Free FNP-C Practice Questions

Question 1

A 52-year-old warehouse supervisor comes in for a pre-employment physical with no complaints. He is not on any medications. Seated, rested readings average 148/92 mm Hg today; a repeat visit two weeks later averages 150/94 mm Hg using proper cuff technique. He has no diabetes and takes no decongestants or NSAIDs. Which classification MOST accurately describes his blood pressure?

Accepted Answer

Stage 2 hypertension

Answer

Stage 1 hypertension

Answer

Elevated blood pressure

Answer

White coat hypertension

Question 2

A 68-year-old man with spirometry-confirmed COPD (post-bronchodilator FEV1/FVC 0.58, FEV1 61% predicted) is breathless climbing one flight of stairs (mMRC 2). He had two exacerbations treated with oral steroids in the past year, neither requiring admission. Blood eosinophils are 150 cells/uL. Which is the MOST appropriate initial maintenance inhaler regimen?

Accepted Answer

Long-acting beta-agonist plus long-acting muscarinic antagonist

Answer

Long-acting muscarinic antagonist alone

Answer

Long-acting beta-agonist plus inhaled corticosteroid

Answer

Triple therapy with LABA, LAMA, and inhaled corticosteroid

Question 3

A 45-year-old woman is newly diagnosed with type 2 diabetes after a confirmed A1c of 7.6%. BMI 29, eGFR 88, BP 122/78. She has no known cardiovascular disease, heart failure, or chronic kidney disease and is not pregnant. You have reviewed nutrition and activity. Which is the BEST initial pharmacologic therapy?

Accepted Answer

Metformin

Answer

Glipizide

Answer

Basal insulin glargine

Answer

Empagliflozin

Question 4

A 15-year-old is brought in by her mother for cramping that begins the day her period starts and eases by the third day. She reached menarche at 13, her cycles are regular, and she is not sexually active. Exam is normal, and she has no fever, abnormal bleeding, or bowel changes. She misses about one school day each month because of the pain. Which is the MOST appropriate initial treatment?

Accepted Answer

Scheduled naproxen started at the onset of menses

Answer

Combined oral contraceptive pill

Answer

Pelvic ultrasound before any therapy

Answer

Diagnostic laparoscopy to evaluate for endometriosis

Question 5

The parents of a 9-month-old boy mention at his check-up that he has not started doing a few things yet. In the room he babbles "bababa," turns to his name, passes a block from one hand to the other, and gets briefly upset when the medical assistant reaches for him. Which one MOST warrants a developmental referral rather than reassurance?

Accepted Answer

He does not sit steadily without support

Answer

He does not pull to stand at the furniture

Answer

He does not wave "bye-bye"

Answer

He does not yet say a single word with meaning

Question 6

An 8-year-old boy is seen because both his teacher and his parents report nine months of not finishing tasks, frequent careless mistakes, constant fidgeting, blurting answers, and difficulty waiting his turn. The behaviors occur at school and at home and his grades are slipping. Hearing and vision are normal, there is no history of abuse or major stressor, and his physical and neurologic exams are normal. He meets DSM-5 criteria for ADHD, combined presentation. Which is the MOST appropriate first-line treatment?

Accepted Answer

Methylphenidate combined with behavioral therapy

Answer

Atomoxetine

Answer

Guanfacine extended-release

Answer

Behavioral therapy alone without medication

Question 7

A 64-year-old man reports a year of progressive nocturia three times nightly, a weak stream, hesitancy, and a sense of incomplete emptying; his IPSS is 18. The prostate is smoothly enlarged, nontender, without nodules. PSA is 2.1 ng/mL, urinalysis is normal with no hematuria, and post-void residual is 60 mL. He is bothered by symptoms, wants medication rather than surgery, and hopes for relief soon. Which is the MOST appropriate first-line pharmacotherapy?

Accepted Answer

Tamsulosin

Answer

Oxybutynin

Answer

Finasteride monotherapy

Answer

Bedtime furosemide

Question 8

"These scaly patches on my elbows and knees have been here for months," reports a 46-year-old man. On exam there are sharply demarcated erythematous plaques topped with thick, silvery-white scale over the extensor surfaces; several fingernails show fine pitting; and removing a bit of scale produces pinpoint bleeding. Which of the following is the MOST likely diagnosis?

Accepted Answer

Plaque psoriasis

Answer

Tinea corporis

Answer

Seborrheic dermatitis

Answer

Atopic dermatitis

Question 9

A nonhealing plantar ulcer beneath the great toe, present for 4 weeks, brings a 64-year-old man with long-standing type 2 diabetes to clinic. The ulcer measures 2 cm with a malodorous, visible base; a sterile metal probe advances to a hard, gritty surface at the wound floor. He is afebrile and hemodynamically stable. Which is the MOST appropriate next step to establish the diagnosis?

Accepted Answer

Obtain plain radiographs of the foot

Answer

Obtain MRI of the foot

Answer

Order ESR and C-reactive protein and begin empiric antibiotics

Answer

Send a superficial wound-swab culture to guide therapy

Question 10

Three weeks of a dull ache spreading through the left groin, thigh, and knee, now with a new limp and no history of injury, bring a 13-year-old boy whose BMI sits at the 97th percentile to clinic. He keeps the leg turned outward. On passive flexion of the hip the thigh obligately rotates outward, and internal rotation of the hip is limited and painful. Which is the MOST likely diagnosis?

Accepted Answer

Slipped capital femoral epiphysis

Answer

Legg-Calve-Perthes disease

Answer

Transient (toxic) synovitis of the hip

Answer

Osgood-Schlatter disease

Question 11

A 45-year-old woman at a routine visit asks when she should start being checked for colon cancer. She has no symptoms, no personal history of polyps or IBD, and no family history of colorectal cancer. Which of the following is the MOST appropriate recommendation?

Accepted Answer

Begin screening now with colonoscopy every 10 years or an annual FIT

Answer

Reassure her that colorectal cancer screening can wait until age 50

Answer

Defer screening until she develops symptoms such as bleeding or a stool change

Answer

Order a serum carcinoembryonic antigen (CEA) level as her screening test

Question 12

A mother brings her 19-month-old daughter for two days of fussiness, tugging at the right ear, and a fever measured at home to 39.1 C (102.4 F); the child had a runny nose the week before. On pneumatic otoscopy the right tympanic membrane is bulging, opaque, and yellow with markedly reduced mobility, while the left ear looks normal. She is drinking well and there is no ear drainage. Which is the MOST likely diagnosis?

Accepted Answer

Acute otitis media

Answer

Bullous myringitis

Answer

Otitis externa

Answer

Otitis media with effusion

Question 13

"My right hand shakes when it's just resting in my lap, but it stops the moment I reach for something," says a 68-year-old man. His wife adds that he has become slower buttoning his shirt over the past year. On exam the tremor is worse on the right, and passive movement of that wrist shows ratchety, cogwheel resistance. Which is the MOST likely diagnosis?

Accepted Answer

Parkinson disease

Answer

Drug-induced parkinsonism

Answer

Essential tremor

Answer

Cerebellar intention tremor

Question 14

A 44-year-old woman with iron-deficiency anemia from heavy menses has taken ferrous sulfate for eight weeks. Her hemoglobin rose from 8.9 to 12.6 g/dL and is now normal, but her ferritin remains at the low end of normal. Which is the MOST appropriate next step?

Accepted Answer

Continue oral iron about 3 more months to rebuild stores

Answer

Switch to intravenous iron because oral therapy has failed

Answer

Stop iron now that the hemoglobin has fully normalized

Answer

Add a vitamin B12 supplement to correct the low ferritin

Question 15

"My first baby was born with spina bifida, and we want to try for another one." A woman comes for a preconception visit and hopes to conceive in about 3 months. She has regular menstrual cycles, takes no medications, and has no chronic illnesses. She asks how to lower the chance that a future pregnancy is affected the same way. Which folic acid regimen is MOST appropriate?

Accepted Answer

Folic acid 4 mg by mouth daily starting at least one month before conception

Answer

Folic acid 0.4 mg by mouth daily begun once pregnancy is confirmed

Answer

Folic acid 0.8 mg by mouth daily started early in the first trimester

Answer

Folic acid 1 mg by mouth daily begun at the first prenatal visit

Question 16

The medication list for a 29-year-old woman at her annual visit includes carbamazepine, which she takes for focal epilepsy that has been seizure-free for two years. She is in a monogamous relationship, has regular cycles, and wants a highly reliable, reversible method of contraception. Her blood pressure is 112/70 mm Hg, BMI is 24 kg/m2, and she has no history of thrombosis. Which contraceptive method is MOST appropriate?

Accepted Answer

Depot medroxyprogesterone acetate intramuscular injection

Answer

Combined estrogen-progestin oral contraceptive pill

Answer

Progestin-only oral contraceptive pill

Answer

Combined estrogen-progestin transdermal patch

Question 17

A temperature of 40.1 C (104.2 F) is the first thing noted in a patient brought in six days after starting haloperidol. Examination shows generalized lead-pipe rigidity, diminished deep-tendon reflexes, and confusion; blood pressure is 168/98 and creatine kinase is 9,800 U/L. There is no clonus. Which is the MOST appropriate initial management?

Accepted Answer

Stop haloperidol and provide aggressive supportive care with dantrolene

Answer

Start intravenous lorazepam and increase the haloperidol dose

Answer

Continue haloperidol and add cyproheptadine

Answer

Give intramuscular benztropine and continue haloperidol

Question 18

Blood pressure has held at 76/48 mm Hg for 40 minutes despite 2 L of intravenous normal saline in a 61-year-old man admitted for a swollen, painful right calf. CT pulmonary angiography obtained for acute dyspnea confirms a large saddle pulmonary embolism. Heart rate is 122/min and oxygen saturation is 89% on 6 L nasal cannula. He has no history of bleeding, recent surgery, or stroke, and a medication review confirms no anticoagulant use. Which of the following is the MOST appropriate next step?

Accepted Answer

Administer intravenous alteplase

Answer

Begin therapeutic-dose subcutaneous enoxaparin alone

Answer

Place a retrievable inferior vena cava filter

Answer

Continue fluid resuscitation and repeat imaging in 6 hours

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