Family Nurse Practitioner (FNP) Certification Exam (ANCC/AANP) — Questions and Answers

Question 1: An FNP is managing a patient after an acute MI. Which medication has MOST clearly demonstrated mortality reduction post-MI?

Calcium channel blocker (e.g., diltiazem)
Beta-blocker (e.g., metoprolol succinate) (Correct answer)
Digoxin
Nitrate (e.g., isosorbide mononitrate)

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 2: A follow-up visit is scheduled for a Chinese male patient, 55, who underwent heart bypass surgery. The patient enters the examining room with his father at his side. How can a family nurse practitioner deliver culturally sensitive care?

Performs the examination without speaking to the patient's father.
Asks the patient's father first if he has any questions regarding his son's care. (Correct answer)
Asks the patient's father to leave the room due to confidentiality issues.
Provides the patient's father an informational packet to read while performing the examination.

Correct answer: Asks the patient's father first if he has any questions regarding his son's care.

The family nurse practitioner can provide culturally sensitive care by first asking the patient's father if he has any questions about his son's treatment. Respect for the patient's family and their cultural values is demonstrated by this method.

Question 3: Guidelines for clinical practice should:

serve as a handbook for best practice (Correct answer)
increase variations in clinical care
mandate practice decisions
protect nurses from legal liability

Correct answer: serve as a handbook for best practice

For high blood pressure, doctors frequently give hydrochlorothiazide (Microzide). It belongs to a group of drugs called diuretics, sometimes referred to as water pills. Some diuretics, such as hydrochlorothiazide, might temporarily increase low-density lipoprotein (LDL) cholesterol and triglycerides when taken at high dosages of 50 mg or more.

Question 4: A 6-year-old boy is brought in for evaluation of inattentiveness and hyperactivity that disrupts class. The FNP wants to diagnose ADHD. According to DSM-5, symptoms must be present in at least how many settings?

Four settings
Three settings
One setting
Two settings (Correct answer)

Correct answer: Two settings

DSM-5 requires that ADHD symptoms be present in two or more settings (e.g., home and school) to meet diagnostic criteria.

Question 5: A 52-year-old woman presents with new-onset headache described as 'the worst headache of my life.' She denies fever or neck stiffness. What is the most critical next step?

Administer IV magnesium for migraine
Prescribe a triptan and reassess in 24 hours
Perform immediate non-contrast CT of the head (Correct answer)
Order an MRI of the brain with contrast

Correct answer: Perform immediate non-contrast CT of the head

A thunderclap 'worst headache of life' requires urgent non-contrast CT head to rule out subarachnoid hemorrhage before any other management.

Question 6: A patient with suspected appendicitis has pain at McBurney's point. Where is this landmark located?

Midway between the umbilicus and right iliac crest
One-third the distance from the umbilicus to the ASIS
One-third the distance from the ASIS to the umbilicus (Correct answer)
Left lower quadrant at the iliac crest

Correct answer: One-third the distance from the ASIS to the umbilicus

McBurney's point is located one-third the distance from the right anterior superior iliac spine (ASIS) to the umbilicus.

Question 7: A patient has pitting edema graded 3+. How deep is the pit and how long does it take to rebound?

3–4 mm pit, rebounds in 10–15 seconds
1–2 mm pit, rebounds quickly
5–6 mm pit, rebounds in >1 minute (Correct answer)
7+ mm pit, permanent indentation

Correct answer: 5–6 mm pit, rebounds in >1 minute

Grade 3+ pitting edema produces a 5–6 mm deep pit that takes more than one minute to rebound.

Question 8: When auscultating the abdomen, the FNP hears a bruit over the renal artery. This finding suggests:

Normal peristalsis
Aortic aneurysm
Bowel obstruction
Renal artery stenosis (Correct answer)

Correct answer: Renal artery stenosis

A renal artery bruit indicates turbulent blood flow, most commonly from renal artery stenosis, a correctable cause of secondary hypertension.

Question 9: Gary, a healthy 16-year-old kid, is getting a sports physical examination. Which question from the past should the doctor ask Kevin or his parent?

Did anyone in your family ever have sudden cardiac death? (Correct answer)
Does anyone in your family have a history of asthma?
Does anyone in your family have elevated cholesterol levels?
Did you ever have any injury requiring stitches?

Correct answer: Did anyone in your family ever have sudden cardiac death?

When conducting a sports physical for an adolescent, it is crucial to screen for conditions that could lead to sudden cardiac death (SCD) during physical exertion. A family history of sudden cardiac death, especially in young individuals, can indicate underlying genetic cardiac conditions like hypertrophic cardiomyopathy or long QT syndrome. These conditions are significant risks for athletes and require further investigation.

Question 10: A 35-year-old woman with migraine with aura is seeking contraception. Which method is contraindicated due to increased stroke risk?

Copper IUD
Combined estrogen-progestin oral contraceptive (Correct answer)
Progestin-only pill
Levonorgestrel IUD

Correct answer: Combined estrogen-progestin oral contraceptive

Combined hormonal contraceptives containing estrogen are contraindicated (WHO MEC Category 4) in women with migraine with aura due to significantly increased ischemic stroke risk.

Question 11: The FNP performs a straight-leg raise (SLR) test and reproduces radicular pain at 45 degrees. This is MOST consistent with:

Lumbar nerve root compression (Correct answer)
Sacroiliac joint dysfunction
Hip flexor strain
Piriformis syndrome

Correct answer: Lumbar nerve root compression

A positive SLR at less than 60 degrees that reproduces radicular symptoms strongly suggests lumbar nerve root compression.

Question 12: A year after having a total gastrectomy, a patient complains of a sore mouth, indigestion, and tingling in the lower extremities. The family nurse practitioner orders which test?

Blood urea nitrogen level
Thyroid function study
Complete blood count (Correct answer)
Liver function study

Correct answer: Complete blood count

From anemia and infections to cancer, a CBC can help doctors pinpoint the cause of symptoms. A family nurse practitioner may order a complete blood count (CBC) to rule out anemia in a patient who has recently presented with complaints of sore mouth, indigestion, and tingling in the lower extremities after having undergone total gastrectomy a year prior. A vitamin B12 deficiency brought on by a gastroplasty may result in a sore mouth and tingling in the extremities (neuropathy). Measure B12 levels to confirm this.

Question 13: When performing a fundoscopic exam, the FNP notes arteriovenous (AV) nicking. This finding is MOST associated with which condition?

Glaucoma
Chronic hypertension (Correct answer)
Papilledema
Diabetic retinopathy

Correct answer: Chronic hypertension

AV nicking, where arteries compress veins at crossing points, is a classic sign of chronic hypertension-related retinal changes.

Question 14: In parasite infections, hypersensitivity reactions, and autoimmune diseases, which white blood cell type is elevated?

Eosinophils (Correct answer)
Neutrophils
Monocytes
Basophils

Correct answer: Eosinophils

Eosinophils are a type of white blood cell that plays a key role in the immune response, particularly against parasitic infections and in allergic reactions (hypersensitivity reactions). Elevated eosinophil counts (eosinophilia) are a classic indicator of these conditions, as well as some autoimmune diseases, due to their involvement in mediating inflammatory responses. They help to neutralize allergens and fight off parasites.

Question 15: A 40-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 8.2 mIU/L and free T4 is low. What is the treatment of choice?

Liothyronine (T3)
Levothyroxine (T4) (Correct answer)
Desiccated thyroid extract
Methimazole

Correct answer: Levothyroxine (T4)

Levothyroxine is the standard of care for hypothyroidism due to its consistent potency and long half-life.

Question 16: A patient with recurrent nephrolithiasis is found to have hypercalcemia, elevated PTH, and low phosphorus. The MOST likely diagnosis is:

Primary hyperparathyroidism (Correct answer)
Vitamin D toxicity
Sarcoidosis
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 17: The veins in Fundi are bigger than the arteries. Cones: for 20/20 vision and color perception Rods: used for night vision, depth perception, and light and shadow detection The macula, which controls central vision, is an anatomical structure. The vast number of cone-containing foveas is positioned in the center. The vision of 20/20 is determined by this region of the eye. Cobblestoning: Atopic pt, allergic rhinitis, and allergic conjunctivitis may all present with moderately increased lymphoid tissue that resembles "cobblestone" in the inner conjunctiva. Presbyopia is an age-related visual alteration brought on by a decrease in the eye's accommodation capacity and lens stiffness. typically begin at age 40,

Dicloxacillin
Eyes normal finding (Correct answer)
Oral steroids
Erythema migrans

Correct answer: Eyes normal finding

Normal assessments include the contraction and dilation of each pupil in reaction to light.

Question 18: A mother brings her 9-month-old for a well-child visit. Which developmental milestone should the FNP expect this infant to have achieved?

Saying 2-word phrases
Walking independently
Stacking 4 blocks
Using a pincer grasp (Correct answer)

Correct answer: Using a pincer grasp

Pincer grasp (using thumb and forefinger) typically emerges between 9-10 months of age.

Question 19: Which of the following is true when trying to determine the difference between pulmonary and cardiac causes of dyspnea on exertion?

When the cause is pulmonary, recovery of normal respiration is slow, and dyspnea eventually abates after cessation of exercise.
Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. (Correct answer)
Clients with pulmonary dyspnea have minimal dyspnea at rest.
In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise.

Correct answer: Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise.

Dyspnea from cardiac causes, often due to the heart's inability to meet the body's demands or fluid congestion in the lungs, tends to persist longer after exercise cessation. The cardiovascular system takes more time to recover and normalize function, leading to prolonged shortness of breath. In contrast, dyspnea from purely pulmonary causes might abate more quickly once the immediate demand for increased respiration is removed, assuming no underlying severe lung disease.

Question 20: A patient with CKD stage 3 (eGFR 35 mL/min) and diabetes has a blood pressure of 142/88 mmHg. The PREFERRED antihypertensive agent is:

Beta-blocker only
Calcium channel blocker only
Thiazide diuretic
ACE inhibitor or ARB for renoprotection (Correct answer)

Correct answer: ACE inhibitor or ARB for renoprotection

ACE inhibitors and ARBs reduce intraglomerular pressure and proteinuria, providing renoprotection in diabetic CKD and are the preferred antihypertensive agents.

Question 21: A 10-year-old child is brought in after a bee sting. She develops urticaria, throat tightness, and hypotension. What is the first-line treatment?

Diphenhydramine 50 mg IV
Albuterol nebulizer treatment
Methylprednisolone 125 mg IV
Epinephrine 0.3 mg IM in the lateral thigh (Correct answer)

Correct answer: Epinephrine 0.3 mg IM in the lateral thigh

Intramuscular epinephrine in the anterolateral thigh is the first and most critical treatment for anaphylaxis due to its rapid onset and life-saving effect.

Question 22: A patient with atrial fibrillation is started on digoxin. The FNP should counsel the patient to report which EARLY sign of toxicity?

Shortness of breath
Chest pain
Edema
Nausea, vomiting, and visual disturbances (Correct answer)

Correct answer: Nausea, vomiting, and visual disturbances

Early digoxin toxicity classically presents with GI symptoms (nausea, vomiting) and yellow-green visual halos before more serious cardiac arrhythmias occur.

Question 23: Jan's mother suffers from Alzheimer's disease (AD). According to Jan, her mother has a terrible short-term memory, is constantly getting lost, mistaking the wrong people for the right ones, and is too tired to do much of anything. "Is this as bad as it gets?" Jan asks. What do you tell her about the mother's condition?

Stage 1
Stage 3 (Correct answer)
Stage 2
Stage 4

Correct answer: Stage 3

Alzheimer's disease progresses through several stages, with increasing cognitive and functional decline. Jan's mother's symptoms—terrible short-term memory, constantly getting lost, mistaking people, and significant fatigue impacting activities—are characteristic of Stage 3, or Moderate Alzheimer's Disease. In this stage, individuals experience more pronounced cognitive deficits that significantly interfere with daily life and independence.

Question 24: A 70-year-old woman presents with sudden-onset severe headache described as 'the worst headache of my life.' Neurological exam is normal. What is the priority action?

Order an MRI of the brain
Perform a lumbar puncture first
Prescribe sumatriptan and follow up in 1 week
Order a CT scan of the head without contrast immediately (Correct answer)

Correct answer: Order a CT scan of the head without contrast immediately

A thunderclap headache requires immediate non-contrast CT to rule out subarachnoid hemorrhage before lumbar puncture.

Question 25: A 50-year-old male patient with no prior cardiovascular events has a 10-year ASCVD risk of 12%. What is the most appropriate recommendation?

Immediate high-intensity statin therapy
No treatment needed, recheck in 5 years
Aspirin therapy alone
Statin therapy discussion based on shared decision-making (Correct answer)

Correct answer: Statin therapy discussion based on shared decision-making

For patients with an intermediate 10-year ASCVD risk (7.5-20%), current guidelines recommend a shared decision-making discussion about initiating moderate-intensity statin therapy.

Question 26: A 25-year-old male presents with urethral discharge and dysuria. Gram stain shows intracellular gram-negative diplococci. What is the first-line treatment?

Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days (Correct answer)
Doxycycline 100mg twice daily for 7 days
Azithromycin 1g orally single dose
Ciprofloxacin 500mg orally single dose

Correct answer: Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days

CDC guidelines recommend ceftriaxone 500mg IM for uncomplicated gonorrhea plus doxycycline to treat concurrent chlamydia infection.

Question 27: A patient reports pain on palpation of the anatomical snuffbox. The FNP should FIRST suspect:

De Quervain's tenosynovitis
Wrist sprain
Scaphoid fracture (Correct answer)
Colles' fracture

Correct answer: Scaphoid fracture

Anatomical snuffbox tenderness after wrist injury is the hallmark sign of scaphoid fracture, which requires imaging even if initial X-rays are negative.

Question 28: Which vaccine is recommended annually for all persons aged 6 months and older, regardless of health status?

Hepatitis B vaccine
Tdap vaccine
Pneumococcal vaccine
Influenza vaccine (Correct answer)

Correct answer: Influenza vaccine

Annual influenza vaccination is recommended by the CDC for everyone 6 months of age and older each flu season.

Question 29: 4 important features -bradykinesia -muscular weakness -a tremor at rest instability in one's posture Medication: Amantadine (Symmetrel), a dopamine agonist.

Parkinson dz (Correct answer)
Pharyngitis
Boys puberty
Sulfonamides

Correct answer: Parkinson dz

Early signs of Parkinson's disease include tremors, muscle stiffness, and sluggishness of movement, but there are also other symptoms to watch out for. Parkinson's disease frequently causes issues with sleep and the nighttime. Parkinson's disease patients are more prone to have insomnia since the disease can cause several symptoms that interfere with sleep.

Question 30: An anterior nosebleed will develop from injury to the Kiesselbach's plexus.

Wrong
Correct (Correct answer)

Correct answer: Correct

The Kiesselbach's plexus is where nosebleeds frequently start, and a careful nasal inspection usually reveals the etiologic vessel. A posterior nosebleed is a common term for bleeding from the superior or posterior nasal cavities.

Question 31: A professional vocalist who is 45 years old complains hoarseness that has gotten worse over the past four weeks. After a three-hour performance, the hoarseness started. No weight loss, upper respiratory infection, dysphagia, or shortness of breath are reported by the patient, who does not smoke. This patient is taken care of by the family nurse practitioner by _____.

ordering a computed tomography scan of the head
requesting a referral for evaluation of the larynx (Correct answer)
ordering an immediate lateral neck x-ray
prescribing systemic antibiotics and cool mist inhalations

Correct answer: requesting a referral for evaluation of the larynx

Overuse of the voice is just one of many potential causes of hoarseness, a common condition. You may experience hoarseness if you speak for too long, cheer too loudly, sing excessively, or speak at a higher or lower pitch than usual. Following a three-hour performance, vocal cord strain may have been the cause of this hoarseness. The decision of the family nurse practitioner to request a referral for evaluation of the larynx is a positive step toward identifying the cause of the hoarseness and determining an appropriate treatment.

Question 32: Which medication used for type 2 diabetes is associated with the highest risk of hypoglycemia?

Metformin (biguanide)
Glipizide (sulfonylurea) (Correct answer)
Empagliflozin (SGLT-2 inhibitor)
Sitagliptin (DPP-4 inhibitor)

Correct answer: Glipizide (sulfonylurea)

Sulfonylureas stimulate insulin secretion regardless of blood glucose levels, making hypoglycemia their primary adverse effect.

Question 33: The FNP prescribes isotretinoin for a female patient with severe acne. Which MANDATORY program must the patient be enrolled in?

REMS
iPLEDGE (Correct answer)
TOUCH
STEPS

Correct answer: iPLEDGE

iPLEDGE is the FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) program for isotretinoin due to its severe teratogenicity.

Question 34: A mother brings her 18-month-old with fever, bulging anterior fontanelle, and irritability. Which diagnosis must be ruled out immediately?

Bacterial meningitis (Correct answer)
Viral gastroenteritis
Roseola infantum
Febrile seizure disorder

Correct answer: Bacterial meningitis

Bulging anterior fontanelle with fever and irritability in an infant is a classic presentation of bacterial meningitis requiring immediate evaluation and empiric treatment.

Question 35: During a thyroid exam, the FNP asks the patient to swallow. This maneuver is done to:

Identify lymphadenopathy
Distinguish thyroid tissue from other neck masses by observing upward movement (Correct answer)
Assess vocal cord function
Evaluate carotid artery pulsation

Correct answer: Distinguish thyroid tissue from other neck masses by observing upward movement

Thyroid tissue is attached to the trachea and moves upward with swallowing, distinguishing it from fixed neck masses.

Question 36: A patient with COPD has an FEV₁/FVC ratio of 0.62 post-bronchodilator. According to GOLD criteria, what severity of obstruction does this indicate if FEV₁ is 55% predicted?

GOLD 2 (Moderate) (Correct answer)
GOLD 4 (Very Severe)
GOLD 3 (Severe)
GOLD 1 (Mild)

Correct answer: GOLD 2 (Moderate)

GOLD 2 (Moderate COPD) is defined by FEV₁/FVC < 0.70 with FEV₁ 50–79% of predicted.

Question 37: Produces states of calm and relaxation

Photopsia
Ligaments
Strain
Serotonin (Correct answer)

Correct answer: Serotonin

Serotonin is involved in a variety of bodily processes, including mood regulation in the brain. It is frequently referred to be your body's inborn "feel good" chemical. You feel more emotionally secure, happier, calmer, and more emotionally focused when serotonin levels are normal.

Question 38: Which of the following neoplasms is considered to be benign?

Osteosarcoma
Glioma
Leiomyoma (Correct answer)
Seminoma

Correct answer: Leiomyoma

A leiomyoma is a benign tumor that originates from smooth muscle tissue, most commonly found in the uterus (often referred to as uterine fibroids). Unlike malignant neoplasms such as seminoma, glioma, or osteosarcoma, leiomyomas are non-cancerous, do not metastasize, and typically grow slowly without invading surrounding tissues. They are generally not life-threatening, though they can cause symptoms depending on their size and location.

Question 39: Is Hand-foot-mouth disease diagnosed in patients who most likely are teenagers and appear with the usual triad of sore throat, protracted lethargy, and enlarged cervical nodes?

True
False (Correct answer)

Correct answer: False

Acute mononucleosis: Mononucleosis (mono) is a viral infection that causes a sore throat and fever. Cases often happen in teens and young adults.

Question 40: A patient has a fasting plasma glucose of 128 mg/dL on two separate occasions. The FNP diagnoses:

Normal fasting glucose
Diabetes mellitus (Correct answer)
Reactive hypoglycemia
Impaired fasting glucose (prediabetes)

Correct answer: Diabetes mellitus

A fasting plasma glucose ≥126 mg/dL on two separate tests meets the ADA diagnostic criteria for diabetes mellitus.

Question 41: A 45-year-old patient presents with a heart rate of 52 bpm, cool extremities, and fatigue. Which assessment finding would MOST concern the FNP?

Mild peripheral edema
Regular rhythm on auscultation
Bradycardia with hypotension (Correct answer)
Normal oxygen saturation

Correct answer: Bradycardia with hypotension

Bradycardia combined with hypotension indicates hemodynamic compromise and requires urgent evaluation.

Question 42: During a pediatric well-visit, the FNP assesses a 6-month-old and notes absence of the Moro reflex. This finding is MOST concerning for:

Hip dysplasia
Normal developmental milestone
Hearing impairment
Central nervous system dysfunction (Correct answer)

Correct answer: Central nervous system dysfunction

The Moro reflex should be present at 6 months; its absence suggests CNS dysfunction or neurological injury.

Question 43: When assessing a patient's JVD (jugular venous distension), the patient should be positioned at:

30–45 degree head elevation (Correct answer)
90 degrees sitting upright
Flat supine
Left lateral decubitus

Correct answer: 30–45 degree head elevation

JVD is best assessed with the head of the bed elevated 30–45 degrees, allowing visualization of the jugular venous pulsation above the clavicle.

Question 44: The family nurse practitioner displays leadership in the workplace by ______.

adding clinical protocols to the nurse practitioner scope of practice.
comparing the workplace roles of the registered nurse and the nurse practitioner.
lobbying to eliminate continuing education requirements.
creating a task force to address scope-of-practice concerns. (Correct answer)

Correct answer: creating a task force to address scope-of-practice concerns.

The purpose of a task force is to address a particular problem or issue by bringing together a number of experts in that field. Task forces can be formed for many different reasons in nursing, including dealing with issues related to scope of practice.

Question 45: A patient with newly diagnosed atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to current guidelines, what is the recommended management?

Rate control alone without anticoagulation
Oral anticoagulation with a DOAC or warfarin (Correct answer)
No anticoagulation needed
Aspirin 81 mg daily

Correct answer: Oral anticoagulation with a DOAC or warfarin

A CHA₂DS₂-VASc score of 2 or higher in males (or 3+ in females) warrants oral anticoagulation to reduce stroke risk.

Question 46: A 45-year-old man visits the clinic for a regular preventive checkup. Although he claims to be in good health, he does admit to having some dark spots on his back. On the back, a physical examination reveals numerous pigmented lesions, including a single, flat, dark, 9-mm lesion with wavy borders. Which of the following is the ideal next move in treating the skin lesion on this patient?

Incisional biopsy
Excisional biopsy (Correct answer)
Reassurance and routine follow up only
Photographic documentation and comparison in 6-12 months

Correct answer: Excisional biopsy

The description of the lesion (single, flat, dark, 9-mm with wavy borders) raises strong suspicion for melanoma, especially given the irregular borders. When melanoma is suspected, an excisional biopsy with narrow margins is the preferred diagnostic and initial therapeutic step. This allows for complete removal of the lesion for pathological examination.

Question 47: Which of the following is a normal finding on abdominal assessment?

Absent bowel sounds after 5 minutes of auscultation
Dullness over the right lower quadrant
Tympany over most of the abdomen (Correct answer)
Hyperresonance over the liver

Correct answer: Tympany over most of the abdomen

Tympany predominates over most of the abdomen due to gas in the gastrointestinal tract, while dullness is normal over solid organs like the liver and spleen.

Question 48: The FNP notes café-au-lait spots (>6, >15mm) in an adult patient. This finding raises suspicion for:

Neurofibromatosis type 1 (Correct answer)
Vitiligo
Tuberous sclerosis
McCune-Albright syndrome

Correct answer: Neurofibromatosis type 1

Six or more café-au-lait macules larger than 15 mm in adults are a major diagnostic criterion for neurofibromatosis type 1 (NF1).

Question 49: When estrogen-using women reach perimenopause, why do doctors typically prescribe a progestational medication?

Prevent osteoporosis
Promote growth of the uterine lining
Decrease the risk of endometrial hyperplasia (Correct answer)
Prevent hot flashes

Correct answer: Decrease the risk of endometrial hyperplasia

To lessen the risk of endometrial hyperplasia, progestational medications are typically given to perimenopausal women who use estrogen. To prevent estrogen-related endometrial hyperplasia, progestational medicine is used in conjunction with estrogen therapy.

Question 50: A patient taking allopurinol for gout asks about alcohol use. The FNP explains that:

Red wine specifically is protective against gout
Alcohol raises uric acid levels and can trigger gout flares, undermining treatment (Correct answer)
Allopurinol interacts with alcohol to cause flushing
Moderate alcohol is safe and does not affect uric acid

Correct answer: Alcohol raises uric acid levels and can trigger gout flares, undermining treatment

Alcohol, especially beer and spirits, increases uric acid production and decreases renal excretion, worsening gout control.

Question 51: A 55-year-old male with known coronary artery disease presents with crushing chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Left main coronary artery
Right coronary artery (RCA) (Correct answer)
Left circumflex artery
Left anterior descending (LAD) artery

Correct answer: Right coronary artery (RCA)

ST elevations in leads II, III, and aVF indicate an inferior STEMI, most commonly caused by occlusion of the right coronary artery.

Question 52: Ann, 49, experiences everyday asthma problems. Her daily routine includes taking her inhaled short-acting beta-2 agonist. At least twice a week, her exacerbations impede her activities and may last days. She has a nighttime exacerbation more frequently than once per week. Which level of asthma severity does Ann fall under?

Intermittent
Severe persistent
Mild persistent
Moderate persistent (Correct answer)

Correct answer: Moderate persistent

Ann's asthma symptoms, including daily use of a short-acting beta-2 agonist, exacerbations impeding activities at least twice a week lasting days, and nighttime exacerbations more frequently than once per week, align with the criteria for moderate persistent asthma. This severity level indicates significant impairment and requires daily controller medication to manage symptoms and prevent exacerbations. It's more severe than mild persistent but less than severe persistent.

Question 53: An adult patient on lithium therapy presents with coarse tremor, confusion, and GI upset. Serum lithium level is 2.4 mEq/L. What is the immediate priority?

Add anticonvulsant and monitor closely
Administer activated charcoal only
Reduce lithium dose by 50%
Discontinue lithium and provide supportive care with hydration (Correct answer)

Correct answer: Discontinue lithium and provide supportive care with hydration

Lithium toxicity at levels >2.0 mEq/L with symptoms requires immediate discontinuation, volume resuscitation, and possibly hemodialysis for severe cases.

Question 54: A 45-year-old woman presents with hot flashes, irregular menses, and vaginal dryness. FSH is 55 mIU/mL. She has no contraindications. What is the first-line treatment for her vasomotor symptoms?

Phytoestrogens
Combined estrogen-progestogen hormone therapy (Correct answer)
Selective serotonin reuptake inhibitors
Medroxyprogesterone acetate alone

Correct answer: Combined estrogen-progestogen hormone therapy

Combined estrogen-progestogen therapy is the most effective treatment for vasomotor symptoms in perimenopausal women with an intact uterus.

Question 55: 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:

Start empiric antibiotics for pneumonia
Order sputum culture
Urgent referral to pulmonology and CT chest (Correct answer)
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 56: Which finding on urinalysis is MOST specific for a urinary tract infection?

Positive nitrites (Correct answer)
Proteinuria
Elevated specific gravity
Hematuria

Correct answer: Positive nitrites

Positive nitrites indicate bacterial conversion of nitrates, which is highly specific for gram-negative bacteriuria such as E. coli.

Question 57: A 70-year-old male smoker reports painless gross hematuria. He has no UTI symptoms. What is the priority next step?

Prescribe antibiotics empirically for UTI
Increase water intake and recheck in 2 weeks
Refer for urgent cystoscopy to rule out bladder cancer (Correct answer)
Order repeat urinalysis in 4 weeks

Correct answer: Refer for urgent cystoscopy to rule out bladder cancer

Painless gross hematuria in an older smoker is bladder cancer until proven otherwise; urgent cystoscopy and urology referral are indicated.

Question 58: The family nurse practitioner will have the patient make quick, alternating movements with their hands to test for:

Cerebellar functioning (Correct answer)
Reflex arc functioning
Cognitive functioning
Stereognostic functioning

Correct answer: Cerebellar functioning

To assess cerebellar function, the family nurse practitioner has a patient make quick, alternating hand motions. It is used to find out how well the cerebellum can coordinate movement. The patient is instructed to place one hand over the other and to quickly switch that hand back and forth.

Question 59: In primary care, which of the following laboratory tests is used to assess renal function?

Blood urea nitrogen (BUN) to creatinine ratio
Electrolyte panel
Alkaline phosphatase
Creatinine (Correct answer)

Correct answer: Creatinine

Serum creatinine is the most commonly used and reliable single laboratory test in primary care to assess renal function. Creatinine is a waste product produced by muscle metabolism and is filtered by the kidneys; elevated levels indicate impaired kidney function. While BUN and electrolyte panels provide additional information, creatinine is the primary marker for estimating glomerular filtration rate (GFR).

Question 60: In active labor at 37 weeks along, a 26-year-old woman is diagnosed as gravida 2 para 1. She has an epidural and is slowly dilated to a full cervical opening. The fetal head is delivered, immediately retracts into the perineum, and the anterior shoulder is not delivered despite the patient pushing for two hours. Which of the following best describes the clinical presentation of this patient at risk?

Maternal chronic hypertension
Fetal gestational age
Maternal age at delivery
Maternal type 2 diabetes mellitus (Correct answer)

Correct answer: Maternal type 2 diabetes mellitus

The clinical presentation describes shoulder dystocia, where the fetal head delivers but the anterior shoulder gets stuck. Maternal type 2 diabetes mellitus is a significant risk factor for shoulder dystocia because it often leads to macrosomia (large baby), which increases the likelihood of the baby's shoulders being too wide to pass through the maternal pelvis.

Question 61: A 32-year-old woman at 28 weeks gestation screens positive on the 1-hour glucose challenge test (152 mg/dL). What is the next appropriate step?

Perform a 3-hour 100g oral glucose tolerance test (Correct answer)
Repeat the 1-hour test in 2 weeks
Diagnose gestational diabetes and start dietary counseling
Start insulin therapy immediately

Correct answer: Perform a 3-hour 100g oral glucose tolerance test

A positive 1-hour screen (≥140 mg/dL) requires a 3-hour 100g OGTT to confirm or rule out gestational diabetes.

Question 62: A 50-year-old woman with a BMI of 32 presents for a wellness visit. She has no symptoms but her fasting glucose is 118 mg/dL on two separate occasions. What is the diagnosis and recommended intervention?

Impaired fasting glucose; start insulin therapy
Type 2 diabetes; start metformin immediately
Impaired fasting glucose (prediabetes); lifestyle modification and consider metformin (Correct answer)
Normal fasting glucose; recheck in 3 years

Correct answer: Impaired fasting glucose (prediabetes); lifestyle modification and consider metformin

Fasting glucose 100–125 mg/dL on two occasions defines prediabetes; intensive lifestyle changes (weight loss, exercise) are first-line, with metformin for high-risk individuals.

Question 63: A 14-year-old patient discloses substance use during a confidential visit. Under HIPAA and most state laws, the FNP should FIRST:

Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality (Correct answer)
Report to child protective services
Refer to psychiatry without disclosure to parents
Immediately notify parents

Correct answer: Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality

Minors have confidentiality rights for substance use treatment in most states; the FNP should assess safety and engage the patient in treatment before any breach.

Question 64: A 62-year-old lady arrives at the office complaining of leg heaviness, particularly while standing for lengthy periods of time. The patient has spent the previous 20 years working as a cashier at a department store, and she reports that her symptoms are at their worst when her job ends. The calves and ankles of both lower limbs have bilaterally dilated, tortuous veins without erythema or edema upon examination. Examination of the upper extremities is unremarkable. Which of the following outcomes is at higher risk due to this patient's present condition?

Myocardial infarction
Pulmonary embolism
Intermittent claudication
Venous stasis ulcers (Correct answer)

Correct answer: Venous stasis ulcers

The patient's symptoms (leg heaviness, bilaterally dilated, tortuous veins, prolonged standing occupation) are consistent with varicose veins and chronic venous insufficiency. Over time, impaired venous return and increased pressure in the veins can lead to skin changes, inflammation, and ultimately, the development of venous stasis ulcers, particularly around the ankles.

Question 65: 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:

Prescribe sumatriptan for migraine
Order an outpatient MRI
Reassure the patient it is likely tension headache
Emergent referral to the ED for CT head and lumbar puncture if negative (Correct answer)

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 66: Which of the following shows that there are more bacteria or proteins present than usual in a urine sample, which is found in severe renal illness and may also be a sign of urinary calculi?

Crystals
Ketones
Casts (Correct answer)
Nitrites

Correct answer: Casts

Urinary casts are cylindrical structures formed in the renal tubules and are composed of precipitated proteins and cells. Their presence in a urine sample indicates a problem within the kidney tubules themselves, often associated with severe renal illness, inflammation, or conditions like urinary calculi that can cause obstruction and damage. The type of cast can further specify the underlying kidney pathology.

Question 67: A 65-year-old patient asks about shingles prevention. Which vaccine should the FNP recommend?

No vaccine available for this age group
Varivax (varicella vaccine)
Zostavax (live attenuated)
Shingrix (recombinant zoster vaccine) 2-dose series (Correct answer)

Correct answer: Shingrix (recombinant zoster vaccine) 2-dose series

Shingrix (RZV) 2-dose series is recommended for adults 50 and older and is preferred over Zostavax due to greater efficacy (>90%).

Question 68: A patient's Weber test shows lateralization to the LEFT ear. Which interpretation is MOST accurate?

Sensorineural hearing loss in the left ear
Conductive hearing loss in the left ear OR sensorineural loss in the right ear (Correct answer)
Normal bilateral hearing
Conductive hearing loss in the right ear only

Correct answer: Conductive hearing loss in the left ear OR sensorineural loss in the right ear

Weber lateralizes to the affected side with conductive loss (sound travels through bone to the blocked ear) or to the better side with sensorineural loss.

Question 69: Micoaneurysms, hard exudates, cotton wool patches, and neovascularization

None of the above
Atopic dermatitis
Diabetic retinopathy (Correct answer)
Acute diverticulitis

Correct answer: Diabetic retinopathy

A consequence of diabetes called diabetic retinopathy is brought on by high blood sugar levels harming the retina, which is the back of the eye. If undetected and mistreated, it can result in blindness.

Question 70: What breath sound results when the inspiratory rate equals the expiratory rate?

Bronchial
Vesicular
Bronchovesicular (Correct answer)
Tracheal

Correct answer: Bronchovesicular

Bronchovesicular breath sounds are characterized by an inspiratory phase that is equal in duration to the expiratory phase. These sounds are typically heard over the major bronchi, such as between the scapulae and next to the sternum. This equality in duration distinguishes them from vesicular sounds (longer inspiration) and bronchial/tracheal sounds (longer expiration or very loud and harsh).

Question 71: An African American man in his mid-fifties seeking medication management comes into your primary care office with recently discovered hypertension. His blood pressure is 145/95 as of right now. He says he doesn't have a headache, impaired vision, chest discomfort, or trouble breathing. Which drug would you prescribe him first?

Hydralazine
Catapres
Metoprolol
Amlodipine (Correct answer)

Correct answer: Amlodipine

For African American patients with hypertension, current guidelines often recommend starting with a thiazide diuretic or a calcium channel blocker (CCB) as first-line therapy, especially in the absence of compelling indications for other drug classes. Amlodipine is a dihydropyridine calcium channel blocker and is generally effective and well-tolerated in this population. Other options like beta-blockers or ACE inhibitors may be less effective as monotherapy in this demographic.

Question 72: A patient with lower extremity weakness and a recent upper respiratory illness is found to have ascending paralysis. The FNP suspects:

Transverse myelitis
Myasthenia gravis
Multiple sclerosis
Guillain-Barré syndrome (Correct answer)

Correct answer: Guillain-Barré syndrome

Post-infectious ascending flaccid paralysis is the hallmark presentation of Guillain-Barré syndrome, an autoimmune peripheral neuropathy.

Question 73: A 2-year-old child is brought in with a bulging fontanelle, high fever, and nuchal rigidity. Which action should the FNP take FIRST?

Order a CT head before any intervention
Administer acetaminophen and observe
Perform a lumbar puncture immediately
Administer empiric IV antibiotics without delay (Correct answer)

Correct answer: Administer empiric IV antibiotics without delay

Bacterial meningitis is a life-threatening emergency; empiric antibiotics must not be delayed even if lumbar puncture or imaging is planned.

Question 74: Which screening test is recommended by the USPSTF for colorectal cancer starting at age 45 in average-risk adults?

Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT (Correct answer)
Annual digital rectal exam
Sigmoidoscopy every 5 years alone
CT colonography every 3 years

Correct answer: Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT

The USPSTF recommends starting colorectal cancer screening at age 45 with several acceptable strategies, including colonoscopy every 10 years or annual stool-based tests.

Question 75: A patient with rheumatoid arthritis on methotrexate develops oral ulcers and fatigue. Which supplement should be routinely recommended?

Vitamin B12
Folic acid (Correct answer)
Iron
Vitamin D

Correct answer: Folic acid

Folic acid supplementation reduces methotrexate-related adverse effects including mucositis, GI upset, and cytopenias.

Question 76: Myocardial infarction patient visits clinic for atorvastatin calcium refill (Lipitor). The family nurse practitioner knows that the prescription is for _____.

cancer prevention
tertiary prevention (Correct answer)
secondary prevention
primary prevention

Correct answer: tertiary prevention

Tertiary prevention focuses on lowering the burden of established illnesses by eliminating or reducing disability, minimizing suffering, and optimizing quality of life. The family nurse practitioner here understands that the patient has previously suffered a myocardial infarction, so the medicine is being provided for tertiary prevention. In patients with cardiovascular disease, atorvastatin calcium (Lipitor) lowers cholesterol and reduces the risk of a heart attack or stroke.

Question 77: In clinical management, evidence-based practice is based on _____.

clinical practice guidelines
expert opinions
systematic reviews (Correct answer)
cohort studies

Correct answer: systematic reviews

A systematic review is a sort of research that use a systematic approach to gather secondary data, assess existing research papers, and synthesize qualitative or quantitative findings. Systematic reviews give a complete summary of all available information on a topic, making them the highest level of EBP evidence.

Question 78: Which kind of antihypertensives may cause problems for diabetics?

Angiotensin-converting enzyme (ACE) inhibitors
Calcium channel blockers
Beta blockers (Correct answer)
Alpha blockers

Correct answer: Beta blockers

Beta-blockers can mask the symptoms of hypoglycemia (low blood sugar) in diabetic patients, such as tremors and palpitations, making it harder for them to recognize and treat a hypoglycemic event. Additionally, some beta-blockers can impair glucose metabolism and worsen insulin resistance. This can make blood sugar control more challenging for individuals with diabetes, requiring careful consideration and monitoring.

Question 79: An elderly patient is found to have a serum sodium of 128 mEq/L with euvolemia. Which is the MOST appropriate initial management?

Administer normal saline at 200 mL/hr
Initiate furosemide diuresis
Rapid correction with 3% hypertonic saline
Fluid restriction and identify underlying cause (e.g., SIADH) (Correct answer)

Correct answer: Fluid restriction and identify underlying cause (e.g., SIADH)

Euvolemic hyponatremia (SIADH) is managed with fluid restriction and identifying the underlying cause; rapid correction risks osmotic demyelination syndrome.

Question 80: Which serotypes of human papillomavirus cause cancer most often?

Serotypes 16 and 18 (Correct answer)
Serotypes 27 and 29
Serotypes 3 and 10
Serotypes 6 and 11

Correct answer: Serotypes 16 and 18

Human Papillomavirus (HPV) serotypes 16 and 18 are classified as high-risk types and are responsible for the vast majority of HPV-related cancers, particularly cervical cancer. These specific genotypes have oncogenic potential due to their ability to integrate into host DNA and disrupt cell cycle regulation. Other serotypes, like 6 and 11, are typically low-risk and cause benign conditions such as genital warts.

Question 81: A mild initial heart sound with a holosystolic apical murmur radiating to the left axilla during cardiac auscultation suggests _____.

mitral valve prolapse
mitral regurgitation (Correct answer)
aortic stenosis
mitral stenosis

Correct answer: mitral regurgitation

When performing cardiac auscultation, mitral regurgitation is indicated by a mild initial heart sound and a holosystolic apical murmur that radiate to the left axilla. When your heart is pumping blood out to your body, a holosystolic murmur might be heard.

Question 82: Which of the following vaccinations is not recommended for young children with acquired immunodeficiency syndrome (AIDS)?

Diphtheria and tetanus (Td)
Td and oral polio
Varicella (Correct answer)
Hepatitis B and mumps

Correct answer: Varicella

Live attenuated vaccines, such as the Varicella (chickenpox) vaccine, are generally contraindicated in individuals with severe immunocompromise, including young children with AIDS, due to the risk of vaccine-induced disease. The weakened virus in these vaccines could cause serious infection in a compromised immune system. Inactivated vaccines (like Hepatitis B, Td) are generally safe.

Question 83: Which medicine is linked to higher lipoprotein levels?

Hydrochlorothiazide (Microzide) (Correct answer)
Spironolactone (Aldactone)
Furosemide (Lasix)
Triamterene (Dyrenium)

Correct answer: Hydrochlorothiazide (Microzide)

Question 84: A 30-year-old woman at average risk asks how often she should have a Pap smear. What is the current USPSTF recommendation?

Annually
Every 2 years
Every 5 years (cytology alone)
Every 3 years (cytology alone) or every 5 years (with HPV co-testing) (Correct answer)

Correct answer: Every 3 years (cytology alone) or every 5 years (with HPV co-testing)

USPSTF recommends cervical cancer screening every 3 years with cytology alone, or every 5 years with high-risk HPV testing or co-testing for women aged 30-65.

Question 85: A 28-year-old woman presents 6 weeks postpartum with low mood, inability to bond with her infant, hopelessness, and passive suicidal ideation. What is the most appropriate initial intervention?

Reassure her that baby blues are normal and will resolve
Refer immediately to the emergency department
Screen with the Edinburgh Postnatal Depression Scale and initiate an SSRI (Correct answer)
Prescribe benzodiazepines for anxiety

Correct answer: Screen with the Edinburgh Postnatal Depression Scale and initiate an SSRI

Postpartum depression presenting at 6 weeks should be formally assessed and SSRIs (many safe during breastfeeding) are first-line pharmacotherapy.

Question 86: A 68-year-old patient with type 2 diabetes has an HbA1c of 9.2%. Which medication adjustment is most appropriate if they are already on metformin 1000mg twice daily?

Switch to insulin glargine only
Add a GLP-1 receptor agonist (Correct answer)
Increase metformin to 2500mg daily
Add a sulfonylurea

Correct answer: Add a GLP-1 receptor agonist

GLP-1 receptor agonists are preferred add-on agents due to cardiovascular benefits, weight loss, and low hypoglycemia risk in patients with uncontrolled T2DM on metformin.

Question 87: A patient with COPD exacerbation is found to have pursed-lip breathing. This compensatory mechanism primarily serves to:

Reduce respiratory rate
Increase tidal volume
Improve oxygen saturation by deep breathing
Slow exhalation to maintain airway pressure and prevent early airway collapse (Correct answer)

Correct answer: Slow exhalation to maintain airway pressure and prevent early airway collapse

Pursed-lip breathing creates positive expiratory pressure that splints small airways open, preventing dynamic collapse during exhalation in COPD.

Question 88: A 25-year-old woman presents with a painful vesicular rash in a dermatomal distribution on her right thorax. What is the treatment of choice if she presents within 72 hours of rash onset?

IV acyclovir only
Oral valacyclovir 1000 mg three times daily for 7 days (Correct answer)
Topical acyclovir cream
Oral prednisone alone

Correct answer: Oral valacyclovir 1000 mg three times daily for 7 days

Oral valacyclovir (or famciclovir) started within 72 hours of rash onset reduces the severity and duration of herpes zoster and lowers postherpetic neuralgia risk.

Question 89: A postmenopausal woman on hormone replacement therapy presents with unexpected vaginal bleeding. What is the priority next step?

Order pelvic ultrasound and endometrial biopsy (Correct answer)
Refer to gynecology in 3 months
Reassure that breakthrough bleeding is normal
Switch to a different HRT formulation

Correct answer: Order pelvic ultrasound and endometrial biopsy

Any postmenopausal bleeding must be evaluated promptly with endometrial biopsy and/or transvaginal ultrasound to rule out endometrial cancer.

Question 90: The family nurse practitioner in a small rural town sees an increase in chlamydia diagnoses and fears people are not telling their spouses, delaying treatment. The nurse practitioner opts to perform a little research study. Nurse practitioners use which sort of hypothesis?

Complex hypothesis
Deductive hypothesis
Non-directional hypothesis
Inductive hypothesis (Correct answer)

Correct answer: Inductive hypothesis

The inductive hypothesis is a strategy to provide a beginning point for the proof and then utilize it as a foundation to build the proof gradually.

Question 91: Alpha blockers are more prevalent among Southeast Asians of Indian, Chinese, or Filipino descent?

True
False (Correct answer)

Correct answer: False

A blood condition called thalassemia, pronounced thal-uh-SEE-mee-uh, is hereditary. This indicates that it is inherited through the genes of one or both parents. Your body creates less hemoglobin than usual when you have thalassemia. Red blood cells contain the iron-rich protein known as hemoglobin.

Question 92: A positive Phalen's test reproduces which symptom and in which condition?

Paresthesias in the first three fingers; carpal tunnel syndrome (Correct answer)
Numbness of the fifth finger; cubital tunnel syndrome
Wrist pain with gripping; De Quervain's tenosynovitis
Lateral elbow pain; tennis elbow

Correct answer: Paresthesias in the first three fingers; carpal tunnel syndrome

Phalen's test reproduces median nerve paresthesias in the thumb, index, and middle fingers, confirming carpal tunnel syndrome.

Question 93: Which breath sound is MOST characteristic of consolidation (pneumonia)?

Expiratory wheezing
Fine crackles bilaterally
Pleural friction rub
Bronchial breath sounds over lung periphery (Correct answer)

Correct answer: Bronchial breath sounds over lung periphery

Bronchial breath sounds heard over the peripheral lung fields indicate consolidation because solid tissue conducts sound differently than aerated lung.

Question 94: Nearsightedness

Myopia (Correct answer)
Proptosis
RICE Mnemonic
Ph of vagina

Correct answer: Myopia

Myopia, a disease that affects many people, causes near objects to appear clear while far-distant objects to appear blurry. It happens when light rays incorrectly bend (refract) due to the shape of the eye or specific portions of the eye.

Question 95: 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:

Immediately start an ACE inhibitor
Immediately start a thiazide diuretic
Lifestyle modification for 3–6 months before initiating medication (Correct answer)
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 96: The FNP notes a S4 heart sound in an older patient with hypertension. This sound occurs because of:

Rapid ventricular filling in early diastole
Mitral valve prolapse
Aortic stenosis turbulence
Reduced ventricular compliance requiring forceful atrial contraction (Correct answer)

Correct answer: Reduced ventricular compliance requiring forceful atrial contraction

An S4 results from atrial contraction against a stiff, noncompliant ventricle, commonly seen in hypertensive heart disease.

Question 97: Which screening tool is recommended by the USPSTF for depression in adults in the primary care setting?

Hamilton Depression Rating Scale (HAM-D)
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Beck Depression Inventory (BDI)
Columbia Suicide Severity Rating Scale (C-SSRS)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is the validated, widely recommended screening tool for depression in primary care settings and is endorsed by USPSTF guidelines.

Question 98: Which of the following is the most appropriate initial antibiotic for uncomplicated community-acquired pneumonia in a healthy adult without comorbidities?

Azithromycin or doxycycline (Correct answer)
Levofloxacin
Amoxicillin-clavulanate
Trimethoprim-sulfamethoxazole

Correct answer: Azithromycin or doxycycline

IDSA/ATS guidelines recommend a macrolide (azithromycin) or doxycycline as monotherapy for outpatient CAP in otherwise healthy adults with no comorbidities.

Question 99: The FNP prescribes metformin for a newly diagnosed type 2 diabetic. Which contraindication should be screened for FIRST?

eGFR <30 mL/min/1.73 m² (Correct answer)
Age >65 years
BMI >35
HbA1c >9%

Correct answer: eGFR <30 mL/min/1.73 m²

Metformin is contraindicated with significant renal impairment (eGFR <30) due to risk of lactic acidosis from drug accumulation.

Question 100: Two days ago, a 21-year-old woman presented to the clinic for evaluation of urine frequency and urgency. She has also observed little vaginal discharge. Symptoms are new to the patient. Urinalysis and culture are done on a urine sample. Which further results suggest pyelonephritis?

Leukocytosis
White blood cell casts (Correct answer)
Bacteriuria
Microscopic hematuria

Correct answer: White blood cell casts

White blood cell casts in a urinalysis are highly indicative of pyelonephritis (kidney infection) because they form in the renal tubules and signify inflammation within the kidney itself. While bacteriuria, leukocytosis, and microscopic hematuria can be present in UTIs, WBC casts specifically point to an upper urinary tract infection.

Question 101: The family nurse practitioner correlates the following in order to adhere to rules regarding documentation and third-party payor reimbursement:

patient privacy with informed consent
evaluation and management codes with history, examination, and medical decision-making (Correct answer)
health outcomes with physical examination findings and plans of care
medication orders and treatment plans with electronic billing

Correct answer: evaluation and management codes with history, examination, and medical decision-making

To meet requirements for reimbursement and documentation from third-party payors, the family nurse practitioner links evaluation and management codes with the patient's history, physical examination, and medical decisions. Many E/M codes need the coder to determine the type of history, examination, and medical decision-making, which may necessitate employing specialized grids and tables to verify requirements.

Question 102: Which intervention is most effective for reducing cardiovascular disease risk in a patient with hypertension and hyperlipidemia?

Vitamin E supplementation
Omega-3 supplementation
Therapeutic lifestyle changes including diet and exercise (Correct answer)
Daily aspirin therapy

Correct answer: Therapeutic lifestyle changes including diet and exercise

Therapeutic lifestyle changes including the DASH diet, weight loss, smoking cessation, and regular exercise are the most effective initial interventions for cardiovascular risk reduction.

Question 103: You are thinking about giving a patient bupropion (Wellbutrin) to help them quit smoking and deal with depression. What about the patient's health history would make you not want to prescribe this?

Coronary artery disease
Failure of other antidepressants to treat depression
Obesity
History of epilepsy (Correct answer)

Correct answer: History of epilepsy

Bupropion (Wellbutrin) is contraindicated in patients with a history of seizures or conditions that lower the seizure threshold, such as epilepsy. Bupropion is known to increase the risk of seizures, and this risk is dose-dependent. Therefore, prescribing it to someone with epilepsy would significantly elevate their risk of experiencing a seizure, making it an unsafe choice.

Question 104: A patient with heart failure and hypertension is started on lisinopril. The FNP should monitor for which MOST common side effect?

Hyperkalemia
Dry, nonproductive cough (Correct answer)
Angioedema
Renal failure

Correct answer: Dry, nonproductive cough

ACE inhibitors like lisinopril commonly cause a dry cough due to accumulation of bradykinin in the airways.

Question 105: A 58-year-old male with type 2 diabetes presents with a fasting glucose of 310 mg/dL and HbA1c of 10.2%. He is currently on metformin 1000 mg twice daily. What is the most appropriate next step?

Initiate insulin therapy (Correct answer)
Add a GLP-1 receptor agonist
Add a sulfonylurea
Increase metformin to 2550 mg/day

Correct answer: Initiate insulin therapy

With an HbA1c >10% and significantly elevated fasting glucose, insulin therapy is indicated to rapidly achieve glycemic control.

Question 106: A 30-year-old woman presents with a 2-cm thyroid nodule found incidentally on imaging. TSH is normal. What is the next appropriate step in evaluation?

Ultrasound-guided evaluation of the nodule (Correct answer)
Fine needle aspiration biopsy
Thyroid scintigraphy (nuclear scan)
Repeat imaging in 12 months

Correct answer: Ultrasound-guided evaluation of the nodule

Thyroid ultrasound is the recommended first-line evaluation for thyroid nodules to assess characteristics and guide further management.

Question 107: A 4-year-old child with a high fever develops a brief generalized tonic-clonic seizure lasting 90 seconds that self-resolves. This is the first episode. Which statement is most accurate?

The child must be started on phenobarbital prophylaxis
This is a simple febrile seizure and routine anti-epileptic therapy is not indicated (Correct answer)
Lumbar puncture is mandatory in all such cases
Immediate EEG and MRI are required

Correct answer: This is a simple febrile seizure and routine anti-epileptic therapy is not indicated

Simple febrile seizures (<15 minutes, generalized, single episode) in children 6 months–5 years do not require anti-epileptic treatment or routine neuroimaging.

Question 108: The FNP counsels a patient about sun safety. Which of the following recommendations aligns with skin cancer primary prevention?

Sunbathing for 30 minutes daily is safe with SPF 15
Avoid sunscreen as it blocks essential vitamin D synthesis
Use SPF 10 sunscreen only on cloudy days
Apply broad-spectrum SPF 30+ sunscreen, wear protective clothing, and avoid peak UV hours (Correct answer)

Correct answer: Apply broad-spectrum SPF 30+ sunscreen, wear protective clothing, and avoid peak UV hours

Primary prevention of skin cancer includes broad-spectrum SPF 30+ sunscreen, UV-protective clothing, and avoiding sun exposure during peak hours (10 AM–4 PM).

Question 109: A 25-year-old woman presents with dysuria and urinary frequency. Urinalysis shows positive nitrites and leukocyte esterase. She is not pregnant. What is the first-line treatment?

Nitrofurantoin for 5 days (Correct answer)
Ciprofloxacin for 3 days
Amoxicillin-clavulanate for 7 days
Trimethoprim-sulfamethoxazole for 3 days

Correct answer: Nitrofurantoin for 5 days

Nitrofurantoin for 5 days is a first-line treatment for uncomplicated UTI due to low resistance rates and minimal systemic side effects.

Question 110: A female patient presents with unilateral lower abdominal pain, missed period, and vaginal spotting. The FIRST test the FNP orders is:

Cervical cultures for STIs
CBC with differential
Pelvic ultrasound
Urine or serum hCG (pregnancy test) (Correct answer)

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 111: A patient is found to have TSH of 0.1 mIU/L with elevated free T4. The FNP interprets this as:

Subclinical hypothyroidism
Primary hyperthyroidism (Correct answer)
Primary hypothyroidism
Secondary hyperthyroidism

Correct answer: Primary hyperthyroidism

Low TSH with elevated free T4 indicates primary hyperthyroidism, where excess thyroid hormone suppresses pituitary TSH secretion.

Question 112: A child presents with a barking cough, stridor, and low-grade fever after a URI. The MOST likely diagnosis is:

Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Asthma exacerbation
Foreign body aspiration

Correct answer: Croup (laryngotracheobronchitis)

The classic triad of barking cough, inspiratory stridor, and low-grade fever following URI is diagnostic of croup, caused most often by parainfluenza virus.

Question 113: A patient in the third trimester of pregnancy presents with severe headache, visual changes, and BP of 162/110. The FNP's IMMEDIATE action is:

Recheck BP in 4 hours
Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia (Correct answer)
Advise bedrest and low-sodium diet
Start oral hydralazine and monitor in office

Correct answer: Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia

Severe-range BPs (≥160/110) with CNS symptoms in the third trimester meet criteria for severe preeclampsia, requiring emergency hospitalization and IV antihypertensives.

Question 114: When examining skin turgor in elderly patients, the best site for assessment is the:

Forearm
Forehead or sternum (Correct answer)
Abdomen
Dorsum of the hand

Correct answer: Forehead or sternum

In elderly patients, skin loses elasticity at the hands and forearms due to aging, making the forehead or sternum more reliable for assessing hydration status.

Question 115: A 5-year-old presents with periorbital edema, frothy urine, and abdominal pain. Urinalysis shows 4+ protein. Which condition is the most common cause in this age group?

IgA nephropathy
Focal segmental glomerulosclerosis
Membranous nephropathy
Minimal change disease (Correct answer)

Correct answer: Minimal change disease

Minimal change disease is the most common cause of nephrotic syndrome in children aged 1–8 years and typically responds well to corticosteroids.

Question 116: A 45-year-old woman presents with fatigue, weight gain, constipation, cold intolerance, and bradycardia. The BEST initial diagnostic test is:

Free T4 level
TSH level (Correct answer)
Thyroid ultrasound
T3 uptake

Correct answer: TSH level

TSH is the most sensitive test for thyroid dysfunction; an elevated TSH confirms primary hypothyroidism before further testing.

Question 117: The FNP is conducting a sports physical for a 16-year-old. Which finding warrants DISQUALIFICATION from contact sports?

History of simple concussion cleared by neurology
Single functional kidney (Correct answer)
Well-controlled asthma
Mild exercise-induced bronchospasm treated with albuterol

Correct answer: Single functional kidney

A single functional kidney is a relative-to-absolute contraindication for contact sports because trauma could result in loss of the only functioning kidney.

Question 118: At what age should women of average risk begin mammography screening according to the USPSTF (2024 guidelines)?

45 years
35 years
40 years (Correct answer)
50 years

Correct answer: 40 years

The USPSTF 2024 updated guidelines recommend that women begin biennial mammography screening at age 40.

Question 119: All of the following are used to treat mild preeclampsia, except for ______.

close monitoring of weight and blood pressure
close follow-up of urinary protein, serum creatinine, and platelet count
a prescription of methyldopa (Aldomet) to control blood pressure (Correct answer)
bed rest except for bathroom privileges

Correct answer: a prescription of methyldopa (Aldomet) to control blood pressure

For *mild preeclampsia*, the primary management focuses on close monitoring and conservative measures rather than immediate antihypertensive medication. Antihypertensives are typically reserved for severe preeclampsia to prevent complications like stroke. Close follow-up of urinary protein, serum creatinine, platelet count, weight, blood pressure, and bed rest are standard for mild cases.

Question 120: When a patient is being examined physically, the facial nerve's health can be determined by asking them to:

clench their teeth
produce a big yawn
puff out both cheeks (Correct answer)
extrude their tongue

Correct answer: puff out both cheeks

During a physical examination, the patient's ability to puff out both cheeks can be used to determine the facial nerve's health. This is a component of the cranial nerve examination, which measures how well the 12 pairs of cranial nerves in the head and neck are functioning.

Question 121: A patient on fluoxetine is prescribed tramadol for pain. The FNP's GREATEST concern is:

Drug-induced hepatitis
QT prolongation
Opioid respiratory depression
Serotonin syndrome (Correct answer)

Correct answer: Serotonin syndrome

Tramadol inhibits serotonin reuptake; combined with SSRIs like fluoxetine, this dramatically increases the risk of serotonin syndrome.

Question 122: First-airway, breathing circulation (ABC) frequently provides the instant response First, assess before diagnosing (working), diagnose before planning, plan before intervening, and intervene before evaluating treatment response. The selection of diagnostics, interventions, and follow-up procedures is guided by the most appropriate evidence-based practice, which also establishes the right response.

M. PNA/C. PNA
Prioritize (Correct answer)
Obturator sign
Drawer sign

Correct answer: Prioritize

When you approach the victim, the first things you should examine are the ABCs of first aid: Airway, Breathing, and Circulation. Make sure the patient's airway is clear, confirm that they are breathing, and check their circulation (by feeling their pulse or observing the color and temperature of their hands and fingers).

Question 123: A 30-year-old woman at 10 weeks gestation presents with nausea and vomiting. She has lost 5 lbs, has dry mucous membranes, and urine specific gravity of 1.030. What is the diagnosis?

Gastroenteritis
Typical morning sickness
Hyperemesis gravidarum (Correct answer)
Peptic ulcer disease

Correct answer: Hyperemesis gravidarum

Hyperemesis gravidarum is characterized by severe nausea/vomiting with weight loss >5% of pre-pregnancy weight and signs of dehydration.

Question 124: 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)
D-dimer is not useful in the Wells score algorithm
A positive D-dimer confirms PE regardless of pre-test probability
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 125: Which counseling intervention is most supported by evidence for helping patients achieve smoking cessation?

Hypnotherapy alone
Cold turkey cessation without support
Combination of pharmacotherapy (varenicline or NRT) with behavioral counseling (Correct answer)
Acupuncture therapy

Correct answer: Combination of pharmacotherapy (varenicline or NRT) with behavioral counseling

Combining FDA-approved pharmacotherapy (varenicline, bupropion, or nicotine replacement therapy) with behavioral counseling yields the highest quit rates in evidence-based guidelines.

Question 126: Which of the following findings on a diabetic foot exam requires immediate referral to a vascular surgeon?

Vibration sense loss at the great toe
Absent hair growth on the dorsum of the foot
Dry skin with mild callus formation
Ankle-brachial index (ABI) of 0.55 with rest pain (Correct answer)

Correct answer: Ankle-brachial index (ABI) of 0.55 with rest pain

An ABI below 0.6 with rest pain indicates critical limb ischemia requiring urgent vascular surgery evaluation.

Question 127: Patients over 60 are more likely to get cataracts. You advise your patient that the following is the best treatment for cataracts _____.

Dietary supplements
Medications
Optical devices
Corrective lens surgery (Correct answer)

Correct answer: Corrective lens surgery

Cataracts are a clouding of the eye's natural lens, leading to blurry vision that cannot be corrected with glasses alone in advanced stages. While optical devices can offer temporary help in early stages, the only definitive and most effective treatment for cataracts is surgical removal of the cloudy lens. This procedure, followed by the implantation of an artificial intraocular lens, restores clear vision and is a common, highly successful operation.

Question 128: Which of the following is an absolute contraindication to the use of combined oral contraceptive pills (COCPs)?

Personal history of DVT or pulmonary embolism (Correct answer)
Mild controlled hypertension
Age over 35 with no smoking history
History of migraines without aura

Correct answer: Personal history of DVT or pulmonary embolism

A personal history of venous thromboembolism (DVT/PE) is an absolute contraindication to estrogen-containing contraceptives due to markedly elevated clot risk.

Question 129: After a car accident, Barbara, age 27, had her spleen removed. Since she was released from the hospital, this is the first time you have seen her at the office. She inquires about the long-term effects of her procedure. What is your response?

Your lymphatic system may have difficulty transporting lymph fluid to the blood vessels.
You'll have difficulty storing the nutritional agents needed to make red blood cells.
You may have difficulty salvaging iron from old red blood cells for reuse. (Correct answer)
Your red blood cell production will be slowed.

Correct answer: You may have difficulty salvaging iron from old red blood cells for reuse.

The spleen plays a crucial role in filtering blood, removing old or damaged red blood cells, and salvaging iron from them for reuse in new red blood cell production. After a splenectomy, the body loses this primary site for red blood cell breakdown and iron recycling. While other organs can partially compensate, there can be long-term implications for iron metabolism and an increased susceptibility to certain infections.

Question 130: A 28-year-old woman presents with a painless, indurated genital ulcer with a clean base and no exudate. Inguinal lymphadenopathy is non-tender. What is the most likely diagnosis?

Primary syphilis (Correct answer)
Chancroid
Genital herpes
Lymphogranuloma venereum

Correct answer: Primary syphilis

A clean, painless, indurated ulcer (chancre) with non-tender lymphadenopathy is the hallmark of primary syphilis caused by Treponema pallidum.

Question 131: A 55-year-old male smoker presents with a 3-cm solitary pulmonary nodule on CT scan. What is the recommended next step?

Immediate surgical resection
Repeat CT in 12 months
Bronchoscopy with biopsy
PET scan (Correct answer)

Correct answer: PET scan

A solid nodule >8mm in a high-risk patient warrants a PET scan or tissue sampling per Fleischner Society guidelines to assess malignancy risk.

Question 132: A 68-year-old man with BPH and hypertension is started on tamsulosin. What key adverse effect should the FNP counsel him about, especially before any planned eye surgery?

Intraoperative floppy iris syndrome (Correct answer)
Acute urinary retention worsening
Hyperkalemia
Retrograde ejaculation only

Correct answer: Intraoperative floppy iris syndrome

Alpha-blockers like tamsulosin cause intraoperative floppy iris syndrome, which ophthalmologists must be notified about prior to cataract surgery.

Question 133: Lea, 29, has been identified as having urticaria and has a number of transitory lesions that appear and go. What will you get?

Antihistamines (Correct answer)
Opioids
Aspirin
Ibuprofen

Correct answer: Antihistamines

Urticaria, commonly known as hives, is an allergic reaction characterized by itchy, red, and transient welts on the skin. The primary mechanism involves the release of histamine, which causes vasodilation and increased capillary permeability. Therefore, antihistamines are the first-line treatment to block histamine receptors, reduce itching, and alleviate the rash.

Question 134: Jerry, 35, has dermatosis and uses a high-potency corticosteroid cream. He also has tinea corporis. Tell him about the cream:

It will work better if you occlude the area.
Be sure to use it daily.
You must use this for an extended period of time for it to be effective.
It may exacerbate your concurrent tinea corporis. (Correct answer)

Correct answer: It may exacerbate your concurrent tinea corporis.

High-potency corticosteroid creams suppress the immune response, which can worsen fungal infections like tinea corporis. Using corticosteroids on a fungal infection can mask symptoms and allow the infection to spread or become more severe. Therefore, it's crucial to warn the patient about this potential exacerbation.

Question 135: A 55-year-old man with hypertension and stage 3 CKD (GFR 42) needs antihypertensive therapy. Which medication class is most beneficial for renoprotection in this patient?

ACE inhibitor (Correct answer)
Calcium channel blocker
Thiazide diuretic
Beta-blocker

Correct answer: ACE inhibitor

ACE inhibitors reduce intraglomerular pressure and proteinuria, providing renoprotective benefits in CKD patients.

Question 136: Which parameter is used to calculate the CURB-65 score for pneumonia severity?

White blood cell count >12,000
Pleural effusion on X-ray
SpO2 <90%
Blood urea nitrogen >19 mg/dL (Correct answer)

Correct answer: Blood urea nitrogen >19 mg/dL

CURB-65 includes Confusion, Urea >7 mmol/L (BUN >19 mg/dL), Respiratory rate ≥30, Blood pressure <90/60, and age ≥65 to assess pneumonia severity.

Question 137: A 72-year-old presents with sudden onset of painless vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?

Acute angle-closure glaucoma
Central retinal artery occlusion
Optic neuritis
Retinal detachment (Correct answer)

Correct answer: Retinal detachment

Painless, sudden vision loss described as a descending curtain is the classic presentation of retinal detachment, an ophthalmologic emergency.

Question 138: A healthy 45-year-old woman asks about osteoporosis screening. What is the appropriate recommendation?

DEXA scan now
No screening needed until menopause
DEXA scan at age 65 (Correct answer)
DEXA scan at age 50

Correct answer: DEXA scan at age 65

USPSTF recommends bone density screening with DEXA for women aged 65 and older; younger postmenopausal women with risk factors may screen earlier.

Question 139: When Trina, 59, arrives for her yearly physical, she has no specific problems. Nonetheless, she has been diagnosed with type 2 diabetes mellitus (DM), mild hypertension, dyslipidemia, and central obesity. How would you make the diagnosis?

As having metabolic syndrome (Correct answer)
As having multiple organ dysfunction
As a healthy adult with several problems
As having a glycemic event

Correct answer: As having metabolic syndrome

Metabolic syndrome is a cluster of conditions that occur together, significantly increasing the risk of heart disease, stroke, and type 2 diabetes. Trina's diagnoses of type 2 diabetes mellitus, mild hypertension, dyslipidemia, and central obesity are all key diagnostic criteria for metabolic syndrome. Therefore, these co-occurring conditions collectively indicate this specific syndrome.

Question 140: The FNP is discussing the HPV vaccine with the parent of a 12-year-old. What is the recommended schedule for this age group?

2-dose series at 0 and 6-12 months (Correct answer)
Single dose only
2-dose series at 0 and 2 months
3-dose series at 0, 1, and 6 months

Correct answer: 2-dose series at 0 and 6-12 months

For adolescents who start the HPV vaccine series before age 15, a 2-dose schedule (0 and 6-12 months apart) is recommended.

Question 141: A 50-year-old man presents with a total cholesterol of 240, LDL of 165, HDL of 38, and triglycerides of 210. He has diabetes and hypertension. Using the ACC/AHA Pooled Cohort Equations, his 10-year ASCVD risk is 13%. Which statin intensity is recommended?

High-intensity statin (Correct answer)
No statin indicated; lifestyle modification only
Low-intensity statin
Moderate-intensity statin

Correct answer: High-intensity statin

A 10-year ASCVD risk ≥10% with diabetes and additional risk factors warrants high-intensity statin therapy per ACC/AHA guidelines.

Question 142: A patient presents with painful vesicles in a dermatomal distribution on one side of the trunk. The FNP diagnoses herpes zoster and notes the MOST important reason to treat promptly with antivirals:

To prevent transmission to others
To eliminate the virus permanently
To reduce the risk of bacterial superinfection only
To reduce the severity and duration of postherpetic neuralgia (Correct answer)

Correct answer: To reduce the severity and duration of postherpetic neuralgia

Early antiviral treatment (within 72 hours) reduces the risk and severity of postherpetic neuralgia, the most common complication of herpes zoster.

Question 143: A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and slight euphoria exhibits signs of using ______.

alprazolam (Xanax)
morphine sulfate (MS Contin)
cocaine (Correct answer)
oxycodone hydrochloride (OxyCONTIN)

Correct answer: cocaine

Cocaine usage is accompanied with epistaxis, dilated pupils, tachycardia, and slight euphoria. Your pupils may seem bigger than usual if you use cocaine. Additionally, it could give you bloodshot, watery eyes. Cocaine elevates blood pressure because it causes blood vessels to constrict. In addition to causing redness and blurred vision, this can also lead to corneal damage. Another typical sign of cocaine toxicity is tachycardia.

Question 144: A 72-year-old patient is prescribed a benzodiazepine for anxiety. The FNP recognizes this is a Beers Criteria concern because:

Renal clearance increases with age requiring higher doses
Older adults are at increased risk for falls, cognitive impairment, and paradoxical agitation (Correct answer)
They cause irreversible memory loss in all patients over 65
Benzodiazepines are less effective in elderly patients

Correct answer: Older adults are at increased risk for falls, cognitive impairment, and paradoxical agitation

The AGS Beers Criteria flags benzodiazepines in older adults due to heightened sensitivity causing falls, fractures, motor impairment, and cognitive decline.

Question 145: In the middle of the night, after having a steak meal with friends, a 55-year-old man with type 2 diabetes mellitus appears with significant right foot discomfort. The first metatarsophalangeal joint is swollen and painful during physical examination. During a joint aspiration, monosodium urate crystals were seen in the synovial fluid under a microscope. Which of the following offers the most effective first care?

Prednisone
Non-steroidal anti-inflammatory drugs (NSAIDs) (Correct answer)
Allopurinol
Probenecid

Correct answer: Non-steroidal anti-inflammatory drugs (NSAIDs)

The patient's symptoms (acute, severe right foot pain, swollen MTP joint after a steak meal, monosodium urate crystals) are classic for an acute gout attack. NSAIDs are typically the first-line treatment for acute gout due to their rapid anti-inflammatory and analgesic effects. Prednisone is an alternative if NSAIDs are contraindicated, while allopurinol and probenecid are for long-term prevention, not acute attacks.

Question 146: Determining occupational exposure to illness might be challenging because of the following _____.

confidentiality of the information within company records
reliance on workers' memories
long latency period between exposure and disease development (Correct answer)
inaccuracy of occupational disease reporting

Correct answer: long latency period between exposure and disease development

Occupational illness exposure is difficult to determine because of the long latency time between exposure and disease development. Occupational illnesses typically have a lengthy latency period between the beginning of exposure and the development of the disease.

Question 147: Which of the following best describes tertiary prevention in the context of a patient with heart failure?

Screening ECG in all adults over 40
Reducing dietary sodium before heart failure develops
Cardiac rehabilitation and medication adherence to prevent hospitalization (Correct answer)
Avoiding smoking to prevent coronary artery disease

Correct answer: Cardiac rehabilitation and medication adherence to prevent hospitalization

Tertiary prevention aims to minimize complications and improve function in patients with established disease, such as cardiac rehab for heart failure patients.

Question 148: The FNP is counseling a 28-year-old woman planning pregnancy. Which supplement should be recommended to reduce the risk of neural tube defects?

Iron 65 mg/day
Calcium 1,200 mg/day
Vitamin D 2,000 IU/day
Folic acid 400-800 mcg/day (Correct answer)

Correct answer: Folic acid 400-800 mcg/day

Folic acid 400-800 mcg daily is recommended for all women of childbearing age, and especially before conception, to prevent neural tube defects.

Question 149: A patient on warfarin for atrial fibrillation presents with an INR of 5.8 but no active bleeding. What is the most appropriate management?

Hold 1-2 doses of warfarin and recheck INR (Correct answer)
Hold warfarin and give vitamin K 10 mg IV
Continue warfarin and recheck INR in 1 week
Administer fresh frozen plasma

Correct answer: Hold 1-2 doses of warfarin and recheck INR

For a supratherapeutic INR without bleeding, holding 1-2 doses and rechecking the INR is the standard approach.

Question 150: Six-year-old Doug presents with abdominal distention and discomfort, a right abdominal mass, a fever, and microscopic hematuria. No precipitating event has occurred. What are your suspicions?

An intestinal obstruction
Appendicitis
A urinary tract infection (UTI)
Wilms tumor (Correct answer)

Correct answer: Wilms tumor

Wilms tumor, also known as nephroblastoma, is a common kidney cancer in children. The classic presentation includes an asymptomatic abdominal mass, which is often discovered during a routine physical exam or when parents notice abdominal distention. Other symptoms like fever and microscopic hematuria (blood in urine) are also consistent with this diagnosis, making it the most suspicious condition given Doug's symptoms.

Question 151: A school-age child presents with an intensely pruritic rash with linear burrows between the fingers and on the wrists, worse at night. What is the treatment?

Topical permethrin 5% cream applied from neck to toes and washed off after 8–14 hours (Correct answer)
Topical hydrocortisone cream
Oral prednisone burst
Oral antihistamine for 2 weeks

Correct answer: Topical permethrin 5% cream applied from neck to toes and washed off after 8–14 hours

Scabies is treated with permethrin 5% cream applied to the entire body surface from neck down and left on for 8–14 hours; all household members should be treated simultaneously.

Question 152: Sharon, 52, has four children and a demanding job. After a normal physical exam, she states that she suffers from insomnia. You suggest several changes to one's daily routine that may improve sleep quality. You know she doesn't understand when she says which of the following?

I'll try some valerian extract from the health food store.
I'll exercise in the evening to tire myself out before bed. (Correct answer)
I'll try some valerian extract from the health food store.
I'll wind down before bedtime by taking a warm bath or by reading for 10 minutes.

Correct answer: I'll exercise in the evening to tire myself out before bed.

Exercising vigorously in the evening, especially close to bedtime, can stimulate the body and raise core body temperature, making it harder to fall asleep. Good sleep hygiene recommends avoiding strenuous physical activity within a few hours of going to bed. The other options, such as using valerian extract, taking a warm bath, or reading, are generally considered beneficial for promoting relaxation and improving sleep quality.

Question 153: B12 deficiency anemia causes which of these symptoms?

Tingling and numbness of both feet (Correct answer)
An abnormal neurological exam
A vegan diet
Spoon-shaped nails and pica

Correct answer: Tingling and numbness of both feet

Vitamin B12 deficiency anemia often manifests with neurological symptoms due to its role in nerve health. Peripheral neuropathy, characterized by tingling, numbness, and paresthesias (often in the feet and hands), is a classic neurological symptom of B12 deficiency. A vegan diet is a *cause*, not a symptom, and spoon-shaped nails/pica are associated with iron deficiency.

Question 154: A 68-year-old male with a history of BPH presents with acute urinary retention. What is the immediate management?

Order a renal ultrasound before any intervention
Administer furosemide to promote urination
Insert a urinary catheter to decompress the bladder (Correct answer)
Start tamsulosin and reassess in 48 hours

Correct answer: Insert a urinary catheter to decompress the bladder

Acute urinary retention requires immediate bladder decompression via urethral catheterization to prevent renal damage and relieve pain.

Question 155: Which finding on fetal non-stress test (NST) indicates a reactive (reassuring) result?

Baseline fetal heart rate of 100 bpm
Absence of fetal movement over 30 minutes
Variable decelerations with each movement
Two or more fetal heart rate accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes (Correct answer)

Correct answer: Two or more fetal heart rate accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes

A reactive NST requires at least two accelerations of ≥15 bpm above baseline for ≥15 seconds within a 20-minute window, indicating fetal well-being.

Question 156: What is Goodpasture syndrome?

An inflammatory autoimmune disorder affecting the connective tissue of the body, with inflammatory lesions involving the supportive tissues of the glomeruli.
Characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes. (Correct answer)
Typically, the end stage of other glomerular disorders, such as rapidly progressive glomerulonephritis, lupus nephritis, or diabetic nephropathy.

Correct answer: Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes.

Goodpasture syndrome is a rare autoimmune disease characterized by the presence of antibodies that target the basement membranes of the glomeruli in the kidneys and the alveoli in the lungs. This immune complex damage leads to a distinctive clinical presentation of rapidly progressive glomerulonephritis and pulmonary hemorrhage. The simultaneous involvement of both organs is a hallmark of this specific condition.

Question 157: A 50-year-old man is examined for a severe headache, motion sickness, and discomfort in his left eye. His symptoms began abruptly few hours ago, and despite rest and ibuprofen, his headache has not gone. He took an over-the-counter oral decongestant this morning due to a little cold he had. Physical examination reveals a nonreactive, mid-dilated left pupil. Conjunctival flushing makes the eye look red. In terms of management, which option below is more appropriate?

No additional management indicated
Fluorescein staining of the eye
Tonometry (Correct answer)
Eye patch placement and follow up in 3 days

Correct answer: Tonometry

The patient's symptoms (severe headache, motion sickness, left eye discomfort, abrupt onset, mid-dilated nonreactive pupil, conjunctival flushing) are highly suggestive of acute angle-closure glaucoma. This is a medical emergency characterized by a sudden increase in intraocular pressure. Tonometry is the diagnostic test used to measure intraocular pressure, which is crucial for confirming the diagnosis and guiding immediate treatment.

Question 158: Which finding on urinalysis is most specific for a urinary tract infection caused by E. coli?

Presence of protein
Hematuria alone
Specific gravity > 1.020
Positive leukocyte esterase and nitrites with WBC casts (Correct answer)

Correct answer: Positive leukocyte esterase and nitrites with WBC casts

Positive leukocyte esterase (indicating WBCs) combined with positive nitrites (indicating gram-negative bacteria like E. coli) is most specific for bacterial UTI.

Question 159: The FNP is performing a cranial nerve assessment and asks the patient to follow a finger in all directions. Which cranial nerves are being tested?

CN V, VII, VIII
CN III, IV, VI (Correct answer)
CN IV, V, VI
CN II, III, IV

Correct answer: CN III, IV, VI

Extraocular movements are controlled by the oculomotor (III), trochlear (IV), and abducens (VI) cranial nerves.

Question 160: Which of the following can be detected with the Lachman maneuver?

The integrity of the patellar tendon
Knee instability (Correct answer)
Tears on the meniscus of the knee
Nerve damage of the knee due to past knee injuries

Correct answer: Knee instability

The Lachman maneuver is a clinical test specifically used to assess the integrity of the anterior cruciate ligament (ACL) in the knee. A positive Lachman test (excessive anterior tibial translation without a firm endpoint) indicates ACL laxity or a tear, which directly contributes to knee instability. It helps diagnose ACL injuries.

Question 161: A patient with hypothyroidism is also started on cholestyramine. The FNP should advise that levothyroxine be taken:

Every other day to reduce binding
At bedtime to avoid interactions
At least 4 hours before or after cholestyramine (Correct answer)
With cholestyramine to improve absorption

Correct answer: At least 4 hours before or after cholestyramine

Cholestyramine binds levothyroxine in the GI tract and significantly impairs its absorption, requiring a 4-hour separation.

Question 162: When an elderly patient's HIV infection is discovered, zidovudine is prescribed (Retrovir). Which diagnostic procedure is useful in determining the drug's side effects?

Immunodeficiency panel
Hemoglobin A1
Serum glucose
Complete blood count (Correct answer)

Correct answer: Complete blood count

The results of a complete blood count (CBC), a diagnostic test, can be used to evaluate the adverse effects of the drug zidovudine (Retrovir). Hematologic side effects of Retrovir (zidovudine), particularly in patients with advanced human immunodeficiency virus (HIV) illness, include neutropenia and severe anemia1. CBC can aid in the detection of these adverse effects.

Question 163: The FNP is counseling a 25-year-old female on combined oral contraceptive pills (COCs). Which absolute contraindication (WHOMEC Category 4) should be screened for?

Controlled hypertension
History of DVT or pulmonary embolism (Correct answer)
Irregular menstrual cycles
Smoking fewer than 15 cigarettes per day under age 35

Correct answer: History of DVT or pulmonary embolism

Personal history of DVT or PE is a WHO Medical Eligibility Criteria Category 4 (absolute) contraindication to estrogen-containing contraceptives due to thrombosis risk.

Question 164: The blood pressure of a diabetic patient, age 60, is 150/96 mmHg. The patient has lost 10 pounds after three months of increased exercise and reduced calories (4.54 kg). The patient's blood pressure was 142/94 mmHg at the follow-up visit. What medicine does the family nurse practitioner recommend?

Hydrochlorothiazide (HydroDIURIL)
Enalapril (Vasotec) (Correct answer)
Furosemide (Lasix)
Propranolol (Inderal)

Correct answer: Enalapril (Vasotec)

A drug called Enalapril (Vasotec) is used to treat heart failure and high blood pressure. It is an angiotensin converting enzyme (ACE) inhibitor, which relaxes the blood vessels by preventing the body from producing a chemical that causes blood vessels to constrict. This decreases blood pressure and supplies more blood and oxygen to the heart.

Question 165: An uncommon yet severe side effect of ACE inhibitors is:

Angioedema (Correct answer)
Bullae
Glaucoma
none of the above

Correct answer: Angioedema

Angioedema, which affects 0.1-0.2% of people, is the most serious side effect of ACE inhibitors. The basic characteristics of angioedema include airway swelling and blockage brought on by fluid (and bradykinin) buildup.

Question 166: Which cervical cancer screening guideline applies to a 32-year-old woman with no prior abnormal results?

No screening needed until age 40
Co-testing (Pap + HPV) every 5 years (Correct answer)
HPV testing alone every 3 years
Pap smear every year

Correct answer: Co-testing (Pap + HPV) every 5 years

Current USPSTF guidelines recommend co-testing with Pap smear and HPV test every 5 years for women aged 30–65 as a preferred option.

Question 167: A 2-year-old presents with fever, irritability, and bulging fontanelle. Lumbar puncture shows CSF with elevated protein, decreased glucose, and WBC 800 cells/μL with 90% neutrophils. What is the most likely causative organism?

Streptococcus pneumoniae (Correct answer)
Neisseria meningitidis
Haemophilus influenzae
Listeria monocytogenes

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the most common cause of bacterial meningitis in children over 1 month and adults.

Question 168: Which change in lifestyle lowers the risk of death most when it comes to coronary heart disease?

Moderate exercise—greater than 30 minutes a day 3 times a week.
Quitting smoking. (Correct answer)
Weight loss.
Fasting low-density lipoprotein (LDL) cholesterol less than 100.

Correct answer: Quitting smoking.

Smoking is one of the most significant modifiable risk factors for coronary heart disease (CHD) and overall mortality. Quitting smoking dramatically reduces the risk of heart attack, stroke, and death from cardiovascular disease, with benefits seen rapidly after cessation. While other lifestyle changes are beneficial, quitting smoking offers the most substantial and immediate reduction in CHD mortality risk.

Question 169: A 3-year-old child presents with inspiratory stridor, a barking cough, and low-grade fever. The symptoms worsen at night. What is the most likely diagnosis?

Croup (laryngotracheobronchitis) (Correct answer)
Foreign body aspiration
Bacterial tracheitis
Epiglottitis

Correct answer: Croup (laryngotracheobronchitis)

Viral croup classically presents with a barking cough, inspiratory stridor, and symptoms that worsen at night in young children.

Question 170: Which inhaler medication is used as a RESCUE (quick-relief) agent in asthma?

Albuterol (short-acting beta-2 agonist) (Correct answer)
Salmeterol (long-acting beta-2 agonist)
Fluticasone (inhaled corticosteroid)
Montelukast (leukotriene modifier)

Correct answer: Albuterol (short-acting beta-2 agonist)

Albuterol, a SABA, acts within minutes to relieve acute bronchoconstriction and is the standard rescue inhaler for asthma.

Question 171: When counseling a patient about the Tdap vaccine, the FNP should advise that protection against pertussis typically wanes after approximately how many years?

10 years
15 years
5 years (Correct answer)
2 years

Correct answer: 5 years

Immunity from the Tdap vaccine against pertussis wanes significantly after about 5 years, which is why booster doses are recommended.

Question 172: The family nurse practitioner takes part in a quality improvement project at the hospital. To make sure diabetic procedures are followed, the nurse practitioner checks four of a colleague's charts each month. This method is a _____.

core competency
peer review (Correct answer)
risk analysis
force field analysis

Correct answer: peer review

Health and social care research and practice are evaluated and validated through a process called "peer review," which involves professionals in the same profession or subject examining and commenting on the work of their colleagues. Peer review is utilized for quality improvement, innovation, and learning across the health care system.

Question 173: A 65-year-old with a 30 pack-year smoking history presents with a FEV1/FVC ratio of 0.65 post-bronchodilator. The MOST likely diagnosis is:

Pulmonary fibrosis
Asthma
Chronic obstructive pulmonary disease (COPD) (Correct answer)
Normal spirometry

Correct answer: Chronic obstructive pulmonary disease (COPD)

A post-bronchodilator FEV1/FVC ratio <0.70 in a smoker confirms the obstructive pattern required for GOLD criteria COPD diagnosis.

Question 174: Congestive heart failure has recently been diagnosed in Greg, age 68. (CHF). Which medicine should be stopped for him?

Hydrochlorothiazide (HydroDIURIL) for his hypertension.
Nifedipine (Procardia XL) for long-term management of his chronic stable angina. (Correct answer)
Enalapril (Vasotec) for his hypertension.
Butalbital for his headaches.

Correct answer: Nifedipine (Procardia XL) for long-term management of his chronic stable angina.

Nifedipine, particularly immediate-release formulations, is a dihydropyridine calcium channel blocker that can cause peripheral vasodilation and reflex tachycardia, which can worsen heart failure symptoms or exacerbate myocardial ischemia. While extended-release forms like Procardia XL are safer, non-dihydropyridine CCBs or other anti-anginal agents are generally preferred in CHF patients if a CCB is needed. Beta-blockers (if stable CHF), ACE inhibitors, and diuretics are often beneficial in CHF management, making nifedipine a less suitable choice.

Question 175: Which medication is first-line for acute gout flare management in a patient with no contraindications?

Allopurinol
Febuxostat
Colchicine or NSAIDs (Correct answer)
Probenecid

Correct answer: Colchicine or NSAIDs

NSAIDs or colchicine (started within 24 hours of flare onset) are first-line treatments for acute gout; allopurinol and probenecid are used for chronic prophylaxis.

Question 176: While playing, a nine-year-old child suffered a small laceration. According to the patient's vaccination history, the patient had a primary series of the pediatric DTaP vaccine, a primary series of the oral poliovirus vaccine, and a DTaP booster shot at age five, right before starting school. The family nurse practitioner provides the patient with the following according to current vaccination recommendations ______.

a DTaP booster
a booster of diphtheria and tetanus toxoids
a tetanus toxoid injection
no injection at this time (Correct answer)

Correct answer: no injection at this time

The patient's immunization history included a primary series of the pediatric DTaP vaccine, a primary series of the oral poliovirus vaccine, and a booster injection at age five before starting school. According to the most recent immunization guidelines, the family nurse practitioner administers the following (no injection required) to the patient.

Family Nurse Practitioner (FNP) Certification Exam (ANCC/AANP)

The FNP certification exam assesses the knowledge and skills required for advanced practice registered nurses to provide comprehensive primary healthcare to individuals and families across the lifespan.

175

Questions

210 min

Time Limit

70%

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