Sarah Michelle Live Review | Sarah Michelle Nurse Practitioner Certification Exam
Study Guide & Exam Prep 2026–2027 | Sarah Michelle Live Review Study Guide | AANP
& ANCC Nurse Practitioner Board Review, NP Certification Exam Prep, Health
Assessment, Physical Examination, Health Promotion, Disease Prevention, Screening
Guidelines, Pharmacology, Pharmacokinetics, Pharmacodynamics, Antibiotics,
Antihypertensives, Diabetes Medications, Cardiovascular Disorders, Respiratory
Disorders, Gastrointestinal Disorders, Genitourinary Disorders, Neurologic
Disorders, Musculoskeletal Disorders, Dermatology, ENT & Ophthalmology,
Hematology, Endocrinology, Women's Health, Men's Health, Pediatrics, Geriatrics,
Infectious Disease, Mental Health, Psychiatric Disorders, Emergency Care,
Differential Diagnosis, Diagnostic Testing, Treatment Planning, Preventive Care,
Patient Education, Evidence-Based Practice & Clinical Management Across the
Lifespan | Practice Questions, Case Studies & Detailed Rationales
Question 1: A 34-year-old woman presents with palpitations. ECG shows a
regular narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail. Which
drug is the first-line treatment?
A. Adenosine
B. Amiodarone
C. Atropine
D. Digoxin
CORRECT ANSWER: A. Adenosine
Rationale: Adenosine is the first-line pharmacologic treatment for stable
paroxysmal supraventricular tachycardia (PSVT) after vagal maneuvers fail. It
transiently blocks the AV node, terminating reentrant circuits. Amiodarone and
digoxin are not first-line for acute PSVT. Atropine would worsen tachycardia.
Question 2: A 68-year-old man with heart failure has an ejection fraction of
30%. Which medication has been shown to reduce mortality in this condition?
A. Nifedipine
B. Carvedilol
C. Verapamil
D. Flecainide
CORRECT ANSWER: B. Carvedilol
,Rationale: Carvedilol is a beta-blocker with proven mortality benefit in heart
failure with reduced ejection fraction. Nifedipine and verapamil may worsen heart
failure. Flecainide is contraindicated in structural heart disease due to
proarrhythmic risk.
Question 3: A 45-year-old man presents with sudden tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
CORRECT ANSWER: C. Aortic dissection
Rationale: Tearing chest pain radiating to the back with interarm blood pressure
differential is classic for aortic dissection. MI typically causes pressure-like pain.
Pulmonary embolism causes dyspnea and pleuritic pain. Pericarditis causes
positional pain.
Question 4: A 7-year-old child presents with fever, strawberry tongue,
conjunctivitis, and a polymorphous rash. What is the most likely diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Rocky Mountain spotted fever
CORRECT ANSWER: C. Kawasaki disease
Rationale: Kawasaki disease presents with fever >5 days, conjunctivitis, oral
mucosal changes (strawberry tongue), polymorphous rash, and extremity
changes. Scarlet fever has a sandpaper rash and sore throat. Measles has Koplik
spots. RMSF has a petechial rash.
Question 5: A 28-year-old woman has a thyroid-stimulating hormone (TSH) level
of 0.01 mIU/L and elevated free T4. Which finding is most consistent with
Graves' disease?
,A. Positive antithyroid peroxidase antibodies
B. Positive thyroid-stimulating immunoglobulin
C. Low radioactive iodine uptake
D. Elevated thyroglobulin
CORRECT ANSWER: B. Positive thyroid-stimulating immunoglobulin
Rationale: Graves' disease is caused by thyroid-stimulating immunoglobulins (TSI)
that activate the TSH receptor. Antithyroid peroxidase antibodies are seen in
Hashimoto's thyroiditis. Low radioactive iodine uptake suggests thyroiditis.
Thyroglobulin is nonspecific.
Question 6: A 55-year-old man with cirrhosis presents with confusion, asterixis,
and elevated ammonia. Which medication is first-line for hepatic
encephalopathy?
A. Lactulose
B. Rifampin
C. Metronidazole
D. Neomycin
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose is first-line for hepatic encephalopathy. It acidifies the colon,
converting ammonia to ammonium, which is poorly absorbed. Rifaximin is
adjunctive. Metronidazole and neomycin are alternatives but not first-line.
Question 7: A 2-day-old neonate has bilirubin of 18 mg/dL. Which factor most
increases the risk of kernicterus?
A. Prematurity
B. Breastfeeding
C. Male sex
D. Asian ethnicity
CORRECT ANSWER: A. Prematurity
Rationale: Prematurity increases the risk of kernicterus because the blood-brain
barrier is immature and albumin binding is reduced. Breastfeeding, male sex, and
Asian ethnicity are risk factors for jaundice but not as strongly for kernicterus.
, Question 8: A 60-year-old woman has a DEXA T-score of -2.7 at the femoral
neck. What is the diagnosis?
A. Osteopenia
B. Osteoporosis
C. Normal bone density
D. Osteomalacia
CORRECT ANSWER: B. Osteoporosis
Rationale: A T-score ≤ -2.5 defines osteoporosis. Osteopenia is between -1.0 and -
2.5. Normal is ≥ -1.0. Osteomalacia is a mineralization defect, not defined by
DEXA.
Question 9: A 40-year-old man presents with recurrent kidney stones. Serum
calcium is elevated, and parathyroid hormone is elevated. What is the most
likely diagnosis?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Malignancy
D. Sarcoidosis
CORRECT ANSWER: A. Primary hyperparathyroidism
Rationale: Elevated calcium with elevated PTH indicates primary
hyperparathyroidism. Secondary hyperparathyroidism has low calcium.
Malignancy and sarcoidosis cause PTH-independent hypercalcemia with
suppressed PTH.
Question 10: A 25-year-old woman has a positive pregnancy test and severe
lower abdominal pain with vaginal bleeding. Ultrasound shows no intrauterine
pregnancy and free fluid in the cul-de-sac. What is the most likely diagnosis?
A. Ectopic pregnancy
B. Miscarriage
C. Ovarian torsion
D. Appendicitis
CORRECT ANSWER: A. Ectopic pregnancy
Study Guide & Exam Prep 2026–2027 | Sarah Michelle Live Review Study Guide | AANP
& ANCC Nurse Practitioner Board Review, NP Certification Exam Prep, Health
Assessment, Physical Examination, Health Promotion, Disease Prevention, Screening
Guidelines, Pharmacology, Pharmacokinetics, Pharmacodynamics, Antibiotics,
Antihypertensives, Diabetes Medications, Cardiovascular Disorders, Respiratory
Disorders, Gastrointestinal Disorders, Genitourinary Disorders, Neurologic
Disorders, Musculoskeletal Disorders, Dermatology, ENT & Ophthalmology,
Hematology, Endocrinology, Women's Health, Men's Health, Pediatrics, Geriatrics,
Infectious Disease, Mental Health, Psychiatric Disorders, Emergency Care,
Differential Diagnosis, Diagnostic Testing, Treatment Planning, Preventive Care,
Patient Education, Evidence-Based Practice & Clinical Management Across the
Lifespan | Practice Questions, Case Studies & Detailed Rationales
Question 1: A 34-year-old woman presents with palpitations. ECG shows a
regular narrow-complex tachycardia at 180 bpm. Vagal maneuvers fail. Which
drug is the first-line treatment?
A. Adenosine
B. Amiodarone
C. Atropine
D. Digoxin
CORRECT ANSWER: A. Adenosine
Rationale: Adenosine is the first-line pharmacologic treatment for stable
paroxysmal supraventricular tachycardia (PSVT) after vagal maneuvers fail. It
transiently blocks the AV node, terminating reentrant circuits. Amiodarone and
digoxin are not first-line for acute PSVT. Atropine would worsen tachycardia.
Question 2: A 68-year-old man with heart failure has an ejection fraction of
30%. Which medication has been shown to reduce mortality in this condition?
A. Nifedipine
B. Carvedilol
C. Verapamil
D. Flecainide
CORRECT ANSWER: B. Carvedilol
,Rationale: Carvedilol is a beta-blocker with proven mortality benefit in heart
failure with reduced ejection fraction. Nifedipine and verapamil may worsen heart
failure. Flecainide is contraindicated in structural heart disease due to
proarrhythmic risk.
Question 3: A 45-year-old man presents with sudden tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the right arm and
140/80 mmHg in the left arm. What is the most likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
CORRECT ANSWER: C. Aortic dissection
Rationale: Tearing chest pain radiating to the back with interarm blood pressure
differential is classic for aortic dissection. MI typically causes pressure-like pain.
Pulmonary embolism causes dyspnea and pleuritic pain. Pericarditis causes
positional pain.
Question 4: A 7-year-old child presents with fever, strawberry tongue,
conjunctivitis, and a polymorphous rash. What is the most likely diagnosis?
A. Measles
B. Scarlet fever
C. Kawasaki disease
D. Rocky Mountain spotted fever
CORRECT ANSWER: C. Kawasaki disease
Rationale: Kawasaki disease presents with fever >5 days, conjunctivitis, oral
mucosal changes (strawberry tongue), polymorphous rash, and extremity
changes. Scarlet fever has a sandpaper rash and sore throat. Measles has Koplik
spots. RMSF has a petechial rash.
Question 5: A 28-year-old woman has a thyroid-stimulating hormone (TSH) level
of 0.01 mIU/L and elevated free T4. Which finding is most consistent with
Graves' disease?
,A. Positive antithyroid peroxidase antibodies
B. Positive thyroid-stimulating immunoglobulin
C. Low radioactive iodine uptake
D. Elevated thyroglobulin
CORRECT ANSWER: B. Positive thyroid-stimulating immunoglobulin
Rationale: Graves' disease is caused by thyroid-stimulating immunoglobulins (TSI)
that activate the TSH receptor. Antithyroid peroxidase antibodies are seen in
Hashimoto's thyroiditis. Low radioactive iodine uptake suggests thyroiditis.
Thyroglobulin is nonspecific.
Question 6: A 55-year-old man with cirrhosis presents with confusion, asterixis,
and elevated ammonia. Which medication is first-line for hepatic
encephalopathy?
A. Lactulose
B. Rifampin
C. Metronidazole
D. Neomycin
CORRECT ANSWER: A. Lactulose
Rationale: Lactulose is first-line for hepatic encephalopathy. It acidifies the colon,
converting ammonia to ammonium, which is poorly absorbed. Rifaximin is
adjunctive. Metronidazole and neomycin are alternatives but not first-line.
Question 7: A 2-day-old neonate has bilirubin of 18 mg/dL. Which factor most
increases the risk of kernicterus?
A. Prematurity
B. Breastfeeding
C. Male sex
D. Asian ethnicity
CORRECT ANSWER: A. Prematurity
Rationale: Prematurity increases the risk of kernicterus because the blood-brain
barrier is immature and albumin binding is reduced. Breastfeeding, male sex, and
Asian ethnicity are risk factors for jaundice but not as strongly for kernicterus.
, Question 8: A 60-year-old woman has a DEXA T-score of -2.7 at the femoral
neck. What is the diagnosis?
A. Osteopenia
B. Osteoporosis
C. Normal bone density
D. Osteomalacia
CORRECT ANSWER: B. Osteoporosis
Rationale: A T-score ≤ -2.5 defines osteoporosis. Osteopenia is between -1.0 and -
2.5. Normal is ≥ -1.0. Osteomalacia is a mineralization defect, not defined by
DEXA.
Question 9: A 40-year-old man presents with recurrent kidney stones. Serum
calcium is elevated, and parathyroid hormone is elevated. What is the most
likely diagnosis?
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Malignancy
D. Sarcoidosis
CORRECT ANSWER: A. Primary hyperparathyroidism
Rationale: Elevated calcium with elevated PTH indicates primary
hyperparathyroidism. Secondary hyperparathyroidism has low calcium.
Malignancy and sarcoidosis cause PTH-independent hypercalcemia with
suppressed PTH.
Question 10: A 25-year-old woman has a positive pregnancy test and severe
lower abdominal pain with vaginal bleeding. Ultrasound shows no intrauterine
pregnancy and free fluid in the cul-de-sac. What is the most likely diagnosis?
A. Ectopic pregnancy
B. Miscarriage
C. Ovarian torsion
D. Appendicitis
CORRECT ANSWER: A. Ectopic pregnancy
