Family Nurse Practitioner Test Diagnostic Reasoning 2 — Questions and Answers
Question 1: A patient has a fasting plasma glucose of 128 mg/dL on two separate occasions. The FNP diagnoses:
- Diabetes mellitus (Correct answer)
- Impaired fasting glucose (prediabetes)
- Normal fasting glucose
- Reactive hypoglycemia
Correct answer: Diabetes mellitus
A fasting plasma glucose ≥126 mg/dL on two separate tests meets the ADA diagnostic criteria for diabetes mellitus.
Question 2: Which finding on urinalysis is MOST specific for a urinary tract infection?
- Positive nitrites (Correct answer)
- Hematuria
- Proteinuria
- Elevated specific gravity
Correct answer: Positive nitrites
Positive nitrites indicate bacterial conversion of nitrates, which is highly specific for gram-negative bacteriuria such as E. coli.
Question 3: A patient is found to have TSH of 0.1 mIU/L with elevated free T4. The FNP interprets this as:
- Primary hyperthyroidism (Correct answer)
- Primary hypothyroidism
- Secondary hyperthyroidism
- Subclinical hypothyroidism
Correct answer: Primary hyperthyroidism
Low TSH with elevated free T4 indicates primary hyperthyroidism, where excess thyroid hormone suppresses pituitary TSH secretion.
Question 4: A patient with recurrent nephrolithiasis is found to have hypercalcemia, elevated PTH, and low phosphorus. The MOST likely diagnosis is:
- Primary hyperparathyroidism (Correct answer)
- Sarcoidosis
- Vitamin D toxicity
- Milk-alkali syndrome
Correct answer: Primary hyperparathyroidism
High PTH with hypercalcemia and hypophosphatemia is the classic triad of primary hyperparathyroidism, the most common cause of outpatient hypercalcemia.
Question 5: Which EKG finding is the EARLIEST sign of hyperkalemia?
- Peaked (tall, narrow, symmetric) T waves (Correct answer)
- Widened QRS complex
- Sine wave pattern
- Absent P waves
Correct answer: Peaked (tall, narrow, symmetric) T waves
Peaked T waves are the earliest EKG manifestation of hyperkalemia, preceding the PR prolongation, wide QRS, and eventually sine wave pattern.
Question 6: A patient with lower extremity weakness and a recent upper respiratory illness is found to have ascending paralysis. The FNP suspects:
- Guillain-Barré syndrome (Correct answer)
- Multiple sclerosis
- Myasthenia gravis
- Transverse myelitis
Correct answer: Guillain-Barré syndrome
Post-infectious ascending flaccid paralysis is the hallmark presentation of Guillain-Barré syndrome, an autoimmune peripheral neuropathy.
Family Nurse Practitioner Test Diagnostic Reasoning 2
A patient has a fasting plasma glucose of 128 mg/dL on two separate occasions.
The FNP diagnoses: