NP Clinical Decision-Making Mega Review
(1–150) – High-Yield Questions +
Explanations
2025/2026
1. A 68-year-old with COPD presents with worsening dyspnea and a
productive cough. The NP’s first diagnostic priority is:
A. Chest CT
B. Chest X-ray
C. CBC
D. Sputum culture
Rationale: A chest X-ray is the most immediate, accessible tool to rule
out pneumonia or acute changes, guiding rapid decision-making.
2. A diabetic patient with foot redness and fever needs which
immediate intervention?
A. Topical antifungal
B. Broad-spectrum antibiotics
C. Foot X-ray
D. Warm compresses
Rationale: Systemic infection is suspected; antibiotics must begin
before imaging.
3. A patient on warfarin with an INR of 8.2 and nosebleed should first
receive:
A. Vitamin K oral
B. Increase warfarin
C. Hold warfarin and give vitamin K
,D. Fresh frozen plasma
Rationale: INR > 8 with bleeding requires rapid reversal with vitamin
K.
4. A 28-year-old with suspected appendicitis:
A. Ultrasound
B. CT abdomen with contrast
C. MRI
D. KUB
Rationale: CT is the diagnostic gold standard for appendicitis in adults.
5. A patient with new unilateral leg swelling:
A. Compression stockings
B. X-ray
C. Venous Doppler ultrasound
D. D-dimer
Rationale: Rule out DVT immediately with Doppler imaging.
6. A 72-year-old presents with confusion, UTI symptoms, and
hypotension. First step:
A. Discharge home
B. Culture urine then wait
C. Initiate sepsis protocol
D. CT head
Rationale: Signs of urosepsis require immediate bundle-based
treatment.
7. Persistent cough >8 weeks in a non-smoker:
A. Stop ACE inhibitor
B. Chest X-ray
C. Start steroids
,D. Sputum testing
Rationale: All chronic cough workups begin with imaging.
8. A patient with sudden worst headache of life:
A. MRI brain
B. CT head without contrast
C. LP
D. CT angiogram
Rationale: Rule out subarachnoid hemorrhage STAT with non-contrast
CT.
9. Child with fever, drooling, sitting forward:
A. Throat swab
B. Emergency airway management
C. Oral antibiotics
D. Chest X-ray
Rationale: Suspected epiglottitis → airway first.
10. A patient with chest pain relieved by leaning forward:
A. GERD treatment
B. ECG and troponins
C. Stress test
D. PPI trial
Rationale: Pericarditis must be ruled out in all acute chest pain cases.
11. Suspected temporal arteritis requires:
A. CT head
B. Immediate high-dose steroids
C. MRI head
, D. Wait for biopsy
Rationale: Prevent blindness—start steroids before biopsy results.
12. A patient with asthma uses SABA daily. Next step:
A. Stop SABA
B. Montelukast only
C. Add inhaled corticosteroid
D. Oral steroids
Rationale: Daily SABA use indicates poor control—ICS is required.
13. New onset anemia with MCV 72:
A. Vitamin B12
B. Iron panel
C. Reticulocyte count
D. RBC folate
Rationale: Microcytosis is usually due to iron deficiency.
14. A patient with abdominal pain, jaundice, RUQ tenderness:
A. GI referral
B. Ultrasound in 2 weeks
C. STAT abdominal ultrasound
D. CT abdomen
Rationale: Suspected biliary obstruction requires rapid ultrasound.
15. A patient with A1C 11.2% and symptoms requires:
A. Metformin alone
B. GLP-1 agonist
C. Basal insulin
D. SGLT2 inhibitor
Rationale: Symptomatic hyperglycemia >10% requires insulin
initiation.
(1–150) – High-Yield Questions +
Explanations
2025/2026
1. A 68-year-old with COPD presents with worsening dyspnea and a
productive cough. The NP’s first diagnostic priority is:
A. Chest CT
B. Chest X-ray
C. CBC
D. Sputum culture
Rationale: A chest X-ray is the most immediate, accessible tool to rule
out pneumonia or acute changes, guiding rapid decision-making.
2. A diabetic patient with foot redness and fever needs which
immediate intervention?
A. Topical antifungal
B. Broad-spectrum antibiotics
C. Foot X-ray
D. Warm compresses
Rationale: Systemic infection is suspected; antibiotics must begin
before imaging.
3. A patient on warfarin with an INR of 8.2 and nosebleed should first
receive:
A. Vitamin K oral
B. Increase warfarin
C. Hold warfarin and give vitamin K
,D. Fresh frozen plasma
Rationale: INR > 8 with bleeding requires rapid reversal with vitamin
K.
4. A 28-year-old with suspected appendicitis:
A. Ultrasound
B. CT abdomen with contrast
C. MRI
D. KUB
Rationale: CT is the diagnostic gold standard for appendicitis in adults.
5. A patient with new unilateral leg swelling:
A. Compression stockings
B. X-ray
C. Venous Doppler ultrasound
D. D-dimer
Rationale: Rule out DVT immediately with Doppler imaging.
6. A 72-year-old presents with confusion, UTI symptoms, and
hypotension. First step:
A. Discharge home
B. Culture urine then wait
C. Initiate sepsis protocol
D. CT head
Rationale: Signs of urosepsis require immediate bundle-based
treatment.
7. Persistent cough >8 weeks in a non-smoker:
A. Stop ACE inhibitor
B. Chest X-ray
C. Start steroids
,D. Sputum testing
Rationale: All chronic cough workups begin with imaging.
8. A patient with sudden worst headache of life:
A. MRI brain
B. CT head without contrast
C. LP
D. CT angiogram
Rationale: Rule out subarachnoid hemorrhage STAT with non-contrast
CT.
9. Child with fever, drooling, sitting forward:
A. Throat swab
B. Emergency airway management
C. Oral antibiotics
D. Chest X-ray
Rationale: Suspected epiglottitis → airway first.
10. A patient with chest pain relieved by leaning forward:
A. GERD treatment
B. ECG and troponins
C. Stress test
D. PPI trial
Rationale: Pericarditis must be ruled out in all acute chest pain cases.
11. Suspected temporal arteritis requires:
A. CT head
B. Immediate high-dose steroids
C. MRI head
, D. Wait for biopsy
Rationale: Prevent blindness—start steroids before biopsy results.
12. A patient with asthma uses SABA daily. Next step:
A. Stop SABA
B. Montelukast only
C. Add inhaled corticosteroid
D. Oral steroids
Rationale: Daily SABA use indicates poor control—ICS is required.
13. New onset anemia with MCV 72:
A. Vitamin B12
B. Iron panel
C. Reticulocyte count
D. RBC folate
Rationale: Microcytosis is usually due to iron deficiency.
14. A patient with abdominal pain, jaundice, RUQ tenderness:
A. GI referral
B. Ultrasound in 2 weeks
C. STAT abdominal ultrasound
D. CT abdomen
Rationale: Suspected biliary obstruction requires rapid ultrasound.
15. A patient with A1C 11.2% and symptoms requires:
A. Metformin alone
B. GLP-1 agonist
C. Basal insulin
D. SGLT2 inhibitor
Rationale: Symptomatic hyperglycemia >10% requires insulin
initiation.
