NP Certification Q&A

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The NP is seeing a 60-year-old woman with a 10 year history of T2DM. Her current medications include oral metformin and an oral SGLT2-I, and states she is feeling well, without report of blurred vision, excessive thirst or polyuria.  She has not had any laboratory tests done in the past 6 months.  Which of the following represents the best choice of test to determine her overall glucose control?

A. Fasting plasma glucose
B. Serum creatinine/ e GFR (estimated glomerular filtration rate)
C. Hemoglobin A1c
D. Random blood glucose

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A 21 year-old woman with a 15 year history of asthma. presents with acute bacterial rhinosinusitis; she is without fever and in no acute distress.  Her current medications include an ICS/LABA inhaler for reliever and prevention asthma therapy, and a LNG-IUD for contraception. She also reports being told by her parents that she has penicillin allergy, and states, “I had a pink rash on my face and body for a few days when I took penicillin at around 3 or 4 years-old.” In considering ABRS antimicrobial therapy for this patient, the preferred treatment option would be: 

A. Cefpodoxime
B. Azithromycin
C. Amoxicillin
D. Trimethoprim-sulfamethoxazole

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A 76 year-old man with a 20-year history of HTN presents for a sick visit in the primary care clinic, stating, “I do not think that new medicine agrees with me.”  Until recently, his BP was at goal with an ARB, but about 1 week ago, due to continued elevated readings, a second BP med, a thiazide diuretic, was added.  Which of the following is most likely to be reported by this patient?

A. “Since I started on the medicine, I passed out and woke up on the floor 4 times.”
B. “About 2 days after I started the new medicine, I started feeling lightheaded when I stand up quickly.”
C.” After starting the new medication, I feel like the room is spinning around me.”
D. “I’ve had chest pain and sweating off and on since I started the new medication.”

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A 60 year-old man who has a 10 year history of Parkinson disease presents with a chief complaint of “flaking skin that just does not go away, sometimes worse, sometimes better”, stating this problem has been present for > 6 years. Concurrent health issues include HTN, dyslipidemia and generalized anxiety disorder. The affected areas are occasionally itchy and will ache when particularly severe. He has used OTC hydrocortisone cream and skin moisturizers without seeing improvement. Physical exam reveals inflamed patches on the scalp, accompanied by greasy yellow scales. Similar lesions are noted in the nasolabial folds and behind the ears and into the ear canals. Which of the following is the most likely diagnosis?

A. Dandruff
B. Seborrheic dermatitis
C. Psoriasis
D. Atopic dermatitis

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A 35-year-old man who is generally well was diagnosed with scabies 3 days ago presents with a chief complaint. “I do not think that skin medicine I was given worked. I am still really itchy and the rash looks the same”.  He reports using topical permethrin as advised. Physical exam reveals excoriated papules on the interdigital area and scattered similar areas in the axillary and groin regions.  Microscopic examination of skin scrapings supports the scabies diagnosis.  He is otherwise without new findings. The NP considers the following:

A. Another course of permethrin is advised, to be used as soon as possible.
B. A skin biopsy should be performed today.
C. Low dose topical corticosteroids and oral antihistamines should be prescribed.
D. A topical antibacterial is advised.

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A 28-year-old woman with a longstanding history of injection drug use presents with a 10-day history of malaise, nausea, and fatigue, and a two day “yellow eyes”.  Physical exam reveals scleral icterus and mild hepatomegaly with right upper quadrant tenderness. Considering the possibility of acute hepatitis B in the differential, the NP anticipates laboratory results will include. 

A. The presence of hepatitis B surface antibody (HBsAb)
B. Thrombocytosis. 
C. Leukocytosis. 
D. The presence hepatitis B surface antigen (HBsAg). 

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A 22-year-old woman presents for follow-up after a recent clinic, requested STI screening. Testing for Chlamydia trachomatis was positive. She states, “I am really surprised, I feel fine.”  Her current medications include combined oral contraceptive and her LMP was about 10 days ago, with appropriate timing and a  3 day light flow. The NP considers which of the following is the best option?
A. Given she is asymptomatic, no further intervention is needed
B. Oral azithromycin as a single dose should be offered
C. Testing for C. trachomatis should be repeated today
D. A 7-day course of oral doxycycline is advised

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A 62-year-old woman with T2DM presents 2 days after noticing a “bug bite” on her left lower leg, stating, “I am not sure what bit me.” During this time, the area has increased in size and she reports discomfort in the region.  Examination reveals a tender warm, red, erythematous area with poorly demarcated borders, approximately 15 cm at its widest diameter on the anterior lower leg.  Calf circumference is equal bilaterally.  The patient is with no fever or additional complaints with no additional contributory history.  This most likely represents:
A. Deep vein thrombus
B. Erythema migrans
C. Cellulitis
D. Contact dermatitis 

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YouTube: https://www.youtube.com/watch?v=JDp6Y1PXtiA&t=5s

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The NP sees a well, 18-month-old with a two-day history of clear nasal discharge, dry cough, intermittent fever to 101.4 or 38.5C, and mild crankiness. She's up to date with all recommended vaccination. Parents report everyone at home has this cold. Testing for RSV, COVID-19, influenza are all negative. She is alert, age appropriately resists the exam, which is consistent with viral URI.  Her father states, “We got her fever under control by giving her two different medicines around the clock.” He presents two medication bottles, one with liquid acetaminophen and one with liquid ibuprofen. The NP considers that alternating between ibuprofen and acetaminophen for a child with fever will:

 A. Result in additive effect in fever reduction.
B. Is encouraged in order to prevent febrile seizures.
C. Is only recommended in higher fever, such as when the fever is 100 degrees F or 38.8 degrees C or greater.
D. Is not recommended due to higher potential for adverse effects.

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The NP is seeing a 35 year-old well woman for a health promotion and physical exam woman. She has not complaints, is a nonsmoker, a light social drinker with 1-2 glasses of wine per month, and exercises about 30 mins 5 days a week. Her BMI is 22 and vital signs are unremarkable with BP= 110/70. Which of the following is an anticipated finding on her funduscopic exam?

A. Retinal arteries wider than veins
B. Arteriovenous nicking
C. Physiologic cup-to-optic disc ratio of less than 0.5 
D. Blurred optic disc margins

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A healthy 1 year old, accompanied by his mother, is in for a well child visit. He is due to receive routine immunizations for a child his age. His mother mentions that she is about 6 weeks pregnant and read that, “I know he should get the chickenpox and German measles vaccines today. Since I am pregnant, is this safe?” The NP considers the following:

A. Neither vaccine contain live virus and both can be given today.

B. Both vaccines contain live virus that the child will not shed, and he can receive these immunizations today.

C. The vaccines contain live virus and should be delayed until the mom is out of the first trimester of pregnancy.

D. Due to the mother’s pregnancy, these vaccines should be delayed until after she gives birth.

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A 78 year-old woman with well-controlled hypertension and dyslipidemia presents with a chief complaint of a many month history of pain, described as achiness, and stiffness in the joints both hands, particularly towards the end of the day. A part-time seamstress, she reports this discomfort is worse on work days.  She denies redness or heat in the affected regions and has no systemic complaints. Physical exam reveals Heberden and Bouchard nodes bilaterally. These findings are most consistent with a diagnosis of:

A. Rheumatoid arthritis
B. Systemic lupus erythematosus 
C. Osteoporosis
D. Osteoarthritis

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A 67-year-old man who is diagnosed with acute bacterial prostatitis presents with a chief complaint of a one-week history of constant perineal pain, arthralgia, irritative voiding symptoms, and intermittent fever. Which of the following is most consistent with anticipated findings on prostatic digital rectal exam (DRE) with this condition?

A. An enlarged prostate with obliterated median sulcus
B. A prostatic exam that reveals multiple firm, non tender nodular lesions
C. A tender, boggy prostate
D. A firm, non tender prostate

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Which of the following is most likely to be reported as part of the HPI in a woman presenting with bacterial vaginosis?

A. A 19-year-old woman with a 3-day history of vaginal and perineal itch, clumping white vaginal discharge that has a slight “musty” odor.

B. A 24-year-old woman with a 1-week history of mild perineal irritation, thin, grey-green vaginal discharge with a strong “fishy” odor.

C. A 68 year-old with chief complaint of vaginal irritation, discomfort on vaginal sexual activity, and denies unusual vaginal discharge or odor.

D. A 28 year-old woman with 10-day history of copious purulent yellow vaginal discharge without unusual odor, perineal irritation and mild dysuria.

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A 67-year-old man has been recently diagnosed with HTN, dyslipidemia and T2DM. As part of his medication treatment plan, he agrees to start statin therapy. The NP appreciates that which of the following laboratory tests should be conducted about 4-12 weeks after starting statin therapy?

A. AST and ALT
B. CK and potassium
C. Lipid profile
D. CBC with WBC differential and platelet count

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YouTube: https://www.youtube.com/watch?v=EwQBD3z6rQs&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=28

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A 65-year-old woman has hypertension, dyslipidemia, type 2 diabetes, a 50 pack-year history of cigarette smoking, currently smoking ½ PPD,  and stage 3B chronic kidney disease (CKD)  (GFR = 37 mL/min/1.73 m2). She is not currently taking any dyslipidemia therapy and her LDL= 140 mg/dL. Which of the following represents the most appropriate pharmacologic intervention for treatment of dyslipidemia?

A. Owing to her age and comorbidity, no further intervention is required.

B. Moderate-intensity statin therapy is the preferred treatment option.

C. Niacin should be prescribed.

D. The use of ezetimibe (Zetia®) will likely be sufficient to achieve dyslipidemia control.

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Leonardo is a healthy 4- month-old who was born at 40-weeks gestation is in the office for a well child visit. His parents voice no concerns and state, “He is a very happy baby who loves to eat and is a good sleeper.” Which of the following is an anticipated normative developmental finding on an infant of this age?

A. Sitting without support  
B. Minimal to no Moro reflex noted
C. Rolling over tummy to back
D. Smiles when smiled to

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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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