is positive for mother and sister with similar headache. She's currently headache free and her neuro exam is within normal limits. Today she asked if she needs, "any tests to find out what causes my headache." The NP considers the following.

A. head MRI due to duration of headache

B. order a head CT with contrast due to frequency of headache

C. discuss the utility of carotid Doppler ultrasonography in confirming the diagnosis of migraine

D. advise the patient that neuroimaging is not routinely indicated in this clinical scenario

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The parents of a four day old infant born at 41.5 weeks gestation via normal spontaneous vaginal delivery after an uneventful pregnancy present with a chief complaint of a "rash" over the baby's face and body that began about 10 hours ago. They report that she is a vigorous nurser, has about six wet diapers and four yellow-green bowel movements in the past 24 hours. For the past 48 hours since she came home from the hospital with her mom, skincare has been limited to the use of a mild skin cleanser as needed. Physical exam reveals an alert child without fever and no acute distress with scattered erythematous macules and papules with occasional pinpoint pustules on the face, trunk, and proximal extremities.The rest of the clinical presentation is unremarkable.

The most likely diagnosis is:

A. Neonatal Acne

B. Milia

C. Neonatal Herpes Simplex

D. Erythema Toxicum Neonatorum

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A 50-year-old woman presents for follow-up on recent lab tests obtained at a health maintenance visit. She reports feeling well and denies fatigue, weight changes, constipation, cold intolerance, palpitations, or changes in mood. She was recently diagnosed with subclinical hypothyroidism.

Which of the following would be her expected lab results?

A. TSH of 8.6, elevated free T4 of 14, which is normal.

B. TSH of less than 0.15, undetectable. Free T4 of 79, markedly elevated.

C. TSH of 24, elevated. A free T4 of three, markedly reduced.

D. TSH of 1.8, which is normal and a free T4 of 14, also normal.

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A 29-year-old otherwise healthy adult presents with a five-day history of nasal congestion, clear to white rhinorrhea, sore throat, and dry cough. She also denies dyspnea, pleuritic chest pain, GI upset, or fever. The patient is in no acute distress. Vital signs are temperature 99.2 Fahrenheit or 37.3 degrees centigrade. Respiratory rate is 16. O2 sat is 98 % on room air. Physical exam reveals mild pharyngeal erythema without exudate, no lymphadenopathy and tympanic membranes within normal limits. Lung resam is unremarkable except for occasional cough. The nurse practitioner diagnoses a viral URI or a common cold. The patient states, “I have trip coming up in five days, and I'm really worried that I might have the start of a sinus infection or pneumonia or a strep throat.”

The NP considers which of the following in addressing the patient's concerns?

A. if you start to cough up phlegm within the next day or so, this could indicate the start of a pneumonia

B. If your nasal discharge turns to green or dark yellow, this usually indicates that an antibiotic is needed

C. your cough could persist for a couple of weeks, which is quite common in a viral respiratory tract infection

D. if your sore throat persists for two to three more days, it means that a strep infection is starting

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A six-month, two-week-old infant who was born at 40.5 weeks gestation after an uneventful pregnancy is brought in for a well child visit. His parents mentioned, “his older sister was a really different baby. I think he's not quite where she was in his development at this age.” Which of the following would not be a red flag requiring further evaluation?

A. Inability to roll in either direction

B. Unable to transfer objects hand to hand

C. Reaches for objects with one hand

D. Ability to sit briefly without support

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Sarah, a healthy infant born at 40.5 weeks gestation after an uncomplicated pregnancy, is brought in for a four-month well child visit. Parents report the infant is feeding well, smiling frequently, and becoming more interactive with family members.

Which of the following is most consistent with a normal developmental exam for an infant of this age?

A. Rolls back to abdomen and transfers objects hand to hand

B. brings hands together and laughs out loud

C. Lifts head briefly when prone and startles to loud sounds

D. Increase babbling and sits without support

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