FNP Rapid Review: Clinical Scenarios
& Critical Thinking (150 Qs&A)
2025/2026
1. A 32-year-old female presents with dysuria, frequency, and
urgency. Urinalysis shows positive nitrites and leukocyte esterase.
What is the first-line treatment for uncomplicated cystitis?
A. Nitrofurantoin
B. Amoxicillin
C. Ciprofloxacin
D. Sulfamethoxazole-trimethoprim
A. Nitrofurantoin
Rationale: Nitrofurantoin is first-line therapy for uncomplicated
cystitis in non-pregnant women due to efficacy and low resistance
rates. Avoid in renal insufficiency.
2. A patient presents with sudden, painless vision loss in one eye.
Fundoscopic exam shows a cherry-red spot at the macula. What is
the most likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Optic neuritis
D. Macular degeneration
B. Central retinal artery occlusion
Rationale: Sudden, painless monocular vision loss with a cherry-red
macula is characteristic of central retinal artery occlusion, an ocular
emergency.
, 3. Which of the following vaccines is recommended annually for all
adults?
A. Tdap
B. Influenza
C. MMR
D. Varicella
B. Influenza
Rationale: Annual influenza vaccination is recommended for all adults
to prevent seasonal flu and complications.
4. A 45-year-old male presents with BMI of 32, fasting glucose of 130
mg/dL, and BP 140/90 mmHg. What is the most appropriate initial
management?
A. Start metformin immediately
B. Lifestyle modification
C. Start insulin
D. Start antihypertensives only
B. Lifestyle modification
Rationale: First-line management for overweight patients with
prediabetes and mild hypertension is lifestyle modification, including
diet, exercise, and weight loss.
5. A patient presents with fatigue, pallor, and spoon-shaped nails.
Lab shows microcytic anemia. Which lab test will confirm the
diagnosis?
A. Serum ferritin
B. Vitamin B12
C. Folate
D. Reticulocyte count
,A. Serum ferritin
Rationale: Microcytic anemia with fatigue and koilonychia (spoon
nails) suggests iron deficiency anemia. Serum ferritin is the most
specific test.
6. Which antibiotic is contraindicated in pregnancy?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
C. Tetracycline
Rationale: Tetracyclines are contraindicated in pregnancy due to risk
of fetal teeth discoloration and bone growth inhibition.
7. A 28-year-old woman presents with sudden-onset right lower
quadrant pain, nausea, and vomiting. Positive McBurney’s point
tenderness. Best next step?
A. MRI
B. CT scan
C. Ultrasound
D. Observation
B. CT scan
Rationale: CT scan is the most sensitive and specific imaging modality
for diagnosing acute appendicitis in adults.
8. Which of the following is the preferred initial treatment for mild
persistent asthma in adults?
A. Short-acting beta-agonist PRN
B. Low-dose inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Oral corticosteroids
, B. Low-dose inhaled corticosteroid
Rationale: Inhaled corticosteroids are first-line therapy for persistent
asthma to control inflammation and prevent exacerbations.
9. A 60-year-old male presents with crushing chest pain radiating to
his left arm. Which ECG change is most indicative of acute
myocardial infarction?
A. ST-segment elevation
B. T-wave inversion
C. QRS widening
D. PR prolongation
A. ST-segment elevation
Rationale: ST-segment elevation in contiguous leads indicates acute
myocardial infarction and requires urgent intervention.
10. What is the most common cause of hypothyroidism in the
United States?
A. Iodine deficiency
B. Hashimoto’s thyroiditis
C. Pituitary adenoma
D. Thyroidectomy
B. Hashimoto’s thyroiditis
Rationale: Hashimoto’s thyroiditis is the most common cause of
hypothyroidism in developed countries due to autoimmune
destruction of the thyroid.
11. A patient has persistent knee pain, worse with activity and
relieved with rest. X-ray shows joint space narrowing and
osteophytes. Diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
& Critical Thinking (150 Qs&A)
2025/2026
1. A 32-year-old female presents with dysuria, frequency, and
urgency. Urinalysis shows positive nitrites and leukocyte esterase.
What is the first-line treatment for uncomplicated cystitis?
A. Nitrofurantoin
B. Amoxicillin
C. Ciprofloxacin
D. Sulfamethoxazole-trimethoprim
A. Nitrofurantoin
Rationale: Nitrofurantoin is first-line therapy for uncomplicated
cystitis in non-pregnant women due to efficacy and low resistance
rates. Avoid in renal insufficiency.
2. A patient presents with sudden, painless vision loss in one eye.
Fundoscopic exam shows a cherry-red spot at the macula. What is
the most likely diagnosis?
A. Retinal detachment
B. Central retinal artery occlusion
C. Optic neuritis
D. Macular degeneration
B. Central retinal artery occlusion
Rationale: Sudden, painless monocular vision loss with a cherry-red
macula is characteristic of central retinal artery occlusion, an ocular
emergency.
, 3. Which of the following vaccines is recommended annually for all
adults?
A. Tdap
B. Influenza
C. MMR
D. Varicella
B. Influenza
Rationale: Annual influenza vaccination is recommended for all adults
to prevent seasonal flu and complications.
4. A 45-year-old male presents with BMI of 32, fasting glucose of 130
mg/dL, and BP 140/90 mmHg. What is the most appropriate initial
management?
A. Start metformin immediately
B. Lifestyle modification
C. Start insulin
D. Start antihypertensives only
B. Lifestyle modification
Rationale: First-line management for overweight patients with
prediabetes and mild hypertension is lifestyle modification, including
diet, exercise, and weight loss.
5. A patient presents with fatigue, pallor, and spoon-shaped nails.
Lab shows microcytic anemia. Which lab test will confirm the
diagnosis?
A. Serum ferritin
B. Vitamin B12
C. Folate
D. Reticulocyte count
,A. Serum ferritin
Rationale: Microcytic anemia with fatigue and koilonychia (spoon
nails) suggests iron deficiency anemia. Serum ferritin is the most
specific test.
6. Which antibiotic is contraindicated in pregnancy?
A. Amoxicillin
B. Azithromycin
C. Tetracycline
D. Cephalexin
C. Tetracycline
Rationale: Tetracyclines are contraindicated in pregnancy due to risk
of fetal teeth discoloration and bone growth inhibition.
7. A 28-year-old woman presents with sudden-onset right lower
quadrant pain, nausea, and vomiting. Positive McBurney’s point
tenderness. Best next step?
A. MRI
B. CT scan
C. Ultrasound
D. Observation
B. CT scan
Rationale: CT scan is the most sensitive and specific imaging modality
for diagnosing acute appendicitis in adults.
8. Which of the following is the preferred initial treatment for mild
persistent asthma in adults?
A. Short-acting beta-agonist PRN
B. Low-dose inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Oral corticosteroids
, B. Low-dose inhaled corticosteroid
Rationale: Inhaled corticosteroids are first-line therapy for persistent
asthma to control inflammation and prevent exacerbations.
9. A 60-year-old male presents with crushing chest pain radiating to
his left arm. Which ECG change is most indicative of acute
myocardial infarction?
A. ST-segment elevation
B. T-wave inversion
C. QRS widening
D. PR prolongation
A. ST-segment elevation
Rationale: ST-segment elevation in contiguous leads indicates acute
myocardial infarction and requires urgent intervention.
10. What is the most common cause of hypothyroidism in the
United States?
A. Iodine deficiency
B. Hashimoto’s thyroiditis
C. Pituitary adenoma
D. Thyroidectomy
B. Hashimoto’s thyroiditis
Rationale: Hashimoto’s thyroiditis is the most common cause of
hypothyroidism in developed countries due to autoimmune
destruction of the thyroid.
11. A patient has persistent knee pain, worse with activity and
relieved with rest. X-ray shows joint space narrowing and
osteophytes. Diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
