Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 2 — Questions and Answers
Question 1: 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 GLP-1 receptor agonist (Correct answer)
- Switch to insulin glargine only
- Add a sulfonylurea
- 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 2: A mother brings her 18-month-old with fever, bulging anterior fontanelle, and irritability. Which diagnosis must be ruled out immediately?
- Roseola infantum
- Bacterial meningitis (Correct answer)
- Febrile seizure disorder
- Viral gastroenteritis
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 3: Which cervical cancer screening guideline applies to a 32-year-old woman with no prior abnormal results?
- Pap smear every year
- Co-testing (Pap + HPV) every 5 years (Correct answer)
- HPV testing alone every 3 years
- No screening needed until age 40
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 4: A patient taking warfarin presents with an INR of 7.2 but no active bleeding. What is the most appropriate management?
- Administer vitamin K 10mg IV push
- Hold warfarin and administer oral vitamin K 2.5mg (Correct answer)
- 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 5: A 55-year-old male smoker presents with a 3-cm solitary pulmonary nodule on CT scan. What is the recommended next step?
- Repeat CT in 12 months
- PET scan (Correct answer)
- Immediate surgical resection
- Bronchoscopy with biopsy
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 6: Which finding on urinalysis is most consistent with nephrotic syndrome?
- Hematuria with RBC casts
- Massive proteinuria (>3.5g/day) (Correct answer)
- Bacteriuria with pyuria
- Granular casts with elevated creatinine
Correct answer: Massive proteinuria (>3.5g/day)
Nephrotic syndrome is characterized by heavy proteinuria (>3.5g/day), hypoalbuminemia, edema, and hyperlipidemia.
Question 7: A postmenopausal woman on hormone replacement therapy presents with unexpected vaginal bleeding. What is the priority next step?
- Reassure that breakthrough bleeding is normal
- Order pelvic ultrasound and endometrial biopsy (Correct answer)
- Switch to a different HRT formulation
- Refer to gynecology in 3 months
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.
Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 2
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?