Family Nurse Practitioner Test Diagnostic Reasoning

Question 1

A 55-year-old male presents with sudden-onset severe headache described as 'the worst headache of my life.' The FNP's PRIORITY action is:

Accepted Answer

Emergent referral to the ED for CT head and lumbar puncture if negative

Answer

Prescribe sumatriptan for migraine

Answer

Order an outpatient MRI

Answer

Reassure the patient it is likely tension headache

Question 2

A female patient presents with unilateral lower abdominal pain, missed period, and vaginal spotting. The FIRST test the FNP orders is:

Accepted Answer

Urine or serum hCG (pregnancy test)

Answer

Pelvic ultrasound

Answer

CBC with differential

Answer

Cervical cultures for STIs

Question 3

A 60-year-old smoker presents with a new persistent cough, hemoptysis, and unintentional weight loss. The FNP orders a chest X-ray, which shows a hilar mass. The NEXT step is:

Accepted Answer

Urgent referral to pulmonology and CT chest

Answer

Start empiric antibiotics for pneumonia

Answer

Order sputum culture

Answer

Reassess in 4 weeks if not improving

Question 4

A patient with sudden painless vision loss in one eye is MOST likely experiencing which condition?

Accepted Answer

Central retinal artery occlusion

Answer

Acute angle-closure glaucoma

Answer

Optic neuritis

Answer

Retinal detachment

Question 5

Which D-dimer result interpretation is CORRECT when using the Wells score for PE pre-test probability?

Accepted Answer

A negative D-dimer effectively rules out PE in LOW pre-test probability patients

Answer

A positive D-dimer confirms PE regardless of pre-test probability

Answer

D-dimer is not useful in the Wells score algorithm

Answer

D-dimer should be ordered for all suspected PE cases regardless of probability

Question 6

A 35-year-old presents with fatigue, pallor, and a mean corpuscular volume (MCV) of 70 fL. The MOST likely diagnosis is:

Accepted Answer

Iron deficiency anemia

Answer

Vitamin B12 deficiency anemia

Answer

Folate deficiency anemia

Answer

Aplastic anemia