Family Nurse Practitioner Test Patient Management 1 — Questions and Answers
Question 1: A pregnant patient at 28 weeks is found to have a 1-hour glucose challenge test result of 155 mg/dL. The NEXT step is:
- Order a 3-hour 100g oral glucose tolerance test (OGTT) (Correct answer)
- Diagnose gestational diabetes and initiate insulin
- Repeat the 1-hour test in 4 weeks
- Refer immediately to maternal-fetal medicine
Correct answer: Order a 3-hour 100g oral glucose tolerance test (OGTT)
A 1-hour GCT ≥140 mg/dL is a positive screen requiring confirmatory 3-hour OGTT to diagnose or exclude gestational diabetes.
Question 2: The FNP is managing a patient with newly diagnosed stage 1 hypertension (130–139/80–89 mmHg) with no comorbidities. The FIRST-LINE intervention is:
- Lifestyle modification for 3–6 months before initiating medication (Correct answer)
- Immediately start a thiazide diuretic
- Immediately start an ACE inhibitor
- Refer to cardiology for management
Correct answer: Lifestyle modification for 3–6 months before initiating medication
ACC/AHA guidelines recommend 3–6 months of lifestyle modification (diet, exercise, weight loss, sodium reduction) as initial therapy for stage 1 hypertension without cardiovascular risk.
Question 3: A 2-year-old with fever of 39.5°C and left ear pain is diagnosed with acute otitis media. Per AAP guidelines, the PREFERRED management is:
- Amoxicillin 80–90 mg/kg/day for 10 days (Correct answer)
- Watchful waiting for 48–72 hours
- Amoxicillin-clavulanate immediately
- Tympanocentesis
Correct answer: Amoxicillin 80–90 mg/kg/day for 10 days
Children under 2 years with AOM and fever ≥39°C should receive immediate antibiotic therapy with high-dose amoxicillin per AAP guidelines.
Question 4: A 68-year-old woman with osteoporosis has a T-score of -2.7 at the lumbar spine. The FNP initiates bisphosphonate therapy and counsels the patient to:
- Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes (Correct answer)
- Take it with food to reduce GI upset
- Crush it and mix with applesauce
- Take it at bedtime for best absorption
Correct answer: Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes
Bisphosphonates must be taken fasting with a full glass of water, and patients must remain upright for 30 minutes to prevent esophageal irritation and ensure absorption.
Question 5: An FNP is managing a patient after an acute MI. Which medication has MOST clearly demonstrated mortality reduction post-MI?
- Beta-blocker (e.g., metoprolol succinate) (Correct answer)
- Calcium channel blocker (e.g., diltiazem)
- Nitrate (e.g., isosorbide mononitrate)
- Digoxin
Correct answer: Beta-blocker (e.g., metoprolol succinate)
Beta-blockers reduce sympathetic stimulation and cardiac remodeling after MI and are associated with significant reduction in mortality.
Question 6: A patient with GERD fails PPI therapy. The FNP considers referral to gastroenterology for which procedure?
- Upper endoscopy (EGD) to assess for Barrett's esophagus or other pathology (Correct answer)
- Barium swallow
- Esophageal pH monitoring only
- Colonoscopy
Correct answer: Upper endoscopy (EGD) to assess for Barrett's esophagus or other pathology
PPI-refractory GERD requires upper endoscopy to evaluate for Barrett's esophagus, esophagitis, strictures, or other conditions requiring intervention.
Family Nurse Practitioner Test Patient Management 1
A pregnant patient at 28 weeks is found to have a 1-hour glucose challenge test result of 155 mg/dL.
The NEXT step is: