FITZGERALD NURSE PRACTITIONER
BOARD CERTIFICATION
MASTERCLASS SOLUTIONS 2026 2027
1. A 64-year-old male with a history of long-standing
hypertension and dyslipidemia presents for a routine
evaluation. On physical examination, the nurse
practitioner auscultates a harsh, crescendo-decrescendo
systolic murmur at the second intercostal space along the
right sternal border that radiates directly upward into the
carotid arteries. Which of the following conditions is most
consistent with this presentation?
A) Mitral valve regurgitation
B) Aortic valve stenosis
C) Tricuspid valve regurgitation
D) Pulmonic valve stenosis
Correct Answer: B) Aortic valve stenosis
Rationale: Aortic stenosis is classically characterized by a
harsh, mid-systolic, crescendo-decrescendo ejection murmur
loudest at the right upper sternal border (aortic area) that
radiates to the carotids. As the valve narrows, it restricts left
ventricular outflow, which can eventually manifest as the
classic triad of syncope, angina, and dyspnea.
2. A 45-year-old female presents to the clinic with an acute
onset of an exquisitely painful, erythematous, and swollen
left great toe at the metatarsophalangeal (MTP) joint. She
reports the pain awoke her from sleep and is so severe that
she cannot tolerate the weight of a bed sheet. She denies
recent trauma. Which of the following diagnostic findings
is considered the gold standard for confirming this
condition?
A) Elevated serum uric acid level above 7.0 mg/dL
B) Identification of negatively birefringent, needle-shaped
, monosodium urate crystals on synovial fluid analysis
C) Radiographic evidence of subchondral bone erosions
and joint space narrowing
D) Positive rheumatoid factor and elevated erythrocyte
sedimentation rate (ESR)
Correct Answer: B) Identification of negatively
birefringent, needle-shaped monosodium urate
crystals on synovial fluid analysis
Rationale: The definitive diagnosis of acute gouty arthritis
(podagra) is made by demonstrating negatively birefringent,
needle-shaped monosodium urate crystals under polarized
light microscopy of synovial fluid aspirated from the affected
joint. While serum uric acid may be elevated, it can be normal
during an acute flare, making it unreliable for absolute
confirmation.
3. A 28-year-old female presents with a 3-month history of
progressive fatigue, a butterfly-shaped erythematous rash
across her cheeks and nasal bridge that spares the
nasolabial folds, and symmetrical polyarthralgias
involving her small hand joints. Initial screening reveals a
positive antinuclear antibody (ANA) titer. Which of the
following highly specific autoantibodies should the nurse
practitioner check next to confirm systemic lupus
erythematosus (SLE)?
A) Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B) Anti-double-stranded DNA (anti-dsDNA) and Anti-
Smith (anti-Sm) antibodies
C) Anti-centromere antibodies
D) Anti-Ro (SSA) and Anti-La (SSB) antibodies
Correct Answer: B) Anti-double-stranded DNA
(anti-dsDNA) and Anti-Smith (anti-Sm) antibodies
Rationale: While ANA is highly sensitive for SLE, it lacks
specificity. Anti-dsDNA and anti-Sm antibodies are highly
,specific for systemic lupus erythematosus and are part of the
classification criteria. Anti-CCP is specific for rheumatoid
arthritis, anti-centromere for limited scleroderma (CREST),
and anti-Ro/La for Sjogren's syndrome.
4. A 72-year-old female presents to the clinic with a new
onset of a severe, throbbing unilateral headache localized
to her right temple, accompanied by localized scalp
tenderness when brushing her hair, and pain in her jaw
muscles while chewing food. Which of the following
interventions represents the most critical immediate
action for the nurse practitioner to implement?
A) Order an outpatient urgent brain MRI and schedule a
follow-up in one week.
B) Obtain immediate inflammatory markers (ESR/CRP)
and initiate high-dose systemic corticosteroid therapy
immediately to prevent permanent blindness.
C) Prescribe an oral triptan medication and recommend a
soft-food diet for jaw rest.
D) Refer the patient to a dentist for an evaluation of
advanced temporomandibular joint (TMJ) dysfunction.
Correct Answer: B) Obtain immediate
inflammatory markers (ESR/CRP) and initiate high-
dose systemic corticosteroid therapy immediately to
prevent permanent blindness.
Rationale: The patient's clinical presentation is classic for
giant cell arteritis (temporal arteritis), a systemic vasculitis
affecting medium and large arteries. Because it can cause
ischemic optic neuropathy leading to irreversible blindness,
treatment with high-dose corticosteroids (e.g., prednisone 40–
60 mg daily) must be initiated immediately upon strong
clinical suspicion, before waiting for a confirmatory temporal
artery biopsy.
, 5. A 54-year-old male with a history of type 2 diabetes
mellitus presents with a 2-day history of burning with
urination, extreme urinary frequency, urgency, and high
systemic fevers up to 38.9°C. On physical examination, the
nurse practitioner notes significant suprapubic
tenderness. A gentle digital rectal examination (DRE)
reveals a warm, swollen, boggy, and exquisitely tender
prostate gland. Which of the following actions is strictly
contraindicated for this patient?
A) Obtaining a midstream clean-catch urine culture and
sensitivity
B) Performing a vigorous, repetitive prostate massage to
express prostatic fluid
C) Initiating empiric oral fluoroquinolone antibiotic
therapy for 4 to 6 weeks
D) Recommending oral antipyretics and increased fluid
consumption
Correct Answer: B) Performing a vigorous,
repetitive prostate massage to express prostatic fluid
Rationale: In acute bacterial prostatitis, the prostate gland
is highly inflamed and highly vascular. Performing a vigorous
prostate massage or repetitive digital manipulation is strictly
contraindicated because it can induce severe bacteremia,
potentially precipitating septic shock.
6. While evaluating the arterial blood gas (ABG) parameters
for a 68-year-old male with an acute exacerbation of
severe chronic obstructive pulmonary disease (COPD), the
nurse practitioner notes a pH of 7.36, PaCO₂ of 56 mm
Hg, and an HCO₃⁻ level of 31 mEq/L. How should the
clinician accurately interpret this acid-base status?
A) Uncompensated respiratory acidosis
B) Fully compensated respiratory acidosis
C) Partially compensated metabolic alkalosis
D) Acute metabolic and respiratory mixed acidosis
BOARD CERTIFICATION
MASTERCLASS SOLUTIONS 2026 2027
1. A 64-year-old male with a history of long-standing
hypertension and dyslipidemia presents for a routine
evaluation. On physical examination, the nurse
practitioner auscultates a harsh, crescendo-decrescendo
systolic murmur at the second intercostal space along the
right sternal border that radiates directly upward into the
carotid arteries. Which of the following conditions is most
consistent with this presentation?
A) Mitral valve regurgitation
B) Aortic valve stenosis
C) Tricuspid valve regurgitation
D) Pulmonic valve stenosis
Correct Answer: B) Aortic valve stenosis
Rationale: Aortic stenosis is classically characterized by a
harsh, mid-systolic, crescendo-decrescendo ejection murmur
loudest at the right upper sternal border (aortic area) that
radiates to the carotids. As the valve narrows, it restricts left
ventricular outflow, which can eventually manifest as the
classic triad of syncope, angina, and dyspnea.
2. A 45-year-old female presents to the clinic with an acute
onset of an exquisitely painful, erythematous, and swollen
left great toe at the metatarsophalangeal (MTP) joint. She
reports the pain awoke her from sleep and is so severe that
she cannot tolerate the weight of a bed sheet. She denies
recent trauma. Which of the following diagnostic findings
is considered the gold standard for confirming this
condition?
A) Elevated serum uric acid level above 7.0 mg/dL
B) Identification of negatively birefringent, needle-shaped
, monosodium urate crystals on synovial fluid analysis
C) Radiographic evidence of subchondral bone erosions
and joint space narrowing
D) Positive rheumatoid factor and elevated erythrocyte
sedimentation rate (ESR)
Correct Answer: B) Identification of negatively
birefringent, needle-shaped monosodium urate
crystals on synovial fluid analysis
Rationale: The definitive diagnosis of acute gouty arthritis
(podagra) is made by demonstrating negatively birefringent,
needle-shaped monosodium urate crystals under polarized
light microscopy of synovial fluid aspirated from the affected
joint. While serum uric acid may be elevated, it can be normal
during an acute flare, making it unreliable for absolute
confirmation.
3. A 28-year-old female presents with a 3-month history of
progressive fatigue, a butterfly-shaped erythematous rash
across her cheeks and nasal bridge that spares the
nasolabial folds, and symmetrical polyarthralgias
involving her small hand joints. Initial screening reveals a
positive antinuclear antibody (ANA) titer. Which of the
following highly specific autoantibodies should the nurse
practitioner check next to confirm systemic lupus
erythematosus (SLE)?
A) Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B) Anti-double-stranded DNA (anti-dsDNA) and Anti-
Smith (anti-Sm) antibodies
C) Anti-centromere antibodies
D) Anti-Ro (SSA) and Anti-La (SSB) antibodies
Correct Answer: B) Anti-double-stranded DNA
(anti-dsDNA) and Anti-Smith (anti-Sm) antibodies
Rationale: While ANA is highly sensitive for SLE, it lacks
specificity. Anti-dsDNA and anti-Sm antibodies are highly
,specific for systemic lupus erythematosus and are part of the
classification criteria. Anti-CCP is specific for rheumatoid
arthritis, anti-centromere for limited scleroderma (CREST),
and anti-Ro/La for Sjogren's syndrome.
4. A 72-year-old female presents to the clinic with a new
onset of a severe, throbbing unilateral headache localized
to her right temple, accompanied by localized scalp
tenderness when brushing her hair, and pain in her jaw
muscles while chewing food. Which of the following
interventions represents the most critical immediate
action for the nurse practitioner to implement?
A) Order an outpatient urgent brain MRI and schedule a
follow-up in one week.
B) Obtain immediate inflammatory markers (ESR/CRP)
and initiate high-dose systemic corticosteroid therapy
immediately to prevent permanent blindness.
C) Prescribe an oral triptan medication and recommend a
soft-food diet for jaw rest.
D) Refer the patient to a dentist for an evaluation of
advanced temporomandibular joint (TMJ) dysfunction.
Correct Answer: B) Obtain immediate
inflammatory markers (ESR/CRP) and initiate high-
dose systemic corticosteroid therapy immediately to
prevent permanent blindness.
Rationale: The patient's clinical presentation is classic for
giant cell arteritis (temporal arteritis), a systemic vasculitis
affecting medium and large arteries. Because it can cause
ischemic optic neuropathy leading to irreversible blindness,
treatment with high-dose corticosteroids (e.g., prednisone 40–
60 mg daily) must be initiated immediately upon strong
clinical suspicion, before waiting for a confirmatory temporal
artery biopsy.
, 5. A 54-year-old male with a history of type 2 diabetes
mellitus presents with a 2-day history of burning with
urination, extreme urinary frequency, urgency, and high
systemic fevers up to 38.9°C. On physical examination, the
nurse practitioner notes significant suprapubic
tenderness. A gentle digital rectal examination (DRE)
reveals a warm, swollen, boggy, and exquisitely tender
prostate gland. Which of the following actions is strictly
contraindicated for this patient?
A) Obtaining a midstream clean-catch urine culture and
sensitivity
B) Performing a vigorous, repetitive prostate massage to
express prostatic fluid
C) Initiating empiric oral fluoroquinolone antibiotic
therapy for 4 to 6 weeks
D) Recommending oral antipyretics and increased fluid
consumption
Correct Answer: B) Performing a vigorous,
repetitive prostate massage to express prostatic fluid
Rationale: In acute bacterial prostatitis, the prostate gland
is highly inflamed and highly vascular. Performing a vigorous
prostate massage or repetitive digital manipulation is strictly
contraindicated because it can induce severe bacteremia,
potentially precipitating septic shock.
6. While evaluating the arterial blood gas (ABG) parameters
for a 68-year-old male with an acute exacerbation of
severe chronic obstructive pulmonary disease (COPD), the
nurse practitioner notes a pH of 7.36, PaCO₂ of 56 mm
Hg, and an HCO₃⁻ level of 31 mEq/L. How should the
clinician accurately interpret this acid-base status?
A) Uncompensated respiratory acidosis
B) Fully compensated respiratory acidosis
C) Partially compensated metabolic alkalosis
D) Acute metabolic and respiratory mixed acidosis
