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