NP Certification Q&A

Physical Exam in Carpal Tunnel Syndrome

A 45-year-old woman who works as a professional baker with a specialty in birthday and wedding cakes presents with a six-month history of progressive numbness and tingling in the thumb, index, and middle fingers of her right hand. She noticed that her symptoms are worse at night and are accompanied by hand weakness and reports being right hand dominant. She denies any injury to the area and states "This is getting in the way of my work. I'm having a much harder time holding the tools that I need to use to decorate a cake." Her concurrent health history includes a five-year history of type 2 diabetes, hypertension, and dyslipidemia, obesity with a BMI of 38. Her current meds include Metformin and an SGLT2I, and ARB with a thiazide diuretic and a statin. When considering the diagnosis of carpal tunnel syndrome, which of the following would be one of the earliest physical exam findings?A. Pain reproduced with forced wrist flexion held for 60 secondsB. Diminished radial pulseC. thenar atrophyD. tingling of the fingers when tapping on the median nerve---YouTube: https://www.youtube.com/watch?v=367DAsZ2M9M&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=130Visit fhea.com to learn more!

Intervention in Lactation Associated Mastitis

A 28-year-old woman who is breastfeeding her healthy six-week-old term infant presents with a four-day history of generalized body aches, intermittent fever to 101.2 degrees Fahrenheit, and localized pain on the upper aspect of her left breast. She states that she's been attempting to nurse her infant as tolerated and pumps the affected breast when unable to nurse. Physical exam is consistent with lactation-associated mastitis. Which of the following is the most appropriate next steps? A. advise continued expressing of milk on the affected breast through pumping or nursing as toleratedB. initiate antimicrobial therapy with oral cephalexin for five to seven days.C. advise discontinuing breastfeeding on the left breast and apply ice packs to the affected area.D. initiate antimicrobial therapy with oral ciprofloxacin for 10 days. ---YouTube: https://www.youtube.com/watch?v=GY54q9yJeJw&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=129Visit fhea.com to learn more!

Incidental Finding of Systolic Murmur in an Asymptomatic Adult

A 35-year-old woman presents for a periodic physical exam with Pap and HPV testing. She states she's feeling well without complaint and has excellent exercise tolerance, running about 30 miles per week. Her current medications include an levonagestrel IUD for contraception. Physical exam includes vital signs within normal limits, a BMI of 23, and no unusual findings, save for a mid-systolic click followed by a grade two, mid to late systolic murmur with a honking quality. The murmur moves forward into systole with position change from supine to standing and does not radiate beyond the precordium. These findings most likely represent:A. A physiologic murmurB. The murmur of aortic stenosisC. The murmur of mitral valve prolapseD. The murmur related to tricuspid valve incompetency---YouTube: https://www.youtube.com/watch?v=TNy9poFuhyA&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=128Visit fhea.com to learn more!

Preparing For Success

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Hepatitis B

A 35-year-old man presents with a one-week history of new onset fatigue, nausea, as well as reporting his urine looks like, quote, ice tea. He also reports, feel like someone kicked me right underneath my ribs on the right. He denies recent travel, contact with individuals with similar signs and symptoms, and reports a new sex partner for the past six months, stating, quote, we sometimes use condoms. In considering the diagnosis of acute hepatitis B, which of the following laboratory profiles would be noted?A. Hep B surface antigen positive, anti-HBs negative, or Hep B surface antibody. ALT markedly elevated at 1390. AST similarly elevated at 1100. Total bilirubin markedly elevated at 4.8B. Hep B surface antigen positive, anti-HBs, HBS- or Hep B surface antibody ALT modestly elevated at 68 as is AST total bilirubin .9 within normal limitsC. Hep B surface antigen negative, anti-HBS- or Hep B surface antibody, ALT 24, AST 22 and a total bilirubin of 0.6D. Hep B surface antigen negative, anti-HPS negative, ALT 150, AST 140, total bilirubin 0.7 within normal limits---YouTube: https://www.youtube.com/watch?v=gIaXKQMAino&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=126Visit fhea.com to learn more!