Family Nurse Practitioner Test Diagnostic Reasoning 1 — Questions and Answers
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:
- Emergent referral to the ED for CT head and lumbar puncture if negative (Correct answer)
- Prescribe sumatriptan for migraine
- Order an outpatient MRI
- Reassure the patient it is likely tension headache
Correct answer: Emergent referral to the ED for CT head and lumbar puncture if negative
A 'thunderclap' headache is a subarachnoid hemorrhage until proven otherwise and requires immediate emergency evaluation with CT head.
Question 2: A female patient presents with unilateral lower abdominal pain, missed period, and vaginal spotting. The FIRST test the FNP orders is:
- Urine or serum hCG (pregnancy test) (Correct answer)
- Pelvic ultrasound
- CBC with differential
- Cervical cultures for STIs
Correct answer: Urine or serum hCG (pregnancy test)
Ruling out ectopic pregnancy is the top priority; a pregnancy test is required immediately because ectopic pregnancy is life-threatening.
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:
- Urgent referral to pulmonology and CT chest (Correct answer)
- Start empiric antibiotics for pneumonia
- Order sputum culture
- Reassess in 4 weeks if not improving
Correct answer: Urgent referral to pulmonology and CT chest
A hilar mass with constitutional symptoms in a smoker has high malignancy risk and requires urgent CT chest and pulmonology referral for tissue diagnosis.
Question 4: A patient with sudden painless vision loss in one eye is MOST likely experiencing which condition?
- Central retinal artery occlusion (Correct answer)
- Acute angle-closure glaucoma
- Optic neuritis
- Retinal detachment
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion causes sudden, painless, complete monocular vision loss and is an ophthalmic emergency requiring immediate intervention.
Question 5: Which D-dimer result interpretation is CORRECT when using the Wells score for PE pre-test probability?
- A negative D-dimer effectively rules out PE in LOW pre-test probability patients (Correct answer)
- A positive D-dimer confirms PE regardless of pre-test probability
- D-dimer is not useful in the Wells score algorithm
- D-dimer should be ordered for all suspected PE cases regardless of probability
Correct answer: A negative D-dimer effectively rules out PE in LOW pre-test probability patients
D-dimer has high sensitivity but low specificity; a negative result rules out PE in low-probability patients, avoiding unnecessary CT-PA.
Question 6: A 35-year-old presents with fatigue, pallor, and a mean corpuscular volume (MCV) of 70 fL. The MOST likely diagnosis is:
- Iron deficiency anemia (Correct answer)
- Vitamin B12 deficiency anemia
- Folate deficiency anemia
- Aplastic anemia
Correct answer: Iron deficiency anemia
Microcytic anemia (MCV <80 fL) with fatigue and pallor in a young adult is most commonly caused by iron deficiency.
Family Nurse Practitioner Test Diagnostic Reasoning 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: