Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 5 — Questions and Answers
Question 1: A 35-year-old woman with migraine with aura is seeking contraception. Which method is contraindicated due to increased stroke risk?
- Progestin-only pill
- Levonorgestrel IUD
- Combined estrogen-progestin oral contraceptive (Correct answer)
- Copper IUD
Correct answer: Combined estrogen-progestin oral contraceptive
Combined hormonal contraceptives containing estrogen are contraindicated (WHO MEC Category 4) in women with migraine with aura due to significantly increased ischemic stroke risk.
Question 2: A 4-year-old child with a high fever develops a brief generalized tonic-clonic seizure lasting 90 seconds that self-resolves. This is the first episode. Which statement is most accurate?
- Immediate EEG and MRI are required
- This is a simple febrile seizure and routine anti-epileptic therapy is not indicated (Correct answer)
- The child must be started on phenobarbital prophylaxis
- Lumbar puncture is mandatory in all such cases
Correct answer: This is a simple febrile seizure and routine anti-epileptic therapy is not indicated
Simple febrile seizures (<15 minutes, generalized, single episode) in children 6 months–5 years do not require anti-epileptic treatment or routine neuroimaging.
Question 3: Which screening tool is recommended by the USPSTF for depression in adults in the primary care setting?
- Hamilton Depression Rating Scale (HAM-D)
- Beck Depression Inventory (BDI)
- Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
- Columbia Suicide Severity Rating Scale (C-SSRS)
Correct answer: Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 is the validated, widely recommended screening tool for depression in primary care settings and is endorsed by USPSTF guidelines.
Question 4: A patient presents with a painful, swollen, erythematous first metatarsophalangeal joint. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. What is the diagnosis?
- Pseudogout
- Septic arthritis
- Gout (Correct answer)
- Rheumatoid arthritis
Correct answer: Gout
Negatively birefringent, needle-shaped monosodium urate crystals under polarized light are diagnostic of gout, which classically affects the first MTP joint (podagra).
Question 5: A 25-year-old male presents with urethral discharge and dysuria. Gram stain shows intracellular gram-negative diplococci. What is the first-line treatment?
- Azithromycin 1g orally single dose
- Doxycycline 100mg twice daily for 7 days
- Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days (Correct answer)
- Ciprofloxacin 500mg orally single dose
Correct answer: Ceftriaxone 500mg IM single dose plus doxycycline 100mg twice daily for 7 days
CDC guidelines recommend ceftriaxone 500mg IM for uncomplicated gonorrhea plus doxycycline to treat concurrent chlamydia infection.
Question 6: A 50-year-old woman with a BMI of 32 presents for a wellness visit. She has no symptoms but her fasting glucose is 118 mg/dL on two separate occasions. What is the diagnosis and recommended intervention?
- Normal fasting glucose; recheck in 3 years
- Impaired fasting glucose (prediabetes); lifestyle modification and consider metformin (Correct answer)
- Type 2 diabetes; start metformin immediately
- Impaired fasting glucose; start insulin therapy
Correct answer: Impaired fasting glucose (prediabetes); lifestyle modification and consider metformin
Fasting glucose 100–125 mg/dL on two occasions defines prediabetes; intensive lifestyle changes (weight loss, exercise) are first-line, with metformin for high-risk individuals.
Question 7: Which finding on fetal non-stress test (NST) indicates a reactive (reassuring) result?
- Two or more fetal heart rate accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes (Correct answer)
- Absence of fetal movement over 30 minutes
- Variable decelerations with each movement
- Baseline fetal heart rate of 100 bpm
Correct answer: Two or more fetal heart rate accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes
A reactive NST requires at least two accelerations of ≥15 bpm above baseline for ≥15 seconds within a 20-minute window, indicating fetal well-being.
Family Nurse Practitioner Test Family Nurse Practitioner Knowledge 5
A 35-year-old woman with migraine with aura is seeking contraception.
Which method is contraindicated due to increased stroke risk?