Ultimate Family Nurse Practitioner Certification
Review 2025/2026
(150Qs&A ,RATIONALES)
1. A 45-year-old male presents with persistent heartburn for 6
months. He reports relief with antacids but has occasional
regurgitation. What is the most appropriate initial management?
Lifestyle modification and trial of proton pump inhibitor (PPI)
Rationale: Initial management of chronic GERD includes lifestyle
modifications (weight loss, avoiding triggers) and a trial of PPI to
control symptoms.
2. A 60-year-old female presents with sudden-onset, severe
headache described as “the worst of her life.” She also has nausea
and photophobia. What is the most appropriate next step?
Immediate non-contrast CT scan of the head
Rationale: Sudden severe headache may indicate subarachnoid
hemorrhage. Non-contrast CT is the first-line diagnostic test.
3. A 32-year-old woman presents for routine screening. She has
never had a Pap smear. What is the recommended cervical cancer
screening?
Pap smear every 3 years starting at age 21
Rationale: Current guidelines recommend Pap smear every 3
years for women aged 21-29, regardless of sexual activity.
4. A 55-year-old male with type 2 diabetes presents for follow-up.
His A1C is 8.2%. Which intervention is most appropriate?
Intensify glycemic control with medication adjustment
Rationale: An A1C >7% indicates suboptimal control. Medication
, adjustment or addition is indicated along with lifestyle
counseling.
5. A 25-year-old presents with dysuria and frequency. Urinalysis
shows positive leukocyte esterase and nitrites. What is the first-
line treatment?
Trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days
Rationale: Uncomplicated urinary tract infections in non-
pregnant women are typically treated with a short course of
TMP-SMX or nitrofurantoin.
6. A 70-year-old patient presents with gradual memory loss and
difficulty performing daily activities. MRI shows cortical atrophy.
What is the most likely diagnosis?
Alzheimer’s disease
Rationale: Progressive memory loss with cortical atrophy in
elderly patients is characteristic of Alzheimer’s disease.
7. A 28-year-old woman presents with sudden, painless vision loss in
her right eye. Fundoscopy shows a pale retina with a cherry-red
spot at the fovea. What is the most likely diagnosis?
Central retinal artery occlusion (CRAO)
Rationale: Sudden, painless monocular vision loss with a cherry-
red spot is classic for CRAO, often an emergency.
8. A 45-year-old male presents with fatigue, pallor, and spoon-
shaped nails. Labs reveal microcytic anemia. What is the most
likely cause?
Iron deficiency anemia
Rationale: Microcytic anemia with spoon-shaped nails is
commonly due to iron deficiency, often from chronic blood loss.
, 9. A 50-year-old female presents with hot flashes, night sweats, and
irregular periods for 6 months. What is the most appropriate next
step?
Confirm menopause with FSH and estradiol levels if diagnosis is
uncertain
Rationale: Menopause is primarily a clinical diagnosis, but lab
confirmation can help if the presentation is atypical.
10. A 30-year-old male presents with sudden swelling of the
right great toe, redness, and severe pain. Labs show elevated uric
acid. What is the most appropriate treatment?
NSAIDs for acute gout attack
Rationale: Acute gout flare is typically treated with NSAIDs,
colchicine, or corticosteroids.
11. A 65-year-old male presents with chronic cough, weight loss,
and hemoptysis. He has a 40-pack-year smoking history. What is
the next best step?
Chest CT scan
Rationale: In patients with high suspicion for lung cancer, chest
CT is indicated for further evaluation.
12. A 24-year-old female presents with a rash on her cheeks in a
butterfly distribution. She also reports joint pain and fatigue.
Which test is most appropriate?
ANA (antinuclear antibody) testing
Rationale: Butterfly rash and systemic symptoms suggest
systemic lupus erythematosus; ANA is the first-line screening
test.
13. A 35-year-old male presents with epigastric pain relieved by
food. Which is the most likely diagnosis?
Duodenal ulcer
Review 2025/2026
(150Qs&A ,RATIONALES)
1. A 45-year-old male presents with persistent heartburn for 6
months. He reports relief with antacids but has occasional
regurgitation. What is the most appropriate initial management?
Lifestyle modification and trial of proton pump inhibitor (PPI)
Rationale: Initial management of chronic GERD includes lifestyle
modifications (weight loss, avoiding triggers) and a trial of PPI to
control symptoms.
2. A 60-year-old female presents with sudden-onset, severe
headache described as “the worst of her life.” She also has nausea
and photophobia. What is the most appropriate next step?
Immediate non-contrast CT scan of the head
Rationale: Sudden severe headache may indicate subarachnoid
hemorrhage. Non-contrast CT is the first-line diagnostic test.
3. A 32-year-old woman presents for routine screening. She has
never had a Pap smear. What is the recommended cervical cancer
screening?
Pap smear every 3 years starting at age 21
Rationale: Current guidelines recommend Pap smear every 3
years for women aged 21-29, regardless of sexual activity.
4. A 55-year-old male with type 2 diabetes presents for follow-up.
His A1C is 8.2%. Which intervention is most appropriate?
Intensify glycemic control with medication adjustment
Rationale: An A1C >7% indicates suboptimal control. Medication
, adjustment or addition is indicated along with lifestyle
counseling.
5. A 25-year-old presents with dysuria and frequency. Urinalysis
shows positive leukocyte esterase and nitrites. What is the first-
line treatment?
Trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days
Rationale: Uncomplicated urinary tract infections in non-
pregnant women are typically treated with a short course of
TMP-SMX or nitrofurantoin.
6. A 70-year-old patient presents with gradual memory loss and
difficulty performing daily activities. MRI shows cortical atrophy.
What is the most likely diagnosis?
Alzheimer’s disease
Rationale: Progressive memory loss with cortical atrophy in
elderly patients is characteristic of Alzheimer’s disease.
7. A 28-year-old woman presents with sudden, painless vision loss in
her right eye. Fundoscopy shows a pale retina with a cherry-red
spot at the fovea. What is the most likely diagnosis?
Central retinal artery occlusion (CRAO)
Rationale: Sudden, painless monocular vision loss with a cherry-
red spot is classic for CRAO, often an emergency.
8. A 45-year-old male presents with fatigue, pallor, and spoon-
shaped nails. Labs reveal microcytic anemia. What is the most
likely cause?
Iron deficiency anemia
Rationale: Microcytic anemia with spoon-shaped nails is
commonly due to iron deficiency, often from chronic blood loss.
, 9. A 50-year-old female presents with hot flashes, night sweats, and
irregular periods for 6 months. What is the most appropriate next
step?
Confirm menopause with FSH and estradiol levels if diagnosis is
uncertain
Rationale: Menopause is primarily a clinical diagnosis, but lab
confirmation can help if the presentation is atypical.
10. A 30-year-old male presents with sudden swelling of the
right great toe, redness, and severe pain. Labs show elevated uric
acid. What is the most appropriate treatment?
NSAIDs for acute gout attack
Rationale: Acute gout flare is typically treated with NSAIDs,
colchicine, or corticosteroids.
11. A 65-year-old male presents with chronic cough, weight loss,
and hemoptysis. He has a 40-pack-year smoking history. What is
the next best step?
Chest CT scan
Rationale: In patients with high suspicion for lung cancer, chest
CT is indicated for further evaluation.
12. A 24-year-old female presents with a rash on her cheeks in a
butterfly distribution. She also reports joint pain and fatigue.
Which test is most appropriate?
ANA (antinuclear antibody) testing
Rationale: Butterfly rash and systemic symptoms suggest
systemic lupus erythematosus; ANA is the first-line screening
test.
13. A 35-year-old male presents with epigastric pain relieved by
food. Which is the most likely diagnosis?
Duodenal ulcer
