LEIK FNP / Family Nurse Practitioner Exam 2026/2027 |
Practice Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A 58-year-old man presents for follow-up of hypertension. His blood pressure is 168/96
mmHg despite adherence to lisinopril 40 mg daily. His serum potassium and creatinine are
normal. Which intervention is most appropriate?
A. Discontinue lisinopril and begin clonidine
B. Add a thiazide-type diuretic
C. Reduce lisinopril to 20 mg daily
D. Begin aspirin therapy
Answer: B
Adding a thiazide-type diuretic is appropriate when blood pressure remains above goal
despite an adequate ACE inhibitor dose. Combination therapy using complementary
mechanisms improves blood-pressure control.
2. A 46-year-old woman has newly diagnosed type 2 diabetes mellitus. Her A1C is 7.4%,
BMI is 31 kg/m², and she has no contraindications to metformin. Which medication is
generally appropriate as initial pharmacologic therapy along with lifestyle modification?
A. Metformin
B. Insulin glargine
C. Glyburide
D. Pioglitazone
Answer: A
Metformin is a commonly appropriate initial medication for type 2 diabetes when there is no
contraindication. It improves insulin sensitivity and has a relatively low risk of hypoglycemia
when used alone.
3. A 72-year-old patient taking warfarin for atrial fibrillation presents with an INR of 6.8
but has no active bleeding. Which factor is most important when determining immediate
management?
A. His resting heart rate
B. His LDL cholesterol level
C. His bleeding risk and degree of INR elevation
D. His most recent hemoglobin A1C
,Answer: C
Management of a markedly elevated INR without bleeding depends on the degree of
elevation and the patient's bleeding risk. Medication interactions, recent illness, and other
risk factors should also be reviewed.
4. A 24-year-old woman reports dysuria and urinary frequency for two days. She is afebrile
and denies flank pain, vaginal discharge, or pelvic pain. Urinalysis is positive for leukocyte
esterase and nitrites. What is the most likely diagnosis?
A. Pyelonephritis
B. Bacterial vaginosis
C. Nephrolithiasis
D. Acute uncomplicated cystitis
Answer: D
Dysuria, frequency, positive leukocyte esterase and nitrites, and absence of systemic or upper-
tract symptoms are characteristic of acute uncomplicated cystitis.
5. A 35-year-old woman presents with fatigue, constipation, weight gain, dry skin, and cold
intolerance. TSH is elevated and free T4 is low. What is the most likely diagnosis?
A. Primary hypothyroidism
B. Secondary adrenal insufficiency
C. Hyperthyroidism
D. Central diabetes insipidus
Answer: A
An elevated TSH with a low free T4 indicates primary hypothyroidism, most commonly caused
by autoimmune thyroid disease in adults.
6. A 67-year-old man develops sudden painless monocular vision loss. Examination
suggests retinal arterial occlusion. What is the most appropriate action?
A. Schedule routine ophthalmology follow-up
B. Treat with artificial tears
C. Arrange urgent evaluation for a vascular emergency
D. Reassure the patient that spontaneous recovery is expected
Answer: C
,Sudden painless monocular vision loss from suspected retinal artery occlusion represents an
ocular and systemic vascular emergency requiring urgent evaluation for ischemic disease and
possible stroke risk.
7. A patient with asthma uses a short-acting bronchodilator several times each week and
wakes at night with wheezing. What does this pattern indicate?
A. Adequately controlled asthma
B. Poorly controlled asthma requiring treatment reassessment
C. Medication-induced emphysema
D. Normal asthma progression
Answer: B
Frequent rescue-inhaler use and nighttime symptoms indicate inadequate asthma control and
should prompt assessment of adherence, inhaler technique, triggers, and controller therapy.
8. A 61-year-old woman reports unilateral calf swelling, warmth, and tenderness that
began yesterday after a long flight. What diagnosis should be considered first?
A. Deep vein thrombosis
B. Cellulitis of both legs
C. Osteoarthritis
D. Chronic venous insufficiency
Answer: A
Acute unilateral calf swelling and tenderness after prolonged immobility are classic
concerning features for deep vein thrombosis and warrant prompt evaluation.
9. A 70-year-old patient with COPD presents with increased dyspnea, increased sputum
volume, and new purulent sputum. Which finding most strongly supports an acute COPD
exacerbation?
A. Stable exercise tolerance
B. Chronic nonproductive cough without change
C. New increase in respiratory symptoms from baseline
D. Long-standing clubbing without respiratory changes
Answer: C
An acute increase in respiratory symptoms, particularly dyspnea and sputum production or
purulence, supports a COPD exacerbation.
, 10. A 42-year-old woman presents with episodic palpitations, tremor, heat intolerance, and
unintentional weight loss. Which laboratory pattern is most consistent with primary
hyperthyroidism?
A. High TSH and low free T4
B. Low TSH and high free T4
C. High TSH and normal free T4
D. Normal TSH and low free T4
Answer: B
Primary hyperthyroidism typically produces suppression of TSH by excess circulating thyroid
hormone, resulting in low TSH and elevated free T4 and/or T3.
11. A 29-year-old patient presents with unilateral ear pain and fever. Otoscopy reveals a
bulging, erythematous tympanic membrane with decreased mobility. Which diagnosis is
most likely?
A. Otitis externa
B. Serous otitis media
C. Acute otitis media
D. Cerumen impaction
Answer: C
A bulging tympanic membrane with acute symptoms and impaired mobility is characteristic
of acute otitis media.
12. A 55-year-old woman has chronic gastroesophageal reflux symptoms despite lifestyle
modification. She has no dysphagia, bleeding, weight loss, or anemia. Which initial
medication is most appropriate for frequent symptoms?
A. Proton pump inhibitor
B. Oral corticosteroid
C. Antibiotic therapy
D. Opioid analgesic
Answer: A
A proton pump inhibitor is effective for frequent GERD symptoms because it suppresses
gastric acid secretion and promotes healing of acid-related mucosal injury.
Practice Questions And Answers (Verified Answers) |
Exam Prep | Comprehensive Exam Guide 2026&2027
1. A 58-year-old man presents for follow-up of hypertension. His blood pressure is 168/96
mmHg despite adherence to lisinopril 40 mg daily. His serum potassium and creatinine are
normal. Which intervention is most appropriate?
A. Discontinue lisinopril and begin clonidine
B. Add a thiazide-type diuretic
C. Reduce lisinopril to 20 mg daily
D. Begin aspirin therapy
Answer: B
Adding a thiazide-type diuretic is appropriate when blood pressure remains above goal
despite an adequate ACE inhibitor dose. Combination therapy using complementary
mechanisms improves blood-pressure control.
2. A 46-year-old woman has newly diagnosed type 2 diabetes mellitus. Her A1C is 7.4%,
BMI is 31 kg/m², and she has no contraindications to metformin. Which medication is
generally appropriate as initial pharmacologic therapy along with lifestyle modification?
A. Metformin
B. Insulin glargine
C. Glyburide
D. Pioglitazone
Answer: A
Metformin is a commonly appropriate initial medication for type 2 diabetes when there is no
contraindication. It improves insulin sensitivity and has a relatively low risk of hypoglycemia
when used alone.
3. A 72-year-old patient taking warfarin for atrial fibrillation presents with an INR of 6.8
but has no active bleeding. Which factor is most important when determining immediate
management?
A. His resting heart rate
B. His LDL cholesterol level
C. His bleeding risk and degree of INR elevation
D. His most recent hemoglobin A1C
,Answer: C
Management of a markedly elevated INR without bleeding depends on the degree of
elevation and the patient's bleeding risk. Medication interactions, recent illness, and other
risk factors should also be reviewed.
4. A 24-year-old woman reports dysuria and urinary frequency for two days. She is afebrile
and denies flank pain, vaginal discharge, or pelvic pain. Urinalysis is positive for leukocyte
esterase and nitrites. What is the most likely diagnosis?
A. Pyelonephritis
B. Bacterial vaginosis
C. Nephrolithiasis
D. Acute uncomplicated cystitis
Answer: D
Dysuria, frequency, positive leukocyte esterase and nitrites, and absence of systemic or upper-
tract symptoms are characteristic of acute uncomplicated cystitis.
5. A 35-year-old woman presents with fatigue, constipation, weight gain, dry skin, and cold
intolerance. TSH is elevated and free T4 is low. What is the most likely diagnosis?
A. Primary hypothyroidism
B. Secondary adrenal insufficiency
C. Hyperthyroidism
D. Central diabetes insipidus
Answer: A
An elevated TSH with a low free T4 indicates primary hypothyroidism, most commonly caused
by autoimmune thyroid disease in adults.
6. A 67-year-old man develops sudden painless monocular vision loss. Examination
suggests retinal arterial occlusion. What is the most appropriate action?
A. Schedule routine ophthalmology follow-up
B. Treat with artificial tears
C. Arrange urgent evaluation for a vascular emergency
D. Reassure the patient that spontaneous recovery is expected
Answer: C
,Sudden painless monocular vision loss from suspected retinal artery occlusion represents an
ocular and systemic vascular emergency requiring urgent evaluation for ischemic disease and
possible stroke risk.
7. A patient with asthma uses a short-acting bronchodilator several times each week and
wakes at night with wheezing. What does this pattern indicate?
A. Adequately controlled asthma
B. Poorly controlled asthma requiring treatment reassessment
C. Medication-induced emphysema
D. Normal asthma progression
Answer: B
Frequent rescue-inhaler use and nighttime symptoms indicate inadequate asthma control and
should prompt assessment of adherence, inhaler technique, triggers, and controller therapy.
8. A 61-year-old woman reports unilateral calf swelling, warmth, and tenderness that
began yesterday after a long flight. What diagnosis should be considered first?
A. Deep vein thrombosis
B. Cellulitis of both legs
C. Osteoarthritis
D. Chronic venous insufficiency
Answer: A
Acute unilateral calf swelling and tenderness after prolonged immobility are classic
concerning features for deep vein thrombosis and warrant prompt evaluation.
9. A 70-year-old patient with COPD presents with increased dyspnea, increased sputum
volume, and new purulent sputum. Which finding most strongly supports an acute COPD
exacerbation?
A. Stable exercise tolerance
B. Chronic nonproductive cough without change
C. New increase in respiratory symptoms from baseline
D. Long-standing clubbing without respiratory changes
Answer: C
An acute increase in respiratory symptoms, particularly dyspnea and sputum production or
purulence, supports a COPD exacerbation.
, 10. A 42-year-old woman presents with episodic palpitations, tremor, heat intolerance, and
unintentional weight loss. Which laboratory pattern is most consistent with primary
hyperthyroidism?
A. High TSH and low free T4
B. Low TSH and high free T4
C. High TSH and normal free T4
D. Normal TSH and low free T4
Answer: B
Primary hyperthyroidism typically produces suppression of TSH by excess circulating thyroid
hormone, resulting in low TSH and elevated free T4 and/or T3.
11. A 29-year-old patient presents with unilateral ear pain and fever. Otoscopy reveals a
bulging, erythematous tympanic membrane with decreased mobility. Which diagnosis is
most likely?
A. Otitis externa
B. Serous otitis media
C. Acute otitis media
D. Cerumen impaction
Answer: C
A bulging tympanic membrane with acute symptoms and impaired mobility is characteristic
of acute otitis media.
12. A 55-year-old woman has chronic gastroesophageal reflux symptoms despite lifestyle
modification. She has no dysphagia, bleeding, weight loss, or anemia. Which initial
medication is most appropriate for frequent symptoms?
A. Proton pump inhibitor
B. Oral corticosteroid
C. Antibiotic therapy
D. Opioid analgesic
Answer: A
A proton pump inhibitor is effective for frequent GERD symptoms because it suppresses
gastric acid secretion and promotes healing of acid-related mucosal injury.
