FNP Exam Review: Comprehensive NP Study Guide for AANP
Boards-200 practice questions
1. A 21-year-old woman has had urinary frequency and urgency for the past 2 days. She has also noticed
scant vaginal discharge. A urine sample is sent for urinalysis and culture. Which of the following
additional findings would be most suggestive of a diagnosis of pyelonephritis?
A. Bacteriuria
B. Leukocytosis
C. Microscopic hematuria
D. White blood cell casts
> Answer: D. White blood cell casts
> Explanation: WBC casts are formed only in renal tubules, confirming upper UTI (pyelonephritis).
Hematuria, pyuria, and bacteriuria can occur in both upper and lower UTIs, but WBC casts are specific
for pyelonephritis.
2. A 55-year-old man with type 2 diabetes presents with sudden severe right foot pain that started in
the middle of the night after a steak dinner. Exam shows swelling and tenderness of the first
metatarsophalangeal joint. Joint aspiration reveals monosodium urate crystals. What is the best initial
treatment?
A. Allopurinol
B. Non-steroidal anti-inflammatory drugs (NSAIDs)
C. Prednisone
D. Probenecid
> Answer: B. Non-steroidal anti-inflammatory drugs (NSAIDs)
> Explanation: Acute gouty arthritis is best treated initially with NSAIDs (e.g., indomethacin or
naproxen). Colchicine or corticosteroids are alternatives. Allopurinol is for chronic management, not
acute flares.
,3. A 21-year-old new mother reports feeling irritable and jittery almost daily for the past few months.
She complains of palpitations, frequent bowel movements, and weight loss. BP is 160/70 mm Hg, pulse
110 bpm. All of the following should be considered in the differential diagnosis EXCEPT:
A. Mitral regurgitation
B. Graves' disease
C. Generalized anxiety disorder
D. Illicit drug use
> Answer: A. Mitral regurgitation
> Explanation: Signs and symptoms of mitral regurgitation do not include frequent bowel movements
with weight loss. This presentation suggests hyperthyroidism (Graves’ disease), anxiety, or stimulant
use.
4. A 63-year-old with a 10-year history of poorly controlled hypertension presents with a cluster of
physical exam findings. Which cluster indicates target organ damage commonly seen in hypertensive
patients?
A. Pedal edema, hepatomegaly, enlarged kidneys
B. Arteriovenous (AV) nicking, left ventricular hypertrophy, stroke
C. Renal infection, S3 heart sound, neuromuscular abnormalities
D. Glaucoma, jugular vein atrophy, heart failure
> Answer: B. Arteriovenous (AV) nicking, left ventricular hypertrophy, stroke
> Explanation: AV nicking and copper/silver wire arterioles indicate hypertensive retinopathy. LVH
affects the heart, and stroke affects the brain. These are all classic target organ damage from long-
standing hypertension.
5. A patient with mitral valve prolapse requests prophylaxis before dental surgery. Which is appropriate?
A. Amoxicillin
B. Clindamycin
C. No prophylaxis needed
D. Vancomycin
,> Answer: C. No prophylaxis needed
> Explanation: Current AHA guidelines (2007) no longer recommend antibiotic prophylaxis for mitral
valve prolapse unless the patient has a prior history of infective endocarditis, a prosthetic valve, or
specific high-risk cardiac conditions.
6. Which of the following medications can impact thyroid function?
A. Amiodarone, lithium, interferon-alpha
B. Labetalol, lisinopril, losartan
C. HCTZ, chlorthalidone, losartan
D. Omeprazole, atorvastatin, lisinopril
> Answer: A. Amiodarone, lithium, interferon-alpha
> Explanation: Amiodarone can cause hyper- or hypothyroidism. Lithium and interferon-alpha can also
cause thyroid dysfunction; thyroid levels should be assessed periodically.
7. Early-morning increases in blood glucose without corresponding nocturnal hypoglycemia are referred
to as:
A. Somogyi phenomenon
B. Insulin shock
C. Diabetic ketoacidosis
D. Dawn phenomenon
> Answer: D. Dawn phenomenon
> Explanation: Dawn phenomenon is an early-morning rise in blood glucose due to natural release of
growth hormone and cortisol. Somogyi phenomenon is rebound hyperglycemia following nocturnal
hypoglycemia.
8. What is the relationship between diabetes and coronary artery disease (CAD)?
A. Hyperinsulinemia decreases sympathetic tone
B. Hyperinsulinemia causes vascular smooth muscle cell proliferation
C. Increased glucose decreases sodium absorption
, D. Increased glucose stimulates epinephrine secretion
> Answer: B. Hyperinsulinemia causes vascular smooth muscle cell proliferation
> Explanation: Hyperinsulinemia promotes the formation and deposition of vascular smooth muscle cells
on vessel walls, leading to atherosclerosis and reduced blood flow.
9. What is the medication of choice for an initial acute attack of gout?
A. NSAIDs
B. Colchicine
C. Corticosteroids
D. Allopurinol
> Answer: A. NSAIDs
> Explanation: Indomethacin (50-75 mg initially, then 25-50 mg q8h for 5-10 days) or naproxen is first-
line. Colchicine or corticosteroids are alternatives. Allopurinol is for chronic management.
10. Before radioactive iodine therapy for Graves’ disease, which test must be performed first?
A. Beta-hCG (pregnancy test)
B. Basal metabolic rate
C. Lithium level
D. Serum calcium
> Answer: A. Beta-hCG (pregnancy test)
> Explanation: Radioactive iodine is contraindicated in pregnancy. A negative pregnancy test must be
confirmed before therapy.
11. All of the following are infections that affect mostly the labia and vagina EXCEPT:
A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
Boards-200 practice questions
1. A 21-year-old woman has had urinary frequency and urgency for the past 2 days. She has also noticed
scant vaginal discharge. A urine sample is sent for urinalysis and culture. Which of the following
additional findings would be most suggestive of a diagnosis of pyelonephritis?
A. Bacteriuria
B. Leukocytosis
C. Microscopic hematuria
D. White blood cell casts
> Answer: D. White blood cell casts
> Explanation: WBC casts are formed only in renal tubules, confirming upper UTI (pyelonephritis).
Hematuria, pyuria, and bacteriuria can occur in both upper and lower UTIs, but WBC casts are specific
for pyelonephritis.
2. A 55-year-old man with type 2 diabetes presents with sudden severe right foot pain that started in
the middle of the night after a steak dinner. Exam shows swelling and tenderness of the first
metatarsophalangeal joint. Joint aspiration reveals monosodium urate crystals. What is the best initial
treatment?
A. Allopurinol
B. Non-steroidal anti-inflammatory drugs (NSAIDs)
C. Prednisone
D. Probenecid
> Answer: B. Non-steroidal anti-inflammatory drugs (NSAIDs)
> Explanation: Acute gouty arthritis is best treated initially with NSAIDs (e.g., indomethacin or
naproxen). Colchicine or corticosteroids are alternatives. Allopurinol is for chronic management, not
acute flares.
,3. A 21-year-old new mother reports feeling irritable and jittery almost daily for the past few months.
She complains of palpitations, frequent bowel movements, and weight loss. BP is 160/70 mm Hg, pulse
110 bpm. All of the following should be considered in the differential diagnosis EXCEPT:
A. Mitral regurgitation
B. Graves' disease
C. Generalized anxiety disorder
D. Illicit drug use
> Answer: A. Mitral regurgitation
> Explanation: Signs and symptoms of mitral regurgitation do not include frequent bowel movements
with weight loss. This presentation suggests hyperthyroidism (Graves’ disease), anxiety, or stimulant
use.
4. A 63-year-old with a 10-year history of poorly controlled hypertension presents with a cluster of
physical exam findings. Which cluster indicates target organ damage commonly seen in hypertensive
patients?
A. Pedal edema, hepatomegaly, enlarged kidneys
B. Arteriovenous (AV) nicking, left ventricular hypertrophy, stroke
C. Renal infection, S3 heart sound, neuromuscular abnormalities
D. Glaucoma, jugular vein atrophy, heart failure
> Answer: B. Arteriovenous (AV) nicking, left ventricular hypertrophy, stroke
> Explanation: AV nicking and copper/silver wire arterioles indicate hypertensive retinopathy. LVH
affects the heart, and stroke affects the brain. These are all classic target organ damage from long-
standing hypertension.
5. A patient with mitral valve prolapse requests prophylaxis before dental surgery. Which is appropriate?
A. Amoxicillin
B. Clindamycin
C. No prophylaxis needed
D. Vancomycin
,> Answer: C. No prophylaxis needed
> Explanation: Current AHA guidelines (2007) no longer recommend antibiotic prophylaxis for mitral
valve prolapse unless the patient has a prior history of infective endocarditis, a prosthetic valve, or
specific high-risk cardiac conditions.
6. Which of the following medications can impact thyroid function?
A. Amiodarone, lithium, interferon-alpha
B. Labetalol, lisinopril, losartan
C. HCTZ, chlorthalidone, losartan
D. Omeprazole, atorvastatin, lisinopril
> Answer: A. Amiodarone, lithium, interferon-alpha
> Explanation: Amiodarone can cause hyper- or hypothyroidism. Lithium and interferon-alpha can also
cause thyroid dysfunction; thyroid levels should be assessed periodically.
7. Early-morning increases in blood glucose without corresponding nocturnal hypoglycemia are referred
to as:
A. Somogyi phenomenon
B. Insulin shock
C. Diabetic ketoacidosis
D. Dawn phenomenon
> Answer: D. Dawn phenomenon
> Explanation: Dawn phenomenon is an early-morning rise in blood glucose due to natural release of
growth hormone and cortisol. Somogyi phenomenon is rebound hyperglycemia following nocturnal
hypoglycemia.
8. What is the relationship between diabetes and coronary artery disease (CAD)?
A. Hyperinsulinemia decreases sympathetic tone
B. Hyperinsulinemia causes vascular smooth muscle cell proliferation
C. Increased glucose decreases sodium absorption
, D. Increased glucose stimulates epinephrine secretion
> Answer: B. Hyperinsulinemia causes vascular smooth muscle cell proliferation
> Explanation: Hyperinsulinemia promotes the formation and deposition of vascular smooth muscle cells
on vessel walls, leading to atherosclerosis and reduced blood flow.
9. What is the medication of choice for an initial acute attack of gout?
A. NSAIDs
B. Colchicine
C. Corticosteroids
D. Allopurinol
> Answer: A. NSAIDs
> Explanation: Indomethacin (50-75 mg initially, then 25-50 mg q8h for 5-10 days) or naproxen is first-
line. Colchicine or corticosteroids are alternatives. Allopurinol is for chronic management.
10. Before radioactive iodine therapy for Graves’ disease, which test must be performed first?
A. Beta-hCG (pregnancy test)
B. Basal metabolic rate
C. Lithium level
D. Serum calcium
> Answer: A. Beta-hCG (pregnancy test)
> Explanation: Radioactive iodine is contraindicated in pregnancy. A negative pregnancy test must be
confirmed before therapy.
11. All of the following are infections that affect mostly the labia and vagina EXCEPT:
A. Bacterial vaginosis
B. Candidiasis
C. Trichomoniasis
