Family Nurse Practitioner Test Family Nurse Practitioner Skill 2 — Questions and Answers
Question 1: A 58-year-old male with hypertension is started on lisinopril. Two weeks later he reports a dry, persistent cough. What is the most appropriate next step?
- Prescribe benzonatate for cough suppression
- Switch to an ARB such as losartan (Correct answer)
- Increase the lisinopril dose to improve efficacy
- Order a chest X-ray to rule out pneumonia
Correct answer: Switch to an ARB such as losartan
ACE inhibitor-induced cough is a class effect due to bradykinin accumulation; switching to an ARB (which does not affect bradykinin) is the preferred management.
Question 2: Which of the following findings on a diabetic foot exam requires immediate referral to a vascular surgeon?
- Absent hair growth on the dorsum of the foot
- Ankle-brachial index (ABI) of 0.55 with rest pain (Correct answer)
- Vibration sense loss at the great toe
- Dry skin with mild callus formation
Correct answer: Ankle-brachial index (ABI) of 0.55 with rest pain
An ABI below 0.6 with rest pain indicates critical limb ischemia requiring urgent vascular surgery evaluation.
Question 3: A 4-year-old presents with a barky cough, inspiratory stridor, and low-grade fever. What is the most likely diagnosis?
- Epiglottitis
- Croup (laryngotracheobronchitis) (Correct answer)
- Bacterial tracheitis
- Foreign body aspiration
Correct answer: Croup (laryngotracheobronchitis)
Croup typically affects children aged 6 months to 3 years but can occur at 4, presenting with a seal-like barky cough, stridor, and low-grade fever caused by parainfluenza virus.
Question 4: A patient with newly diagnosed atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to current guidelines, what is the recommended management?
- Aspirin 81 mg daily
- No anticoagulation needed
- Oral anticoagulation with a DOAC or warfarin (Correct answer)
- Rate control alone without anticoagulation
Correct answer: Oral anticoagulation with a DOAC or warfarin
A CHA₂DS₂-VASc score of 2 or higher in males (or 3+ in females) warrants oral anticoagulation to reduce stroke risk.
Question 5: Which screening test is recommended by the USPSTF for colorectal cancer starting at age 45 in average-risk adults?
- Annual digital rectal exam
- Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT (Correct answer)
- Sigmoidoscopy every 5 years alone
- CT colonography every 3 years
Correct answer: Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT
The USPSTF recommends starting colorectal cancer screening at age 45 with several acceptable strategies, including colonoscopy every 10 years or annual stool-based tests.
Question 6: A 30-year-old woman at 10 weeks gestation presents with nausea and vomiting. She has lost 5 lbs, has dry mucous membranes, and urine specific gravity of 1.030. What is the diagnosis?
- Typical morning sickness
- Hyperemesis gravidarum (Correct answer)
- Gastroenteritis
- Peptic ulcer disease
Correct answer: Hyperemesis gravidarum
Hyperemesis gravidarum is characterized by severe nausea/vomiting with weight loss >5% of pre-pregnancy weight and signs of dehydration.
Question 7: Which medication is first-line for acute gout flare management in a patient with no contraindications?
- Allopurinol
- Colchicine or NSAIDs (Correct answer)
- Probenecid
- Febuxostat
Correct answer: Colchicine or NSAIDs
NSAIDs or colchicine (started within 24 hours of flare onset) are first-line treatments for acute gout; allopurinol and probenecid are used for chronic prophylaxis.
Family Nurse Practitioner Test Family Nurse Practitioner Skill 2
A 58-year-old male with hypertension is started on lisinopril.
Two weeks later he reports a dry, persistent cough.
What is the most appropriate next step?