A 28 year-old woman presents with a 2-day history of urinary frequency, urgency and dysuria, stating, “This feels like when I had a urine infection 4 years ago.” She denies fever or GI upset and otherwise feels well.  In consideration of the diagnosis of lower UTI/cystitis, a urinalysis is ordered.  Which of the following is the most sensitive and specific finding for UTI caused by  a Gram-negative organism?

A. Positive leukocyte esterase

B. Presence of bacteriuria

C. Proteinuria

D. Positive nitrite

---
YouTube: https://www.youtube.com/watch?v=LxjF5uUuSHg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=51

Visit fhea.com to learn more!

Which of the following examples represents a potential medical malpractice scenario?

A. A 25-year-old who is being treated for acute otitis media, reports penicillin allergy to the healthcare provider. An amoxicillin prescription is advised. The patient takes prescribed amoxicillin without adverse reaction.
B. A 40-year-old patient with acute bacterial sinusitis reports to his healthcare provider that his symptoms have not improved after 2 days of a dose-appropriate prescription for amox with clavulanate.
C. Before taking a medication, a 28-year-old patient realizes the wrong drug was dispensed at the pharmacy. She returned the prescription and the correct medication was dispensed.
D. A 50-year-old patient has an abnormal mammogram and was not advised by her healthcare providers about appropriate follow-up. A  mammogram  1 year later confirmed the prior findings, the HCP shared the findings and the patient was referred for further evaluation and breast biopsy.

---YouTube: https://www.youtube.com/watch?v=41Ee5brI-N0

Visit fhea.com to learn more!

A 67-year-old man with a five-year history of heart failure with reduced ejection fraction presented to the ER approximately 7 days ago with worsening shortness of breath, and new onset orthopnea. He was hospitalized for two days, with medications adjusted, and states at that time his symptoms were significantly improved. The nurse practitioner now sees him in follow up. The patient states today that, “For the past day, I feel just like I did the day I was admitted to the hospital. I might even feel worse.”  The patient reports a 5 lb weight gain since arriving home from the hospital. He denies dietary indiscretion with high sodium foods and states he is taking all medications prescribed at hospital discharge as advised   On physical exam, he is sitting upright, slightly labored breathing,  BP=165/92, his resting heart rate=110 with S3 heart sound present, respiratory rate 26, neck veins to 8 cm, and bilateral crackles through the lung fields. The most appropriate next step in his care is to:

A. Perform medication reconciliation.
B. Obtain a detailed 48-hour dietary and fluid intake history.
C. Advise on the need for evaluation and treatment in the emergency department.
D. Ensure he has a cardiology follow-up within the next week.

---
YouTube: https://www.youtube.com/watch?v=bFdd4tB96hQ

Visit fhea.com to learn more!

A 14-month-old is brought into the clinic for a well-child visit. Born at 39.5 weeks gestation, he has been healthy and is up-to-date with immunizations. The child started to walk at age 12 months and the parents note that “his feet look a little crooked when he stands and sometimes he will trip when he is trying to run because they curve in.”  The NP notes a mild inward curvature of the front half of the foot bilaterally,  with an intoeing positioning when he stands. The feet are flexible and the child walks with ease without evidence of discomfort during ambulation or on exam. There is no joint redness, heat, or swelling. This most likely represents: 

1. Pes planus. 
2. Club foot. 
3. Metatarsus adductus. 
4. Idiopathic juvenile arthritis. 

---
YouTube: https://www.youtube.com/watch?v=NvjewWxJpUE

Visit fhea.com to learn more!

A 68-year-old with atrial fibrillation is taking warfarin as part of therapy for the prevention of thromboembolic event.  His goal INR is 2-3, which is checked monthly and has been within acceptable range for the past 6 months. Today he presents with an INR=3.8. He denies bleeding events and reports, “I am taking my medicine just like I was told.” The NP considers that:

A. The INR should be repeated today.
B. A single dose of injectable vitamin K should be ordered.
C. His health history should be reviewed carefully, with a focus on interacting with medications and/or foods.
D.   His weekly warfarin dose should be increased by 15%.

---
YouTube: https://www.youtube.com/watch?v=GNOlaFUosp0&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=47

Visit fhea.com to learn more!

A 35-year-old woman presents for a well-woman exam. She is without complaint, with BMI=22, and reports that she runs about 28 miles per week, 4-5 miles with each run, and has excellent exercise tolerance. She states, “I am in great health.”  On physical examination, the NP notes a faint mid-systolic click followed by a grade 2/6  mid- to late-systolic murmur, best heard at the apex. No other abnormalities are noted.  These findings are most suggestive of

A. aortic stenosis
B. mitral stenosis
C. mitral regurgitation
D. mitral valve prolapse

---
YouTube: https://www.youtube.com/watch?v=etnHh0ST5XY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=46

Visit fhea.com to learn more!

A 28-year-old woman who is breastfeeding her healthy 3-month-old term infant presents with a 48-hour history of generalized body aches, intermittent fever to 101.2 F, and localized pain on the upper aspect of her left breast. Nursing her child worsens the breast pain, while putting a cool compress on the area helps with pain control. She denies cough, GI symptoms or other skin alterations and does not have allergies to any medication. Physical exam is consistent with the diagnosis of lactation mastitis.  Which of the following represents the two best treatment options?

A. Discontinue breastfeeding on the affected side.
B. Prescribe an appropriate course of antimicrobial therapy.
C. Ensure that milk flow through the breast is encouraged via nursing as is tolerated or pumping.
D. Discard the milk from the affected breast.

---
YouTube: https://www.youtube.com/watch?v=JravIOgsQm0&t=4s

Visit fhea.com to learn more!

A nurse practitioner is newly licensed to practice. Which of the following best describes the NP’s ability to prescribe controlled substances?

A. Any NP who meets state-level requirements for a license to practice is able to prescribe controlled substances.
B. NPs are significantly restricted nationally from prescribing controlled substances.
C. NPs are able to prescribe controlled substances with significant physician oversight.
D. Controlled substance prescribing authority for NPs is regulated at the state and national level.

---
YouTube: https://www.youtube.com/watch?v=I69XvssB_1k&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=44

Visit fhea.com to learn more!

Visit fhea.com to learn more!

The NP is seeing a 60-year-old woman with a 10 year history of T2DM. Her current medications include oral metformin and an oral SGLT2-I, and states she is feeling well, without report of blurred vision, excessive thirst or polyuria.  She has not had any laboratory tests done in the past 6 months.  Which of the following represents the best choice of test to determine her overall glucose control?

A. Fasting plasma glucose
B. Serum creatinine/ e GFR (estimated glomerular filtration rate)
C. Hemoglobin A1c
D. Random blood glucose

---
YouTube: https://www.youtube.com/watch?v=yz94zsqABG8&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=42

Visit fhea.com to learn more!