NP Certification Q&A

A 62 year old man with a 60 pack year cigarette smoking history presents with a chief complaint of progressive dyspnea on exertion and a chronic productive cough over the past eight years. Significant contributing history include two episodes of being seen in urgent care in the past year for "bronchitis" and being told he should follow up with primary care. 
When considering the diagnosis of COPD, which of the following is the most important diagnostic parameter? 
A. patient report of progressive dyspnea and chronic productive cough
B. 60-pack year cigarette smoking history
C. FEV1 to FEC ratio of less than 0.7 post bronchodilator
D. FEV1 of less than 50 % of predicted
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A 72-year-old with a prosthetic aortic valve presents stating, "I was told I have to take a medicine before I have a deep dental cleaning." Concurrent health issues include hypertension, type 2 diabetes, and dyslipidemia, currently at treatment goals. Medications include metformin, hydrochlorothiazide, telmisartan, and rosuvastatin. She has no drug allergies. Which of the following is the most appropriate next step in her care?
A. amoxicillin 2 grams PO 30 to 60 minutes prior to the procedure
B. amoxicillin 2 grams PO 1 to 2 hours after the procedure
C. cephalexin 2 grams PO 30 to 60 minutes prior to the procedure
D. inform the patient that no antimicrobial prophylaxis is needed during dental care. 
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A patient presents stating, "I've been told I need to take a medicine before I have a deep dental cleaning." Which of the following patients requires antimicrobial prophylaxis prior to this dental visit?
A. A 28-year-old female taking combined oral contraceptives with a history of the murmur of mitral valve prolapse
B. An 18 year old with a physiologic murmur and a history of ACL repair
C. A 64 year old male with hypertension, type 2 diabetes, dyslipidemia, and an A1c of 9.5%
D. A 72-year-old woman with a prosthetic aortic valve
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A 68-year-old man with a 15-year history of hypertension and dyslipidemia, as well as a 45 pack-year history of cigarette smoking, currently smoking one pack per day, was recently diagnosed with COPD. His FEV1 to FEC ratio is less than 0.7, and his FEV1 is 48% of predicted. He reports two COPD exacerbations in the past year, both treated as an outpatient, and also mentions "I need to pace myself or I get short of breath even if I walk up just a flight of stairs. I can't do any work in the yard anymore." Per current treatment recommendations, which of the following is advised for his COPD maintenance therapy?
A. SABA as needed for shortness of breath
B. Daily use of an ICS LABA
C. As needed use of a LABA for symptoms
D. Scheduled use of an inhaled LABA/LAMA
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A 45 year old woman who works as a professional baker, with a specialty in birthday and wedding cakes, is diagnosed today with carpal tunnel syndrome. Her history of present illness include a four month history of numbness and tingling of the thumb, index and middle finger of her dominant hand. Physical exam reveals normal grip strength and decreased sensation along the median nerve distribution. Thenar atrophy is absent. 
Which of the following is the most appropriate next step?
A. referral for carpal tunnel surgical decompression
B. arranging for carpal tunnel corticosteroid injection
C. advice on the use of neutral position wrist splinting
D. obtain a TSH and an A1C
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YouTube: https://www.youtube.com/watch?v=HoPq8PhUVw0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=131
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