NSG 6998 FNP PRE PREDICTOR EXAM
STUDY GUIDE 2026 SOUTH UNIVERSITY
FAMILY NURSE PRACTITIONER REVIEW
1. A 65-year-old male with a history of hypertension and type 2
diabetes presents for a routine visit. His blood pressure is
148/92 mmHg. He is currently on lisinopril 20 mg daily.
According to JNC 8 and ADA guidelines, what is the most
appropriate next step in management?
A. Add hydrochlorothiazide 25 mg daily B. Increase lisinopril to
40 mg daily C. Add amlodipine 5 mg daily D. Switch to losartan
50 mg daily
Correct Answer: C. Add amlodipine 5 mg daily
Rationale: For patients with diabetes and hypertension who
are not at goal on an ACE inhibitor, adding a calcium channel
blocker (CCB) or a thiazide diuretic is recommended.
However, in patients with diabetes, CCBs are often preferred
over thiazides if there are concerns about metabolic effects,
though both are acceptable. Adding a second agent from a
different class is generally more effective than maximizing the
dose of a single agent. Given his BP is significantly above goal
(<140/90 or <130/80 depending on specific guideline
interpretation for high risk), combination therapy is indicated.
2. A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Physical exam reveals dry skin and delayed
deep tendon reflexes. TSH is 12 mIU/L (high) and Free T4 is
0.8 ng/dL (low). Which of the following is the most likely
etiology?
A. Subacute thyroiditis B. Hashimoto’s thyroiditis C. Pituitary
adenoma D. Graves’ disease
,Correct Answer: B. Hashimoto’s thyroiditis
Rationale: The patient has primary hypothyroidism (high
TSH, low T4). Hashimoto’s thyroiditis is the most common
cause of hypothyroidism in iodine-sufficient areas. Anti-TPO
antibodies would confirm the diagnosis. Subacute thyroiditis
is usually painful and transient. Pituitary adenoma would
cause secondary hypothyroidism (low TSH, low T4). Graves’
causes hyperthyroidism.
3. A 70-year-old male presents with gradual memory loss,
getting lost in familiar places, and difficulty managing finances.
He has no motor deficits. MRI shows hippocampal atrophy.
Which of the following medications is FDA-approved for
moderate-to-severe stages of this condition?
A. Donepezil B. Rivastigmine C. Memantine D. Galantamine
Correct Answer: C. Memantine Rationale: Memantine
is an NMDA receptor antagonist approved for moderate-to-
severe Alzheimer’s disease. Cholinesterase inhibitors
(Donepezil, Rivastigmine, Galantamine) are typically used for
mild-to-moderate stages, though Donepezil is sometimes
continued into severe stages. Memantine helps regulate
glutamate activity.
4. A 25-year-old female presents with dysuria and frequency.
She denies fever or flank pain. Urinalysis shows positive nitrites
and leukocyte esterase. She is not pregnant. Which of the
following is the first-line treatment per IDSA guidelines?
A. Ciprofloxacin 500 mg BID x 3 days B. Nitrofurantoin 100 mg
BID x 5 days C. Amoxicillin 500 mg TID x 7 days D. Fosfomycin
3g x 1 dose
,Correct Answer: B. Nitrofurantoin 100 mg BID x 5
days Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis. Fluoroquinolones (Cipro) are reserved
for complicated cases or pyelonephritis due to resistance and
side effect profiles. Amoxicillin has high resistance rates.
Fosfomycin is an alternative but Nitrofurantoin is generally
preferred first-line.
5. A 55-year-old male smoker presents with chronic cough and
sputum production for 3 years. Spirometry shows FEV1/FVC
ratio of 0.65 post-bronchodilator. Which of the following is the
most important intervention to slow disease progression?
A. Start albuterol PRN B. Start tiotropium daily C. Smoking
cessation D. Annual influenza vaccine
Correct Answer: C. Smoking cessation Rationale:
Smoking cessation is the only intervention proven to slow the
decline in lung function in COPD. Bronchodilators and
vaccines improve symptoms and reduce exacerbations but do
not alter the natural history of lung function decline as
effectively as quitting smoking.
6. A 30-year-old female presents with irregular periods,
hirsutism, and acne. Pelvic ultrasound shows polycystic ovaries.
Testosterone is mildly elevated. Which of the following is the
first-line pharmacologic treatment for her menstrual
irregularity and hirsutism if she is not seeking pregnancy?
A. Metformin B. Spironolactone C. Combined oral
contraceptives (COCPs) D. Clomiphene
Correct Answer: C. Combined oral contraceptives
(COCPs) Rationale: COCPs are first-line for managing
menstrual irregularity and hyperandrogenism
, (hirsutism/acne) in PCOS. They increase SHBG, lowering free
testosterone. Spironolactone is added if COCPs are insufficient.
Metformin helps insulin resistance but is less effective for
hirsutism. Clomiphene is for ovulation induction.
7. A 60-year-old male presents with sudden onset of severe
pain in the first metatarsophalangeal joint. The joint is red,
swollen, and warm. He reports drinking beer and eating steak
the previous night. Which of the following is the best initial
treatment for the acute attack?
A. Allopurinol B. Indomethacin C. Febuxostat D. Probenecid
Correct Answer: B. Indomethacin Rationale: NSAIDs
like indomethacin are first-line for acute gout flares.
Allopurinol and febuxostat are urate-lowering therapies for
chronic management and should not be started during an
acute flare as they can worsen symptoms. Probenecid is also
for chronic management.
8. A 40-year-old female presents with a butterfly rash,
photosensitivity, and joint pain. ANA is positive. Anti-dsDNA is
positive. Complement levels are low. Which of the following
organ systems requires immediate monitoring?
A. Liver B. Kidneys C. Lungs D. GI Tract
Correct Answer: B. Kidneys Rationale: Positive anti-
dsDNA and low complement levels in SLE are strongly
associated with Lupus Nephritis. Renal involvement is a major
cause of morbidity. Urinalysis and renal function tests should
be monitored closely.
STUDY GUIDE 2026 SOUTH UNIVERSITY
FAMILY NURSE PRACTITIONER REVIEW
1. A 65-year-old male with a history of hypertension and type 2
diabetes presents for a routine visit. His blood pressure is
148/92 mmHg. He is currently on lisinopril 20 mg daily.
According to JNC 8 and ADA guidelines, what is the most
appropriate next step in management?
A. Add hydrochlorothiazide 25 mg daily B. Increase lisinopril to
40 mg daily C. Add amlodipine 5 mg daily D. Switch to losartan
50 mg daily
Correct Answer: C. Add amlodipine 5 mg daily
Rationale: For patients with diabetes and hypertension who
are not at goal on an ACE inhibitor, adding a calcium channel
blocker (CCB) or a thiazide diuretic is recommended.
However, in patients with diabetes, CCBs are often preferred
over thiazides if there are concerns about metabolic effects,
though both are acceptable. Adding a second agent from a
different class is generally more effective than maximizing the
dose of a single agent. Given his BP is significantly above goal
(<140/90 or <130/80 depending on specific guideline
interpretation for high risk), combination therapy is indicated.
2. A 45-year-old female presents with fatigue, weight gain, and
cold intolerance. Physical exam reveals dry skin and delayed
deep tendon reflexes. TSH is 12 mIU/L (high) and Free T4 is
0.8 ng/dL (low). Which of the following is the most likely
etiology?
A. Subacute thyroiditis B. Hashimoto’s thyroiditis C. Pituitary
adenoma D. Graves’ disease
,Correct Answer: B. Hashimoto’s thyroiditis
Rationale: The patient has primary hypothyroidism (high
TSH, low T4). Hashimoto’s thyroiditis is the most common
cause of hypothyroidism in iodine-sufficient areas. Anti-TPO
antibodies would confirm the diagnosis. Subacute thyroiditis
is usually painful and transient. Pituitary adenoma would
cause secondary hypothyroidism (low TSH, low T4). Graves’
causes hyperthyroidism.
3. A 70-year-old male presents with gradual memory loss,
getting lost in familiar places, and difficulty managing finances.
He has no motor deficits. MRI shows hippocampal atrophy.
Which of the following medications is FDA-approved for
moderate-to-severe stages of this condition?
A. Donepezil B. Rivastigmine C. Memantine D. Galantamine
Correct Answer: C. Memantine Rationale: Memantine
is an NMDA receptor antagonist approved for moderate-to-
severe Alzheimer’s disease. Cholinesterase inhibitors
(Donepezil, Rivastigmine, Galantamine) are typically used for
mild-to-moderate stages, though Donepezil is sometimes
continued into severe stages. Memantine helps regulate
glutamate activity.
4. A 25-year-old female presents with dysuria and frequency.
She denies fever or flank pain. Urinalysis shows positive nitrites
and leukocyte esterase. She is not pregnant. Which of the
following is the first-line treatment per IDSA guidelines?
A. Ciprofloxacin 500 mg BID x 3 days B. Nitrofurantoin 100 mg
BID x 5 days C. Amoxicillin 500 mg TID x 7 days D. Fosfomycin
3g x 1 dose
,Correct Answer: B. Nitrofurantoin 100 mg BID x 5
days Rationale: Nitrofurantoin is a first-line agent for
uncomplicated cystitis. Fluoroquinolones (Cipro) are reserved
for complicated cases or pyelonephritis due to resistance and
side effect profiles. Amoxicillin has high resistance rates.
Fosfomycin is an alternative but Nitrofurantoin is generally
preferred first-line.
5. A 55-year-old male smoker presents with chronic cough and
sputum production for 3 years. Spirometry shows FEV1/FVC
ratio of 0.65 post-bronchodilator. Which of the following is the
most important intervention to slow disease progression?
A. Start albuterol PRN B. Start tiotropium daily C. Smoking
cessation D. Annual influenza vaccine
Correct Answer: C. Smoking cessation Rationale:
Smoking cessation is the only intervention proven to slow the
decline in lung function in COPD. Bronchodilators and
vaccines improve symptoms and reduce exacerbations but do
not alter the natural history of lung function decline as
effectively as quitting smoking.
6. A 30-year-old female presents with irregular periods,
hirsutism, and acne. Pelvic ultrasound shows polycystic ovaries.
Testosterone is mildly elevated. Which of the following is the
first-line pharmacologic treatment for her menstrual
irregularity and hirsutism if she is not seeking pregnancy?
A. Metformin B. Spironolactone C. Combined oral
contraceptives (COCPs) D. Clomiphene
Correct Answer: C. Combined oral contraceptives
(COCPs) Rationale: COCPs are first-line for managing
menstrual irregularity and hyperandrogenism
, (hirsutism/acne) in PCOS. They increase SHBG, lowering free
testosterone. Spironolactone is added if COCPs are insufficient.
Metformin helps insulin resistance but is less effective for
hirsutism. Clomiphene is for ovulation induction.
7. A 60-year-old male presents with sudden onset of severe
pain in the first metatarsophalangeal joint. The joint is red,
swollen, and warm. He reports drinking beer and eating steak
the previous night. Which of the following is the best initial
treatment for the acute attack?
A. Allopurinol B. Indomethacin C. Febuxostat D. Probenecid
Correct Answer: B. Indomethacin Rationale: NSAIDs
like indomethacin are first-line for acute gout flares.
Allopurinol and febuxostat are urate-lowering therapies for
chronic management and should not be started during an
acute flare as they can worsen symptoms. Probenecid is also
for chronic management.
8. A 40-year-old female presents with a butterfly rash,
photosensitivity, and joint pain. ANA is positive. Anti-dsDNA is
positive. Complement levels are low. Which of the following
organ systems requires immediate monitoring?
A. Liver B. Kidneys C. Lungs D. GI Tract
Correct Answer: B. Kidneys Rationale: Positive anti-
dsDNA and low complement levels in SLE are strongly
associated with Lupus Nephritis. Renal involvement is a major
cause of morbidity. Urinalysis and renal function tests should
be monitored closely.
