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

Question 1: Which inhaler medication is used as a RESCUE (quick-relief) agent in asthma?

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

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 2: 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?

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

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 3: Guidelines for clinical practice should:

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

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

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

Correct answer: Central retinal artery occlusion

Central retinal artery occlusion causes sudden, painless, complete monocular vision loss and is an ophthalmic emergency requiring immediate intervention.

Question 5: A 2-year-old child is brought in with a bulging fontanelle, high fever, and nuchal rigidity. Which action should the FNP take FIRST?

Administer acetaminophen and observe
Perform a lumbar puncture immediately
Order a CT head before any intervention
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 6: A patient has pitting edema graded 3+. How deep is the pit and how long does it take to rebound?

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

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 7: A 40-year-old woman with fatigue, weight gain, cold intolerance, and constipation has a TSH of 9.2 mIU/L and free T4 of 0.6 ng/dL. What is the treatment?

Methimazole therapy
Levothyroxine therapy (Correct answer)
Radioactive iodine ablation
Propylthiouracil therapy

Correct answer: Levothyroxine therapy

Primary hypothyroidism with elevated TSH and low free T4 is treated with synthetic levothyroxine (T4) replacement therapy.

Question 8: 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?

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

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

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

Correct answer: Primary hyperthyroidism

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

Question 10: A 72-year-old patient is prescribed a benzodiazepine for anxiety. The FNP recognizes this is a Beers Criteria concern because:

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

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 11: Which of the following is a primary prevention strategy for type 2 diabetes in a high-risk patient?

Lifestyle modification including weight loss and increased physical activity (Correct answer)
Referring to endocrinology
Starting metformin immediately
Annual HbA1c testing

Correct answer: Lifestyle modification including weight loss and increased physical activity

Lifestyle interventions including 5-7% weight loss and 150 minutes of moderate physical activity weekly are first-line primary prevention for type 2 diabetes in high-risk individuals.

Question 12: Which screening test is recommended by the USPSTF for colorectal cancer starting at age 45 in average-risk adults?

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

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

Beta-blocker (e.g., metoprolol succinate) (Correct answer)
Calcium channel blocker (e.g., diltiazem)
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 14: 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?

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

No screening needed until age 40
HPV testing alone every 3 years
Co-testing (Pap + HPV) every 5 years (Correct answer)
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 16: 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 an immediate lateral neck x-ray
requesting a referral for evaluation of the larynx (Correct answer)
ordering a computed tomography scan of the head
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 17: 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 exercise in the evening to tire myself out before bed. (Correct answer)
I'll wind down before bedtime by taking a warm bath or by reading for 10 minutes.
I'll try some valerian extract from the health food store.
I'll try some valerian extract from the health food store.

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

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

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 19: For sickle cell anemia, G6PD anemia, and alpha or beta thalassemia, the diagnostic or gold standard test is Angioedema?

No (Correct answer)
Yes

Correct answer: No

For sickle cell anemia, G6PD anemia, and alpha or beta thalassemia, the diagnostic or gold standard test is Hemoglobin electrophoresis

Question 20: A 55-year-old male patient with a 30 pack-year smoking history is currently smoking. Which cancer screening should the FNP recommend?

Low-dose CT scan of the chest annually (Correct answer)
PET scan annually
Sputum cytology every 6 months
Chest X-ray annually

Correct answer: Low-dose CT scan of the chest annually

USPSTF recommends annual low-dose CT lung cancer screening for adults aged 50-80 with a 20+ pack-year history who currently smoke or quit within the past 15 years.

Question 21: 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.
It may exacerbate your concurrent tinea corporis. (Correct answer)
You must use this for an extended period of time for it to be effective.

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

90 degrees sitting upright
Flat supine
30–45 degree head elevation (Correct answer)
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 23: Which kind of antihypertensives may cause problems for diabetics?

Angiotensin-converting enzyme (ACE) inhibitors
Alpha blockers
Beta blockers (Correct answer)
Calcium channel 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 24: Which lab finding is most consistent with iron-deficiency anemia?

Low serum ferritin, elevated TIBC, microcytic hypochromic RBCs (Correct answer)
Elevated MCV with hypersegmented neutrophils
Normal ferritin with elevated reticulocyte count
Elevated serum ferritin, low TIBC

Correct answer: Low serum ferritin, elevated TIBC, microcytic hypochromic RBCs

Iron-deficiency anemia is characterized by low ferritin (depleted stores), elevated TIBC, and microcytic hypochromic red cells on CBC.

Question 25: 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 3 (Severe)
GOLD 4 (Very Severe)
GOLD 1 (Mild)
GOLD 2 (Moderate) (Correct answer)

Correct answer: GOLD 2 (Moderate)

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

Question 26: The family nurse practitioner displays leadership in the workplace by ______.

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

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

Correct answer: CN III, IV, VI

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

Question 28: Which breath sound is MOST characteristic of consolidation (pneumonia)?

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

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 29: A 60-year-old man with a 40 pack-year history undergoes low-dose CT lung cancer screening. What are the eligibility criteria per USPSTF guidelines?

Ages 55–75, 30 pack-year history, current smoker only
Ages 50–80, 20 pack-year history, current or former smoker quit within 15 years (Correct answer)
Ages 50–75, 20 pack-year history, any smoking history
Ages 45–80, 30 pack-year history, current or former smoker

Correct answer: Ages 50–80, 20 pack-year history, current or former smoker quit within 15 years

USPSTF 2021 guidelines recommend annual low-dose CT for adults aged 50–80 with a 20 pack-year history who currently smoke or quit within the past 15 years.

Question 30: 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 31: A patient who has suffered a non-work-related injury that affects his or her capacity to perform their job is examined by a family nurse practitioner. The patient is not considered medically disabled and has a good possibility of finding a suitable job with the right therapy. The nurse practitioner advises the patient to submit an application for ______.

Family and Medical Leave Act benefits
home health services
Social Security benefits
vocational rehabilitation services (Correct answer)

Correct answer: vocational rehabilitation services

Vocational rehabilitation services help disabled or injured persons find, stay, or return to employment. Assessment, evaluation, counseling, supervision, training, work placement, and employment adjustments are just a few examples. They are made available through the efforts of federal and state agencies and qualified professionals. They strive to eliminate disability-related occupational and psychological problems and provide suitable jobs.

Question 32: Which vaccine is recommended annually for all persons aged 6 months and older, regardless of health status?

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

Correct answer: Influenza vaccine

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

Question 33: 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:

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

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

One-third the distance from the ASIS to the umbilicus (Correct answer)
Left lower quadrant at the iliac crest
One-third the distance from the umbilicus to the ASIS
Midway between the umbilicus and right 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 35: 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?

Lymphogranuloma venereum
Genital herpes
Chancroid
Primary syphilis (Correct answer)

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 36: Produces states of calm and relaxation

Ligaments
Serotonin (Correct answer)
Strain
Photopsia

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 37: The FNP is counseling a postmenopausal woman on hormone therapy (HT). Which combination is preferred for a woman WITH a uterus?

Progestogen alone
Estrogen plus progestogen (combined HT) (Correct answer)
Testosterone supplementation
Estrogen alone

Correct answer: Estrogen plus progestogen (combined HT)

Women with an intact uterus must receive progestogen with estrogen to prevent unopposed estrogen stimulation causing endometrial hyperplasia and cancer.

Question 38: Ryan, who is 20 years old, goes to the college health clinic because he is having trouble passing urine and has a discharge from his penis. You discover the discharge is urethral. These symptoms are most common in young adult males due to ____.

chronic prostatitis
prostatic abscess
prostatic hyperplasia
acute prostatitis (Correct answer)

Correct answer: acute prostatitis

In young males, acute prostatitis is caused by gonorrhea or other bacterial infections.

Question 39: A patient has a positive ANA titer of 1:320 with a butterfly rash across the cheeks and nose. The FNP suspects:

Dermatomyositis
Systemic lupus erythematosus (SLE) (Correct answer)
Rosacea
Scleroderma

Correct answer: Systemic lupus erythematosus (SLE)

A malar (butterfly) rash sparing the nasolabial folds combined with a high-titer ANA are classic features of SLE.

Question 40: The FNP is treating an uncomplicated UTI in a non-pregnant woman. Which antibiotic is preferred as FIRST-LINE according to current guidelines?

Cephalexin
Ciprofloxacin
Nitrofurantoin or trimethoprim-sulfamethoxazole (Correct answer)
Amoxicillin-clavulanate

Correct answer: Nitrofurantoin or trimethoprim-sulfamethoxazole

IDSA guidelines recommend nitrofurantoin (5 days) or TMP-SMX (3 days) as first-line for uncomplicated UTI to preserve fluoroquinolones for more serious infections.

Question 41: The FNP notes café-au-lait spots (>6, >15mm) in an adult patient. This finding raises suspicion for:

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

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 42: 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?

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

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 43: A 16-year-old athlete presents with anterior knee pain worsened by stairs and prolonged sitting. Examination reveals tenderness at the inferior pole of the patella. What is the most likely diagnosis?

Meniscal tear
Osgood-Schlatter disease
Patellofemoral pain syndrome
Sinding-Larsen-Johansson syndrome (Correct answer)

Correct answer: Sinding-Larsen-Johansson syndrome

Sinding-Larsen-Johansson syndrome involves traction apophysitis at the inferior pole of the patella, distinct from Osgood-Schlatter which affects the tibial tuberosity.

Question 44: All of the following are used to treat mild preeclampsia, except for ______.

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

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 45: Micoaneurysms, hard exudates, cotton wool patches, and neovascularization

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

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

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

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

Distinguish thyroid tissue from other neck masses by observing upward movement (Correct answer)
Identify lymphadenopathy
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 48: Which of the following neoplasms is considered to be benign?

Osteosarcoma
Glioma
Seminoma
Leiomyoma (Correct answer)

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 49: 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?

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

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 50: A patient with alcohol use disorder requires treatment for acute alcohol withdrawal. Which medication class is FIRST-LINE?

Antipsychotics (e.g., haloperidol)
Benzodiazepines (e.g., lorazepam) (Correct answer)
Opioids
Beta-blockers (e.g., propranolol)

Correct answer: Benzodiazepines (e.g., lorazepam)

Benzodiazepines are first-line for alcohol withdrawal as they treat GABA deficiency, preventing seizures and progression to delirium tremens.

Question 51: A 70-year-old male smoker reports painless gross hematuria. He has no UTI symptoms. What is the priority next step?

Increase water intake and recheck in 2 weeks
Prescribe antibiotics empirically for UTI
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 52: As an advanced practice registered nurse, you work in an emergency room (APRN). An adolescent guy who was hit by a car and is brought in unconscious and with a head injury. He is unaccompanied by an adult and without proper identification. What would you do?

Provide the appropriate medical treatment even if it involves surgery. (Correct answer)
Contact all local police stations in an attempt to identify the client and find his parents before instituting treatment.
Do everything except order a blood transfusion, even if it is indicated, because you do not know the client's religious preferences.
Call the hospital attorney before instituting any care.

Correct answer: Provide the appropriate medical treatment even if it involves surgery.

In emergency situations involving an unconscious minor without identification or accompanying adults, the principle of implied consent applies. Healthcare providers are ethically and legally obligated to provide necessary life-saving treatment, including surgery if indicated, to prevent death or serious harm. Delaying care to find family or legal counsel would be detrimental to the patient's well-being and is not permissible in such critical circumstances.

Question 53: A patient with rheumatoid arthritis on methotrexate develops oral ulcers and fatigue. Which supplement should be routinely recommended?

Folic acid (Correct answer)
Iron
Vitamin B12
Vitamin D

Correct answer: Folic acid

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

Question 54: Which intervention is recommended for a 70-year-old woman with a DEXA scan T-score of -2.7 at the lumbar spine?

Calcium and vitamin D supplementation only
Recheck DEXA scan in 2 years before treating
Weight-bearing exercise program only
Initiate pharmacologic therapy with a bisphosphonate (Correct answer)

Correct answer: Initiate pharmacologic therapy with a bisphosphonate

A T-score of ≤-2.5 meets the diagnostic criteria for osteoporosis and warrants pharmacologic treatment, typically with a bisphosphonate, along with calcium and vitamin D.

Question 55: Which medication is first-line for acute gout flare management in a patient with no contraindications?

Colchicine or NSAIDs (Correct answer)
Febuxostat
Probenecid
Allopurinol

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

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

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 57: 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?

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

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

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

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 59: Nearsightedness

Proptosis
Ph of vagina
Myopia (Correct answer)
RICE Mnemonic

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 60: The ideal test for temporal arteritis is:

Biopsy of the temporal artery refers the patient to ophthalmologists for mgt. (Correct answer)
Occurs in the third trimester of pregnancy and presents with bright red painless bleeding
Central retinal artery until proven otherwise
None of the above

Correct answer: Biopsy of the temporal artery refers the patient to ophthalmologists for mgt.

An ophthalmologist or vascular surgeon would often perform a temporal artery biopsy, which is an outpatient operation.

Question 61: 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?

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

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

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

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

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

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 64: What is McMurray's sign:

Problem is anterior to the chiasm
Variation in red blood cell size
None of the above
Positive in meniscus injuries of the knee (Correct answer)

Correct answer: Positive in meniscus injuries of the knee

The patient must be relaxed and supine to perform McMurray's test. The examiner holds the patient's heel in one hand and the knee joint line in the other. The knee is fully extended and rotated either internally (medial meniscus) or externally (lateral meniscus).

Question 65: 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 66: 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?

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

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 67: 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)
Propranolol (Inderal)
Enalapril (Vasotec) (Correct answer)
Furosemide (Lasix)

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

CBC with differential
Cervical cultures for STIs
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 69: A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and slight euphoria exhibits signs of using ______.

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

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

Absent hair growth on the dorsum of the foot
Dry skin with mild callus formation
Vibration sense loss at the great toe
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 71: 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 72: 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
Switch to a different HRT formulation
Reassure that breakthrough bleeding is normal

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 73: A 58-year-old male with hypertension is started on lisinopril. Two weeks later he reports a dry, persistent cough. What is the most appropriate next step?

Switch to an ARB such as losartan (Correct answer)
Increase the lisinopril dose to improve efficacy
Order a chest X-ray to rule out pneumonia
Prescribe benzonatate for cough suppression

Correct answer: Switch to an ARB such as losartan

ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB (which does not affect bradykinin) is the preferred management.

Question 74: 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?

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

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 75: 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:

Reassess in 4 weeks if not improving
Order sputum culture
Start empiric antibiotics for pneumonia
Urgent referral to pulmonology and CT chest (Correct answer)

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 76: 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?

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

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

Cerebellar functioning (Correct answer)
Stereognostic functioning
Reflex arc functioning
Cognitive 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 78: Tina, a 34-year-old AIDS patient, is experiencing diarrhea right now. What kind of protozoal infection of the bowel do you think she has?

Cryptosporidiosis (Correct answer)
Giardiasis
Escherichia coli
Amebiasis

Correct answer: Cryptosporidiosis

Cryptosporidiosis is a parasitic infection caused by *Cryptosporidium* species, which can cause severe, chronic, and often debilitating diarrhea in immunocompromised individuals, such as those with AIDS. While other protozoal infections can cause diarrhea, *Cryptosporidium* is particularly notorious for causing persistent and difficult-to-treat diarrhea in AIDS patients due to their compromised immune systems.

Question 79: Which finding on urinalysis is MOST specific for a urinary tract infection?

Hematuria
Positive nitrites (Correct answer)
Proteinuria
Elevated specific gravity

Correct answer: Positive nitrites

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

Question 80: A 65-year-old patient asks about shingles prevention. Which vaccine should the FNP recommend?

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

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 81: 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?

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

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 82: 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?

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

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

Primary hyperparathyroidism (Correct answer)
Sarcoidosis
Vitamin D toxicity
Milk-alkali syndrome

Correct answer: Primary hyperparathyroidism

High PTH with hypercalcemia and hypophosphatemia is the classic triad of primary hyperparathyroidism, the most common cause of outpatient hypercalcemia.

Question 84: A 68-year-old woman with osteoporosis has a T-score of -2.7 at the lumbar spine. The FNP initiates bisphosphonate therapy and counsels the patient to:

Crush it and mix with applesauce
Take it at bedtime for best absorption
Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes (Correct answer)
Take it with food to reduce GI upset

Correct answer: Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes

Bisphosphonates must be taken fasting with a full glass of water, and patients must remain upright for 30 minutes to prevent esophageal irritation and ensure absorption.

Question 85: 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?

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

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 86: A 36-year-old healthy guy arrives with 2 months' worth of sporadic episodes of rectal bleeding. When he first started noticing blood on the tissue after wiping, it was only in small streaks. However, after defecating yesterday, he dripped bright red blood and the stool was coated with blood. No anal or abdominal discomfort, anorexia, weight loss, or changes in bowel habits have been reported in the patient. No anomalies may be seen in the perianal skin. A digital rectal exam reveals no palpable masses or pain. Bulges in the mucosa are purple, as seen on anoscopy. The ideal next step in management is which of the following?

Referral for colonoscopy
Referral for surgical evaluation
Biopsy of the anal lesions
High-fiber diet and follow-up (Correct answer)

Correct answer: High-fiber diet and follow-up

The patient's symptoms (sporadic bright red rectal bleeding, blood on tissue/coating stool, purple bulges on anoscopy) without pain, weight loss, or changes in bowel habits are classic for internal hemorrhoids. Initial management for hemorrhoids typically involves conservative measures like a high-fiber diet, increased fluid intake, and stool softeners to reduce straining, often followed by observation.

Question 87: Which of the following can be detected with the Lachman maneuver?

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

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

35 years
45 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 89: Lea, 29, has been identified as having urticaria and has a number of transitory lesions that appear and go. What will you get?

Aspirin
Opioids
Antihistamines (Correct answer)
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 90: A patient with GERD fails PPI therapy. The FNP considers referral to gastroenterology for which procedure?

Upper endoscopy (EGD) to assess for Barrett's esophagus or other pathology (Correct answer)
Barium swallow
Esophageal pH monitoring only
Colonoscopy

Correct answer: Upper endoscopy (EGD) to assess for Barrett's esophagus or other pathology

PPI-refractory GERD requires upper endoscopy to evaluate for Barrett's esophagus, esophagitis, strictures, or other conditions requiring intervention.

Question 91: A patient has a fasting plasma glucose of 128 mg/dL on two separate occasions. The FNP diagnoses:

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

Correct answer: Diabetes mellitus

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

Question 92: The FNP counsels a patient about sun safety. Which of the following recommendations aligns with skin cancer primary prevention?

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

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 93: 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
Normal oxygen saturation
Bradycardia with hypotension (Correct answer)
Regular rhythm on auscultation

Correct answer: Bradycardia with hypotension

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

Question 94: Which parameter is used to calculate the CURB-65 score for pneumonia severity?

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

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 95: Which vaccine is contraindicated in a pregnant woman at 20 weeks gestation?

Inactivated influenza
COVID-19 mRNA vaccine
Tdap
MMR (Correct answer)

Correct answer: MMR

MMR is a live-attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection.

Question 96: Place the tips of your first two fingers in front of each ear and ask the patient to open and close his mouth in order to assess him. Next, check to see if the mandible moves smoothly by placing your fingers into the depressed area over the joint. By doing this, you are trying to ensure _____.

Mastoid inflammation.
Well-positioned permanent teeth or well-fitting dentures.
Maxillomandibular integrity.
Temporomandibular joint syndrome. (Correct answer)

Correct answer: Temporomandibular joint syndrome.

The described assessment technique, involving placing fingers in front of the ears and having the patient open and close their mouth, is specifically designed to evaluate the temporomandibular joint (TMJ). This maneuver allows the practitioner to feel for smooth movement, clicking, popping, or pain, which are common indicators of temporomandibular joint syndrome (TMJ syndrome) or dysfunction. Therefore, the goal is to ensure the proper functioning and health of this joint.

Question 97: The FNP is conducting a sports physical for a 16-year-old. Which finding warrants DISQUALIFICATION from contact sports?

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

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

Wrist sprain
Scaphoid fracture (Correct answer)
De Quervain's tenosynovitis
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 99: Which physical exam finding is most consistent with aortic stenosis?

Diastolic blowing murmur at left sternal border
Midsystolic click followed by a late systolic murmur
Harsh systolic crescendo-decrescendo murmur at the right upper sternal border (Correct answer)
Holosystolic murmur at the apex radiating to the axilla

Correct answer: Harsh systolic crescendo-decrescendo murmur at the right upper sternal border

Aortic stenosis produces a harsh systolic ejection (crescendo-decrescendo) murmur best heard at the right upper sternal border, radiating to the carotids.

Question 100: A 7-year-old child is brought in with a rash that started on the face and moved to the trunk, along with low-grade fever and Koplik spots. What is the diagnosis?

Scarlet fever
Roseola
Measles (Correct answer)
Rubella

Correct answer: Measles

Koplik spots (white spots on the buccal mucosa) are pathognomonic for measles (rubeola), which presents with cephalocaudal rash spread.

Question 101: An important point to emphasize when teaching Janice, age 77, to use a cane due to osteoarthritis of her left knee, is ______.

Making sure the cane length equals the height of the iliac crest.
Making sure the cane length equals the height of the iliac crest.
Advancing the cane with the ipsilateral leg. (Correct answer)
Carrying the cane in the ipsilateral hand.

Correct answer: Advancing the cane with the ipsilateral leg.

When using a cane for support due to weakness or pain in one leg (e.g., left knee osteoarthritis), the cane should be held in the hand opposite to the affected leg (contralateral side). The correct gait pattern involves moving the cane forward simultaneously with the *affected* leg (ipsilateral to the affected knee). This provides a wider base of support and stability, allowing the cane to bear weight as the affected leg steps forward, thus reducing stress on the painful joint.

Question 102: A positive Phalen's test reproduces which symptom and in which condition?

Numbness of the fifth finger; cubital tunnel syndrome
Wrist pain with gripping; De Quervain's tenosynovitis
Paresthesias in the first three fingers; carpal tunnel syndrome (Correct answer)
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 103: Deep tendon reflex testing:

Quinsy (collection of pus b/t tonsil & capsule of tonsillar pillar)
none of the above
absent(0),hypoactive (1)normal(2)hyperactive(3)clonus(4) (Correct answer)
Undescended testes left testicle hangs lower than the right one

Correct answer: absent(0),hypoactive (1)normal(2)hyperactive(3)clonus(4)

The DTR can be quickly and easily tested, but for a solid result, a certain technique is needed. An examination hammer is used to tap the muscle tendon, and the response is then graded and observed. The patient should be as at ease as feasible for efficient and dependable results.

Question 104: Angelo, age 35, says he recently returned from a business trip and feels strange pressure in his ear, therefore he believes he has an ear infection. Your barotrauma diagnosis. What will you do next?

Prescribe nasal steroids and oral decongestants. (Correct answer)
Refer Max to an ear, nose, and throat specialist.
Prescribe antibiotic ear drops.
Prescribe systemic antibiotics.

Correct answer: Prescribe nasal steroids and oral decongestants.

Barotrauma, or "ear pressure," often results from pressure differences between the middle ear and the external environment, commonly experienced after air travel or diving. This can cause Eustachian tube dysfunction. Nasal steroids and oral decongestants help reduce inflammation and open the Eustachian tubes, allowing for pressure equalization and symptom relief without the need for antibiotics unless there's evidence of bacterial infection.

Question 105: 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
Febrile seizure disorder
Roseola infantum

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 106: Which antibiotic class is MOST appropriate for treating community-acquired pneumonia in a healthy adult without comorbidities?

Beta-lactams + macrolide combination
Fluoroquinolones (e.g., levofloxacin)
Cephalosporins (e.g., ceftriaxone)
Macrolides (e.g., azithromycin) (Correct answer)

Correct answer: Macrolides (e.g., azithromycin)

IDSA/ATS guidelines recommend macrolide monotherapy as first-line for outpatient CAP in previously healthy patients with no antibiotic use in the past 3 months.

Question 107: Which level of prevention involves early detection of disease before symptoms appear, such as screening mammography?

Tertiary prevention
Secondary prevention (Correct answer)
Quaternary prevention
Primary prevention

Correct answer: Secondary prevention

Secondary prevention focuses on early detection and prompt treatment of disease before symptoms develop, such as screening for breast cancer with mammography.

Question 108: According to the US Preventive Services Task Force (USPSTF), at what age should average-risk adults begin colorectal cancer screening?

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

Correct answer: 45 years

The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.

Question 109: An uncommon yet severe side effect of ACE inhibitors is:

none of the above
Angioedema (Correct answer)
Glaucoma
Bullae

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 110: 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,

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

Correct answer: Eyes normal finding

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

Question 111: What statement about mitral regurgitation is correct?

It is caused by stiff leaflets that limit flow from the left atrium to the left ventricle.
It results in a prolonged PR interval on electrocardiogram.
It may be noted as a holosystolic murmur. (Correct answer)
It occurs only as a result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps.

Correct answer: It may be noted as a holosystolic murmur.

Mitral regurgitation (MR) is the backflow of blood from the left ventricle into the left atrium during systole due to incomplete closure of the mitral valve. This abnormal flow creates a characteristic heart sound known as a holosystolic (or pansystolic) murmur. This murmur is typically heard throughout the entire systole, distinguishing it from other types of murmurs.

Question 112: When examining skin turgor in elderly patients, the best site for assessment is the:

Forehead or sternum (Correct answer)
Forearm
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 113: 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
Reduce lithium dose by 50%
Administer activated charcoal only
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 114: Which patient would you recommend getting the HPV vaccine for?

Jean, age 25, who is pregnant.
Cess, age 7.
Rhea, age 18, who is allergic to yeast.
Sally, age 17, who had a baby 6 months ago and is breastfeeding. (Correct answer)

Correct answer: Sally, age 17, who had a baby 6 months ago and is breastfeeding.

The HPV vaccine is recommended for individuals up to age 26, and it can be safely administered to breastfeeding women. Pregnancy is a contraindication for receiving the vaccine, and while the vaccine can be started as early as age 9, a 7-year-old is generally too young for the standard recommendation. A yeast allergy is not a contraindication for the HPV vaccine.

Question 115: Which of the following vaccinations is not recommended for young children with acquired immunodeficiency syndrome (AIDS)?

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

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 116: 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 117: Which of the following is the most important risk factor for the development of type 2 diabetes mellitus?

Central obesity and insulin resistance (Correct answer)
Chronic use of NSAIDs
Excessive alcohol consumption
Low dietary fiber intake alone

Correct answer: Central obesity and insulin resistance

Central obesity leading to insulin resistance is the predominant modifiable risk factor for type 2 diabetes mellitus.

Question 118: Which of the following is a normal finding on abdominal assessment?

Absent bowel sounds after 5 minutes of auscultation
Tympany over most of the abdomen (Correct answer)
Dullness over the right lower quadrant
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 119: 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 a healthy adult with several problems
As having metabolic syndrome (Correct answer)
As having a glycemic event
As having multiple organ dysfunction

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

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

Correct answer: Glipizide (sulfonylurea)

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

Question 121: Taking ACE inhibitors frequently results in a

Ibuprofen, naproxen(aleve, anaprox)
Dry cough(10%) (Correct answer)
none of the above
Rice(rest, ice, compression , elevation)

Correct answer: Dry cough(10%)

Dry cough is one of the potential ACE inhibitor side effects. Hyperkalemia, or elevated blood potassium levels, fatigue

Question 122: If a nursing woman develops postpartum mastitis, the family nurse practitioner will recommend that she take the recommended antibiotics and also:

take cool showers
temporarily switch to formula
continue to nurse with both breasts (Correct answer)
pump the unaffected breast with a lactation pump

Correct answer: continue to nurse with both breasts

A family nurse practitioner will advise a nursing mother to continue using both breasts while taking the prescribed antibiotics she develops postpartum mastitis. This will assist in maintaining milk production and preventing breast engorgement.

Question 123: Which EKG finding is the EARLIEST sign of hyperkalemia?

Sine wave pattern
Peaked (tall, narrow, symmetric) T waves (Correct answer)
Widened QRS complex
Absent P waves

Correct answer: Peaked (tall, narrow, symmetric) T waves

Peaked T waves are the earliest EKG manifestation of hyperkalemia, preceding the PR prolongation, wide QRS, and eventually sine wave pattern.

Question 124: What is Goodpasture syndrome?

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

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 125: 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?

Casts (Correct answer)
Nitrites
Crystals
Ketones

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

D-dimer should be ordered for all suspected PE cases regardless of probability
A positive D-dimer confirms PE regardless of pre-test probability
D-dimer is not useful in the Wells score algorithm
A negative D-dimer effectively rules out PE in LOW pre-test probability patients (Correct answer)

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 127: 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?

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

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 128: 4 important features -bradykinesia -muscular weakness -a tremor at rest instability in one's posture Medication: Amantadine (Symmetrel), a dopamine agonist.

Pharyngitis
Boys puberty
Parkinson dz (Correct answer)
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 129: The FNP performs a straight-leg raise (SLR) test and reproduces radicular pain at 45 degrees. This is MOST consistent with:

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

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

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

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 131: 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:

Asthma
Pulmonary fibrosis
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 132: Is the patient, who is most likely an adolescent, suffering from acute mononucleosis if they exhibit the traditional trio of a sore throat, protracted weariness, and swollen cervical nodes?

True (Correct answer)
False

Correct answer: True

Infectious mononucleosis is most frequently caused by the Epstein-Barr virus (EBV), but other viruses can also be to blame. Teenagers and young adults, particularly college students, are particularly prone to it. When exposed to EBV, at least one in four adolescents and young adults will develop infectious mononucleosis.

Question 133: 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?

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

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

Correct (Correct answer)
Wrong

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

Tracheal
Bronchial
Vesicular
Bronchovesicular (Correct answer)

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 136: 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:

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)
Prescribe sumatriptan for migraine

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

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
patient privacy with informed consent

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 138: 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 4
Stage 2
Stage 1
Stage 3 (Correct answer)

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 139: When counseling an adolescent patient confidentially, which of the following situations legally requires the FNP to breach confidentiality and notify parents or authorities?

The teen discloses an imminent plan to harm themselves or another person (Correct answer)
The teen reports past alcohol experimentation
The teen discloses cannabis use at parties
The teen requests STI testing

Correct answer: The teen discloses an imminent plan to harm themselves or another person

Imminent risk of harm to self or others is a legally and ethically mandated exception to adolescent confidentiality in all US states.

Question 140: A 14-year-old patient discloses substance use during a confidential visit. Under HIPAA and most state laws, the FNP should FIRST:

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

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 141: A 45-year-old male presents with fatigue, weight gain, cold intolerance, and constipation. TSH is 8.5 mIU/L and free T4 is low. What is the treatment of choice?

Liothyronine (T3 only)
Methimazole
Radioactive iodine ablation
Levothyroxine (T4 replacement) (Correct answer)

Correct answer: Levothyroxine (T4 replacement)

Hypothyroidism is treated with levothyroxine, the synthetic form of T4, titrated to normalize TSH.

Question 142: Which intervention is most effective for reducing cardiovascular disease risk in a patient with hypertension and hyperlipidemia?

Omega-3 supplementation
Vitamin E 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 143: Myocardial infarction patient visits clinic for atorvastatin calcium refill (Lipitor). The family nurse practitioner knows that the prescription is for _____.

cancer prevention
secondary prevention
tertiary prevention (Correct answer)
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 144: A patient has a BMI of 32 kg/m². According to the USPSTF, what is the most appropriate intervention?

Recommend surgical consultation
Refer for intensive multicomponent behavioral intervention (Correct answer)
Repeat BMI in 1 year with no intervention
Prescribe weight loss medication immediately

Correct answer: Refer for intensive multicomponent behavioral intervention

USPSTF recommends referring adults with obesity (BMI ≥30) to intensive, multicomponent behavioral weight loss interventions.

Question 145: Which of the following is the hallmark physical finding in cardiac tamponade?

Wide pulse pressure with bounding pulses
Bradycardia with hypertension
Loud S3 gallop with pulmonary crackles
Beck's triad: hypotension, muffled heart sounds, and JVD (Correct answer)

Correct answer: Beck's triad: hypotension, muffled heart sounds, and JVD

Beck's triad (hypotension, muffled/distant heart sounds, and jugular venous distension) is the classic presentation of cardiac tamponade.

Question 146: The FNP prescribes isotretinoin for a female patient with severe acne. Which MANDATORY program must the patient be enrolled in?

STEPS
TOUCH
REMS
iPLEDGE (Correct answer)

Correct answer: iPLEDGE

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

Question 147: 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:

Hearing impairment
Normal developmental milestone
Hip dysplasia
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 148: When auscultating the abdomen, the FNP hears a bruit over the renal artery. This finding suggests:

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

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 149: 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.

Prioritize (Correct answer)
Obturator sign
M. PNA/C. PNA
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 150: When performing a fundoscopic exam, the FNP notes arteriovenous (AV) nicking. This finding is MOST associated with which condition?

Papilledema
Chronic hypertension (Correct answer)
Diabetic retinopathy
Glaucoma

Correct answer: Chronic hypertension

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

Question 151: A 45-year-old woman presents with fatigue, weight gain, constipation, cold intolerance, and bradycardia. The BEST initial diagnostic test is:

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

Correct answer: TSH level

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

Question 152: A patient taking warfarin presents with an INR of 7.2 but no active bleeding. What is the most appropriate management?

Hold warfarin and administer oral vitamin K 2.5mg (Correct answer)
Administer vitamin K 10mg IV push
Transfuse fresh frozen plasma immediately
Continue warfarin at reduced dose

Correct answer: Hold warfarin and administer oral vitamin K 2.5mg

For supratherapeutic INR without bleeding, holding warfarin and giving low-dose oral vitamin K (2–2.5mg) is the recommended approach per ACCP guidelines.

Question 153: When a patient is being examined physically, the facial nerve's health can be determined by asking them to:

puff out both cheeks (Correct answer)
produce a big yawn
clench their teeth
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 154: A mild initial heart sound with a holosystolic apical murmur radiating to the left axilla during cardiac auscultation suggests _____.

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

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 155: 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)
In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise.
Clients with pulmonary dyspnea have minimal dyspnea at rest.

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

Bronchoscopy with biopsy
Immediate surgical resection
Repeat CT in 12 months
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 157: 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)
BMI >35
Age >65 years
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 158: The FNP is managing a patient with newly diagnosed stage 1 hypertension (130–139/80–89 mmHg) with no comorbidities. The FIRST-LINE intervention is:

Lifestyle modification for 3–6 months before initiating medication (Correct answer)
Immediately start an ACE inhibitor
Immediately start a thiazide diuretic
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 159: 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?

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

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 160: Is Lupus present in a patient with a malar rash (butterfly rash) who needs to avoid or limit sunlight exposure because of photosensitivity?

No
Yes (Correct answer)

Correct answer: Yes

First Sign of Lupus are Fatigue, Joint pain, stiffness and swelling, Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body and Skin lesions that appear or worsen with sun exposure.

Question 161: A patient taking warfarin reports adding daily vitamin K supplements. The FNP anticipates which effect on INR?

Increased INR due to bleeding risk
No effect on INR
Variable effect depending on warfarin dose
Decreased INR due to increased clotting factor synthesis (Correct answer)

Correct answer: Decreased INR due to increased clotting factor synthesis

Vitamin K is a cofactor for clotting factor synthesis; supplementing it antagonizes warfarin's anticoagulant effect, lowering the INR.

Question 162: The FNP is initiating a statin in a patient. Which laboratory test should be checked at baseline and periodically?

Complete blood count
Thyroid-stimulating hormone
Liver function tests (ALT/AST) (Correct answer)
Renal function (BUN/creatinine)

Correct answer: Liver function tests (ALT/AST)

Statins can rarely cause hepatotoxicity, so baseline and periodic liver function monitoring is recommended per guidelines.

Question 163: A patient with an MRSA skin infection requires oral outpatient treatment. Which antibiotic is MOST appropriate?

Trimethoprim-sulfamethoxazole (TMP-SMX) (Correct answer)
Cephalexin
Dicloxacillin
Amoxicillin-clavulanate

Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX)

TMP-SMX provides reliable oral coverage against community-acquired MRSA for uncomplicated skin and soft tissue infections.

Question 164: A patient taking allopurinol for gout asks about alcohol use. The FNP explains that:

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

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 165: A patient newly diagnosed with rheumatoid arthritis has active synovitis. Per ACR guidelines, which is the FIRST-LINE disease-modifying agent (DMARD)?

Hydroxychloroquine alone
Prednisone alone
NSAIDs alone
Methotrexate (Correct answer)

Correct answer: Methotrexate

Methotrexate is the anchor DMARD for rheumatoid arthritis, recommended as first-line therapy due to its efficacy, long-term safety profile, and cost-effectiveness.

Question 166: Which counseling intervention is most supported by evidence for helping patients achieve smoking cessation?

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

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 167: A 2-year-old with fever of 39.5°C and left ear pain is diagnosed with acute otitis media. Per AAP guidelines, the PREFERRED management is:

Amoxicillin 80–90 mg/kg/day for 10 days (Correct answer)
Watchful waiting for 48–72 hours
Tympanocentesis
Amoxicillin-clavulanate immediately

Correct answer: Amoxicillin 80–90 mg/kg/day for 10 days

Children under 2 years with AOM and fever ≥39°C should receive immediate antibiotic therapy with high-dose amoxicillin per AAP guidelines.

Question 168: A 45-year-old with newly diagnosed hypertension also has chronic kidney disease (eGFR 42). Which antihypertensive is the first-line choice?

Metoprolol
Hydrochlorothiazide
Lisinopril (Correct answer)
Amlodipine

Correct answer: Lisinopril

ACE inhibitors (e.g., lisinopril) are first-line in CKD with hypertension due to their nephroprotective effects and reduction of proteinuria.

Question 169: Tx: 500 mg of cipro BID for 7–14 days 500 mg of metronidazole every 6 to 8 hours for 7 to 14 days 7-10 days with Bactrim

Rovsing sign
Migraines
Diverticulitis (Correct answer)
Varicocele

Correct answer: Diverticulitis

The large intestine (colon) is affected by diverticular disease, diverticulitis, and associated digestive diseases. Diverticular illness causes the lining of the gut to develop tiny bulges or pockets known as diverticula. When these pockets swell or become infected, it is known as diverticulitis.

Question 170: A healthy 45-year-old woman asks about osteoporosis screening. What is the appropriate recommendation?

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

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 171: You are recommending hormonal therapy for the treatment of prostate cancer in a patient aged 73. It is thought that goserelin acetate (Zoladex) works as an androgen ablation by _____.

inhibiting the binding of testosterone to cancer cells.
inhibiting the progression of cancer cells through the cell cycle.
blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). (Correct answer)
inhibiting the progression of cancer cells through the cell cycle.

Correct answer: blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

To prevent the production of FSH and LH, the IM injections of goserelin acetate (Zoladex) and leuprolide acetate (Lupron) are used.

Question 172: Leo, a 22-year-old stock boy, is experiencing severe low back pain. If the nurse practitioner prescribes an NSAID, the patient should be taught about which of the following?

Maintaining moderate bed rest for 3 to 4 days.
Beginning lower back strengthening exercises depending on pain tolerance. (Correct answer)
Calling the office for narcotic medication if there is no relief with the NSAID after 24 to 48 hours.
Wearing a Boston brace at night.

Correct answer: Beginning lower back strengthening exercises depending on pain tolerance.

For acute low back pain, current recommendations emphasize early mobilization and activity within pain limits, rather than prolonged bed rest. Strengthening exercises, once acute pain subsides, are crucial for long-term management, preventing recurrence, and improving core stability. NSAIDs help manage pain, allowing the patient to engage in these beneficial activities and promote recovery.

Question 173: 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 tetanus toxoid injection
a booster of diphtheria and tetanus toxoids
a DTaP booster
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.

Question 174: Which screening is recommended by USPSTF for sexually active women under age 25 regardless of symptoms?

Chlamydia and gonorrhea screening annually (Correct answer)
Hepatitis C screening annually
HIV testing annually
Syphilis testing annually

Correct answer: Chlamydia and gonorrhea screening annually

USPSTF recommends screening for chlamydia and gonorrhea in all sexually active women aged 24 and younger, and in older women at increased risk.

Question 175: A 35-year-old presents with fatigue, pallor, and a mean corpuscular volume (MCV) of 70 fL. The MOST likely diagnosis is:

Iron deficiency anemia (Correct answer)
Aplastic anemia
Vitamin B12 deficiency anemia
Folate deficiency anemia

Correct answer: Iron deficiency anemia

Microcytic anemia (MCV <80 fL) with fatigue and pallor in a young adult is most commonly caused by iron deficiency.

Question 176: 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.

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%

To Pass

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These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

nursingworld.org — Retake policy, test delivery, eligibility, exam format, test dates, score validity, passing score, exam information · verified Oct 2026
aanpcert.org — Exam format, test delivery, test dates, eligibility, passing score, retake policy, time limit, score validity, exam information · verified Oct 2026