NP Certification Q&A

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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YouTube: https://www.youtube.com/watch?v=rT6JNb0yN9Q&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=150
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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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YouTube: https://www.youtube.com/watch?v=Jvx_eDhKLqw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=149
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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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YouTube: https://www.youtube.com/watch?v=RCXz36twv8k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=148
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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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YouTube: https://www.youtube.com/watch?v=PaHg61Doc8E&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=147
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