NURSE PRACTITIONERS IN PRIMARY CARE PROCTORED EXAM (2025/2026)
Actual Exam | Latest Edition | Primary Care NP Certification | Comprehensive Assessment
Overview
This 2025/2026 validated resource contains the complete Nurse Practitioners in
Primary Care proctored exam with actual questions and verified answers, directly
aligned with current certification standards for primary care nurse practitioners. Essential
for NP students and graduates preparing for certification and demonstrating comprehensive
competency in primary care management.
Key Features
✓ 100-Question Proctored Exam matching certification format
✓ Comprehensive Primary Care Management across lifespan
✓ Diagnostic Reasoning & Clinical Judgment applications
✓ Updated 2025/2026 clinical practice guidelines
✓ Pharmacotherapy & Treatment Protocols with evidence-based rationales
Content Domains
• Chronic Disease Management (25 Questions)
• Acute & Common Conditions (20 Questions)
• Preventive Care & Health Promotion (18 Questions)
• Pharmacology & Therapeutic Management (17 Questions)
• Complex Patient Presentations (12 Questions)
• Professional & Ethical Practice (8 Questions)
Answer Format
Verified correct answers in bold green with:
• Evidence-based guideline citations
• Diagnostic reasoning pathways
• Treatment protocol justifications
• Risk-benefit analysis frameworks
Critical Updates 2025/2026
NEW - 2025 CDC immunization schedule integration
UPDATED - Hypertension management guidelines (JNC)
REVISED - Diabetes management protocols (ADA)
MODIFIED - Mental health screening standards
CHRONIC DISEASE MANAGEMENT (Questions 1–25)
1. A 58-year-old male with HTN (BP 160/100 mmHg) on lisinopril 10 mg daily
returns for 6-week follow-up. BP remains 158/98 mmHg. Next step:
a) Increase lisinopril to 20 mg daily
b) Add amlodipine 5 mg daily per 2025 JNC-9 guidelines (dual therapy if BP ≥20/10 mmHg
above target)
,c) Switch to losartan
d) Reassess in 6 months
b) Add amlodipine 5 mg daily
Rationale: Urgent to achieve <130/80 mmHg; combination ACE inhibitor + CCB reduces
CV events more than monotherapy.
2. A 45-year-old female with T2DM (A1C 8.2 %) on metformin 1000 mg BID.
BMI 32. Best add-on therapy:
a) Glipizide
b) Start semaglutide 1 mg weekly SC per 2025 ADA Standards (GLP-1 RA with CVD/weight
benefit)
c) NPH insulin
d) Sitagliptin
b) Start semaglutide 1 mg weekly SC
Rationale: Promotes weight loss and MACE reduction; target A1C ≤7 % for most non-
pregnant adults.
3. A 67-year-old with HFpEF (EF 50 %) and dyspnea on exertion. BP 130/80
mmHg. First-line therapy:
a) Carvedilol
b) Start dapagliflozin 10 mg daily per 2025 ACC/AHA/HFSA guidelines (SGLT2i reduces CV
death/HF hospitalization regardless of EF)
c) Digoxin
d) Verapamil
b) Start dapagliflozin 10 mg daily
Rationale: SGLT2 inhibitors now Class I recommendation for HFpEF and HFrEF; monitor
for genital infections.
4. A 55-year-old with COPD (GOLD C) on LABA/LAMA with persistent dyspnea.
FEV1 55 %. Next step:
a) Add high-dose ICS
b) Add roflumilast
c) Start triple therapy (ICS/LABA/LAMA) per 2025 GOLD report if ≥2 exacerbations/year or
eos ≥300
d) Theophylline
c) Start triple therapy (ICS/LABA/LAMA)
Rationale: Reduces exacerbations and improves lung function; reassess response in 3
months.
5. A 70-year-old with CKD stage 3 (eGFR 45 mL/min/1.73 m²) and proteinuria.
BP 145/90 mmHg on lisinopril 10 mg. Next step:
a) Add diltiazem
b) Increase lisinopril to 20 mg and add SGLT2i (dapagliflozin 10 mg) per 2025 KDIGO
guidelines (reduce renal progression)
c) Stop ACEi
d) Add hydralazine
b) Increase lisinopril to 20 mg and add SGLT2i
Rationale: ACE inhibitor titration reduces proteinuria; SGLT2i slows CKD progression
independent of glycemia.
6. A 62-year-old with RA on methotrexate 20 mg weekly reports fatigue. Labs:
Hgb 10.5 g/dL, MCV 72 fL. Most likely cause:
a) B12 deficiency
, b) Anemia of chronic disease + iron deficiency per 2025 rheumatology guidelines (check
ferritin, TSAT)
c) Folate deficiency
d) Hemolysis
b) Anemia of chronic disease + iron deficiency
Rationale: Chronic inflammation suppresses iron availability; MTX can also cause
macrocytic anemia—check folate.
7. A 38-year-old female with migraine ≥15 days/month on topiramate 100 mg
BID with breakthrough pain. Best add-on:
a) Sumatriptan PRN
b) Start onabotulinumtoxinA 155 units every 12 weeks per 2025 AAN guidelines for chronic
migraine
c) Prednisone
d) Oxycodone
b) Start onabotulinumtoxinA 155 units every 12 weeks
Rationale: FDA-approved for chronic migraine; reduces headache days and acute
medication use.
8. A 30-year-old with asthma on high-dose ICS/LABA with AERD. FEV1 60 %.
Next step:
a) Add montelukast
b) Start anti-IL5 (mepolizumab) per 2025 GINA severe asthma pathway
c) Omalizumab
d) Theophylline
b) Start anti-IL5 (mepolizumab)
Rationale: Type 2 inflammation (eos ≥150 or FeNO ≥20 ppb); reduces exacerbations and
oral steroid need.
9. A 75-year-old with osteoporosis (T-score −2.8) and recent wrist fracture.
Already on calcium + vitamin D. Next therapy:
a) Continue current regimen
b) Start romosozumab 210 mg SC monthly ×12 months per 2025 AACE guidelines (high
fracture risk)
c) Raloxifene
d) Calcitonin
b) Start romosozumab 210 mg SC monthly ×12 months
Rationale: Anabolic agent increases BMD and reduces fractures; follow with
bisphosphonate.
10. A 50-year-old with HTN and BPH (IPSS 18) on tamsulosin with residual
symptoms. Add:
a) Finasteride
b) Start tadalafil 5 mg daily per 2025 AUA guidelines (dual benefit for BPH and ED)
c) Solifenacin
d) Dutasteride
b) Start tadalafil 5 mg daily
Rationale: Improves LUTS and quality of life; monitor for hypotension with alpha-blocker.
11. A 45-year-old with hyperlipidemia (LDL 160 mg/dL) on atorvastatin 20 mg.
LDL 130 mg/dL after 6 weeks. Next step:
a) Add ezetimibe 10 mg daily per 2025 AHA/ACC cholesterol guidelines (intensify if ≥50 %
reduction not achieved)
Actual Exam | Latest Edition | Primary Care NP Certification | Comprehensive Assessment
Overview
This 2025/2026 validated resource contains the complete Nurse Practitioners in
Primary Care proctored exam with actual questions and verified answers, directly
aligned with current certification standards for primary care nurse practitioners. Essential
for NP students and graduates preparing for certification and demonstrating comprehensive
competency in primary care management.
Key Features
✓ 100-Question Proctored Exam matching certification format
✓ Comprehensive Primary Care Management across lifespan
✓ Diagnostic Reasoning & Clinical Judgment applications
✓ Updated 2025/2026 clinical practice guidelines
✓ Pharmacotherapy & Treatment Protocols with evidence-based rationales
Content Domains
• Chronic Disease Management (25 Questions)
• Acute & Common Conditions (20 Questions)
• Preventive Care & Health Promotion (18 Questions)
• Pharmacology & Therapeutic Management (17 Questions)
• Complex Patient Presentations (12 Questions)
• Professional & Ethical Practice (8 Questions)
Answer Format
Verified correct answers in bold green with:
• Evidence-based guideline citations
• Diagnostic reasoning pathways
• Treatment protocol justifications
• Risk-benefit analysis frameworks
Critical Updates 2025/2026
NEW - 2025 CDC immunization schedule integration
UPDATED - Hypertension management guidelines (JNC)
REVISED - Diabetes management protocols (ADA)
MODIFIED - Mental health screening standards
CHRONIC DISEASE MANAGEMENT (Questions 1–25)
1. A 58-year-old male with HTN (BP 160/100 mmHg) on lisinopril 10 mg daily
returns for 6-week follow-up. BP remains 158/98 mmHg. Next step:
a) Increase lisinopril to 20 mg daily
b) Add amlodipine 5 mg daily per 2025 JNC-9 guidelines (dual therapy if BP ≥20/10 mmHg
above target)
,c) Switch to losartan
d) Reassess in 6 months
b) Add amlodipine 5 mg daily
Rationale: Urgent to achieve <130/80 mmHg; combination ACE inhibitor + CCB reduces
CV events more than monotherapy.
2. A 45-year-old female with T2DM (A1C 8.2 %) on metformin 1000 mg BID.
BMI 32. Best add-on therapy:
a) Glipizide
b) Start semaglutide 1 mg weekly SC per 2025 ADA Standards (GLP-1 RA with CVD/weight
benefit)
c) NPH insulin
d) Sitagliptin
b) Start semaglutide 1 mg weekly SC
Rationale: Promotes weight loss and MACE reduction; target A1C ≤7 % for most non-
pregnant adults.
3. A 67-year-old with HFpEF (EF 50 %) and dyspnea on exertion. BP 130/80
mmHg. First-line therapy:
a) Carvedilol
b) Start dapagliflozin 10 mg daily per 2025 ACC/AHA/HFSA guidelines (SGLT2i reduces CV
death/HF hospitalization regardless of EF)
c) Digoxin
d) Verapamil
b) Start dapagliflozin 10 mg daily
Rationale: SGLT2 inhibitors now Class I recommendation for HFpEF and HFrEF; monitor
for genital infections.
4. A 55-year-old with COPD (GOLD C) on LABA/LAMA with persistent dyspnea.
FEV1 55 %. Next step:
a) Add high-dose ICS
b) Add roflumilast
c) Start triple therapy (ICS/LABA/LAMA) per 2025 GOLD report if ≥2 exacerbations/year or
eos ≥300
d) Theophylline
c) Start triple therapy (ICS/LABA/LAMA)
Rationale: Reduces exacerbations and improves lung function; reassess response in 3
months.
5. A 70-year-old with CKD stage 3 (eGFR 45 mL/min/1.73 m²) and proteinuria.
BP 145/90 mmHg on lisinopril 10 mg. Next step:
a) Add diltiazem
b) Increase lisinopril to 20 mg and add SGLT2i (dapagliflozin 10 mg) per 2025 KDIGO
guidelines (reduce renal progression)
c) Stop ACEi
d) Add hydralazine
b) Increase lisinopril to 20 mg and add SGLT2i
Rationale: ACE inhibitor titration reduces proteinuria; SGLT2i slows CKD progression
independent of glycemia.
6. A 62-year-old with RA on methotrexate 20 mg weekly reports fatigue. Labs:
Hgb 10.5 g/dL, MCV 72 fL. Most likely cause:
a) B12 deficiency
, b) Anemia of chronic disease + iron deficiency per 2025 rheumatology guidelines (check
ferritin, TSAT)
c) Folate deficiency
d) Hemolysis
b) Anemia of chronic disease + iron deficiency
Rationale: Chronic inflammation suppresses iron availability; MTX can also cause
macrocytic anemia—check folate.
7. A 38-year-old female with migraine ≥15 days/month on topiramate 100 mg
BID with breakthrough pain. Best add-on:
a) Sumatriptan PRN
b) Start onabotulinumtoxinA 155 units every 12 weeks per 2025 AAN guidelines for chronic
migraine
c) Prednisone
d) Oxycodone
b) Start onabotulinumtoxinA 155 units every 12 weeks
Rationale: FDA-approved for chronic migraine; reduces headache days and acute
medication use.
8. A 30-year-old with asthma on high-dose ICS/LABA with AERD. FEV1 60 %.
Next step:
a) Add montelukast
b) Start anti-IL5 (mepolizumab) per 2025 GINA severe asthma pathway
c) Omalizumab
d) Theophylline
b) Start anti-IL5 (mepolizumab)
Rationale: Type 2 inflammation (eos ≥150 or FeNO ≥20 ppb); reduces exacerbations and
oral steroid need.
9. A 75-year-old with osteoporosis (T-score −2.8) and recent wrist fracture.
Already on calcium + vitamin D. Next therapy:
a) Continue current regimen
b) Start romosozumab 210 mg SC monthly ×12 months per 2025 AACE guidelines (high
fracture risk)
c) Raloxifene
d) Calcitonin
b) Start romosozumab 210 mg SC monthly ×12 months
Rationale: Anabolic agent increases BMD and reduces fractures; follow with
bisphosphonate.
10. A 50-year-old with HTN and BPH (IPSS 18) on tamsulosin with residual
symptoms. Add:
a) Finasteride
b) Start tadalafil 5 mg daily per 2025 AUA guidelines (dual benefit for BPH and ED)
c) Solifenacin
d) Dutasteride
b) Start tadalafil 5 mg daily
Rationale: Improves LUTS and quality of life; monitor for hypotension with alpha-blocker.
11. A 45-year-old with hyperlipidemia (LDL 160 mg/dL) on atorvastatin 20 mg.
LDL 130 mg/dL after 6 weeks. Next step:
a) Add ezetimibe 10 mg daily per 2025 AHA/ACC cholesterol guidelines (intensify if ≥50 %
reduction not achieved)
