**Family Nurse Practitioner
Certification Exam 2024: Primary Care
Focus**
1. Nurse practitioner assessing 45yo with fatigue, weight gain, cold intolerance, constipation. TSH 12,
free T4 0.6. Next step?
💫RATIONALE✔️✔️: Primary hypothyroidism. Start levothyroxine 1.6 mcg/kg/day (approx 100 mcg).
Recheck TSH in 6 weeks.
💫ANSWER✔️✔️: C. Start levothyroxine.
2. Pt with type 2 diabetes, A1c 8.5% on metformin 1000 mg BID. Add second agent?
💫RATIONALE✔️✔️: Add empagliflozin (SGLT2i) or semaglutide (GLP-1) for CV/renal benefit. Avoid
sulfonylureas if possible.
💫ANSWER✔️✔️: B. Empagliflozin.
3. Pt with hypertension, BP 150/92 on lisinopril 20 mg daily. Home BP log 145-150/90-95. Next?
💫RATIONALE✔️✔️: Add amlodipine 5 mg daily (CCB). Target BP <130/80 for DM/CKD, <140/90
otherwise.
💫ANSWER✔️✔️: D. Add amlodipine.
4. NP assessing 35yo with dysuria, frequency, no flank pain. UA: nitrite positive, leukocyte esterase
positive, no pregnancy. First-line antibiotic?
💫RATIONALE✔️✔️: Uncomplicated cystitis: nitrofurantoin 100 mg BID x 5 days or TMP-SMX if local
resistance <20%.
💫ANSWER✔️✔️: A. Nitrofurantoin.
, 5. Pt with GERD symptoms 3x/week, no alarm symptoms. After lifestyle modification, symptoms persist.
Next?
💫RATIONALE✔️✔️: PPI (omeprazole 20 mg daily) for 8 weeks. If response, taper to lowest effective dose.
💫ANSWER✔️✔️: C. Omeprazole.
6. NP assessing 55yo with knee pain, worse with activity, morning stiffness <15 min. X-ray: joint space
narrowing, osteophytes. Diagnosis?
💫RATIONALE✔️✔️: Osteoarthritis. First-line: weight loss, exercise, acetaminophen or topical NSAIDs.
💫ANSWER✔️✔️: B. Osteoarthritis.
7. Pt with anxiety, GAD-7 score 14, no prior treatment. First-line medication?
💫RATIONALE✔️✔️: SSRIs (sertraline, escitalopram) first-line for GAD. Start low, go slow.
💫ANSWER✔️✔️: D. Sertraline.
8. NP assessing 60yo with chronic cough, dyspnea, smoking history 40 pack-years. Spirometry: FEV1/FVC
0.65, FEV1 60% predicted. Diagnosis?
💫RATIONALE✔️✔️: COPD (GOLD stage 2). Start LAMA or LABA/ICS if exacerbations.
💫ANSWER✔️✔️: C. COPD.
9. Pt with insomnia, difficulty falling asleep, wakes refreshed? No. Next?
💫RATIONALE✔️✔️: CBT-I first-line. Medications: melatonin, doxepin, or ramelteon. Avoid
benzodiazepines.
💫ANSWER✔️✔️: A. CBT-I.
10. NP assessing 30yo with sore throat, fever, no cough. Centor criteria: fever, tender anterior nodes,
exudate, no cough = 4. Next?
💫RATIONALE✔️✔️: Centor score 4 → treat empirically or rapid strep. Amoxicillin or penicillin.
💫ANSWER✔️✔️: D. Amoxicillin.
11. Pt with hypothyroidism on levothyroxine 125 mcg, TSH 0.1 (low). Action?
Certification Exam 2024: Primary Care
Focus**
1. Nurse practitioner assessing 45yo with fatigue, weight gain, cold intolerance, constipation. TSH 12,
free T4 0.6. Next step?
💫RATIONALE✔️✔️: Primary hypothyroidism. Start levothyroxine 1.6 mcg/kg/day (approx 100 mcg).
Recheck TSH in 6 weeks.
💫ANSWER✔️✔️: C. Start levothyroxine.
2. Pt with type 2 diabetes, A1c 8.5% on metformin 1000 mg BID. Add second agent?
💫RATIONALE✔️✔️: Add empagliflozin (SGLT2i) or semaglutide (GLP-1) for CV/renal benefit. Avoid
sulfonylureas if possible.
💫ANSWER✔️✔️: B. Empagliflozin.
3. Pt with hypertension, BP 150/92 on lisinopril 20 mg daily. Home BP log 145-150/90-95. Next?
💫RATIONALE✔️✔️: Add amlodipine 5 mg daily (CCB). Target BP <130/80 for DM/CKD, <140/90
otherwise.
💫ANSWER✔️✔️: D. Add amlodipine.
4. NP assessing 35yo with dysuria, frequency, no flank pain. UA: nitrite positive, leukocyte esterase
positive, no pregnancy. First-line antibiotic?
💫RATIONALE✔️✔️: Uncomplicated cystitis: nitrofurantoin 100 mg BID x 5 days or TMP-SMX if local
resistance <20%.
💫ANSWER✔️✔️: A. Nitrofurantoin.
, 5. Pt with GERD symptoms 3x/week, no alarm symptoms. After lifestyle modification, symptoms persist.
Next?
💫RATIONALE✔️✔️: PPI (omeprazole 20 mg daily) for 8 weeks. If response, taper to lowest effective dose.
💫ANSWER✔️✔️: C. Omeprazole.
6. NP assessing 55yo with knee pain, worse with activity, morning stiffness <15 min. X-ray: joint space
narrowing, osteophytes. Diagnosis?
💫RATIONALE✔️✔️: Osteoarthritis. First-line: weight loss, exercise, acetaminophen or topical NSAIDs.
💫ANSWER✔️✔️: B. Osteoarthritis.
7. Pt with anxiety, GAD-7 score 14, no prior treatment. First-line medication?
💫RATIONALE✔️✔️: SSRIs (sertraline, escitalopram) first-line for GAD. Start low, go slow.
💫ANSWER✔️✔️: D. Sertraline.
8. NP assessing 60yo with chronic cough, dyspnea, smoking history 40 pack-years. Spirometry: FEV1/FVC
0.65, FEV1 60% predicted. Diagnosis?
💫RATIONALE✔️✔️: COPD (GOLD stage 2). Start LAMA or LABA/ICS if exacerbations.
💫ANSWER✔️✔️: C. COPD.
9. Pt with insomnia, difficulty falling asleep, wakes refreshed? No. Next?
💫RATIONALE✔️✔️: CBT-I first-line. Medications: melatonin, doxepin, or ramelteon. Avoid
benzodiazepines.
💫ANSWER✔️✔️: A. CBT-I.
10. NP assessing 30yo with sore throat, fever, no cough. Centor criteria: fever, tender anterior nodes,
exudate, no cough = 4. Next?
💫RATIONALE✔️✔️: Centor score 4 → treat empirically or rapid strep. Amoxicillin or penicillin.
💫ANSWER✔️✔️: D. Amoxicillin.
11. Pt with hypothyroidism on levothyroxine 125 mcg, TSH 0.1 (low). Action?
