FITZGERALD FNP Exit Exam-style practice exam 2
Questions and Answers with Rationales Latest
Version Top Rated
Question 1
A 68-year-old man with hypertension and type 2 diabetes presents for routine follow-up. His
blood pressure averages 148/92 mm Hg despite taking lisinopril 40 mg daily. His eGFR is 72
mL/min/1.73 m², and his potassium is 4.3 mEq/L.
What is the most appropriate next step?
A. Increase lisinopril to 80 mg daily
B. Add hydrochlorothiazide
C. Discontinue lisinopril and begin propranolol
D. Continue current therapy and recheck in 6 months
Correct Answer: B. Add hydrochlorothiazide
Rationale
According to current hypertension guidelines, patients whose blood pressure remains above goal
despite maximally tolerated ACE inhibitor therapy generally require combination treatment. A
thiazide diuretic is an appropriate second-line medication in patients with preserved renal
function.
• A: Incorrect. Forty milligrams is generally the maximum recommended daily dose of
lisinopril.
• B: Correct. Adding a thiazide diuretic provides additive blood pressure reduction.
• C: Incorrect. Beta-blockers are not first-line therapy for uncomplicated hypertension.
• D: Incorrect. The patient's blood pressure remains uncontrolled.
Clinical Pearl: Most patients require two or more antihypertensive medications to reach target
blood pressure.
Question 2
,A 26-year-old woman reports dysuria, urinary frequency, and urgency for 2 days. She has no
fever, flank pain, or vaginal discharge.
The best initial treatment is:
A. Nitrofurantoin
B. Ciprofloxacin
C. IV ceftriaxone
D. Metronidazole
Correct Answer: A. Nitrofurantoin
Rationale
This patient has uncomplicated acute cystitis.
• A: Correct. Nitrofurantoin is recommended as first-line treatment for uncomplicated
cystitis when renal function is adequate.
• B: Fluoroquinolones should generally be reserved for more complicated infections
because of adverse effects and antimicrobial stewardship.
• C: Reserved for pyelonephritis or severe infections.
• D: Treats bacterial vaginosis and certain protozoal infections.
Clinical Pearl: Fever and costovertebral angle tenderness suggest pyelonephritis rather than
cystitis.
Question 3
A patient with asthma uses an albuterol inhaler four times each week and awakens with
symptoms twice monthly.
The patient's asthma severity is best classified as:
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
,Correct Answer: B. Mild persistent
Rationale
Criteria for mild persistent asthma include:
• Symptoms >2 days/week but not daily
• Nighttime awakenings 3–4 times/month
• Minor limitation in activity
This patient's symptoms fit mild persistent asthma.
Clinical Pearl: Mild persistent asthma generally requires initiation of controller therapy,
typically an inhaled corticosteroid.
Question 4
Which medication is contraindicated during pregnancy?
A. Labetalol
B. Methyldopa
C. Enalapril
D. Nifedipine
Correct Answer: C. Enalapril
Rationale
ACE inhibitors can cause fetal renal injury, oligohydramnios, skull abnormalities, and fetal
death, particularly in the second and third trimesters.
Acceptable antihypertensives during pregnancy include:
• Labetalol
• Nifedipine
• Methyldopa
Question 5
, A 60-year-old smoker presents with painless hematuria.
The priority diagnosis to exclude is:
A. Nephrolithiasis
B. Bladder cancer
C. Benign prostatic hyperplasia
D. Glomerulonephritis
Correct Answer: B. Bladder cancer
Rationale
Painless gross hematuria in an older smoker should be considered bladder cancer until proven
otherwise.
Clinical Pearl: Smoking is the strongest modifiable risk factor for urothelial carcinoma.
Question 6
Which laboratory test is most sensitive for diagnosing iron deficiency anemia?
A. Hemoglobin
B. Ferritin
C. Total iron-binding capacity
D. Reticulocyte count
Correct Answer: B. Ferritin
Rationale
Serum ferritin reflects iron stores and is typically the earliest laboratory value to decrease in iron
deficiency.
• Low ferritin strongly supports iron deficiency (unless elevated by inflammation).
Questions and Answers with Rationales Latest
Version Top Rated
Question 1
A 68-year-old man with hypertension and type 2 diabetes presents for routine follow-up. His
blood pressure averages 148/92 mm Hg despite taking lisinopril 40 mg daily. His eGFR is 72
mL/min/1.73 m², and his potassium is 4.3 mEq/L.
What is the most appropriate next step?
A. Increase lisinopril to 80 mg daily
B. Add hydrochlorothiazide
C. Discontinue lisinopril and begin propranolol
D. Continue current therapy and recheck in 6 months
Correct Answer: B. Add hydrochlorothiazide
Rationale
According to current hypertension guidelines, patients whose blood pressure remains above goal
despite maximally tolerated ACE inhibitor therapy generally require combination treatment. A
thiazide diuretic is an appropriate second-line medication in patients with preserved renal
function.
• A: Incorrect. Forty milligrams is generally the maximum recommended daily dose of
lisinopril.
• B: Correct. Adding a thiazide diuretic provides additive blood pressure reduction.
• C: Incorrect. Beta-blockers are not first-line therapy for uncomplicated hypertension.
• D: Incorrect. The patient's blood pressure remains uncontrolled.
Clinical Pearl: Most patients require two or more antihypertensive medications to reach target
blood pressure.
Question 2
,A 26-year-old woman reports dysuria, urinary frequency, and urgency for 2 days. She has no
fever, flank pain, or vaginal discharge.
The best initial treatment is:
A. Nitrofurantoin
B. Ciprofloxacin
C. IV ceftriaxone
D. Metronidazole
Correct Answer: A. Nitrofurantoin
Rationale
This patient has uncomplicated acute cystitis.
• A: Correct. Nitrofurantoin is recommended as first-line treatment for uncomplicated
cystitis when renal function is adequate.
• B: Fluoroquinolones should generally be reserved for more complicated infections
because of adverse effects and antimicrobial stewardship.
• C: Reserved for pyelonephritis or severe infections.
• D: Treats bacterial vaginosis and certain protozoal infections.
Clinical Pearl: Fever and costovertebral angle tenderness suggest pyelonephritis rather than
cystitis.
Question 3
A patient with asthma uses an albuterol inhaler four times each week and awakens with
symptoms twice monthly.
The patient's asthma severity is best classified as:
A. Intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
,Correct Answer: B. Mild persistent
Rationale
Criteria for mild persistent asthma include:
• Symptoms >2 days/week but not daily
• Nighttime awakenings 3–4 times/month
• Minor limitation in activity
This patient's symptoms fit mild persistent asthma.
Clinical Pearl: Mild persistent asthma generally requires initiation of controller therapy,
typically an inhaled corticosteroid.
Question 4
Which medication is contraindicated during pregnancy?
A. Labetalol
B. Methyldopa
C. Enalapril
D. Nifedipine
Correct Answer: C. Enalapril
Rationale
ACE inhibitors can cause fetal renal injury, oligohydramnios, skull abnormalities, and fetal
death, particularly in the second and third trimesters.
Acceptable antihypertensives during pregnancy include:
• Labetalol
• Nifedipine
• Methyldopa
Question 5
, A 60-year-old smoker presents with painless hematuria.
The priority diagnosis to exclude is:
A. Nephrolithiasis
B. Bladder cancer
C. Benign prostatic hyperplasia
D. Glomerulonephritis
Correct Answer: B. Bladder cancer
Rationale
Painless gross hematuria in an older smoker should be considered bladder cancer until proven
otherwise.
Clinical Pearl: Smoking is the strongest modifiable risk factor for urothelial carcinoma.
Question 6
Which laboratory test is most sensitive for diagnosing iron deficiency anemia?
A. Hemoglobin
B. Ferritin
C. Total iron-binding capacity
D. Reticulocyte count
Correct Answer: B. Ferritin
Rationale
Serum ferritin reflects iron stores and is typically the earliest laboratory value to decrease in iron
deficiency.
• Low ferritin strongly supports iron deficiency (unless elevated by inflammation).
