Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 4 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 4
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?