FITZ / Fitzgerald-Style NP Exit Exam
Primary Care Board-Prep Practice
Bank Original Questions with Detailed
Rationales
1. 28-year-old woman 32 weeks pregnant BP 154/98,
protein 2+, headache, brisk DTRs, platelets 95k, AST
90. Diagnosis and immediate APRN action?
A. Chronic HTN, bed rest
B. Preeclampsia with severe features plus
thrombocytopenia and elevated LFTs suggests HELLP,
admit, CBC, LFTs, creatinine, protein/Cr ratio,
magnesium sulfate seizure prophylaxis,
betamethasone for fetal lung maturity, delivery
planning
C. No labs needed
D. Ibuprofen
Answer: B
Rationale: Severe features BP ≥160/110 or <160 with
labs low platelets <100k, AST/ALT >2x normal,
creatinine >1.1 or doubling, pulmonary edema,
headache. HELLP hemolysis elevated liver low
, platelets. Magnesium prevents eclampsia. Delivery
definitive.
2. 65-year-old on warfarin INR 2.8, starts TMP-SMX for
UTI. What happens?
A. INR decreases
B. INR increases bleeding risk, TMP-SMX inhibits
CYP2C9 warfarin metabolism and displaces protein
binding, check INR in 2-3 days, consider dose
reduction, counsel bleeding signs
C. No interaction
D. Safe combination
Answer: B
3. 2-year-old with bulging erythematous TM, fever 39C,
ear tugging. No drug allergy, no conjunctivitis, no
amoxicillin in past 30 days. First-line per AAP 2026?
A. Azithromycin
B. Amoxicillin high-dose 80-90 mg/kg/day divided
BID x 10 days if <2 years or severe, watchful waiting
only if mild and >2 years
C. Ceftriaxone IV always
D. No antibiotic
Answer: B
, Rationale: High-dose amoxicillin covers resistant S.
pneumoniae. If otitis-conjunctivitis syndrome use
amoxicillin-clavulanate.
4. 55-year-old diabetic ASCVD risk 20% on atorvastatin
20 mg, LDL 148 after 3 months adherence, diet
controlled. Next step per ACC 2026?
A. Continue 20 mg
B. Intensify to high-intensity atorvastatin 40-80 mg
or rosuvastatin 20-40 mg goal LDL reduction ≥50%,
check adherence, LFTs if symptoms, CK if myalgia
C. Stop statin
D. Add gemfibrozil
Answer: B
Rationale: High ASCVD risk needs high-intensity
statin. Gemfibrozil + statin increases myopathy.
5. 30-year-old woman dysuria, frequency, suprapubic
pain, afebrile, no vaginal discharge, no CVA
tenderness. UA nitrites+, LE+. Best treatment?
A. Admit pyelonephritis
B. Uncomplicated cystitis nitrofurantoin 100 mg BID
x5 days or TMP-SMX x3 days if local resistance <20%,
or fosfomycin single dose, counsel hydration
, C. Ceftriaxone IM
D. No treatment
Answer: B
Rationale: Avoid fluoroquinolones first-line due to
resistance and adverse effects.
6. 60-year-old COPD GOLD D frequent exacerbations,
CAT 18. Maintenance per GOLD 2026?
A. SABA only
B. LAMA/LABA dual therapy e.g.,
tiotropium/olodaterol, add ICS if eosinophils ≥300 or
frequent exacerbations, vaccinate influenza,
pneumococcal, RSV, smoking cessation
C. No LAMA
D. Only ICS
Answer: B
7. 22-year-old sore throat fever, tonsillar exudates,
tender anterior nodes, no cough, Centor 4. Next?
A. No testing
B. Rapid strep antigen, if positive penicillin V or
amoxicillin first-line 10 days, if penicillin allergy non-
anaphylaxis cephalexin, anaphylaxis clindamycin or
azithromycin
Primary Care Board-Prep Practice
Bank Original Questions with Detailed
Rationales
1. 28-year-old woman 32 weeks pregnant BP 154/98,
protein 2+, headache, brisk DTRs, platelets 95k, AST
90. Diagnosis and immediate APRN action?
A. Chronic HTN, bed rest
B. Preeclampsia with severe features plus
thrombocytopenia and elevated LFTs suggests HELLP,
admit, CBC, LFTs, creatinine, protein/Cr ratio,
magnesium sulfate seizure prophylaxis,
betamethasone for fetal lung maturity, delivery
planning
C. No labs needed
D. Ibuprofen
Answer: B
Rationale: Severe features BP ≥160/110 or <160 with
labs low platelets <100k, AST/ALT >2x normal,
creatinine >1.1 or doubling, pulmonary edema,
headache. HELLP hemolysis elevated liver low
, platelets. Magnesium prevents eclampsia. Delivery
definitive.
2. 65-year-old on warfarin INR 2.8, starts TMP-SMX for
UTI. What happens?
A. INR decreases
B. INR increases bleeding risk, TMP-SMX inhibits
CYP2C9 warfarin metabolism and displaces protein
binding, check INR in 2-3 days, consider dose
reduction, counsel bleeding signs
C. No interaction
D. Safe combination
Answer: B
3. 2-year-old with bulging erythematous TM, fever 39C,
ear tugging. No drug allergy, no conjunctivitis, no
amoxicillin in past 30 days. First-line per AAP 2026?
A. Azithromycin
B. Amoxicillin high-dose 80-90 mg/kg/day divided
BID x 10 days if <2 years or severe, watchful waiting
only if mild and >2 years
C. Ceftriaxone IV always
D. No antibiotic
Answer: B
, Rationale: High-dose amoxicillin covers resistant S.
pneumoniae. If otitis-conjunctivitis syndrome use
amoxicillin-clavulanate.
4. 55-year-old diabetic ASCVD risk 20% on atorvastatin
20 mg, LDL 148 after 3 months adherence, diet
controlled. Next step per ACC 2026?
A. Continue 20 mg
B. Intensify to high-intensity atorvastatin 40-80 mg
or rosuvastatin 20-40 mg goal LDL reduction ≥50%,
check adherence, LFTs if symptoms, CK if myalgia
C. Stop statin
D. Add gemfibrozil
Answer: B
Rationale: High ASCVD risk needs high-intensity
statin. Gemfibrozil + statin increases myopathy.
5. 30-year-old woman dysuria, frequency, suprapubic
pain, afebrile, no vaginal discharge, no CVA
tenderness. UA nitrites+, LE+. Best treatment?
A. Admit pyelonephritis
B. Uncomplicated cystitis nitrofurantoin 100 mg BID
x5 days or TMP-SMX x3 days if local resistance <20%,
or fosfomycin single dose, counsel hydration
, C. Ceftriaxone IM
D. No treatment
Answer: B
Rationale: Avoid fluoroquinolones first-line due to
resistance and adverse effects.
6. 60-year-old COPD GOLD D frequent exacerbations,
CAT 18. Maintenance per GOLD 2026?
A. SABA only
B. LAMA/LABA dual therapy e.g.,
tiotropium/olodaterol, add ICS if eosinophils ≥300 or
frequent exacerbations, vaccinate influenza,
pneumococcal, RSV, smoking cessation
C. No LAMA
D. Only ICS
Answer: B
7. 22-year-old sore throat fever, tonsillar exudates,
tender anterior nodes, no cough, Centor 4. Next?
A. No testing
B. Rapid strep antigen, if positive penicillin V or
amoxicillin first-line 10 days, if penicillin allergy non-
anaphylaxis cephalexin, anaphylaxis clindamycin or
azithromycin
