LEIK FNP Exam Prep 2026, 300+ FNP Practice Questions,
Detailed Rationales (Digital Download)
1. A 68-year-old male presents for a routine physical. He has a 40-pack-year smoking history but quit
10 years ago. According to USPSTF guidelines, what is the most appropriate lung cancer screening
recommendation?
A) No screening is indicated because he quit smoking.
B) Annual low-dose CT chest.
C) Annual chest X-ray.
D) Sputum cytology every 2 years.
Answer: B
Rationale: The USPSTF recommends annual low-dose CT screening for adults aged 50–80 with a 20-pack-
year history who currently smoke or quit within 15 years.
2. A 72-year-old woman on hydrochlorothiazide 12.5 mg for Stage II hypertension presents with BP
168/96. She has increased ibuprofen to 800 mg TID for hip and knee pain. Which statement best
explains the effect of ibuprofen on her disease?
A) It increases the chances of adverse effects to her health.
B) It inhibits renal prostaglandins and blunts the effectiveness of the diuretic.
C) It prolongs the therapeutic effects of hydrochlorothiazide.
D) None of the statements are true.
Answer: B
Rationale: NSAIDs inhibit vasodilatory renal prostaglandins, predisposing the kidney to ischemia. NSAIDs
and diuretics can cause acute prerenal failure by decreasing renal blood flow, blunting diuretic effectiveness
and worsening hypertension.
3. A patient with hypertension and osteoarthritis is on lisinopril 20 mg daily and reports a persistent
dry, non-productive cough for 3 months. What is the most appropriate next step?
A) Reassure the patient that the cough will resolve.
B) Add a cough suppressant.
C) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB).
,D) Order a chest X-ray.
Answer: C
Rationale: A persistent dry cough is a common ACE inhibitor side effect due to bradykinin accumulation.
Switching to an ARB (which does not affect bradykinin) is appropriate.
4. An elderly male of Mediterranean descent has a routine CBC: hemoglobin 13.0 g/dL, hematocrit
39%, MCV 72 fL. Which laboratory tests are indicated?
A) Serum iron, serum ferritin, TIBC, and RDW.
B) Serum B12 and folate with peripheral smear.
C) CBC with white cell differential and urinalysis.
D) Urine culture and sensitivity.
Answer: A
Rationale: Microcytosis (MCV < 80 fL) suggests iron-deficiency anemia or thalassemia. Iron studies (serum
iron, ferritin, TIBC) and RDW help differentiate.
5. A left supraclavicular lymph node is palpated in an adult. This finding is most concerning for:
A) Local infection.
B) Lymphoma.
C) Thoracic or abdominal malignancy (Virchow’s node).
D) Autoimmune disease.
Answer: C
Rationale: A left supraclavicular node (Virchow’s node) receives lymphatic drainage from the thorax and
abdomen and is a classic sign of malignancy.
6. A 55-year-old asymptomatic patient with no risk factors presents for a routine physical. According
to USPSTF, which colorectal cancer screening test is recommended?
A) Fecal occult blood testing annually starting at age 45.
B) Colonoscopy every 10 years starting at age 45.
C) Flexible sigmoidoscopy every 5 years starting at age 50.
D) CT colonography every 5 years starting at age 50.
Answer: B
Rationale: The USPSTF recommends colorectal cancer screening for adults aged 45–75. Colonoscopy every
10 years or annual FIT are acceptable options; screening begins at age 45 for average-risk individuals.
2
,7. A 65-year-old woman with no history of osteoporosis presents for preventive care. What is the
most appropriate screening recommendation?
A) DEXA scan every year.
B) DEXA scan at age 65 and then every 2 years.
C) DEXA scan only if she has had a fracture.
D) No screening is recommended.
Answer: B
Rationale: The USPSTF recommends DEXA screening for all women aged 65 and older, and in younger
women with risk factors. Every 2 years is generally recommended for those with normal bone density.
8. A 30-year-old woman at 8 weeks gestation presents for her first prenatal visit. Which
immunization should be administered during pregnancy?
A) MMR vaccine.
B) Varicella vaccine.
C) Tdap vaccine (between 27–36 weeks).
D) HPV vaccine.
Answer: C
Rationale: Tdap is recommended during each pregnancy, preferably between 27 and 36 weeks, to provide
passive immunity to the newborn. MMR and varicella are live vaccines and are contraindicated.
9. A 50-year-old man with a 30-pack-year smoking history presents for preventive care. Which
screening test should be recommended according to USPSTF?
A) Annual chest X-ray.
B) Annual low-dose CT chest.
C) Sputum cytology every 2 years.
D) No screening is indicated.
Answer: B
Rationale: Annual low-dose CT is recommended for adults aged 50–80 with a 20-pack-year history who
currently smoke or quit within 15 years.
3
, 10. A 34-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows positive
leukocyte esterase and nitrites. What is the most appropriate management?
A) Observation.
B) Empiric antibiotics.
C) Cystoscopy.
D) Referral to urology.
Answer: B
Rationale: Uncomplicated urinary tract infections in healthy women are treated empirically with antibiotics.
11. A 55-year-old man presents with crushing chest pain radiating to the left arm and jaw. EKG shows
ST-elevation in leads II, III, and aVF. What is the most likely diagnosis?
A) Anterior STEMI.
B) Inferior STEMI.
C) NSTEMI.
D) Pericarditis.
Answer: B
Rationale: ST-elevation in II, III, and aVF corresponds to the inferior myocardial wall.
12. A 22-year-old presents with fever, sore throat, and generalized lymphadenopathy. Monospot test
is positive. Which advice is most appropriate?
A) Start antibiotics immediately.
B) Recommend rest, fluids, and supportive care.
C) Prescribe antivirals.
D) Schedule tonsillectomy.
Answer: B
Rationale: Infectious mononucleosis is viral; supportive care is first-line.
13. A 68-year-old female presents with sudden-onset confusion and right-sided weakness. CT scan
shows ischemic stroke. Which therapy should be considered within the first 3 hours of symptom
onset?
A) Aspirin.
B) Intravenous thrombolysis.
C) Heparin.
4
Detailed Rationales (Digital Download)
1. A 68-year-old male presents for a routine physical. He has a 40-pack-year smoking history but quit
10 years ago. According to USPSTF guidelines, what is the most appropriate lung cancer screening
recommendation?
A) No screening is indicated because he quit smoking.
B) Annual low-dose CT chest.
C) Annual chest X-ray.
D) Sputum cytology every 2 years.
Answer: B
Rationale: The USPSTF recommends annual low-dose CT screening for adults aged 50–80 with a 20-pack-
year history who currently smoke or quit within 15 years.
2. A 72-year-old woman on hydrochlorothiazide 12.5 mg for Stage II hypertension presents with BP
168/96. She has increased ibuprofen to 800 mg TID for hip and knee pain. Which statement best
explains the effect of ibuprofen on her disease?
A) It increases the chances of adverse effects to her health.
B) It inhibits renal prostaglandins and blunts the effectiveness of the diuretic.
C) It prolongs the therapeutic effects of hydrochlorothiazide.
D) None of the statements are true.
Answer: B
Rationale: NSAIDs inhibit vasodilatory renal prostaglandins, predisposing the kidney to ischemia. NSAIDs
and diuretics can cause acute prerenal failure by decreasing renal blood flow, blunting diuretic effectiveness
and worsening hypertension.
3. A patient with hypertension and osteoarthritis is on lisinopril 20 mg daily and reports a persistent
dry, non-productive cough for 3 months. What is the most appropriate next step?
A) Reassure the patient that the cough will resolve.
B) Add a cough suppressant.
C) Discontinue lisinopril and switch to an angiotensin receptor blocker (ARB).
,D) Order a chest X-ray.
Answer: C
Rationale: A persistent dry cough is a common ACE inhibitor side effect due to bradykinin accumulation.
Switching to an ARB (which does not affect bradykinin) is appropriate.
4. An elderly male of Mediterranean descent has a routine CBC: hemoglobin 13.0 g/dL, hematocrit
39%, MCV 72 fL. Which laboratory tests are indicated?
A) Serum iron, serum ferritin, TIBC, and RDW.
B) Serum B12 and folate with peripheral smear.
C) CBC with white cell differential and urinalysis.
D) Urine culture and sensitivity.
Answer: A
Rationale: Microcytosis (MCV < 80 fL) suggests iron-deficiency anemia or thalassemia. Iron studies (serum
iron, ferritin, TIBC) and RDW help differentiate.
5. A left supraclavicular lymph node is palpated in an adult. This finding is most concerning for:
A) Local infection.
B) Lymphoma.
C) Thoracic or abdominal malignancy (Virchow’s node).
D) Autoimmune disease.
Answer: C
Rationale: A left supraclavicular node (Virchow’s node) receives lymphatic drainage from the thorax and
abdomen and is a classic sign of malignancy.
6. A 55-year-old asymptomatic patient with no risk factors presents for a routine physical. According
to USPSTF, which colorectal cancer screening test is recommended?
A) Fecal occult blood testing annually starting at age 45.
B) Colonoscopy every 10 years starting at age 45.
C) Flexible sigmoidoscopy every 5 years starting at age 50.
D) CT colonography every 5 years starting at age 50.
Answer: B
Rationale: The USPSTF recommends colorectal cancer screening for adults aged 45–75. Colonoscopy every
10 years or annual FIT are acceptable options; screening begins at age 45 for average-risk individuals.
2
,7. A 65-year-old woman with no history of osteoporosis presents for preventive care. What is the
most appropriate screening recommendation?
A) DEXA scan every year.
B) DEXA scan at age 65 and then every 2 years.
C) DEXA scan only if she has had a fracture.
D) No screening is recommended.
Answer: B
Rationale: The USPSTF recommends DEXA screening for all women aged 65 and older, and in younger
women with risk factors. Every 2 years is generally recommended for those with normal bone density.
8. A 30-year-old woman at 8 weeks gestation presents for her first prenatal visit. Which
immunization should be administered during pregnancy?
A) MMR vaccine.
B) Varicella vaccine.
C) Tdap vaccine (between 27–36 weeks).
D) HPV vaccine.
Answer: C
Rationale: Tdap is recommended during each pregnancy, preferably between 27 and 36 weeks, to provide
passive immunity to the newborn. MMR and varicella are live vaccines and are contraindicated.
9. A 50-year-old man with a 30-pack-year smoking history presents for preventive care. Which
screening test should be recommended according to USPSTF?
A) Annual chest X-ray.
B) Annual low-dose CT chest.
C) Sputum cytology every 2 years.
D) No screening is indicated.
Answer: B
Rationale: Annual low-dose CT is recommended for adults aged 50–80 with a 20-pack-year history who
currently smoke or quit within 15 years.
3
, 10. A 34-year-old woman presents with dysuria, frequency, and urgency. Urinalysis shows positive
leukocyte esterase and nitrites. What is the most appropriate management?
A) Observation.
B) Empiric antibiotics.
C) Cystoscopy.
D) Referral to urology.
Answer: B
Rationale: Uncomplicated urinary tract infections in healthy women are treated empirically with antibiotics.
11. A 55-year-old man presents with crushing chest pain radiating to the left arm and jaw. EKG shows
ST-elevation in leads II, III, and aVF. What is the most likely diagnosis?
A) Anterior STEMI.
B) Inferior STEMI.
C) NSTEMI.
D) Pericarditis.
Answer: B
Rationale: ST-elevation in II, III, and aVF corresponds to the inferior myocardial wall.
12. A 22-year-old presents with fever, sore throat, and generalized lymphadenopathy. Monospot test
is positive. Which advice is most appropriate?
A) Start antibiotics immediately.
B) Recommend rest, fluids, and supportive care.
C) Prescribe antivirals.
D) Schedule tonsillectomy.
Answer: B
Rationale: Infectious mononucleosis is viral; supportive care is first-line.
13. A 68-year-old female presents with sudden-onset confusion and right-sided weakness. CT scan
shows ischemic stroke. Which therapy should be considered within the first 3 hours of symptom
onset?
A) Aspirin.
B) Intravenous thrombolysis.
C) Heparin.
4
