Family Nurse Practitioner Test Family Nurse Practitioner Practice 2 — Questions and Answers
Question 1: A 58-year-old male with type 2 diabetes presents with a fasting glucose of 310 mg/dL and HbA1c of 10.2%. He is currently on metformin 1000 mg twice daily. What is the most appropriate next step?
- Add a GLP-1 receptor agonist
- Add a sulfonylurea
- Initiate insulin therapy (Correct answer)
- Increase metformin to 2550 mg/day
Correct answer: Initiate insulin therapy
With an HbA1c >10% and significantly elevated fasting glucose, insulin therapy is indicated to rapidly achieve glycemic control.
Question 2: A 32-year-old woman at 28 weeks gestation screens positive on the 1-hour glucose challenge test (152 mg/dL). What is the next appropriate step?
- Diagnose gestational diabetes and start dietary counseling
- Perform a 3-hour 100g oral glucose tolerance test (Correct answer)
- Start insulin therapy immediately
- Repeat the 1-hour test in 2 weeks
Correct answer: Perform a 3-hour 100g oral glucose tolerance test
A positive 1-hour screen (≥140 mg/dL) requires a 3-hour 100g OGTT to confirm or rule out gestational diabetes.
Question 3: A 45-year-old woman presents with hot flashes, irregular menses, and vaginal dryness. FSH is 55 mIU/mL. She has no contraindications. What is the first-line treatment for her vasomotor symptoms?
- Selective serotonin reuptake inhibitors
- Medroxyprogesterone acetate alone
- Combined estrogen-progestogen hormone therapy (Correct answer)
- Phytoestrogens
Correct answer: Combined estrogen-progestogen hormone therapy
Combined estrogen-progestogen therapy is the most effective treatment for vasomotor symptoms in perimenopausal women with an intact uterus.
Question 4: A 6-year-old boy is brought in for evaluation of inattentiveness and hyperactivity that disrupts class. The FNP wants to diagnose ADHD. According to DSM-5, symptoms must be present in at least how many settings?
- One setting
- Two settings (Correct answer)
- Three settings
- Four settings
Correct answer: Two settings
DSM-5 requires that ADHD symptoms be present in two or more settings (e.g., home and school) to meet diagnostic criteria.
Question 5: A 70-year-old woman presents with sudden-onset severe headache described as 'the worst headache of my life.' Neurological exam is normal. What is the priority action?
- Prescribe sumatriptan and follow up in 1 week
- Order a CT scan of the head without contrast immediately (Correct answer)
- Perform a lumbar puncture first
- Order an MRI of the brain
Correct answer: Order a CT scan of the head without contrast immediately
A thunderclap headache requires immediate non-contrast CT to rule out subarachnoid hemorrhage before lumbar puncture.
Question 6: A 55-year-old man with hypertension and stage 3 CKD (GFR 42) needs antihypertensive therapy. Which medication class is most beneficial for renoprotection in this patient?
- Calcium channel blocker
- Beta-blocker
- ACE inhibitor (Correct answer)
- Thiazide diuretic
Correct answer: ACE inhibitor
ACE inhibitors reduce intraglomerular pressure and proteinuria, providing renoprotective benefits in CKD patients.
Question 7: A patient on warfarin for atrial fibrillation presents with an INR of 5.8 but no active bleeding. What is the most appropriate management?
- Hold warfarin and give vitamin K 10 mg IV
- Hold 1-2 doses of warfarin and recheck INR (Correct answer)
- Continue warfarin and recheck INR in 1 week
- Administer fresh frozen plasma
Correct answer: Hold 1-2 doses of warfarin and recheck INR
For a supratherapeutic INR without bleeding, holding 1-2 doses and rechecking the INR is the standard approach.
Family Nurse Practitioner Test Family Nurse Practitioner Practice 2
A 58-year-old male with type 2 diabetes presents with a fasting glucose of 310 mg/dL and HbA1c of 10.2%.
He is currently on metformin 1000 mg twice daily.
What is the most appropriate next step?