Family Nurse Practitioner Test Family Nurse Practitioner Skill 3 — Questions and Answers
Question 1: 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 2: 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 3: 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 4: 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 5: 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 6: 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 7: 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.
Family Nurse Practitioner Test Family Nurse Practitioner Skill 3
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?