NP Family Nurse Practitioner 2 — Questions and Answers
Question 1: A 58-year-old male with type 2 diabetes presents with an HbA1c of 9.2% despite metformin 1000mg twice daily. What is the most appropriate next step?
- Add a GLP-1 receptor agonist (Correct answer)
- Switch to insulin glargine only
- Increase metformin to 2500mg daily
- Add a beta-blocker
Correct answer: Add a GLP-1 receptor agonist
Adding a GLP-1 receptor agonist is appropriate for uncontrolled T2DM on metformin, offering both glycemic control and cardiovascular benefits.
Question 2: A 4-year-old presents with a barky cough, inspiratory stridor, and low-grade fever. The most likely diagnosis is:
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Bacterial tracheitis
- Foreign body aspiration
Correct answer: Croup (laryngotracheobronchitis)
Croup presents with the classic barky (seal-like) cough, inspiratory stridor, and low-grade fever, typically caused by parainfluenza virus.
Question 3: Which medication is considered first-line treatment for uncomplicated urinary tract infections in non-pregnant women?
- Ciprofloxacin 500mg BID x 3 days
- Nitrofurantoin 100mg BID x 5 days (Correct answer)
- Amoxicillin 500mg TID x 7 days
- Trimethoprim-sulfamethoxazole DS BID x 3 days
Correct answer: Nitrofurantoin 100mg BID x 5 days
Nitrofurantoin for 5 days is first-line for uncomplicated UTI due to high efficacy, low resistance rates, and minimal collateral damage to gut flora.
Question 4: A 32-year-old woman at 10 weeks gestation is found to have a TSH of 6.8 mIU/L with normal free T4. What is the most appropriate management?
- Reassure and recheck in third trimester
- Start levothyroxine therapy (Correct answer)
- Order thyroid ultrasound immediately
- Refer to endocrinology before any treatment
Correct answer: Start levothyroxine therapy
Subclinical hypothyroidism in pregnancy (TSH >2.5 mIU/L in first trimester) warrants levothyroxine to prevent adverse fetal neurodevelopmental outcomes.
Question 5: A 70-year-old patient on warfarin presents with an INR of 8.5 and no active bleeding. The best management is:
- Hold warfarin and give vitamin K 10mg IV
- Hold warfarin and give oral vitamin K 2.5mg (Correct answer)
- Continue warfarin and recheck INR in 48 hours
- Give fresh frozen plasma immediately
Correct answer: Hold warfarin and give oral vitamin K 2.5mg
For supratherapeutic INR without bleeding, holding warfarin and administering low-dose oral vitamin K (1–2.5mg) is the recommended approach.
Question 6: Which finding on physical exam is most consistent with bacterial sinusitis rather than viral rhinosinusitis?
- Clear nasal discharge for 5 days
- Symptoms worsening after initial improvement (double-sickening) (Correct answer)
- Sneezing and watery eyes
- Low-grade fever on day 2 of illness
Correct answer: Symptoms worsening after initial improvement (double-sickening)
The 'double-sickening' pattern—initial improvement followed by worsening—strongly suggests secondary bacterial sinusitis.
Question 7: A 45-year-old patient is diagnosed with latent tuberculosis infection (LTBI) via positive IGRA. He has no active TB symptoms. First-line treatment is:
- Rifampin 600mg daily x 4 months
- Isoniazid 300mg daily x 9 months
- Isoniazid + rifapentine weekly x 12 weeks (3HP) (Correct answer)
- Observation only; treat if symptoms develop
Correct answer: Isoniazid + rifapentine weekly x 12 weeks (3HP)
The 3HP regimen (weekly isoniazid + rifapentine for 12 weeks) is now preferred for LTBI due to shorter duration and improved adherence.
NP Family Nurse Practitioner 2
A 58-year-old male with type 2 diabetes presents with an HbA1c of 9.2% despite metformin 1000mg twice daily.
What is the most appropriate next step?