Family Nurse Practitioner Test Family Nurse Practitioner Knowledge — 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.
Question 8: A 45-year-old with newly diagnosed hypertension also has chronic kidney disease (eGFR 42). Which antihypertensive is the first-line choice?
- Amlodipine
- Metoprolol
- Lisinopril (Correct answer)
- Hydrochlorothiazide
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 9: Which vaccine is contraindicated in a pregnant woman at 20 weeks gestation?
- Tdap
- Inactivated influenza
- MMR (Correct answer)
- COVID-19 mRNA vaccine
Correct answer: MMR
MMR is a live-attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection.
Question 10: 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?
- Roseola
- Scarlet fever
- 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 11: A patient with rheumatoid arthritis on methotrexate develops oral ulcers and fatigue. Which supplement should be routinely recommended?
- Vitamin D
- Iron
- Folic acid (Correct answer)
- Vitamin B12
Correct answer: Folic acid
Folic acid supplementation reduces methotrexate-related adverse effects including mucositis, GI upset, and cytopenias.
Question 12: A 72-year-old presents with sudden onset of painless vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?
- Central retinal artery occlusion
- Acute angle-closure glaucoma
- Retinal detachment (Correct answer)
- Optic neuritis
Correct answer: Retinal detachment
Painless, sudden vision loss described as a descending curtain is the classic presentation of retinal detachment, an ophthalmologic emergency.
Question 13: Which parameter is used to calculate the CURB-65 score for pneumonia severity?
- SpO2 <90%
- Blood urea nitrogen >19 mg/dL (Correct answer)
- White blood cell count >12,000
- Pleural effusion on X-ray
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 14: 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?
- Osgood-Schlatter disease
- Patellofemoral pain syndrome
- Sinding-Larsen-Johansson syndrome (Correct answer)
- Meniscal tear
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 15: 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?
- Genital herpes
- Chancroid
- Primary syphilis (Correct answer)
- Lymphogranuloma venereum
Correct answer: Primary syphilis
A clean, painless, indurated ulcer (chancre) with non-tender lymphadenopathy is the hallmark of primary syphilis caused by Treponema pallidum.
Question 16: 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?
- Reduce lithium dose by 50%
- Add anticonvulsant and monitor closely
- Discontinue lithium and provide supportive care with hydration (Correct answer)
- Administer activated charcoal only
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 17: 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 18: 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?
- Levothyroxine therapy (Correct answer)
- Methimazole therapy
- Propylthiouracil therapy
- Radioactive iodine ablation
Correct answer: Levothyroxine therapy
Primary hypothyroidism with elevated TSH and low free T4 is treated with synthetic levothyroxine (T4) replacement therapy.
Question 19: 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?
- Focal segmental glomerulosclerosis
- Minimal change disease (Correct answer)
- Membranous nephropathy
- IgA nephropathy
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 20: 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 50–80, 20 pack-year history, current or former smoker quit within 15 years (Correct answer)
- Ages 55–75, 30 pack-year history, current smoker only
- 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 21: 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
- Weight-bearing exercise program only
- Initiate pharmacologic therapy with a bisphosphonate (Correct answer)
- Recheck DEXA scan in 2 years before treating
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.
