Family Nurse Practitioner Test Family Nurse Practitioner Practice 5 — Questions and Answers
Question 1: A 16-year-old female presents for a sports physical. She reports her last menstrual period was 14 months ago. She is at 85% ideal body weight and exercises 2 hours daily. What is the most likely diagnosis?
- Polycystic ovary syndrome
- Hypothyroidism
- Female athlete triad with functional hypothalamic amenorrhea (Correct answer)
- Primary ovarian insufficiency
Correct answer: Female athlete triad with functional hypothalamic amenorrhea
The female athlete triad consists of low energy availability, menstrual dysfunction, and low bone density, commonly seen in young athletes.
Question 2: A 45-year-old man presents with a painful, swollen right first metatarsophalangeal joint that began suddenly overnight. Serum uric acid is 9.2 mg/dL. Synovial fluid shows negatively birefringent needle-shaped crystals. What is the acute treatment?
- Allopurinol 300 mg daily
- Indomethacin or colchicine (Correct answer)
- Probenecid 500 mg twice daily
- Prednisone 60 mg daily for 2 weeks
Correct answer: Indomethacin or colchicine
NSAIDs (e.g., indomethacin) or colchicine are first-line treatments for acute gout attacks to reduce inflammation.
Question 3: A 30-year-old woman presents with a 2-cm thyroid nodule found incidentally on imaging. TSH is normal. What is the next appropriate step in evaluation?
- Thyroid scintigraphy (nuclear scan)
- Fine needle aspiration biopsy
- Ultrasound-guided evaluation of the nodule (Correct answer)
- Repeat imaging in 12 months
Correct answer: Ultrasound-guided evaluation of the nodule
Thyroid ultrasound is the recommended first-line evaluation for thyroid nodules to assess characteristics and guide further management.
Question 4: A 68-year-old man with BPH and hypertension is started on tamsulosin. What key adverse effect should the FNP counsel him about, especially before any planned eye surgery?
- Hyperkalemia
- Intraoperative floppy iris syndrome (Correct answer)
- Acute urinary retention worsening
- Retrograde ejaculation only
Correct answer: Intraoperative floppy iris syndrome
Alpha-blockers like tamsulosin cause intraoperative floppy iris syndrome, which ophthalmologists must be notified about prior to cataract surgery.
Question 5: A 2-year-old presents with fever, irritability, and bulging fontanelle. Lumbar puncture shows CSF with elevated protein, decreased glucose, and WBC 800 cells/μL with 90% neutrophils. What is the most likely causative organism?
- Neisseria meningitidis
- Streptococcus pneumoniae (Correct answer)
- Listeria monocytogenes
- Haemophilus influenzae
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae is the most common cause of bacterial meningitis in children over 1 month and adults.
Question 6: A 72-year-old woman taking lisinopril develops a persistent dry cough 3 weeks after starting the medication. Blood pressure is well controlled at 128/78 mmHg. What is the most appropriate next step?
- Add a cough suppressant and continue lisinopril
- Switch to an angiotensin receptor blocker (ARB) (Correct answer)
- Switch to a beta-blocker
- Perform pulmonary function tests
Correct answer: Switch to an angiotensin receptor blocker (ARB)
ACE inhibitor-induced cough is a class effect; switching to an ARB provides equivalent blood pressure control without this side effect.
Question 7: A 14-year-old girl presents with acne consisting of open and closed comedones with a few inflammatory papules on her face. There are no nodules or cysts. What is the first-line topical treatment?
- Topical clindamycin monotherapy
- Topical retinoid (tretinoin or adapalene) (Correct answer)
- Oral doxycycline
- Benzoyl peroxide monotherapy
Correct answer: Topical retinoid (tretinoin or adapalene)
Topical retinoids are first-line for comedonal and mild inflammatory acne as they normalize follicular keratinization.
Family Nurse Practitioner Test Family Nurse Practitioner Practice 5
A 16-year-old female presents for a sports physical.
She reports her last menstrual period was 14 months ago.
She is at 85% ideal body weight and exercises 2 hours daily.
What is the most likely diagnosis?