The Brainscape team designed these FNP exam-style questions in partnership with Brittani Holseke, an experienced family nurse practitioner and founder of Brittani Holsbeke NP Review. There are 20 questions in total with the correct answers and rationales hidden in collapsible sections after each one.
Let’s go!
Question 1:
A 4-year-old boy is brought to clinic by his parents for evaluation of fever (101.5°F) and a barky cough that worsens at night. The child has mild inspiratory stridor when agitated but no stridor at rest. Oxygen saturation is 98% on room air, and he is in no acute distress.
Which of the following is the most appropriate initial management?
A. Administer racemic epinephrine nebulizer and admit to hospital
B. Administer oral dexamethasone and provide supportive care at home
C. Start azithromycin and send throat culture
D. Order a chest X-ray to evaluate for foreign body aspiration
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Correct Answer: B
The presentation is classic for mild croup (parainfluenza most common cause): barky cough, inspiratory stridor when agitated, but no resting stridor, normal oxygen, non-toxic appearance. Mild croup is managed with a single dose of oral dexamethasone and supportive care (humidified air, fluids). Racemic epinephrine (A) is reserved for moderate/severe croup (stridor at rest, significant distress). Azithromycin (C) is not indicated, as this is viral. Imaging (D) is not necessary given clear diagnosis.
Question 2:
A 24-year-old nonpregnant woman presents with 2 days of dysuria and urinary frequency. She denies fever, flank pain, vaginal discharge, or recent antibiotic use. She is sexually active with one partner and uses condoms inconsistently. Vitals are normal. Abdominal exam is benign; no CVA tenderness. Point-of-care urinalysis is positive for leukocyte esterase and nitrites.
Which of the following is the most appropriate initial management?
A. Nitrofurantoin monohydrate/macrocrystals 100 mg orally twice daily for 5 days
B. Ciprofloxacin 500 mg orally twice daily for 7 days
C. Amoxicillin-clavulanate 875/125 mg orally twice daily for 7 days
D. Phenazopyridine 200 mg orally three times daily for 2 days as monotherapy.
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Correct Answer: A
Presentation is classic for acute uncomplicated cystitis. First-line therapy is a nitrofurantoin 5-day course in regions with usual resistance patterns and no concern for pyelonephritis (afebrile, no flank pain). Fluoroquinolones (B) are effective but are not first-line for uncomplicated cystitis due to collateral damage and safety concerns when alternatives exist. Amoxicillin-clavulanate (C) is an alternative but generally not preferred as initial therapy given resistance considerations. Phenazopyridine (D) may relieve dysuria but does not treat infection and should not be used as monotherapy.
Question 3:
A 58-year-old man presents for routine follow-up. He has hypertension and type 2 diabetes, well-controlled on lisinopril and metformin. His labs today show LDL cholesterol of 140 mg/dL, HDL of 38 mg/dL, and triglycerides of 180 mg/dL. He does not smoke. His calculated 10-year ASCVD risk is 15%.
What is the most appropriate management recommendation?
A. No statin therapy; reinforce diet and exercise only
B. Initiate moderate-intensity statin therapy
C. Initiate high-intensity statin therapy
D. Initiate aspirin 81 mg daily for primary prevention only
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Correct Answer: C
Patients age 40–75 with diabetes and an elevated ASCVD risk score (≥7.5%) should be started on high-intensity statin therapy for primary prevention. (Examples: atorvastatin 40–80 mg, rosuvastatin 20–40 mg). Moderate-intensity statin (B) is used for lower-risk patients or if high-intensity is not tolerated. Lifestyle changes (A) are important but not sufficient alone. Aspirin (D) may be considered in select high-risk individuals but does not replace statin therapy as the most effective prevention.
Question 4:
A 45-year-old woman presents with gradual onset of knee pain that worsens with activity and improves with rest. Exam reveals crepitus and bony enlargement of the joint but no erythema or warmth.
What is the most appropriate initial management?
A. Acetaminophen or NSAIDs and exercise therapy
B. Oral prednisone taper
C. Intra-articular corticosteroid injection immediately
D. Arthroscopic surgery
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Correct Answer: A
Classic presentation of osteoarthritis. First-line therapy includes acetaminophen or NSAIDs (if no contraindication), weight management, and low-impact exercise. Injections are reserved for refractory cases; systemic steroids and surgery are not first-line.
Question 5:
A 38-year-old woman complains of weight loss, palpitations, and heat intolerance. PE: fine tremor, brisk reflexes, and a diffusely enlarged, non-tender thyroid.
Which diagnostic test best confirms the suspected diagnosis?
A. MRI of the pituitary
B. Thyroid ultrasound
C. Serum cortisol
D. Serum TSH
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Correct Answer: D
The best initial test for suspected hyperthyroidism is serum TSH, which will be suppressed. Free T4 confirms hyperfunction. Imaging is only indicated for nodules or atypical findings.
Question 6:
A 72-year-old man presents with fatigue and pallor. CBC: Hgb 9.5 g/dL, MCV 72 fL, ferritin 8 ng/mL.
What is the next best step?
A. Prescribe oral ferrous sulfate and recheck in 3 months
B. Refer for erythropoietin therapy
C. Order bone marrow biopsy
D. Evaluate for occult gastrointestinal bleeding
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Correct Answer: D
Iron-deficiency anemia in an older adult requires identifying the cause. GI blood loss (e.g., colon cancer, ulcer) must be ruled out before empiric iron therapy alone.
Question 7:
A 65-year-old man reports weak urinary stream and nocturia. DRE: smooth, non-tender, enlarged prostate. PSA 3.2 ng/mL.
Which is the most appropriate first-line pharmacologic treatment?
A. Finasteride
B. Tamsulosin
C. Ciprofloxacin
D. Oxybutynin
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Correct Answer: B
Benign prostatic hyperplasia (BPH) with mild-moderate symptoms is treated first with an α-1 blocker (tamsulosin) to improve urinary flow. 5-α-reductase inhibitors like finasteride are added if the prostate is significantly enlarged or symptoms persist.
Question 8:
A 60-year-old man with chronic NSAID use presents with epigastric pain relieved by food. H. pylori test is positive.
What is the best treatment?
A. Omeprazole monotherapy
B. Ranitidine and antacids
C. Bismuth, metronidazole, tetracycline, and PPI
D. Stop NSAIDs only
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Correct Answer: C
Positive H. pylori requires quadruple therapy (PPI + bismuth + metronidazole + tetracycline) for 10–14 days. PPI alone or H2 blockers are insufficient to eradicate infection.
Question 9:
A 28-year-old woman presents with shortness of breath and wheezing after exposure to cat dander. PEF improves by 15% after albuterol.
What is the preferred long-term controller medication?
A. Inhaled corticosteroid (ICS)
B. Short-acting beta-agonist (SABA) only
C. Leukotriene receptor antagonist alone
D. Oral corticosteroid
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Correct Answer: A
Persistent asthma requires daily inhaled corticosteroid therapy as controller medication. SABA is for rescue only. Leukotriene antagonists are adjuncts; oral steroids are for severe exacerbations.
Question 10:
A 70-year-old man presents with new-onset ankle edema, dyspnea on exertion, and orthopnea. Exam reveals S3 gallop and bibasilar crackles.
Which medication class provides mortality benefit?
A. ACE inhibitors
B. Loop diuretics
C. Nitrates
D. Digoxin
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Correct Answer: A
In systolic heart failure, ACE inhibitors (or ARBs) improve survival by reducing afterload and ventricular remodeling. Loop diuretics relieve symptoms but do not improve mortality.
Question 11:
A 16-year-old girl presents with multiple open and closed comedones on her face and upper back.
What is the best initial management?
A. Oral isotretinoin
B. Systemic corticosteroids
C. Oral doxycycline
D. Topical benzoyl peroxide and a topical retinoid
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Correct Answer: D
Mild-moderate acne vulgaris is managed first with combination topical therapies—benzoyl peroxide plus a retinoid. Oral antibiotics are added for inflammatory or resistant cases; isotretinoin reserved for severe nodulocystic acne.
Question 12:
A 6-year-old presents with ear pain and fever. Otoscopy shows a bulging, erythematous tympanic membrane with poor light reflex.
What is the most appropriate first-line antibiotic?
A. Ciprofloxacin ear drops
B. Azithromycin
C. Amoxicillin
D. Trimethoprim-sulfamethoxazole
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Correct Answer: C
Acute otitis media in children is treated first-line with high-dose amoxicillin (45mg/kg twice a day). Macrolides are alternatives only for true penicillin allergy.
Question 13:
A 23-year-old woman presents with mucopurulent cervical discharge and intermenstrual spotting. NAAT is positive for Chlamydia trachomatis only.
What is the recommended treatment?
A. Ceftriaxone IM once
B. Azithromycin 1 g PO single dose
C. Doxycycline 100 mg PO BID × 7 days
D. Metronidazole 2 g PO single dose
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Correct Answer: C
Per current CDC 2021 STI guidelines, uncomplicated chlamydial infection is treated with doxycycline 100 mg twice daily for 7 days. Azithromycin is now an alternative when adherence is uncertain, or if the patient is pregnant.
Question 14:
A 52-year-old man reports fatigue and decreased libido. Morning total testosterone is 220 ng/dL (low). LH and FSH are elevated.
What is the most likely diagnosis?
A. Primary hypogonadism
B. Secondary hypogonadism
C. Normal age-related decline
D. Cushing syndrome
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Correct Answer: A
Low testosterone with elevated gonadotropins indicates primary testicular failure (primary hypogonadism). Secondary forms show low or inappropriately normal LH/FSH.
Question 15:
A 70-year-old woman presents with sudden right facial droop sparing the forehead. Speech is slurred, and right arm weakness is present.
What is the most likely diagnosis?
A. Bell’s palsy
B. Ischemic stroke
C. Trigeminal neuralgia
D. Temporal arteritis
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Correct Answer: B
Central facial weakness (forehead spared) plus other neurologic deficits (speech, limb weakness) = stroke, not Bell’s palsy. Bell’s palsy affects the entire side of the face, including the forehead.
Question 16:
A 30-year-old woman presents with 3 weeks of depressed mood, anhedonia, fatigue, and impaired concentration. She denies mania or substance use.
Which medication is considered first-line?
A. Bupropion
B. Sertraline
C. Amitriptyline
D. Diazepam
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Correct Answer: B
For major depressive disorder, SSRIs (e.g., sertraline) are first-line due to safety and efficacy. Bupropion is an alternative if sexual side effects or weight gain are issues. TCAs and benzodiazepines are not first-line.
Question 17:
A 55-year-old woman with no family history of cancer asks about preventive screening.Which of the following is recommended by USPSTF?
A. Begin colon cancer screening at age 60
B. CT lung scan for all women over 55
C. Pap smear annually after age 50
D. Mammogram every 2 years starting at age 40
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Correct Answer: D
USPSTF: Women aged 40 and older should have screening with mammography every 2 years; may start at 40 based on risk and preference. Colon screening begins at 45. A pap smear, also referred to as a cervical cytology test, begins at age 21 and is repeated every 3 years, generally until age 65.
Question 18:
A 66-year-old man with a 40-pack-year smoking history quit 5 years ago. He is asymptomatic.Which imaging is appropriate for screening?
A. Low-dose CT scan
B. Chest X-ray
C. PET scan
D. MRI chest
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Correct Answer: A
Annual low-dose CT is recommended for adults aged 50–80 with ≥20-pack-year history who currently smoke or quit within 15 years. Chest X-ray is not an adequate screening tool.
Question 19:
A 67-year-old woman with atrial fibrillation and CKD (eGFR 40 mL/min) is on apixaban. She starts clarithromycin for pneumonia.
What is the NP’s best action?
A. Continue both drugs without change
B. Reduce apixaban dose by 50%
C. Stop clarithromycin immediately
D. Switch antibiotic to one with fewer interactions
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Correct Answer: D
Clarithromycin is a strong CYP3A4/P-gp inhibitor that increases apixaban levels, raising bleeding risk. The safest approach is to use an alternative antibiotic (e.g., azithromycin or doxycycline). Adjusting the anticoagulant dose is not recommended without specialist guidance.
Question 20:
During a telehealth visit, a patient begins discussing suicidal thoughts.
Which is the most appropriate next step?
A. Document the conversation and end the call
B. Schedule follow-up in one week
C. Provide crisis hotline information and ensure patient safety
D. Inform family without patient consent
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Correct Answer: C
The NP must ensure immediate safety: stay on the line, assess risk, provide crisis resources (e.g., 988), and arrange emergency intervention if needed. Breach of confidentiality is permitted when there’s imminent risk, but direct engagement comes first.