Family Nurse Practitioner Test Family Nurse Practitioner Skill — 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.
Question 8: A 65-year-old woman with osteoporosis has a T-score of -2.8 on DEXA scan. In addition to calcium and vitamin D, which pharmacologic therapy is first-line?
- Calcitonin nasal spray
- Teriparatide
- Oral bisphosphonate (alendronate or risedronate) (Correct answer)
- Raloxifene
Correct answer: Oral bisphosphonate (alendronate or risedronate)
Oral bisphosphonates are the first-line pharmacologic treatment for postmenopausal osteoporosis due to proven efficacy in reducing vertebral and hip fractures.
Question 9: A 2-year-old child is brought in with a bulging fontanelle, high fever, and nuchal rigidity. Which action should the FNP take FIRST?
- Perform a lumbar puncture immediately
- Administer empiric IV antibiotics without delay (Correct answer)
- Order a CT head before any intervention
- Administer acetaminophen and observe
Correct answer: Administer empiric IV antibiotics without delay
Bacterial meningitis is a life-threatening emergency; empiric antibiotics must not be delayed even if lumbar puncture or imaging is planned.
Question 10: Which of the following is the most appropriate initial antibiotic for uncomplicated community-acquired pneumonia in a healthy adult without comorbidities?
- Amoxicillin-clavulanate
- Azithromycin or doxycycline (Correct answer)
- Levofloxacin
- Trimethoprim-sulfamethoxazole
Correct answer: Azithromycin or doxycycline
IDSA/ATS guidelines recommend a macrolide (azithromycin) or doxycycline as monotherapy for outpatient CAP in otherwise healthy adults with no comorbidities.
Question 11: A 45-year-old male presents with fatigue, weight gain, cold intolerance, and constipation. TSH is 8.5 mIU/L and free T4 is low. What is the treatment of choice?
- Levothyroxine (T4 replacement) (Correct answer)
- Liothyronine (T3 only)
- Methimazole
- Radioactive iodine ablation
Correct answer: Levothyroxine (T4 replacement)
Hypothyroidism is treated with levothyroxine, the synthetic form of T4, titrated to normalize TSH.
Question 12: A mother brings her 6-week-old infant who vomits forcefully after every feeding and appears hungry immediately afterward. The FNP palpates an olive-shaped mass in the epigastrium. What is the most likely diagnosis?
- Gastroesophageal reflux disease
- Pyloric stenosis (Correct answer)
- Intussusception
- Hirschsprung disease
Correct answer: Pyloric stenosis
Pyloric stenosis classically presents at 3–6 weeks of age with projectile non-bilious vomiting, persistent hunger, and a palpable 'olive' mass representing the hypertrophied pylorus.
Question 13: Which of the following is the most important risk factor for the development of type 2 diabetes mellitus?
- Excessive alcohol consumption
- Central obesity and insulin resistance (Correct answer)
- Chronic use of NSAIDs
- Low dietary fiber intake alone
Correct answer: Central obesity and insulin resistance
Central obesity leading to insulin resistance is the predominant modifiable risk factor for type 2 diabetes mellitus.
Question 14: A 70-year-old male smoker reports painless gross hematuria. He has no UTI symptoms. What is the priority next step?
- Prescribe antibiotics empirically for UTI
- Refer for urgent cystoscopy to rule out bladder cancer (Correct answer)
- Order repeat urinalysis in 4 weeks
- Increase water intake and recheck in 2 weeks
Correct answer: Refer for urgent cystoscopy to rule out bladder cancer
Painless gross hematuria in an older smoker is bladder cancer until proven otherwise; urgent cystoscopy and urology referral are indicated.
Question 15: A 25-year-old woman presents with a painful vesicular rash in a dermatomal distribution on her right thorax. What is the treatment of choice if she presents within 72 hours of rash onset?
- Topical acyclovir cream
- Oral valacyclovir 1000 mg three times daily for 7 days (Correct answer)
- Oral prednisone alone
- IV acyclovir only
Correct answer: Oral valacyclovir 1000 mg three times daily for 7 days
Oral valacyclovir (or famciclovir) started within 72 hours of rash onset reduces the severity and duration of herpes zoster and lowers postherpetic neuralgia risk.
Question 16: Which lab finding is most consistent with iron-deficiency anemia?
- Elevated serum ferritin, low TIBC
- Low serum ferritin, elevated TIBC, microcytic hypochromic RBCs (Correct answer)
- Elevated MCV with hypersegmented neutrophils
- Normal ferritin with elevated reticulocyte count
Correct answer: Low serum ferritin, elevated TIBC, microcytic hypochromic RBCs
Iron-deficiency anemia is characterized by low ferritin (depleted stores), elevated TIBC, and microcytic hypochromic red cells on CBC.
Question 17: A 52-year-old woman presents with new-onset headache described as 'the worst headache of my life.' She denies fever or neck stiffness. What is the most critical next step?
- Prescribe a triptan and reassess in 24 hours
- Perform immediate non-contrast CT of the head (Correct answer)
- Order an MRI of the brain with contrast
- Administer IV magnesium for migraine
Correct answer: Perform immediate non-contrast CT of the head
A thunderclap 'worst headache of life' requires urgent non-contrast CT head to rule out subarachnoid hemorrhage before any other management.
Question 18: When counseling an adolescent patient confidentially, which of the following situations legally requires the FNP to breach confidentiality and notify parents or authorities?
- The teen discloses cannabis use at parties
- The teen discloses an imminent plan to harm themselves or another person (Correct answer)
- The teen requests STI testing
- The teen reports past alcohol experimentation
Correct answer: The teen discloses an imminent plan to harm themselves or another person
Imminent risk of harm to self or others is a legally and ethically mandated exception to adolescent confidentiality in all US states.
Question 19: A patient with COPD has an FEV₁/FVC ratio of 0.62 post-bronchodilator. According to GOLD criteria, what severity of obstruction does this indicate if FEV₁ is 55% predicted?
- GOLD 1 (Mild)
- GOLD 2 (Moderate) (Correct answer)
- GOLD 3 (Severe)
- GOLD 4 (Very Severe)
Correct answer: GOLD 2 (Moderate)
GOLD 2 (Moderate COPD) is defined by FEV₁/FVC < 0.70 with FEV₁ 50–79% of predicted.
Question 20: A 35-year-old woman is found to have a blood pressure of 150/95 mmHg on three separate visits. She is pregnant at 22 weeks. Which antihypertensive is safest to initiate?
- Lisinopril
- Labetalol (Correct answer)
- Hydrochlorothiazide
- Amlodipine alone first-line
Correct answer: Labetalol
Labetalol (and nifedipine or methyldopa) are preferred antihypertensives in pregnancy; ACE inhibitors are contraindicated due to fetal toxicity.
Question 21: Which of the following is the hallmark physical finding in cardiac tamponade?
- Wide pulse pressure with bounding pulses
- Beck's triad: hypotension, muffled heart sounds, and JVD (Correct answer)
- Loud S3 gallop with pulmonary crackles
- Bradycardia with hypertension
Correct answer: Beck's triad: hypotension, muffled heart sounds, and JVD
Beck's triad (hypotension, muffled/distant heart sounds, and jugular venous distension) is the classic presentation of cardiac tamponade.
