Family Nurse Practitioner (FNP) Certification Exam (ANCC/AANP) — Questions and Answers

Question 1: A 58-year-old male with type 2 diabetes presents with a fasting glucose of 310 mg/dL and HbA1c of 10.2%. He is currently on metformin 1000 mg twice daily. What is the most appropriate next step?

Add a GLP-1 receptor agonist
Increase metformin to 2550 mg/day
Add a sulfonylurea
Initiate insulin therapy (Correct answer)

Correct answer: Initiate insulin therapy

With an HbA1c >10% and significantly elevated fasting glucose, insulin therapy is indicated to rapidly achieve glycemic control.

Question 2: A 14-year-old patient discloses substance use during a confidential visit. Under HIPAA and most state laws, the FNP should FIRST:

Refer to psychiatry without disclosure to parents
Immediately notify parents
Report to child protective services
Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality (Correct answer)

Correct answer: Provide counseling, assess for dependence, and determine if the minor is in immediate danger before breaching confidentiality

Minors have confidentiality rights for substance use treatment in most states; the FNP should assess safety and engage the patient in treatment before any breach.

Question 3: For sickle cell anemia, G6PD anemia, and alpha or beta thalassemia, the diagnostic or gold standard test is Angioedema?

Yes
No (Correct answer)

Correct answer: No

For sickle cell anemia, G6PD anemia, and alpha or beta thalassemia, the diagnostic or gold standard test is Hemoglobin electrophoresis

Question 4: A 65-year-old patient asks about shingles prevention. Which vaccine should the FNP recommend?

No vaccine available for this age group
Shingrix (recombinant zoster vaccine) 2-dose series (Correct answer)
Varivax (varicella vaccine)
Zostavax (live attenuated)

Correct answer: Shingrix (recombinant zoster vaccine) 2-dose series

Shingrix (RZV) 2-dose series is recommended for adults 50 and older and is preferred over Zostavax due to greater efficacy (>90%).

Question 5: A patient is found to have TSH of 0.1 mIU/L with elevated free T4. The FNP interprets this as:

Subclinical hypothyroidism
Secondary hyperthyroidism
Primary hyperthyroidism (Correct answer)
Primary hypothyroidism

Correct answer: Primary hyperthyroidism

Low TSH with elevated free T4 indicates primary hyperthyroidism, where excess thyroid hormone suppresses pituitary TSH secretion.

Question 6: The FNP is discussing the HPV vaccine with the parent of a 12-year-old. What is the recommended schedule for this age group?

3-dose series at 0, 1, and 6 months
2-dose series at 0 and 2 months
2-dose series at 0 and 6-12 months (Correct answer)
Single dose only

Correct answer: 2-dose series at 0 and 6-12 months

For adolescents who start the HPV vaccine series before age 15, a 2-dose schedule (0 and 6-12 months apart) is recommended.

Question 7: A 48-year-old man presents with a blood pressure of 158/96 mmHg on three separate visits. He has no other comorbidities. According to JNC guidelines, which is the most appropriate initial pharmacotherapy?

Alpha-1 blocker
ACE inhibitor
Thiazide diuretic (Correct answer)
Beta-blocker

Correct answer: Thiazide diuretic

Thiazide diuretics are recommended as first-line pharmacotherapy for uncomplicated hypertension by JNC guidelines.

Question 8: A 3-year-old child presents with inspiratory stridor, a barking cough, and low-grade fever. The symptoms worsen at night. What is the most likely diagnosis?

Epiglottitis
Croup (laryngotracheobronchitis) (Correct answer)
Bacterial tracheitis
Foreign body aspiration

Correct answer: Croup (laryngotracheobronchitis)

Viral croup classically presents with a barking cough, inspiratory stridor, and symptoms that worsen at night in young children.

Question 9: A 62-year-old man with a 40 pack-year smoking history and COPD presents with progressive dyspnea. Spirometry shows FEV1/FVC ratio of 0.62 and FEV1 of 55% predicted. According to GOLD guidelines, what stage is his COPD?

GOLD Stage 1 (Mild)
GOLD Stage 3 (Severe)
GOLD Stage 2 (Moderate) (Correct answer)
GOLD Stage 4 (Very Severe)

Correct answer: GOLD Stage 2 (Moderate)

GOLD Stage 2 (Moderate) COPD is defined by FEV1/FVC <0.70 and FEV1 between 50-79% predicted.

Question 10: A patient presents with painful vesicles in a dermatomal distribution on one side of the trunk. The FNP diagnoses herpes zoster and notes the MOST important reason to treat promptly with antivirals:

To eliminate the virus permanently
To reduce the severity and duration of postherpetic neuralgia (Correct answer)
To prevent transmission to others
To reduce the risk of bacterial superinfection only

Correct answer: To reduce the severity and duration of postherpetic neuralgia

Early antiviral treatment (within 72 hours) reduces the risk and severity of postherpetic neuralgia, the most common complication of herpes zoster.

Question 11: An 80-year-old man with moderate dementia is brought in by his daughter who suspects elder abuse. During the visit, the patient has unexplained bruises and appears fearful. What is the FNP's mandatory obligation?

Discuss the situation with the daughter first before taking any action
Report the suspected abuse to Adult Protective Services (Correct answer)
Consult psychiatry for the patient's behavioral issues
Document the findings and follow up in 2 weeks

Correct answer: Report the suspected abuse to Adult Protective Services

FNPs are mandated reporters and must report suspected elder abuse to Adult Protective Services regardless of caregiver relationship.

Question 12: A patient with sudden painless vision loss in one eye is MOST likely experiencing which condition?

Acute angle-closure glaucoma
Central retinal artery occlusion (Correct answer)
Optic neuritis
Retinal detachment

Correct answer: Central retinal artery occlusion

Central retinal artery occlusion causes sudden, painless, complete monocular vision loss and is an ophthalmic emergency requiring immediate intervention.

Question 13: A 16-year-old athlete presents with anterior knee pain worsened by stairs and prolonged sitting. Examination reveals tenderness at the inferior pole of the patella. What is the most likely diagnosis?

Osgood-Schlatter disease
Sinding-Larsen-Johansson syndrome (Correct answer)
Meniscal tear
Patellofemoral pain syndrome

Correct answer: Sinding-Larsen-Johansson syndrome

Sinding-Larsen-Johansson syndrome involves traction apophysitis at the inferior pole of the patella, distinct from Osgood-Schlatter which affects the tibial tuberosity.

Question 14: A 45-year-old woman presents with hot flashes, irregular menses, and vaginal dryness. FSH is 55 mIU/mL. She has no contraindications. What is the first-line treatment for her vasomotor symptoms?

Phytoestrogens
Combined estrogen-progestogen hormone therapy (Correct answer)
Medroxyprogesterone acetate alone
Selective serotonin reuptake inhibitors

Correct answer: Combined estrogen-progestogen hormone therapy

Combined estrogen-progestogen therapy is the most effective treatment for vasomotor symptoms in perimenopausal women with an intact uterus.

Question 15: A school-age child presents with an intensely pruritic rash with linear burrows between the fingers and on the wrists, worse at night. What is the treatment?

Oral prednisone burst
Oral antihistamine for 2 weeks
Topical hydrocortisone cream
Topical permethrin 5% cream applied from neck to toes and washed off after 8–14 hours (Correct answer)

Correct answer: Topical permethrin 5% cream applied from neck to toes and washed off after 8–14 hours

Scabies is treated with permethrin 5% cream applied to the entire body surface from neck down and left on for 8–14 hours; all household members should be treated simultaneously.

Question 16: A 5-year-old presents with periorbital edema, frothy urine, and abdominal pain. Urinalysis shows 4+ protein. Which condition is the most common cause in this age group?

Membranous nephropathy
Focal segmental glomerulosclerosis
Minimal change disease (Correct answer)
IgA nephropathy

Correct answer: Minimal change disease

Minimal change disease is the most common cause of nephrotic syndrome in children aged 1–8 years and typically responds well to corticosteroids.

Question 17: Is the patient, who is most likely an adolescent, suffering from acute mononucleosis if they exhibit the traditional trio of a sore throat, protracted weariness, and swollen cervical nodes?

True (Correct answer)
False

Correct answer: True

Infectious mononucleosis is most frequently caused by the Epstein-Barr virus (EBV), but other viruses can also be to blame. Teenagers and young adults, particularly college students, are particularly prone to it. When exposed to EBV, at least one in four adolescents and young adults will develop infectious mononucleosis.

Question 18: A patient with COPD exacerbation is found to have pursed-lip breathing. This compensatory mechanism primarily serves to:

Slow exhalation to maintain airway pressure and prevent early airway collapse (Correct answer)
Reduce respiratory rate
Improve oxygen saturation by deep breathing
Increase tidal volume

Correct answer: Slow exhalation to maintain airway pressure and prevent early airway collapse

Pursed-lip breathing creates positive expiratory pressure that splints small airways open, preventing dynamic collapse during exhalation in COPD.

Question 19: Which method of health promotion would be best for patients of adolescent age who are overweight?

Individual-based behavior modification
Motivational interviewing (Correct answer)
Parental regulation of meals
Presentation of video case studies

Correct answer: Motivational interviewing

It has been discovered that the health promotion method of motivational interviewing works well in treating obese teenagers. It is a patient-centered, directive counseling approach that relies on intrinsic motivation. Research has shown that it can help people overcome ambivalence, increase intrinsic motivation, and boost confidence in their capacity to change their behavior.

Question 20: An uncommon yet severe side effect of ACE inhibitors is:

Bullae
Glaucoma
Angioedema (Correct answer)
none of the above

Correct answer: Angioedema

Angioedema, which affects 0.1-0.2% of people, is the most serious side effect of ACE inhibitors. The basic characteristics of angioedema include airway swelling and blockage brought on by fluid (and bradykinin) buildup.

Question 21: 4 important features -bradykinesia -muscular weakness -a tremor at rest instability in one's posture Medication: Amantadine (Symmetrel), a dopamine agonist.

Sulfonamides
Parkinson dz (Correct answer)
Pharyngitis
Boys puberty

Correct answer: Parkinson dz

Early signs of Parkinson's disease include tremors, muscle stiffness, and sluggishness of movement, but there are also other symptoms to watch out for. Parkinson's disease frequently causes issues with sleep and the nighttime. Parkinson's disease patients are more prone to have insomnia since the disease can cause several symptoms that interfere with sleep.

Question 22: 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?

Hypothyroidism
Female athlete triad with functional hypothalamic amenorrhea (Correct answer)
Polycystic ovary syndrome
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 23: Ann, 49, experiences everyday asthma problems. Her daily routine includes taking her inhaled short-acting beta-2 agonist. At least twice a week, her exacerbations impede her activities and may last days. She has a nighttime exacerbation more frequently than once per week. Which level of asthma severity does Ann fall under?

Moderate persistent (Correct answer)
Severe persistent
Intermittent
Mild persistent

Correct answer: Moderate persistent

Ann's asthma symptoms, including daily use of a short-acting beta-2 agonist, exacerbations impeding activities at least twice a week lasting days, and nighttime exacerbations more frequently than once per week, align with the criteria for moderate persistent asthma. This severity level indicates significant impairment and requires daily controller medication to manage symptoms and prevent exacerbations. It's more severe than mild persistent but less than severe persistent.

Question 24: You are recommending hormonal therapy for the treatment of prostate cancer in a patient aged 73. It is thought that goserelin acetate (Zoladex) works as an androgen ablation by _____.

blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). (Correct answer)
inhibiting the progression of cancer cells through the cell cycle.
inhibiting the progression of cancer cells through the cell cycle.
inhibiting the binding of testosterone to cancer cells.

Correct answer: blocking the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

To prevent the production of FSH and LH, the IM injections of goserelin acetate (Zoladex) and leuprolide acetate (Lupron) are used.

Question 25: 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 2 (Moderate) (Correct answer)
GOLD 3 (Severe)
GOLD 1 (Mild)
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 26: The FNP notes café-au-lait spots (>6, >15mm) in an adult patient. This finding raises suspicion for:

Vitiligo
Tuberous sclerosis
Neurofibromatosis type 1 (Correct answer)
McCune-Albright syndrome

Correct answer: Neurofibromatosis type 1

Six or more café-au-lait macules larger than 15 mm in adults are a major diagnostic criterion for neurofibromatosis type 1 (NF1).

Question 27: A patient with recurrent nephrolithiasis is found to have hypercalcemia, elevated PTH, and low phosphorus. The MOST likely diagnosis is:

Vitamin D toxicity
Milk-alkali syndrome
Sarcoidosis
Primary hyperparathyroidism (Correct answer)

Correct answer: Primary hyperparathyroidism

High PTH with hypercalcemia and hypophosphatemia is the classic triad of primary hyperparathyroidism, the most common cause of outpatient hypercalcemia.

Question 28: What breath sound results when the inspiratory rate equals the expiratory rate?

Vesicular
Bronchial
Bronchovesicular (Correct answer)
Tracheal

Correct answer: Bronchovesicular

Bronchovesicular breath sounds are characterized by an inspiratory phase that is equal in duration to the expiratory phase. These sounds are typically heard over the major bronchi, such as between the scapulae and next to the sternum. This equality in duration distinguishes them from vesicular sounds (longer inspiration) and bronchial/tracheal sounds (longer expiration or very loud and harsh).

Question 29: In parasite infections, hypersensitivity reactions, and autoimmune diseases, which white blood cell type is elevated?

Neutrophils
Eosinophils (Correct answer)
Monocytes
Basophils

Correct answer: Eosinophils

Eosinophils are a type of white blood cell that plays a key role in the immune response, particularly against parasitic infections and in allergic reactions (hypersensitivity reactions). Elevated eosinophil counts (eosinophilia) are a classic indicator of these conditions, as well as some autoimmune diseases, due to their involvement in mediating inflammatory responses. They help to neutralize allergens and fight off parasites.

Question 30: The FNP notes a S4 heart sound in an older patient with hypertension. This sound occurs because of:

Reduced ventricular compliance requiring forceful atrial contraction (Correct answer)
Mitral valve prolapse
Rapid ventricular filling in early diastole
Aortic stenosis turbulence

Correct answer: Reduced ventricular compliance requiring forceful atrial contraction

An S4 results from atrial contraction against a stiff, noncompliant ventricle, commonly seen in hypertensive heart disease.

Question 31: Which of the following neoplasms is considered to be benign?

Glioma
Leiomyoma (Correct answer)
Osteosarcoma
Seminoma

Correct answer: Leiomyoma

A leiomyoma is a benign tumor that originates from smooth muscle tissue, most commonly found in the uterus (often referred to as uterine fibroids). Unlike malignant neoplasms such as seminoma, glioma, or osteosarcoma, leiomyomas are non-cancerous, do not metastasize, and typically grow slowly without invading surrounding tissues. They are generally not life-threatening, though they can cause symptoms depending on their size and location.

Question 32: A 70-year-old male smoker reports painless gross hematuria. He has no UTI symptoms. What is the priority next step?

Order repeat urinalysis in 4 weeks
Refer for urgent cystoscopy to rule out bladder cancer (Correct answer)
Increase water intake and recheck in 2 weeks
Prescribe antibiotics empirically for UTI

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 33: Produces states of calm and relaxation

Photopsia
Ligaments
Serotonin (Correct answer)
Strain

Correct answer: Serotonin

Serotonin is involved in a variety of bodily processes, including mood regulation in the brain. It is frequently referred to be your body's inborn "feel good" chemical. You feel more emotionally secure, happier, calmer, and more emotionally focused when serotonin levels are normal.

Question 34: A 35-year-old woman with migraine with aura is seeking contraception. Which method is contraindicated due to increased stroke risk?

Copper IUD
Combined estrogen-progestin oral contraceptive (Correct answer)
Progestin-only pill
Levonorgestrel IUD

Correct answer: Combined estrogen-progestin oral contraceptive

Combined hormonal contraceptives containing estrogen are contraindicated (WHO MEC Category 4) in women with migraine with aura due to significantly increased ischemic stroke risk.

Question 35: Which counseling intervention is most supported by evidence for helping patients achieve smoking cessation?

Hypnotherapy alone
Cold turkey cessation without support
Acupuncture therapy
Combination of pharmacotherapy (varenicline or NRT) with behavioral counseling (Correct answer)

Correct answer: Combination of pharmacotherapy (varenicline or NRT) with behavioral counseling

Combining FDA-approved pharmacotherapy (varenicline, bupropion, or nicotine replacement therapy) with behavioral counseling yields the highest quit rates in evidence-based guidelines.

Question 36: A patient has a fasting plasma glucose of 128 mg/dL on two separate occasions. The FNP diagnoses:

Reactive hypoglycemia
Diabetes mellitus (Correct answer)
Impaired fasting glucose (prediabetes)
Normal fasting glucose

Correct answer: Diabetes mellitus

A fasting plasma glucose ≥126 mg/dL on two separate tests meets the ADA diagnostic criteria for diabetes mellitus.

Question 37: A patient with chronic kidney disease and secondary hyperparathyroidism has low calcium and elevated phosphorus. The FNP should FIRST address:

Calcium supplementation alone
High-dose vitamin D supplementation alone
Phosphorus restriction and phosphate binders (Correct answer)
Parathyroidectomy

Correct answer: Phosphorus restriction and phosphate binders

Hyperphosphatemia drives secondary hyperparathyroidism in CKD; dietary phosphorus restriction combined with phosphate binders is the first-line approach.

Question 38: Angelo, age 35, says he recently returned from a business trip and feels strange pressure in his ear, therefore he believes he has an ear infection. Your barotrauma diagnosis. What will you do next?

Prescribe nasal steroids and oral decongestants. (Correct answer)
Refer Max to an ear, nose, and throat specialist.
Prescribe antibiotic ear drops.
Prescribe systemic antibiotics.

Correct answer: Prescribe nasal steroids and oral decongestants.

Barotrauma, or "ear pressure," often results from pressure differences between the middle ear and the external environment, commonly experienced after air travel or diving. This can cause Eustachian tube dysfunction. Nasal steroids and oral decongestants help reduce inflammation and open the Eustachian tubes, allowing for pressure equalization and symptom relief without the need for antibiotics unless there's evidence of bacterial infection.

Question 39: Which finding on urinalysis is MOST specific for a urinary tract infection?

Positive nitrites (Correct answer)
Hematuria
Proteinuria
Elevated specific gravity

Correct answer: Positive nitrites

Positive nitrites indicate bacterial conversion of nitrates, which is highly specific for gram-negative bacteriuria such as E. coli.

Question 40: When counseling a patient about the Tdap vaccine, the FNP should advise that protection against pertussis typically wanes after approximately how many years?

15 years
10 years
2 years
5 years (Correct answer)

Correct answer: 5 years

Immunity from the Tdap vaccine against pertussis wanes significantly after about 5 years, which is why booster doses are recommended.

Question 41: Which breath sound is MOST characteristic of consolidation (pneumonia)?

Bronchial breath sounds over lung periphery (Correct answer)
Pleural friction rub
Fine crackles bilaterally
Expiratory wheezing

Correct answer: Bronchial breath sounds over lung periphery

Bronchial breath sounds heard over the peripheral lung fields indicate consolidation because solid tissue conducts sound differently than aerated lung.

Question 42: Which of the following is the hallmark physical finding in cardiac tamponade?

Wide pulse pressure with bounding pulses
Bradycardia with hypertension
Beck's triad: hypotension, muffled heart sounds, and JVD (Correct answer)
Loud S3 gallop with pulmonary crackles

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.

Question 43: According to the US Preventive Services Task Force (USPSTF), at what age should average-risk adults begin colorectal cancer screening?

55 years
40 years
45 years (Correct answer)
50 years

Correct answer: 45 years

The USPSTF updated its recommendation in 2021 to begin colorectal cancer screening at age 45 for average-risk adults.

Question 44: A patient with newly diagnosed atrial fibrillation has a CHA₂DS₂-VASc score of 3. According to current guidelines, what is the recommended management?

No anticoagulation needed
Aspirin 81 mg daily
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 45: When estrogen-using women reach perimenopause, why do doctors typically prescribe a progestational medication?

Prevent osteoporosis
Decrease the risk of endometrial hyperplasia (Correct answer)
Promote growth of the uterine lining
Prevent hot flashes

Correct answer: Decrease the risk of endometrial hyperplasia

To lessen the risk of endometrial hyperplasia, progestational medications are typically given to perimenopausal women who use estrogen. To prevent estrogen-related endometrial hyperplasia, progestational medicine is used in conjunction with estrogen therapy.

Question 46: The FNP is conducting a sports physical for a 16-year-old. Which finding warrants DISQUALIFICATION from contact sports?

History of simple concussion cleared by neurology
Mild exercise-induced bronchospasm treated with albuterol
Well-controlled asthma
Single functional kidney (Correct answer)

Correct answer: Single functional kidney

A single functional kidney is a relative-to-absolute contraindication for contact sports because trauma could result in loss of the only functioning kidney.

Question 47: A 55-year-old male with known coronary artery disease presents with crushing chest pain radiating to the left arm, diaphoresis, and nausea. ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Left main coronary artery
Left circumflex artery
Right coronary artery (RCA) (Correct answer)
Left anterior descending (LAD) artery

Correct answer: Right coronary artery (RCA)

ST elevations in leads II, III, and aVF indicate an inferior STEMI, most commonly caused by occlusion of the right coronary artery.

Question 48: The FNP is counseling a postmenopausal woman on hormone therapy (HT). Which combination is preferred for a woman WITH a uterus?

Testosterone supplementation
Estrogen plus progestogen (combined HT) (Correct answer)
Estrogen alone
Progestogen alone

Correct answer: Estrogen plus progestogen (combined HT)

Women with an intact uterus must receive progestogen with estrogen to prevent unopposed estrogen stimulation causing endometrial hyperplasia and cancer.

Question 49: A 40-year-old woman with fatigue, weight gain, cold intolerance, and constipation has a TSH of 9.2 mIU/L and free T4 of 0.6 ng/dL. What is the treatment?

Methimazole therapy
Radioactive iodine ablation
Propylthiouracil therapy
Levothyroxine therapy (Correct answer)

Correct answer: Levothyroxine therapy

Primary hypothyroidism with elevated TSH and low free T4 is treated with synthetic levothyroxine (T4) replacement therapy.

Question 50: 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?

Oral valacyclovir 1000 mg three times daily for 7 days (Correct answer)
IV acyclovir only
Oral prednisone alone
Topical acyclovir cream

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 51: Which antibiotic class is MOST appropriate for treating community-acquired pneumonia in a healthy adult without comorbidities?

Cephalosporins (e.g., ceftriaxone)
Beta-lactams + macrolide combination
Fluoroquinolones (e.g., levofloxacin)
Macrolides (e.g., azithromycin) (Correct answer)

Correct answer: Macrolides (e.g., azithromycin)

IDSA/ATS guidelines recommend macrolide monotherapy as first-line for outpatient CAP in previously healthy patients with no antibiotic use in the past 3 months.

Question 52: A follow-up visit is scheduled for a Chinese male patient, 55, who underwent heart bypass surgery. The patient enters the examining room with his father at his side. How can a family nurse practitioner deliver culturally sensitive care?

Performs the examination without speaking to the patient's father.
Asks the patient's father to leave the room due to confidentiality issues.
Asks the patient's father first if he has any questions regarding his son's care. (Correct answer)
Provides the patient's father an informational packet to read while performing the examination.

Correct answer: Asks the patient's father first if he has any questions regarding his son's care.

The family nurse practitioner can provide culturally sensitive care by first asking the patient's father if he has any questions about his son's treatment. Respect for the patient's family and their cultural values is demonstrated by this method.

Question 53: A patient with an MRSA skin infection requires oral outpatient treatment. Which antibiotic is MOST appropriate?

Trimethoprim-sulfamethoxazole (TMP-SMX) (Correct answer)
Amoxicillin-clavulanate
Cephalexin
Dicloxacillin

Correct answer: Trimethoprim-sulfamethoxazole (TMP-SMX)

TMP-SMX provides reliable oral coverage against community-acquired MRSA for uncomplicated skin and soft tissue infections.

Question 54: 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 reports past alcohol experimentation
The teen discloses an imminent plan to harm themselves or another person (Correct answer)
The teen discloses cannabis use at parties
The teen requests STI testing

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 55: Which of the following is a normal finding on abdominal assessment?

Hyperresonance over the liver
Tympany over most of the abdomen (Correct answer)
Absent bowel sounds after 5 minutes of auscultation
Dullness over the right lower quadrant

Correct answer: Tympany over most of the abdomen

Tympany predominates over most of the abdomen due to gas in the gastrointestinal tract, while dullness is normal over solid organs like the liver and spleen.

Question 56: A 68-year-old woman with osteoporosis has a T-score of -2.7 at the lumbar spine. The FNP initiates bisphosphonate therapy and counsels the patient to:

Crush it and mix with applesauce
Take it with food to reduce GI upset
Take it at bedtime for best absorption
Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes (Correct answer)

Correct answer: Take it on an empty stomach with 8 oz of water and remain upright for 30 minutes

Bisphosphonates must be taken fasting with a full glass of water, and patients must remain upright for 30 minutes to prevent esophageal irritation and ensure absorption.

Question 57: Which of the following is recommended by USPSTF for depression screening in the general adult population?

Screen only postpartum women
Screen all adults aged 18 and older (Correct answer)
Screen only patients with a family history of depression
Screen only adults with chronic illness

Correct answer: Screen all adults aged 18 and older

USPSTF recommends screening for depression in all adults 18 and older when adequate systems are in place to ensure diagnosis, treatment, and follow-up.

Question 58: A 65-year-old with a 30 pack-year smoking history presents with a FEV1/FVC ratio of 0.65 post-bronchodilator. The MOST likely diagnosis is:

Asthma
Chronic obstructive pulmonary disease (COPD) (Correct answer)
Normal spirometry
Pulmonary fibrosis

Correct answer: Chronic obstructive pulmonary disease (COPD)

A post-bronchodilator FEV1/FVC ratio <0.70 in a smoker confirms the obstructive pattern required for GOLD criteria COPD diagnosis.

Question 59: A 55-year-old man with hypertension and stage 3 CKD (GFR 42) needs antihypertensive therapy. Which medication class is most beneficial for renoprotection in this patient?

Thiazide diuretic
Calcium channel blocker
ACE inhibitor (Correct answer)
Beta-blocker

Correct answer: ACE inhibitor

ACE inhibitors reduce intraglomerular pressure and proteinuria, providing renoprotective benefits in CKD patients.

Question 60: The FNP prescribes an oral fluoroquinolone. Which patient education point is MOST critical?

Avoid sunlight for 48 hours only
Avoid antacids within 2 hours of the dose and report tendon pain immediately (Correct answer)
Expect pink discoloration of urine
Take with a full glass of milk

Correct answer: Avoid antacids within 2 hours of the dose and report tendon pain immediately

Fluoroquinolones chelate with divalent cations in antacids reducing absorption, and carry a Black Box Warning for tendinopathy and tendon rupture.

Question 61: At what age should women of average risk begin mammography screening according to the USPSTF (2024 guidelines)?

45 years
50 years
40 years (Correct answer)
35 years

Correct answer: 40 years

The USPSTF 2024 updated guidelines recommend that women begin biennial mammography screening at age 40.

Question 62: Determining occupational exposure to illness might be challenging because of the following _____.

long latency period between exposure and disease development (Correct answer)
inaccuracy of occupational disease reporting
confidentiality of the information within company records
reliance on workers' memories

Correct answer: long latency period between exposure and disease development

Occupational illness exposure is difficult to determine because of the long latency time between exposure and disease development. Occupational illnesses typically have a lengthy latency period between the beginning of exposure and the development of the disease.

Question 63: 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?

Streptococcus pneumoniae (Correct answer)
Neisseria meningitidis
Haemophilus influenzae
Listeria monocytogenes

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the most common cause of bacterial meningitis in children over 1 month and adults.

Question 64: When teaching smokers about using nicotine gum to help them quit smoking, advise them to _____.

Chew 1 piece every 4 hours for the first 6 weeks,
Chew the gum like regular gum.
Drink a cup of coffee before chewing the gum because it assists the nicotine absorption.
Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa. (Correct answer)

Correct answer: Chew until a peppery taste or tingling sensation is felt and then place in buccal mucosa.

The correct way to use nicotine gum involves chewing it slowly until a 'peppery' taste or tingling sensation is felt, which indicates nicotine release. At this point, the gum should be 'parked' or placed between the cheek and gum (buccal mucosa) to allow for gradual absorption of nicotine. This method prevents rapid nicotine release, which can cause side effects, and ensures effective delivery of the medication.

Question 65: While playing, a nine-year-old child suffered a small laceration. According to the patient's vaccination history, the patient had a primary series of the pediatric DTaP vaccine, a primary series of the oral poliovirus vaccine, and a DTaP booster shot at age five, right before starting school. The family nurse practitioner provides the patient with the following according to current vaccination recommendations ______.

a DTaP booster
a booster of diphtheria and tetanus toxoids
no injection at this time (Correct answer)
a tetanus toxoid injection

Correct answer: no injection at this time

The patient's immunization history included a primary series of the pediatric DTaP vaccine, a primary series of the oral poliovirus vaccine, and a booster injection at age five before starting school. According to the most recent immunization guidelines, the family nurse practitioner administers the following (no injection required) to the patient.

Question 66: A 45-year-old with newly diagnosed hypertension also has chronic kidney disease (eGFR 42). Which antihypertensive is the first-line choice?

Lisinopril (Correct answer)
Hydrochlorothiazide
Metoprolol
Amlodipine

Correct answer: Lisinopril

ACE inhibitors (e.g., lisinopril) are first-line in CKD with hypertension due to their nephroprotective effects and reduction of proteinuria.

Question 67: Which level of prevention involves early detection of disease before symptoms appear, such as screening mammography?

Primary prevention
Quaternary prevention
Secondary prevention (Correct answer)
Tertiary prevention

Correct answer: Secondary prevention

Secondary prevention focuses on early detection and prompt treatment of disease before symptoms develop, such as screening for breast cancer with mammography.

Question 68: A 62-year-old lady arrives at the office complaining of leg heaviness, particularly while standing for lengthy periods of time. The patient has spent the previous 20 years working as a cashier at a department store, and she reports that her symptoms are at their worst when her job ends. The calves and ankles of both lower limbs have bilaterally dilated, tortuous veins without erythema or edema upon examination. Examination of the upper extremities is unremarkable. Which of the following outcomes is at higher risk due to this patient's present condition?

Pulmonary embolism
Intermittent claudication
Myocardial infarction
Venous stasis ulcers (Correct answer)

Correct answer: Venous stasis ulcers

The patient's symptoms (leg heaviness, bilaterally dilated, tortuous veins, prolonged standing occupation) are consistent with varicose veins and chronic venous insufficiency. Over time, impaired venous return and increased pressure in the veins can lead to skin changes, inflammation, and ultimately, the development of venous stasis ulcers, particularly around the ankles.

Question 69: Guidelines for clinical practice should:

increase variations in clinical care
mandate practice decisions
serve as a handbook for best practice (Correct answer)
protect nurses from legal liability

Correct answer: serve as a handbook for best practice

For high blood pressure, doctors frequently give hydrochlorothiazide (Microzide). It belongs to a group of drugs called diuretics, sometimes referred to as water pills. Some diuretics, such as hydrochlorothiazide, might temporarily increase low-density lipoprotein (LDL) cholesterol and triglycerides when taken at high dosages of 50 mg or more.

Question 70: A 50-year-old male patient with no prior cardiovascular events has a 10-year ASCVD risk of 12%. What is the most appropriate recommendation?

No treatment needed, recheck in 5 years
Statin therapy discussion based on shared decision-making (Correct answer)
Immediate high-intensity statin therapy
Aspirin therapy alone

Correct answer: Statin therapy discussion based on shared decision-making

For patients with an intermediate 10-year ASCVD risk (7.5-20%), current guidelines recommend a shared decision-making discussion about initiating moderate-intensity statin therapy.

Question 71: What is Goodpasture syndrome?

Typically, the end stage of other glomerular disorders, such as rapidly progressive glomerulonephritis, lupus nephritis, or diabetic nephropathy.
Characterized by massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema.
An inflammatory autoimmune disorder affecting the connective tissue of the body, with inflammatory lesions involving the supportive tissues of the glomeruli.
Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes. (Correct answer)

Correct answer: Characterized by glomerulonephritis and pulmonary hemorrhage resulting from immune complex damage to the glomerular and alveolar basement membranes.

Goodpasture syndrome is a rare autoimmune disease characterized by the presence of antibodies that target the basement membranes of the glomeruli in the kidneys and the alveoli in the lungs. This immune complex damage leads to a distinctive clinical presentation of rapidly progressive glomerulonephritis and pulmonary hemorrhage. The simultaneous involvement of both organs is a hallmark of this specific condition.

Question 72: A 50-year-old man presents with a total cholesterol of 240, LDL of 165, HDL of 38, and triglycerides of 210. He has diabetes and hypertension. Using the ACC/AHA Pooled Cohort Equations, his 10-year ASCVD risk is 13%. Which statin intensity is recommended?

High-intensity statin (Correct answer)
Low-intensity statin
Moderate-intensity statin
No statin indicated; lifestyle modification only

Correct answer: High-intensity statin

A 10-year ASCVD risk ≥10% with diabetes and additional risk factors warrants high-intensity statin therapy per ACC/AHA guidelines.

Question 73: Which of the following is true when trying to determine the difference between pulmonary and cardiac causes of dyspnea on exertion?

Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise. (Correct answer)
In dyspnea arising from cardiac causes, the heart rate will return to pre-exercise levels within a few minutes after cessation of exercise.
When the cause is pulmonary, recovery of normal respiration is slow, and dyspnea eventually abates after cessation of exercise.
Clients with pulmonary dyspnea have minimal dyspnea at rest.

Correct answer: Clients with dyspnea from cardiac causes remain dyspneic much longer after cessation of exercise.

Dyspnea from cardiac causes, often due to the heart's inability to meet the body's demands or fluid congestion in the lungs, tends to persist longer after exercise cessation. The cardiovascular system takes more time to recover and normalize function, leading to prolonged shortness of breath. In contrast, dyspnea from purely pulmonary causes might abate more quickly once the immediate demand for increased respiration is removed, assuming no underlying severe lung disease.

Question 74: Which finding on urinalysis is most specific for a urinary tract infection caused by E. coli?

Positive leukocyte esterase and nitrites with WBC casts (Correct answer)
Specific gravity > 1.020
Hematuria alone
Presence of protein

Correct answer: Positive leukocyte esterase and nitrites with WBC casts

Positive leukocyte esterase (indicating WBCs) combined with positive nitrites (indicating gram-negative bacteria like E. coli) is most specific for bacterial UTI.

Question 75: A 6-year-old boy is brought in for evaluation of inattentiveness and hyperactivity that disrupts class. The FNP wants to diagnose ADHD. According to DSM-5, symptoms must be present in at least how many settings?

One setting
Two settings (Correct answer)
Three settings
Four settings

Correct answer: Two settings

DSM-5 requires that ADHD symptoms be present in two or more settings (e.g., home and school) to meet diagnostic criteria.

Question 76: A 72-year-old presents with sudden onset of painless vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?

Optic neuritis
Retinal detachment (Correct answer)
Central retinal artery occlusion
Acute angle-closure glaucoma

Correct answer: Retinal detachment

Painless, sudden vision loss described as a descending curtain is the classic presentation of retinal detachment, an ophthalmologic emergency.

Question 77: A 4-year-old is brought in by parents for fever and appears non-toxic. On exam the FNP notes a petechial rash that does NOT blanch with pressure. The PRIORITY action is:

Diagnose viral exanthem and reassure parents
Order CBC and CMP and see results next day
Prescribe oral amoxicillin and observe at home
Emergency transfer to the ED for suspected meningococcemia (Correct answer)

Correct answer: Emergency transfer to the ED for suspected meningococcemia

Non-blanching petechiae with fever can indicate meningococcemia (Neisseria meningitidis), a rapidly fatal condition requiring immediate emergency evaluation and IV antibiotics.

Question 78: The FNP prescribes metformin for a newly diagnosed type 2 diabetic. Which contraindication should be screened for FIRST?

BMI >35
HbA1c >9%
eGFR <30 mL/min/1.73 m² (Correct answer)
Age >65 years

Correct answer: eGFR <30 mL/min/1.73 m²

Metformin is contraindicated with significant renal impairment (eGFR <30) due to risk of lactic acidosis from drug accumulation.

Question 79: Which finding on urinalysis is most consistent with nephrotic syndrome?

Granular casts with elevated creatinine
Massive proteinuria (>3.5g/day) (Correct answer)
Bacteriuria with pyuria
Hematuria with RBC casts

Correct answer: Massive proteinuria (>3.5g/day)

Nephrotic syndrome is characterized by heavy proteinuria (>3.5g/day), hypoalbuminemia, edema, and hyperlipidemia.

Question 80: An FNP is managing a patient after an acute MI. Which medication has MOST clearly demonstrated mortality reduction post-MI?

Calcium channel blocker (e.g., diltiazem)
Digoxin
Nitrate (e.g., isosorbide mononitrate)
Beta-blocker (e.g., metoprolol succinate) (Correct answer)

Correct answer: Beta-blocker (e.g., metoprolol succinate)

Beta-blockers reduce sympathetic stimulation and cardiac remodeling after MI and are associated with significant reduction in mortality.

Question 81: In the middle of the night, after having a steak meal with friends, a 55-year-old man with type 2 diabetes mellitus appears with significant right foot discomfort. The first metatarsophalangeal joint is swollen and painful during physical examination. During a joint aspiration, monosodium urate crystals were seen in the synovial fluid under a microscope. Which of the following offers the most effective first care?

Non-steroidal anti-inflammatory drugs (NSAIDs) (Correct answer)
Prednisone
Allopurinol
Probenecid

Correct answer: Non-steroidal anti-inflammatory drugs (NSAIDs)

The patient's symptoms (acute, severe right foot pain, swollen MTP joint after a steak meal, monosodium urate crystals) are classic for an acute gout attack. NSAIDs are typically the first-line treatment for acute gout due to their rapid anti-inflammatory and analgesic effects. Prednisone is an alternative if NSAIDs are contraindicated, while allopurinol and probenecid are for long-term prevention, not acute attacks.

Question 82: In clinical management, evidence-based practice is based on _____.

expert opinions
cohort studies
clinical practice guidelines
systematic reviews (Correct answer)

Correct answer: systematic reviews

A systematic review is a sort of research that use a systematic approach to gather secondary data, assess existing research papers, and synthesize qualitative or quantitative findings. Systematic reviews give a complete summary of all available information on a topic, making them the highest level of EBP evidence.

Question 83: The FNP counsels a patient about sun safety. Which of the following recommendations aligns with skin cancer primary prevention?

Apply broad-spectrum SPF 30+ sunscreen, wear protective clothing, and avoid peak UV hours (Correct answer)
Use SPF 10 sunscreen only on cloudy days
Sunbathing for 30 minutes daily is safe with SPF 15
Avoid sunscreen as it blocks essential vitamin D synthesis

Correct answer: Apply broad-spectrum SPF 30+ sunscreen, wear protective clothing, and avoid peak UV hours

Primary prevention of skin cancer includes broad-spectrum SPF 30+ sunscreen, UV-protective clothing, and avoiding sun exposure during peak hours (10 AM–4 PM).

Question 84: Which kind of antihypertensives may cause problems for diabetics?

Beta blockers (Correct answer)
Alpha blockers
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors

Correct answer: Beta blockers

Beta-blockers can mask the symptoms of hypoglycemia (low blood sugar) in diabetic patients, such as tremors and palpitations, making it harder for them to recognize and treat a hypoglycemic event. Additionally, some beta-blockers can impair glucose metabolism and worsen insulin resistance. This can make blood sugar control more challenging for individuals with diabetes, requiring careful consideration and monitoring.

Question 85: Congestive heart failure has recently been diagnosed in Greg, age 68. (CHF). Which medicine should be stopped for him?

Nifedipine (Procardia XL) for long-term management of his chronic stable angina. (Correct answer)
Hydrochlorothiazide (HydroDIURIL) for his hypertension.
Butalbital for his headaches.
Enalapril (Vasotec) for his hypertension.

Correct answer: Nifedipine (Procardia XL) for long-term management of his chronic stable angina.

Nifedipine, particularly immediate-release formulations, is a dihydropyridine calcium channel blocker that can cause peripheral vasodilation and reflex tachycardia, which can worsen heart failure symptoms or exacerbate myocardial ischemia. While extended-release forms like Procardia XL are safer, non-dihydropyridine CCBs or other anti-anginal agents are generally preferred in CHF patients if a CCB is needed. Beta-blockers (if stable CHF), ACE inhibitors, and diuretics are often beneficial in CHF management, making nifedipine a less suitable choice.

Question 86: A mother brings her 18-month-old with fever, bulging anterior fontanelle, and irritability. Which diagnosis must be ruled out immediately?

Febrile seizure disorder
Bacterial meningitis (Correct answer)
Viral gastroenteritis
Roseola infantum

Correct answer: Bacterial meningitis

Bulging anterior fontanelle with fever and irritability in an infant is a classic presentation of bacterial meningitis requiring immediate evaluation and empiric treatment.

Question 87: Gary, a healthy 16-year-old kid, is getting a sports physical examination. Which question from the past should the doctor ask Kevin or his parent?

Did you ever have any injury requiring stitches?
Does anyone in your family have elevated cholesterol levels?
Did anyone in your family ever have sudden cardiac death? (Correct answer)
Does anyone in your family have a history of asthma?

Correct answer: Did anyone in your family ever have sudden cardiac death?

When conducting a sports physical for an adolescent, it is crucial to screen for conditions that could lead to sudden cardiac death (SCD) during physical exertion. A family history of sudden cardiac death, especially in young individuals, can indicate underlying genetic cardiac conditions like hypertrophic cardiomyopathy or long QT syndrome. These conditions are significant risks for athletes and require further investigation.

Question 88: A 7-year-old child is brought in with a rash that started on the face and moved to the trunk, along with low-grade fever and Koplik spots. What is the diagnosis?

Measles (Correct answer)
Rubella
Scarlet fever
Roseola

Correct answer: Measles

Koplik spots (white spots on the buccal mucosa) are pathognomonic for measles (rubeola), which presents with cephalocaudal rash spread.

Question 89: Which inhaler medication is used as a RESCUE (quick-relief) agent in asthma?

Albuterol (short-acting beta-2 agonist) (Correct answer)
Salmeterol (long-acting beta-2 agonist)
Montelukast (leukotriene modifier)
Fluticasone (inhaled corticosteroid)

Correct answer: Albuterol (short-acting beta-2 agonist)

Albuterol, a SABA, acts within minutes to relieve acute bronchoconstriction and is the standard rescue inhaler for asthma.

Question 90: A patient taking amiodarone for arrhythmia asks about thyroid effects. The FNP explains that amiodarone can cause:

Only hyperthyroidism
Both hypothyroidism and hyperthyroidism due to its high iodine content (Correct answer)
No thyroid effects at standard doses
Only hypothyroidism

Correct answer: Both hypothyroidism and hyperthyroidism due to its high iodine content

Amiodarone is 37% iodine by weight and can cause either hypo- or hyperthyroidism via the Wolff-Chaikoff effect or Jod-Basedow phenomenon.

Question 91: Which medication used for type 2 diabetes is associated with the highest risk of hypoglycemia?

Glipizide (sulfonylurea) (Correct answer)
Metformin (biguanide)
Sitagliptin (DPP-4 inhibitor)
Empagliflozin (SGLT-2 inhibitor)

Correct answer: Glipizide (sulfonylurea)

Sulfonylureas stimulate insulin secretion regardless of blood glucose levels, making hypoglycemia their primary adverse effect.

Question 92: Which of the following best describes tertiary prevention in the context of a patient with heart failure?

Cardiac rehabilitation and medication adherence to prevent hospitalization (Correct answer)
Reducing dietary sodium before heart failure develops
Avoiding smoking to prevent coronary artery disease
Screening ECG in all adults over 40

Correct answer: Cardiac rehabilitation and medication adherence to prevent hospitalization

Tertiary prevention aims to minimize complications and improve function in patients with established disease, such as cardiac rehab for heart failure patients.

Question 93: A 55-year-old woman with osteoporosis has a T-score of -2.8. She has no history of fractures. According to the NOF/USPSTF guidelines, what FRAX 10-year fracture risk threshold typically warrants pharmacotherapy in the US?

≥7% hip fracture or ≥25% major osteoporotic fracture
≥3% hip fracture or ≥10% major osteoporotic fracture (Correct answer)
≥10% hip fracture or ≥30% major osteoporotic fracture
≥5% hip fracture or ≥15% major osteoporotic fracture

Correct answer: ≥3% hip fracture or ≥10% major osteoporotic fracture

The NOF recommends treatment when 10-year FRAX probability is ≥3% for hip fracture or ≥20% for major osteoporotic fracture.

Question 94: When assessing a patient's JVD (jugular venous distension), the patient should be positioned at:

30–45 degree head elevation (Correct answer)
Flat supine
90 degrees sitting upright
Left lateral decubitus

Correct answer: 30–45 degree head elevation

JVD is best assessed with the head of the bed elevated 30–45 degrees, allowing visualization of the jugular venous pulsation above the clavicle.

Question 95: A patient who has suffered a non-work-related injury that affects his or her capacity to perform their job is examined by a family nurse practitioner. The patient is not considered medically disabled and has a good possibility of finding a suitable job with the right therapy. The nurse practitioner advises the patient to submit an application for ______.

Family and Medical Leave Act benefits
Social Security benefits
home health services
vocational rehabilitation services (Correct answer)

Correct answer: vocational rehabilitation services

Vocational rehabilitation services help disabled or injured persons find, stay, or return to employment. Assessment, evaluation, counseling, supervision, training, work placement, and employment adjustments are just a few examples. They are made available through the efforts of federal and state agencies and qualified professionals. They strive to eliminate disability-related occupational and psychological problems and provide suitable jobs.

Question 96: Which screening test is recommended by the USPSTF for colorectal cancer starting at age 45 in average-risk adults?

Sigmoidoscopy every 5 years alone
CT colonography every 3 years
Annual digital rectal exam
Colonoscopy every 10 years OR annual high-sensitivity FOBT/FIT (Correct answer)

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 97: A positive Phalen's test reproduces which symptom and in which condition?

Lateral elbow pain; tennis elbow
Wrist pain with gripping; De Quervain's tenosynovitis
Numbness of the fifth finger; cubital tunnel syndrome
Paresthesias in the first three fingers; carpal tunnel syndrome (Correct answer)

Correct answer: Paresthesias in the first three fingers; carpal tunnel syndrome

Phalen's test reproduces median nerve paresthesias in the thumb, index, and middle fingers, confirming carpal tunnel syndrome.

Question 98: Is Hand-foot-mouth disease diagnosed in patients who most likely are teenagers and appear with the usual triad of sore throat, protracted lethargy, and enlarged cervical nodes?

True
False (Correct answer)

Correct answer: False

Acute mononucleosis: Mononucleosis (mono) is a viral infection that causes a sore throat and fever. Cases often happen in teens and young adults.

Question 99: A 35-year-old presents with fatigue, pallor, and a mean corpuscular volume (MCV) of 70 fL. The MOST likely diagnosis is:

Vitamin B12 deficiency anemia
Iron deficiency anemia (Correct answer)
Aplastic anemia
Folate deficiency anemia

Correct answer: Iron deficiency anemia

Microcytic anemia (MCV <80 fL) with fatigue and pallor in a young adult is most commonly caused by iron deficiency.

Question 100: A 30-year-old woman at average risk asks how often she should have a Pap smear. What is the current USPSTF recommendation?

Annually
Every 2 years
Every 3 years (cytology alone) or every 5 years (with HPV co-testing) (Correct answer)
Every 5 years (cytology alone)

Correct answer: Every 3 years (cytology alone) or every 5 years (with HPV co-testing)

USPSTF recommends cervical cancer screening every 3 years with cytology alone, or every 5 years with high-risk HPV testing or co-testing for women aged 30-65.

Question 101: When your thyroid-stimulating hormone (TSH) is low, it can cause ______.

Brittle hair
Osteoporosis (Correct answer)
Weight gain
Weight gain

Correct answer: Osteoporosis

A low TSH indicates hyperthyroidism (overactive thyroid), not hypothyroidism. Hyperthyroidism accelerates bone turnover, leading to increased bone loss and a higher risk of osteoporosis. Weight gain and brittle hair are typically associated with hypothyroidism, while osteoporosis is a known complication of chronic hyperthyroidism.

Question 102: Myocardial infarction patient visits clinic for atorvastatin calcium refill (Lipitor). The family nurse practitioner knows that the prescription is for _____.

secondary prevention
cancer prevention
primary prevention
tertiary prevention (Correct answer)

Correct answer: tertiary prevention

Tertiary prevention focuses on lowering the burden of established illnesses by eliminating or reducing disability, minimizing suffering, and optimizing quality of life. The family nurse practitioner here understands that the patient has previously suffered a myocardial infarction, so the medicine is being provided for tertiary prevention. In patients with cardiovascular disease, atorvastatin calcium (Lipitor) lowers cholesterol and reduces the risk of a heart attack or stroke.

Question 103: If a nursing woman develops postpartum mastitis, the family nurse practitioner will recommend that she take the recommended antibiotics and also:

temporarily switch to formula
continue to nurse with both breasts (Correct answer)
take cool showers
pump the unaffected breast with a lactation pump

Correct answer: continue to nurse with both breasts

A family nurse practitioner will advise a nursing mother to continue using both breasts while taking the prescribed antibiotics she develops postpartum mastitis. This will assist in maintaining milk production and preventing breast engorgement.

Question 104: Six-year-old Doug presents with abdominal distention and discomfort, a right abdominal mass, a fever, and microscopic hematuria. No precipitating event has occurred. What are your suspicions?

Appendicitis
A urinary tract infection (UTI)
An intestinal obstruction
Wilms tumor (Correct answer)

Correct answer: Wilms tumor

Wilms tumor, also known as nephroblastoma, is a common kidney cancer in children. The classic presentation includes an asymptomatic abdominal mass, which is often discovered during a routine physical exam or when parents notice abdominal distention. Other symptoms like fever and microscopic hematuria (blood in urine) are also consistent with this diagnosis, making it the most suspicious condition given Doug's symptoms.

Question 105: The FNP performs a straight-leg raise (SLR) test and reproduces radicular pain at 45 degrees. This is MOST consistent with:

Hip flexor strain
Sacroiliac joint dysfunction
Lumbar nerve root compression (Correct answer)
Piriformis syndrome

Correct answer: Lumbar nerve root compression

A positive SLR at less than 60 degrees that reproduces radicular symptoms strongly suggests lumbar nerve root compression.

Question 106: The FNP is initiating a statin in a patient. Which laboratory test should be checked at baseline and periodically?

Complete blood count
Renal function (BUN/creatinine)
Liver function tests (ALT/AST) (Correct answer)
Thyroid-stimulating hormone

Correct answer: Liver function tests (ALT/AST)

Statins can rarely cause hepatotoxicity, so baseline and periodic liver function monitoring is recommended per guidelines.

Question 107: A patient with bipolar I disorder is started on lithium. Which parameter requires the MOST vigilant monitoring?

Fasting lipid panel monthly
Serum lithium level, renal function (creatinine), and thyroid function (Correct answer)
CBC weekly for the first month
Liver function tests

Correct answer: Serum lithium level, renal function (creatinine), and thyroid function

Lithium has a narrow therapeutic index, is renally excreted, and causes hypothyroidism; regular serum levels, renal function, and thyroid function tests are mandatory.

Question 108: A patient has a BMI of 32 kg/m². According to the USPSTF, what is the most appropriate intervention?

Repeat BMI in 1 year with no intervention
Prescribe weight loss medication immediately
Recommend surgical consultation
Refer for intensive multicomponent behavioral intervention (Correct answer)

Correct answer: Refer for intensive multicomponent behavioral intervention

USPSTF recommends referring adults with obesity (BMI ≥30) to intensive, multicomponent behavioral weight loss interventions.

Question 109: As an advanced practice registered nurse, you work in an emergency room (APRN). An adolescent guy who was hit by a car and is brought in unconscious and with a head injury. He is unaccompanied by an adult and without proper identification. What would you do?

Call the hospital attorney before instituting any care.
Provide the appropriate medical treatment even if it involves surgery. (Correct answer)
Do everything except order a blood transfusion, even if it is indicated, because you do not know the client's religious preferences.
Contact all local police stations in an attempt to identify the client and find his parents before instituting treatment.

Correct answer: Provide the appropriate medical treatment even if it involves surgery.

In emergency situations involving an unconscious minor without identification or accompanying adults, the principle of implied consent applies. Healthcare providers are ethically and legally obligated to provide necessary life-saving treatment, including surgery if indicated, to prevent death or serious harm. Delaying care to find family or legal counsel would be detrimental to the patient's well-being and is not permissible in such critical circumstances.

Question 110: A 7-year-old child presents with a 3-day history of sore throat, fever of 101.5°F, tonsillar exudates, and tender anterior cervical lymphadenopathy. Rapid strep test is positive. What is the treatment?

No antibiotics; supportive care only
Cephalexin 7-day course
Amoxicillin 10-day course (Correct answer)
Azithromycin 5-day course

Correct answer: Amoxicillin 10-day course

Amoxicillin for 10 days is the first-line treatment for Group A Streptococcal pharyngitis to prevent rheumatic fever.

Question 111: Which screening is recommended by USPSTF for sexually active women under age 25 regardless of symptoms?

HIV testing annually
Hepatitis C screening annually
Chlamydia and gonorrhea screening annually (Correct answer)
Syphilis testing annually

Correct answer: Chlamydia and gonorrhea screening annually

USPSTF recommends screening for chlamydia and gonorrhea in all sexually active women aged 24 and younger, and in older women at increased risk.

Question 112: A 36-year-old healthy guy arrives with 2 months' worth of sporadic episodes of rectal bleeding. When he first started noticing blood on the tissue after wiping, it was only in small streaks. However, after defecating yesterday, he dripped bright red blood and the stool was coated with blood. No anal or abdominal discomfort, anorexia, weight loss, or changes in bowel habits have been reported in the patient. No anomalies may be seen in the perianal skin. A digital rectal exam reveals no palpable masses or pain. Bulges in the mucosa are purple, as seen on anoscopy. The ideal next step in management is which of the following?

High-fiber diet and follow-up (Correct answer)
Referral for surgical evaluation
Biopsy of the anal lesions
Referral for colonoscopy

Correct answer: High-fiber diet and follow-up

The patient's symptoms (sporadic bright red rectal bleeding, blood on tissue/coating stool, purple bulges on anoscopy) without pain, weight loss, or changes in bowel habits are classic for internal hemorrhoids. Initial management for hemorrhoids typically involves conservative measures like a high-fiber diet, increased fluid intake, and stool softeners to reduce straining, often followed by observation.

Question 113: Which of the following findings on a diabetic foot exam requires immediate referral to a vascular surgeon?

Ankle-brachial index (ABI) of 0.55 with rest pain (Correct answer)
Dry skin with mild callus formation
Vibration sense loss at the great toe
Absent hair growth on the dorsum of the foot

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 114: During a pediatric well-visit, the FNP assesses a 6-month-old and notes absence of the Moro reflex. This finding is MOST concerning for:

Hip dysplasia
Normal developmental milestone
Hearing impairment
Central nervous system dysfunction (Correct answer)

Correct answer: Central nervous system dysfunction

The Moro reflex should be present at 6 months; its absence suggests CNS dysfunction or neurological injury.

Question 115: Sharon, 52, has four children and a demanding job. After a normal physical exam, she states that she suffers from insomnia. You suggest several changes to one's daily routine that may improve sleep quality. You know she doesn't understand when she says which of the following?

I'll try some valerian extract from the health food store.
I'll exercise in the evening to tire myself out before bed. (Correct answer)
I'll wind down before bedtime by taking a warm bath or by reading for 10 minutes.
I'll try some valerian extract from the health food store.

Correct answer: I'll exercise in the evening to tire myself out before bed.

Exercising vigorously in the evening, especially close to bedtime, can stimulate the body and raise core body temperature, making it harder to fall asleep. Good sleep hygiene recommends avoiding strenuous physical activity within a few hours of going to bed. The other options, such as using valerian extract, taking a warm bath, or reading, are generally considered beneficial for promoting relaxation and improving sleep quality.

Question 116: Which vaccine is recommended annually for all persons aged 6 months and older, regardless of health status?

Pneumococcal vaccine
Hepatitis B vaccine
Influenza vaccine (Correct answer)
Tdap vaccine

Correct answer: Influenza vaccine

Annual influenza vaccination is recommended by the CDC for everyone 6 months of age and older each flu season.

Question 117: Which intervention is recommended for a 70-year-old woman with a DEXA scan T-score of -2.7 at the lumbar spine?

Weight-bearing exercise program only
Initiate pharmacologic therapy with a bisphosphonate (Correct answer)
Recheck DEXA scan in 2 years before treating
Calcium and vitamin D supplementation only

Correct answer: Initiate pharmacologic therapy with a bisphosphonate

A T-score of ≤-2.5 meets the diagnostic criteria for osteoporosis and warrants pharmacologic treatment, typically with a bisphosphonate, along with calcium and vitamin D.

Question 118: The FNP is performing a cranial nerve assessment and asks the patient to follow a finger in all directions. Which cranial nerves are being tested?

CN IV, V, VI
CN III, IV, VI (Correct answer)
CN II, III, IV
CN V, VII, VIII

Correct answer: CN III, IV, VI

Extraocular movements are controlled by the oculomotor (III), trochlear (IV), and abducens (VI) cranial nerves.

Question 119: When performing a fundoscopic exam, the FNP notes arteriovenous (AV) nicking. This finding is MOST associated with which condition?

Chronic hypertension (Correct answer)
Diabetic retinopathy
Papilledema
Glaucoma

Correct answer: Chronic hypertension

AV nicking, where arteries compress veins at crossing points, is a classic sign of chronic hypertension-related retinal changes.

Question 120: A patient has a positive ANA titer of 1:320 with a butterfly rash across the cheeks and nose. The FNP suspects:

Rosacea
Scleroderma
Systemic lupus erythematosus (SLE) (Correct answer)
Dermatomyositis

Correct answer: Systemic lupus erythematosus (SLE)

A malar (butterfly) rash sparing the nasolabial folds combined with a high-titer ANA are classic features of SLE.

Question 121: Nearsightedness

RICE Mnemonic
Ph of vagina
Myopia (Correct answer)
Proptosis

Correct answer: Myopia

Myopia, a disease that affects many people, causes near objects to appear clear while far-distant objects to appear blurry. It happens when light rays incorrectly bend (refract) due to the shape of the eye or specific portions of the eye.

Question 122: Which of the following is the most important risk factor for the development of type 2 diabetes mellitus?

Chronic use of NSAIDs
Low dietary fiber intake alone
Excessive alcohol consumption
Central obesity and insulin resistance (Correct answer)

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 123: A 40-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. TSH is 8.2 mIU/L and free T4 is low. What is the treatment of choice?

Levothyroxine (T4) (Correct answer)
Liothyronine (T3)
Desiccated thyroid extract
Methimazole

Correct answer: Levothyroxine (T4)

Levothyroxine is the standard of care for hypothyroidism due to its consistent potency and long half-life.

Question 124: A mother brings her 9-month-old for a well-child visit. Which developmental milestone should the FNP expect this infant to have achieved?

Stacking 4 blocks
Walking independently
Using a pincer grasp (Correct answer)
Saying 2-word phrases

Correct answer: Using a pincer grasp

Pincer grasp (using thumb and forefinger) typically emerges between 9-10 months of age.

Question 125: Which screening tool is recommended by the USPSTF for depression in adults in the primary care setting?

Columbia Suicide Severity Rating Scale (C-SSRS)
Beck Depression Inventory (BDI)
Patient Health Questionnaire-9 (PHQ-9) (Correct answer)
Hamilton Depression Rating Scale (HAM-D)

Correct answer: Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is the validated, widely recommended screening tool for depression in primary care settings and is endorsed by USPSTF guidelines.

Question 126: A patient taking warfarin reports adding daily vitamin K supplements. The FNP anticipates which effect on INR?

No effect on INR
Decreased INR due to increased clotting factor synthesis (Correct answer)
Variable effect depending on warfarin dose
Increased INR due to bleeding risk

Correct answer: Decreased INR due to increased clotting factor synthesis

Vitamin K is a cofactor for clotting factor synthesis; supplementing it antagonizes warfarin's anticoagulant effect, lowering the INR.

Question 127: A 28-year-old woman presents 6 weeks postpartum with low mood, inability to bond with her infant, hopelessness, and passive suicidal ideation. What is the most appropriate initial intervention?

Prescribe benzodiazepines for anxiety
Refer immediately to the emergency department
Screen with the Edinburgh Postnatal Depression Scale and initiate an SSRI (Correct answer)
Reassure her that baby blues are normal and will resolve

Correct answer: Screen with the Edinburgh Postnatal Depression Scale and initiate an SSRI

Postpartum depression presenting at 6 weeks should be formally assessed and SSRIs (many safe during breastfeeding) are first-line pharmacotherapy.

Question 128: All of the following are used to treat mild preeclampsia, except for ______.

close follow-up of urinary protein, serum creatinine, and platelet count
bed rest except for bathroom privileges
a prescription of methyldopa (Aldomet) to control blood pressure (Correct answer)
close monitoring of weight and blood pressure

Correct answer: a prescription of methyldopa (Aldomet) to control blood pressure

For *mild preeclampsia*, the primary management focuses on close monitoring and conservative measures rather than immediate antihypertensive medication. Antihypertensives are typically reserved for severe preeclampsia to prevent complications like stroke. Close follow-up of urinary protein, serum creatinine, platelet count, weight, blood pressure, and bed rest are standard for mild cases.

Question 129: A 55-year-old male smoker presents with a 3-cm solitary pulmonary nodule on CT scan. What is the recommended next step?

PET scan (Correct answer)
Bronchoscopy with biopsy
Immediate surgical resection
Repeat CT in 12 months

Correct answer: PET scan

A solid nodule >8mm in a high-risk patient warrants a PET scan or tissue sampling per Fleischner Society guidelines to assess malignancy risk.

Question 130: When examining skin turgor in elderly patients, the best site for assessment is the:

Dorsum of the hand
Forehead or sternum (Correct answer)
Forearm
Abdomen

Correct answer: Forehead or sternum

In elderly patients, skin loses elasticity at the hands and forearms due to aging, making the forehead or sternum more reliable for assessing hydration status.

Question 131: The family nurse practitioner in a small rural town sees an increase in chlamydia diagnoses and fears people are not telling their spouses, delaying treatment. The nurse practitioner opts to perform a little research study. Nurse practitioners use which sort of hypothesis?

Inductive hypothesis (Correct answer)
Deductive hypothesis
Non-directional hypothesis
Complex hypothesis

Correct answer: Inductive hypothesis

The inductive hypothesis is a strategy to provide a beginning point for the proof and then utilize it as a foundation to build the proof gradually.

Question 132: Patients over 60 are more likely to get cataracts. You advise your patient that the following is the best treatment for cataracts _____.

Corrective lens surgery (Correct answer)
Medications
Dietary supplements
Optical devices

Correct answer: Corrective lens surgery

Cataracts are a clouding of the eye's natural lens, leading to blurry vision that cannot be corrected with glasses alone in advanced stages. While optical devices can offer temporary help in early stages, the only definitive and most effective treatment for cataracts is surgical removal of the cloudy lens. This procedure, followed by the implantation of an artificial intraocular lens, restores clear vision and is a common, highly successful operation.

Question 133: When auscultating the abdomen, the FNP hears a bruit over the renal artery. This finding suggests:

Normal peristalsis
Bowel obstruction
Renal artery stenosis (Correct answer)
Aortic aneurysm

Correct answer: Renal artery stenosis

A renal artery bruit indicates turbulent blood flow, most commonly from renal artery stenosis, a correctable cause of secondary hypertension.

Question 134: Which cervical cancer screening guideline applies to a 32-year-old woman with no prior abnormal results?

No screening needed until age 40
Pap smear every year
Co-testing (Pap + HPV) every 5 years (Correct answer)
HPV testing alone every 3 years

Correct answer: Co-testing (Pap + HPV) every 5 years

Current USPSTF guidelines recommend co-testing with Pap smear and HPV test every 5 years for women aged 30–65 as a preferred option.

Question 135: 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?

Prednisone 60 mg daily for 2 weeks
Probenecid 500 mg twice daily
Allopurinol 300 mg daily
Indomethacin or colchicine (Correct answer)

Correct answer: Indomethacin or colchicine

NSAIDs (e.g., indomethacin) or colchicine are first-line treatments for acute gout attacks to reduce inflammation.

Question 136: After a car accident, Barbara, age 27, had her spleen removed. Since she was released from the hospital, this is the first time you have seen her at the office. She inquires about the long-term effects of her procedure. What is your response?

Your red blood cell production will be slowed.
You may have difficulty salvaging iron from old red blood cells for reuse. (Correct answer)
You'll have difficulty storing the nutritional agents needed to make red blood cells.
Your lymphatic system may have difficulty transporting lymph fluid to the blood vessels.

Correct answer: You may have difficulty salvaging iron from old red blood cells for reuse.

The spleen plays a crucial role in filtering blood, removing old or damaged red blood cells, and salvaging iron from them for reuse in new red blood cell production. After a splenectomy, the body loses this primary site for red blood cell breakdown and iron recycling. While other organs can partially compensate, there can be long-term implications for iron metabolism and an increased susceptibility to certain infections.

Question 137: The veins in Fundi are bigger than the arteries. Cones: for 20/20 vision and color perception Rods: used for night vision, depth perception, and light and shadow detection The macula, which controls central vision, is an anatomical structure. The vast number of cone-containing foveas is positioned in the center. The vision of 20/20 is determined by this region of the eye. Cobblestoning: Atopic pt, allergic rhinitis, and allergic conjunctivitis may all present with moderately increased lymphoid tissue that resembles "cobblestone" in the inner conjunctiva. Presbyopia is an age-related visual alteration brought on by a decrease in the eye's accommodation capacity and lens stiffness. typically begin at age 40,

Dicloxacillin
Eyes normal finding (Correct answer)
Oral steroids
Erythema migrans

Correct answer: Eyes normal finding

Normal assessments include the contraction and dilation of each pupil in reaction to light.

Question 138: Which change in lifestyle lowers the risk of death most when it comes to coronary heart disease?

Fasting low-density lipoprotein (LDL) cholesterol less than 100.
Moderate exercise—greater than 30 minutes a day 3 times a week.
Quitting smoking. (Correct answer)
Weight loss.

Correct answer: Quitting smoking.

Smoking is one of the most significant modifiable risk factors for coronary heart disease (CHD) and overall mortality. Quitting smoking dramatically reduces the risk of heart attack, stroke, and death from cardiovascular disease, with benefits seen rapidly after cessation. While other lifestyle changes are beneficial, quitting smoking offers the most substantial and immediate reduction in CHD mortality risk.

Question 139: A 45-year-old patient presents with a heart rate of 52 bpm, cool extremities, and fatigue. Which assessment finding would MOST concern the FNP?

Bradycardia with hypotension (Correct answer)
Regular rhythm on auscultation
Mild peripheral edema
Normal oxygen saturation

Correct answer: Bradycardia with hypotension

Bradycardia combined with hypotension indicates hemodynamic compromise and requires urgent evaluation.

Question 140: The FNP prescribes isotretinoin for a female patient with severe acne. Which MANDATORY program must the patient be enrolled in?

STEPS
iPLEDGE (Correct answer)
TOUCH
REMS

Correct answer: iPLEDGE

iPLEDGE is the FDA-mandated Risk Evaluation and Mitigation Strategy (REMS) program for isotretinoin due to its severe teratogenicity.

Question 141: An African American man in his mid-fifties seeking medication management comes into your primary care office with recently discovered hypertension. His blood pressure is 145/95 as of right now. He says he doesn't have a headache, impaired vision, chest discomfort, or trouble breathing. Which drug would you prescribe him first?

Hydralazine
Catapres
Amlodipine (Correct answer)
Metoprolol

Correct answer: Amlodipine

For African American patients with hypertension, current guidelines often recommend starting with a thiazide diuretic or a calcium channel blocker (CCB) as first-line therapy, especially in the absence of compelling indications for other drug classes. Amlodipine is a dihydropyridine calcium channel blocker and is generally effective and well-tolerated in this population. Other options like beta-blockers or ACE inhibitors may be less effective as monotherapy in this demographic.

Question 142: A patient with heart failure and hypertension is started on lisinopril. The FNP should monitor for which MOST common side effect?

Angioedema
Dry, nonproductive cough (Correct answer)
Renal failure
Hyperkalemia

Correct answer: Dry, nonproductive cough

ACE inhibitors like lisinopril commonly cause a dry cough due to accumulation of bradykinin in the airways.

Question 143: Which vaccine is contraindicated in a pregnant woman at 20 weeks gestation?

Tdap
COVID-19 mRNA vaccine
Inactivated influenza
MMR (Correct answer)

Correct answer: MMR

MMR is a live-attenuated vaccine and is contraindicated during pregnancy due to theoretical risk of fetal infection.

Question 144: A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and slight euphoria exhibits signs of using ______.

oxycodone hydrochloride (OxyCONTIN)
cocaine (Correct answer)
alprazolam (Xanax)
morphine sulfate (MS Contin)

Correct answer: cocaine

Cocaine usage is accompanied with epistaxis, dilated pupils, tachycardia, and slight euphoria. Your pupils may seem bigger than usual if you use cocaine. Additionally, it could give you bloodshot, watery eyes. Cocaine elevates blood pressure because it causes blood vessels to constrict. In addition to causing redness and blurred vision, this can also lead to corneal damage. Another typical sign of cocaine toxicity is tachycardia.

Question 145: Which D-dimer result interpretation is CORRECT when using the Wells score for PE pre-test probability?

D-dimer is not useful in the Wells score algorithm
A positive D-dimer confirms PE regardless of pre-test probability
A negative D-dimer effectively rules out PE in LOW pre-test probability patients (Correct answer)
D-dimer should be ordered for all suspected PE cases regardless of probability

Correct answer: A negative D-dimer effectively rules out PE in LOW pre-test probability patients

D-dimer has high sensitivity but low specificity; a negative result rules out PE in low-probability patients, avoiding unnecessary CT-PA.

Question 146: A 60-year-old smoker presents with a new persistent cough, hemoptysis, and unintentional weight loss. The FNP orders a chest X-ray, which shows a hilar mass. The NEXT step is:

Order sputum culture
Reassess in 4 weeks if not improving
Urgent referral to pulmonology and CT chest (Correct answer)
Start empiric antibiotics for pneumonia

Correct answer: Urgent referral to pulmonology and CT chest

A hilar mass with constitutional symptoms in a smoker has high malignancy risk and requires urgent CT chest and pulmonology referral for tissue diagnosis.

Question 147: A patient with lower extremity weakness and a recent upper respiratory illness is found to have ascending paralysis. The FNP suspects:

Myasthenia gravis
Guillain-Barré syndrome (Correct answer)
Transverse myelitis
Multiple sclerosis

Correct answer: Guillain-Barré syndrome

Post-infectious ascending flaccid paralysis is the hallmark presentation of Guillain-Barré syndrome, an autoimmune peripheral neuropathy.

Question 148: A 55-year-old male presents with sudden-onset severe headache described as 'the worst headache of my life.' The FNP's PRIORITY action is:

Emergent referral to the ED for CT head and lumbar puncture if negative (Correct answer)
Order an outpatient MRI
Reassure the patient it is likely tension headache
Prescribe sumatriptan for migraine

Correct answer: Emergent referral to the ED for CT head and lumbar puncture if negative

A 'thunderclap' headache is a subarachnoid hemorrhage until proven otherwise and requires immediate emergency evaluation with CT head.

Question 149: Which intervention is most effective for reducing cardiovascular disease risk in a patient with hypertension and hyperlipidemia?

Vitamin E supplementation
Therapeutic lifestyle changes including diet and exercise (Correct answer)
Omega-3 supplementation
Daily aspirin therapy

Correct answer: Therapeutic lifestyle changes including diet and exercise

Therapeutic lifestyle changes including the DASH diet, weight loss, smoking cessation, and regular exercise are the most effective initial interventions for cardiovascular risk reduction.

Question 150: What statement about mitral regurgitation is correct?

It occurs only as a result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps.
It is caused by stiff leaflets that limit flow from the left atrium to the left ventricle.
It results in a prolonged PR interval on electrocardiogram.
It may be noted as a holosystolic murmur. (Correct answer)

Correct answer: It may be noted as a holosystolic murmur.

Mitral regurgitation (MR) is the backflow of blood from the left ventricle into the left atrium during systole due to incomplete closure of the mitral valve. This abnormal flow creates a characteristic heart sound known as a holosystolic (or pansystolic) murmur. This murmur is typically heard throughout the entire systole, distinguishing it from other types of murmurs.

Question 151: In active labor at 37 weeks along, a 26-year-old woman is diagnosed as gravida 2 para 1. She has an epidural and is slowly dilated to a full cervical opening. The fetal head is delivered, immediately retracts into the perineum, and the anterior shoulder is not delivered despite the patient pushing for two hours. Which of the following best describes the clinical presentation of this patient at risk?

Maternal type 2 diabetes mellitus (Correct answer)
Maternal chronic hypertension
Fetal gestational age
Maternal age at delivery

Correct answer: Maternal type 2 diabetes mellitus

The clinical presentation describes shoulder dystocia, where the fetal head delivers but the anterior shoulder gets stuck. Maternal type 2 diabetes mellitus is a significant risk factor for shoulder dystocia because it often leads to macrosomia (large baby), which increases the likelihood of the baby's shoulders being too wide to pass through the maternal pelvis.

Question 152: The FNP is managing a patient with newly diagnosed stage 1 hypertension (130–139/80–89 mmHg) with no comorbidities. The FIRST-LINE intervention is:

Refer to cardiology for management
Immediately start an ACE inhibitor
Lifestyle modification for 3–6 months before initiating medication (Correct answer)
Immediately start a thiazide diuretic

Correct answer: Lifestyle modification for 3–6 months before initiating medication

ACC/AHA guidelines recommend 3–6 months of lifestyle modification (diet, exercise, weight loss, sodium reduction) as initial therapy for stage 1 hypertension without cardiovascular risk.

Question 153: Jerry, 35, has dermatosis and uses a high-potency corticosteroid cream. He also has tinea corporis. Tell him about the cream:

It will work better if you occlude the area.
Be sure to use it daily.
It may exacerbate your concurrent tinea corporis. (Correct answer)
You must use this for an extended period of time for it to be effective.

Correct answer: It may exacerbate your concurrent tinea corporis.

High-potency corticosteroid creams suppress the immune response, which can worsen fungal infections like tinea corporis. Using corticosteroids on a fungal infection can mask symptoms and allow the infection to spread or become more severe. Therefore, it's crucial to warn the patient about this potential exacerbation.

Question 154: A 45-year-old woman presents with fatigue, weight gain, constipation, cold intolerance, and bradycardia. The BEST initial diagnostic test is:

TSH level (Correct answer)
Free T4 level
Thyroid ultrasound
T3 uptake

Correct answer: TSH level

TSH is the most sensitive test for thyroid dysfunction; an elevated TSH confirms primary hypothyroidism before further testing.

Question 155: A 4-year-old presents with a barky cough, inspiratory stridor, and low-grade fever. What is the most likely diagnosis?

Foreign body aspiration
Epiglottitis
Bacterial tracheitis
Croup (laryngotracheobronchitis) (Correct answer)

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 156: A female patient presents with unilateral lower abdominal pain, missed period, and vaginal spotting. The FIRST test the FNP orders is:

Cervical cultures for STIs
CBC with differential
Pelvic ultrasound
Urine or serum hCG (pregnancy test) (Correct answer)

Correct answer: Urine or serum hCG (pregnancy test)

Ruling out ectopic pregnancy is the top priority; a pregnancy test is required immediately because ectopic pregnancy is life-threatening.

Question 157: A 50-year-old man is examined for a severe headache, motion sickness, and discomfort in his left eye. His symptoms began abruptly few hours ago, and despite rest and ibuprofen, his headache has not gone. He took an over-the-counter oral decongestant this morning due to a little cold he had. Physical examination reveals a nonreactive, mid-dilated left pupil. Conjunctival flushing makes the eye look red. In terms of management, which option below is more appropriate?

No additional management indicated
Tonometry (Correct answer)
Eye patch placement and follow up in 3 days
Fluorescein staining of the eye

Correct answer: Tonometry

The patient's symptoms (severe headache, motion sickness, left eye discomfort, abrupt onset, mid-dilated nonreactive pupil, conjunctival flushing) are highly suggestive of acute angle-closure glaucoma. This is a medical emergency characterized by a sudden increase in intraocular pressure. Tonometry is the diagnostic test used to measure intraocular pressure, which is crucial for confirming the diagnosis and guiding immediate treatment.

Question 158: A 40-year-old woman is newly diagnosed with major depressive disorder and has no prior psychiatric history. Which class of medication is the first-line pharmacologic treatment?

Tricyclic antidepressants (TCAs)
Benzodiazepines
Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
Monoamine oxidase inhibitors (MAOIs)

Correct answer: Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are first-line for major depressive disorder due to their favorable side effect profile, efficacy, and safety in overdose compared to older antidepressants.

Question 159: The family nurse practitioner will have the patient make quick, alternating movements with their hands to test for:

Cerebellar functioning (Correct answer)
Reflex arc functioning
Stereognostic functioning
Cognitive functioning

Correct answer: Cerebellar functioning

To assess cerebellar function, the family nurse practitioner has a patient make quick, alternating hand motions. It is used to find out how well the cerebellum can coordinate movement. The patient is instructed to place one hand over the other and to quickly switch that hand back and forth.

Question 160: What is McMurray's sign:

Variation in red blood cell size
Positive in meniscus injuries of the knee (Correct answer)
Problem is anterior to the chiasm
None of the above

Correct answer: Positive in meniscus injuries of the knee

The patient must be relaxed and supine to perform McMurray's test. The examiner holds the patient's heel in one hand and the knee joint line in the other. The knee is fully extended and rotated either internally (medial meniscus) or externally (lateral meniscus).

Question 161: Ryan, who is 20 years old, goes to the college health clinic because he is having trouble passing urine and has a discharge from his penis. You discover the discharge is urethral. These symptoms are most common in young adult males due to ____.

prostatic hyperplasia
prostatic abscess
chronic prostatitis
acute prostatitis (Correct answer)

Correct answer: acute prostatitis

In young males, acute prostatitis is caused by gonorrhea or other bacterial infections.

Question 162: A patient has pitting edema graded 3+. How deep is the pit and how long does it take to rebound?

7+ mm pit, permanent indentation
1–2 mm pit, rebounds quickly
5–6 mm pit, rebounds in >1 minute (Correct answer)
3–4 mm pit, rebounds in 10–15 seconds

Correct answer: 5–6 mm pit, rebounds in >1 minute

Grade 3+ pitting edema produces a 5–6 mm deep pit that takes more than one minute to rebound.

Question 163: A patient with suspected appendicitis has pain at McBurney's point. Where is this landmark located?

Left lower quadrant at the iliac crest
Midway between the umbilicus and right iliac crest
One-third the distance from the ASIS to the umbilicus (Correct answer)
One-third the distance from the umbilicus to the ASIS

Correct answer: One-third the distance from the ASIS to the umbilicus

McBurney's point is located one-third the distance from the right anterior superior iliac spine (ASIS) to the umbilicus.

Question 164: Which EKG finding is the EARLIEST sign of hyperkalemia?

Absent P waves
Widened QRS complex
Sine wave pattern
Peaked (tall, narrow, symmetric) T waves (Correct answer)

Correct answer: Peaked (tall, narrow, symmetric) T waves

Peaked T waves are the earliest EKG manifestation of hyperkalemia, preceding the PR prolongation, wide QRS, and eventually sine wave pattern.

Question 165: A 10-year-old child is brought in after a bee sting. She develops urticaria, throat tightness, and hypotension. What is the first-line treatment?

Diphenhydramine 50 mg IV
Epinephrine 0.3 mg IM in the lateral thigh (Correct answer)
Albuterol nebulizer treatment
Methylprednisolone 125 mg IV

Correct answer: Epinephrine 0.3 mg IM in the lateral thigh

Intramuscular epinephrine in the anterolateral thigh is the first and most critical treatment for anaphylaxis due to its rapid onset and life-saving effect.

Question 166: A patient with atrial fibrillation is started on digoxin. The FNP should counsel the patient to report which EARLY sign of toxicity?

Edema
Chest pain
Shortness of breath
Nausea, vomiting, and visual disturbances (Correct answer)

Correct answer: Nausea, vomiting, and visual disturbances

Early digoxin toxicity classically presents with GI symptoms (nausea, vomiting) and yellow-green visual halos before more serious cardiac arrhythmias occur.

Question 167: During a thyroid exam, the FNP asks the patient to swallow. This maneuver is done to:

Identify lymphadenopathy
Distinguish thyroid tissue from other neck masses by observing upward movement (Correct answer)
Evaluate carotid artery pulsation
Assess vocal cord function

Correct answer: Distinguish thyroid tissue from other neck masses by observing upward movement

Thyroid tissue is attached to the trachea and moves upward with swallowing, distinguishing it from fixed neck masses.

Question 168: Which blood pressure threshold is used to diagnose hypertension according to the 2017 ACC/AHA guidelines?

≥120/80 mmHg
≥150/90 mmHg
≥130/80 mmHg (Correct answer)
≥140/90 mmHg

Correct answer: ≥130/80 mmHg

The 2017 ACC/AHA guidelines lowered the threshold for hypertension diagnosis to ≥130/80 mmHg, replacing the prior ≥140/90 threshold.

Question 169: A 17-year-old male athlete presents with sharp left-sided chest pain that worsens with inspiration and began suddenly during practice. Breath sounds are diminished on the left. What is the most likely diagnosis?

Pericarditis
Spontaneous pneumothorax (Correct answer)
Costochondritis
Pleuritis

Correct answer: Spontaneous pneumothorax

Tall, thin young males are at risk for spontaneous pneumothorax, which presents with sudden pleuritic chest pain and decreased breath sounds.

Question 170: A 4-year-old child with a high fever develops a brief generalized tonic-clonic seizure lasting 90 seconds that self-resolves. This is the first episode. Which statement is most accurate?

Lumbar puncture is mandatory in all such cases
This is a simple febrile seizure and routine anti-epileptic therapy is not indicated (Correct answer)
The child must be started on phenobarbital prophylaxis
Immediate EEG and MRI are required

Correct answer: This is a simple febrile seizure and routine anti-epileptic therapy is not indicated

Simple febrile seizures (<15 minutes, generalized, single episode) in children 6 months–5 years do not require anti-epileptic treatment or routine neuroimaging.

Question 171: 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?

Order an MRI of the brain with contrast
Perform immediate non-contrast CT of the head (Correct answer)
Administer IV magnesium for migraine
Prescribe a triptan and reassess in 24 hours

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 172: A mild initial heart sound with a holosystolic apical murmur radiating to the left axilla during cardiac auscultation suggests _____.

mitral stenosis
mitral valve prolapse
aortic stenosis
mitral regurgitation (Correct answer)

Correct answer: mitral regurgitation

When performing cardiac auscultation, mitral regurgitation is indicated by a mild initial heart sound and a holosystolic apical murmur that radiate to the left axilla. When your heart is pumping blood out to your body, a holosystolic murmur might be heard.

Question 173: A patient reports pain on palpation of the anatomical snuffbox. The FNP should FIRST suspect:

De Quervain's tenosynovitis
Scaphoid fracture (Correct answer)
Wrist sprain
Colles' fracture

Correct answer: Scaphoid fracture

Anatomical snuffbox tenderness after wrist injury is the hallmark sign of scaphoid fracture, which requires imaging even if initial X-rays are negative.

Question 174: An important point to emphasize when teaching Janice, age 77, to use a cane due to osteoarthritis of her left knee, is ______.

Advancing the cane with the ipsilateral leg. (Correct answer)
Making sure the cane length equals the height of the iliac crest.
Making sure the cane length equals the height of the iliac crest.
Carrying the cane in the ipsilateral hand.

Correct answer: Advancing the cane with the ipsilateral leg.

When using a cane for support due to weakness or pain in one leg (e.g., left knee osteoarthritis), the cane should be held in the hand opposite to the affected leg (contralateral side). The correct gait pattern involves moving the cane forward simultaneously with the *affected* leg (ipsilateral to the affected knee). This provides a wider base of support and stability, allowing the cane to bear weight as the affected leg steps forward, thus reducing stress on the painful joint.

Question 175: A patient in the third trimester of pregnancy presents with severe headache, visual changes, and BP of 162/110. The FNP's IMMEDIATE action is:

Recheck BP in 4 hours
Start oral hydralazine and monitor in office
Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia (Correct answer)
Advise bedrest and low-sodium diet

Correct answer: Emergency transfer to the hospital for evaluation of severe preeclampsia/eclampsia

Severe-range BPs (≥160/110) with CNS symptoms in the third trimester meet criteria for severe preeclampsia, requiring emergency hospitalization and IV antihypertensives.

Question 176: Tx: 500 mg of cipro BID for 7–14 days 500 mg of metronidazole every 6 to 8 hours for 7 to 14 days 7-10 days with Bactrim

Migraines
Rovsing sign
Varicocele
Diverticulitis (Correct answer)

Correct answer: Diverticulitis

The large intestine (colon) is affected by diverticular disease, diverticulitis, and associated digestive diseases. Diverticular illness causes the lining of the gut to develop tiny bulges or pockets known as diverticula. When these pockets swell or become infected, it is known as diverticulitis.

Family Nurse Practitioner (FNP) Certification Exam (ANCC/AANP)

The FNP certification exam assesses the knowledge and skills required for advanced practice registered nurses to provide comprehensive primary healthcare to individuals and families across the lifespan.

175

Questions

210 min

Time Limit

70%

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