NP Certification Q&A

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. --- YouTube: https://www.youtube.com/watch?v=_W6PE873iKQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=159 Visit fhea.com to learn more!

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. --- YouTube: https://www.youtube.com/watch?v=OtJ8LiFErYA&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=158 Visit fhea.com to learn more!

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. --- YouTube: https://www.youtube.com/watch?v=LwI3U9b81U0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=158 Visit fhea.com to learn more!

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. --- YouTube: https://www.youtube.com/watch?v=721Kl3sP5o4&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=156 Visit fhea.com to learn more!

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. --- YouTube: https://www.youtube.com/watch?v=lE3ITcwCxNA&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=155 Visit fhea.com to learn more!

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. Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=AcXiEUw94kY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=153 Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=2kWxQiKJo20&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=152 Visit fhea.com to learn more!

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 Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=rT6JNb0yN9Q&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=150 Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=Jvx_eDhKLqw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=149 Visit fhea.com to learn more!

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. --- YouTube: https://www.youtube.com/watch?v=RCXz36twv8k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=148 Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=PaHg61Doc8E&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=147 Visit fhea.com to learn more!

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 --- YouTube: https://www.youtube.com/watch?v=hR4oy4NXV5s&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=146 Visit fhea.com to learn more!

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 ---- YouTube: https://youtu.be/TDwbqgwDimw?si=H9VP_6uzlXJbRnsp Visit fhea.com to learn more!

A 24-year-old woman presents for a well-adult visit. Her health history includes the diagnosis of mitral valve prolapse without significant mitral regurgitation. She is feeling well, has no chief complaint, and denies activity intolerance, stating she plays tennis or pickleball for about one hour three to four times a week. Her only medication is an oral combined hormonal contraceptive and reports being pleased with her contraceptive method. She states that she read online that “I know I have a heart murmur and I'm worried about whether the birth control pill is safe for me.” The nurse practitioner considers the following when advising this patient A. she should switch to a progestin only contraceptive method B. if no other contraindications are present, she can continue to use combined hormonal contraception C. in this clinical scenario, barrier contraceptive method is advised D. she should be referred to cardiology for advice on contraceptive methods --- YouTube: https://www.youtube.com/watch?v=fkJkZLA1BM8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=144 Visit fhea.com to learn more!

A 51 year old woman who works as a real estate agent presents for an office visit with a chief complaint of severe vasomotor symptoms reporting, "I can't sleep through the night without being drenched in sweat. I have at least four hot flashes a day. Sometimes while I'm working with clients. I need some help. What do you think about hormone therapy? " Her LMP was approximately 13 months ago and she's without chronic health problems. When considering postmenopause hormone therapy, which of the following is the most accurate statement? A. The use of hormone therapy post menopause is associated with a significant increase in cardiovascular and cancer risk. B. The use of select low dose SSRIs for the management of vasomotor symptoms is as effective as hormone therapy. C. Short duration lower dose hormone therapy offers an effective form of therapy for menopausal vasomotor symptoms. D. Hormone therapy postmenopause offers an effective treatment for osteoporosis. --- YouTube: https://www.youtube.com/watch?v=80j1H7FVrJY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=143 Visit fhea.com to learn more!

Which of the following best describes the use of contraception for a 26 year old woman who has migraine without aura, usually three episodes per month controlled with high dose ibuprofen who is otherwise well states. "I want to get on some birth control that's really reliable for the next three years while I'm in graduate school." A. All combined hormonal contraceptive forms are contraindicated with any type of migraine. B. Combined hormonal contraception is acceptable for use in this clinical situation. C. Progestin-only contraceptive methods should be avoided in migraine with or without aura due to the increased risk for elevated blood pressure. D. Barrier contraceptive methods are preferred in this situation. --- YouTube: https://www.youtube.com/watch?v=PyCwq8NMkPw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=142 Visit fhea.com to learn more!

A 56-year-old man with a 10-year history of hypertension presents for a primary care visit, stating he has not taken his high blood pressure medicines, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the last three months due to, quote, running out of medication and not getting to the pharmacy, close quote. Today's blood pressure is 192 over 120, and he's 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 half an hour." His physical exam shows no acute distress, grade one hypertensive retinopathy, and S4 heart sound. His neck veins are within normal limit, chest is clear, no peripheral edema with a resting heart rate of 73. Respiratory rate 16, 12 lead ECG is within normal limits. His BMI is 33. Which of the following is the next best step in the 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=xpsNR1uxO4Y&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=141 Visit fhea.com to learn more!

A 56 year old man with a 10 year history of hypertension presents for a primary care visit, stating he's not taking his hypertension med, a calcium channel blocker, an angiotensin converting enzyme inhibitor, and a thiazide diuretic for the past three months due to "running out of the medication and not getting to the pharmacy." Today, his blood pressure is 192 over 120 and he has no 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 my blood pressure refills. I need to get back to work in a half an hour." When considering the diagnosis of asymptomatic markedly elevated blood pressure, the clinician would predict his physical exam 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=GlnpCn_tg48&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=140 Visit fhea.com to learn more!