NP NP Diagnosis & Clinical Decision-Making 3

Question 1

A 70-year-old patient presents with a new murmur described as a harsh systolic ejection murmur radiating to the carotids, with exertional syncope and dyspnea. The most likely valvular pathology is:

Accepted Answer

Aortic stenosis

Answer

The classic triad of angina, syncope, and heart failure with a crescendo-decrescendo systolic murmur radiating to the neck is the hallmark of severe aortic stenosis.

Question 2

Which diagnostic criteria must be met for a diagnosis of major depressive disorder (MDD)?

Accepted Answer

Five or more DSM-5 criteria symptoms for at least 2 weeks, including depressed mood or anhedonia

Answer

DSM-5 requires five or more symptoms present for at least two weeks, with at least one being depressed mood or anhedonia, causing functional impairment.

Question 3

A patient with known Addison's disease presents with hypotension, weakness, nausea, and hyperkalemia after a gastrointestinal illness. The NP recognizes this as:

Accepted Answer

Addisonian (adrenal) crisis

Answer

Physiologic stress in a patient with adrenal insufficiency can precipitate an adrenal crisis with life-threatening hypotension, electrolyte imbalances, and shock.

Question 4

Which score is used at the bedside to predict 30-day mortality risk in community-acquired pneumonia to guide admission decisions?

Accepted Answer

CURB-65 score

Answer

CURB-65 assesses confusion, urea, respiratory rate, blood pressure, and age ≥65 to stratify pneumonia severity and guide outpatient vs. inpatient vs. ICU management.

Question 5

A patient with type 2 diabetes has an HbA1c of 9.8% and is on metformin alone. The NP decides to intensify therapy. According to ADA guidelines, which combination is most appropriate next?

Accepted Answer

Add a GLP-1 receptor agonist or SGLT-2 inhibitor, especially with cardiovascular or renal disease

Answer

ADA guidelines prioritize GLP-1 RAs or SGLT-2 inhibitors as add-on therapy after metformin, especially in patients with established ASCVD, heart failure, or CKD.

NP - Nurse Practitioner Practice Test

NP - Nurse Practitioner Practice Test

NP NP Diagnosis & Clinical Decision-Making 3