NSG 6998 – FNP Predictor Exam Questions with Answers -
South University
1. A 68-year-old man with type 2 diabetes and hypertension is started on
lisinopril. Two weeks later his potassium is 5.6 mEq/L. Which mechanism
explains this finding?
A) Increased aldosterone secretion
B) Decreased angiotensin II formation, reducing aldosterone-mediated
potassium excretion
C) Direct renal tubular toxicity
D) Increased sodium reabsorption in the distal tubule
Answer: B
Rationale: ACE inhibitors block conversion of angiotensin I to angiotensin II, which
lowers aldosterone secretion. Aldosterone normally promotes potassium excretion
in the collecting duct, so reduced aldosterone activity leads to potassium retention
(hyperkalemia). This is a well-known class effect of ACE inhibitors and ARBs and
requires potassium and renal function monitoring after initiation.
2. Which laboratory finding is most consistent with a diagnosis of iron deficiency
anemia rather than anemia of chronic disease?
A) Low ferritin, high TIBC
B) High ferritin, low TIBC
C) Normal ferritin, normal TIBC
D) Low ferritin, low TIBC
Answer: A
Rationale: In iron deficiency anemia, total iron-binding capacity (TIBC) rises as the
body upregulates transferrin to capture available iron, while ferritin (iron stores) is
low. In anemia of chronic disease, ferritin is normal or elevated (an acute-phase
reactant) and TIBC is typically low or normal, reflecting inflammation rather than
true iron depletion.
3. A patient on warfarin presents with an INR of 8.0 and no bleeding. According
to standard guidelines, what is the most appropriate initial action?
, A) Administer fresh frozen plasma immediately
B) Hold warfarin and give oral vitamin K
C) Continue current warfarin dose and recheck INR in 1 week
D) Administer intravenous vitamin K and admit to ICU
Answer: B
Rationale: For an INR greater than 4.5-10 without significant bleeding, guidelines
recommend holding warfarin and giving low-dose oral vitamin K, then monitoring
the INR closely. IV vitamin K and FFP are reserved for serious or life-threatening
bleeding. Continuing the dose unchanged would prolong the risk of hemorrhage.
4. Which statin-associated adverse effect requires immediate discontinuation of
therapy?
A) Mild myalgia without elevated CK
B) Rhabdomyolysis with markedly elevated CK and myoglobinuria
C) Transient elevation of ALT less than 3 times normal
D) Mild GI upset
Answer: B
Rationale: Rhabdomyolysis is a rare but serious statin adverse effect characterized
by muscle breakdown, markedly elevated creatine kinase, myoglobinuria, and risk
of acute kidney injury. It requires immediate discontinuation of the statin and
supportive care. Mild myalgia or modest transaminase elevation alone does not
mandate stopping therapy but warrants monitoring.
5. A patient taking metformin is scheduled for a CT scan with IV contrast. What
is the recommended management?
A) Continue metformin without interruption
B) Hold metformin at the time of contrast and for 48 hours after, resuming
only after renal function is confirmed stable
C) Double the metformin dose before the scan
D) Switch to insulin permanently
Answer: B
Rationale: Iodinated contrast can rarely precipitate contrast-induced nephropathy,
and metformin accumulation in renal impairment raises the risk of lactic acidosis.
Standard practice is to hold metformin at the time of contrast administration and
,for approximately 48 hours afterward, then reassess renal function before
resuming.
6. Which finding on physical exam is most specific for a diagnosis of appendicitis?
A) Diffuse abdominal tenderness
B) Rovsing sign and psoas sign with McBurney point tenderness
C) Costovertebral angle tenderness
D) Murphy sign
Answer: B
Rationale: McBurney point tenderness (one-third the distance from the anterior
superior iliac spine to the umbilicus), along with positive Rovsing sign (pain in the
right lower quadrant with palpation of the left lower quadrant) and psoas sign,
are classic findings supporting appendicitis. Murphy sign is associated with
cholecystitis, and CVA tenderness suggests pyelonephritis.
7. A 45-year-old woman reports fatigue, cold intolerance, and weight gain. TSH
is 8.5 mIU/L and free T4 is low. What is the most likely diagnosis?
A) Graves disease
B) Primary hypothyroidism
C) Subclinical hyperthyroidism
D) Secondary hyperthyroidism
Answer: B
Rationale: An elevated TSH with a low free T4 indicates primary hypothyroidism,
most commonly due to Hashimoto thyroiditis in this age group. The pituitary
appropriately increases TSH in an attempt to stimulate an underactive thyroid
gland. Graves disease would present with low TSH and elevated free T4/T3.
8. Which medication is considered first-line for an otherwise healthy patient
newly diagnosed with hypertension and no compelling comorbid indications?
A) Clonidine
B) Thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker
C) Beta-blocker
D) Alpha-1 blocker
, Answer: B
Rationale: Per JNC 8 and subsequent guidelines, first-line agents for
uncomplicated essential hypertension include thiazide diuretics, ACE inhibitors,
ARBs, and calcium channel blockers. Beta-blockers are no longer considered first-
line therapy for uncomplicated hypertension unless a compelling indication (such
as coronary disease or heart failure) exists.
9. A patient presents with sudden vision loss described as a curtain coming
down over one eye. What is the most likely diagnosis?
A) Retinal detachment
B) Acute angle-closure glaucoma
C) Cataract
D) Conjunctivitis
Answer: A
Rationale: A painless, sudden 'curtain' or 'shade' descending over the visual field is
classic for retinal detachment, often preceded by floaters and flashes of light. This
is an ophthalmologic emergency requiring immediate referral. Angle-closure
glaucoma typically presents with severe eye pain, headache, and nausea.
10. Which vaccine is contraindicated in a patient with a history of Guillain-Barre
syndrome within 6 weeks of a prior influenza vaccination?
A) Pneumococcal vaccine
B) Influenza vaccine (relative contraindication requiring risk-benefit discussion)
C) Tetanus vaccine
D) Hepatitis B vaccine
Answer: B
Rationale: A history of Guillain-Barre syndrome occurring within 6 weeks of a
previous influenza vaccination is considered a precaution; the decision to
revaccinate should weigh the risk of recurrence against the benefit of influenza
protection, often in consultation with a specialist. It is not an absolute
contraindication in all cases but warrants careful discussion.
11. A 3-year-old presents with a barky cough, inspiratory stridor, and low-grade
fever that worsens at night. What is the most likely diagnosis?
South University
1. A 68-year-old man with type 2 diabetes and hypertension is started on
lisinopril. Two weeks later his potassium is 5.6 mEq/L. Which mechanism
explains this finding?
A) Increased aldosterone secretion
B) Decreased angiotensin II formation, reducing aldosterone-mediated
potassium excretion
C) Direct renal tubular toxicity
D) Increased sodium reabsorption in the distal tubule
Answer: B
Rationale: ACE inhibitors block conversion of angiotensin I to angiotensin II, which
lowers aldosterone secretion. Aldosterone normally promotes potassium excretion
in the collecting duct, so reduced aldosterone activity leads to potassium retention
(hyperkalemia). This is a well-known class effect of ACE inhibitors and ARBs and
requires potassium and renal function monitoring after initiation.
2. Which laboratory finding is most consistent with a diagnosis of iron deficiency
anemia rather than anemia of chronic disease?
A) Low ferritin, high TIBC
B) High ferritin, low TIBC
C) Normal ferritin, normal TIBC
D) Low ferritin, low TIBC
Answer: A
Rationale: In iron deficiency anemia, total iron-binding capacity (TIBC) rises as the
body upregulates transferrin to capture available iron, while ferritin (iron stores) is
low. In anemia of chronic disease, ferritin is normal or elevated (an acute-phase
reactant) and TIBC is typically low or normal, reflecting inflammation rather than
true iron depletion.
3. A patient on warfarin presents with an INR of 8.0 and no bleeding. According
to standard guidelines, what is the most appropriate initial action?
, A) Administer fresh frozen plasma immediately
B) Hold warfarin and give oral vitamin K
C) Continue current warfarin dose and recheck INR in 1 week
D) Administer intravenous vitamin K and admit to ICU
Answer: B
Rationale: For an INR greater than 4.5-10 without significant bleeding, guidelines
recommend holding warfarin and giving low-dose oral vitamin K, then monitoring
the INR closely. IV vitamin K and FFP are reserved for serious or life-threatening
bleeding. Continuing the dose unchanged would prolong the risk of hemorrhage.
4. Which statin-associated adverse effect requires immediate discontinuation of
therapy?
A) Mild myalgia without elevated CK
B) Rhabdomyolysis with markedly elevated CK and myoglobinuria
C) Transient elevation of ALT less than 3 times normal
D) Mild GI upset
Answer: B
Rationale: Rhabdomyolysis is a rare but serious statin adverse effect characterized
by muscle breakdown, markedly elevated creatine kinase, myoglobinuria, and risk
of acute kidney injury. It requires immediate discontinuation of the statin and
supportive care. Mild myalgia or modest transaminase elevation alone does not
mandate stopping therapy but warrants monitoring.
5. A patient taking metformin is scheduled for a CT scan with IV contrast. What
is the recommended management?
A) Continue metformin without interruption
B) Hold metformin at the time of contrast and for 48 hours after, resuming
only after renal function is confirmed stable
C) Double the metformin dose before the scan
D) Switch to insulin permanently
Answer: B
Rationale: Iodinated contrast can rarely precipitate contrast-induced nephropathy,
and metformin accumulation in renal impairment raises the risk of lactic acidosis.
Standard practice is to hold metformin at the time of contrast administration and
,for approximately 48 hours afterward, then reassess renal function before
resuming.
6. Which finding on physical exam is most specific for a diagnosis of appendicitis?
A) Diffuse abdominal tenderness
B) Rovsing sign and psoas sign with McBurney point tenderness
C) Costovertebral angle tenderness
D) Murphy sign
Answer: B
Rationale: McBurney point tenderness (one-third the distance from the anterior
superior iliac spine to the umbilicus), along with positive Rovsing sign (pain in the
right lower quadrant with palpation of the left lower quadrant) and psoas sign,
are classic findings supporting appendicitis. Murphy sign is associated with
cholecystitis, and CVA tenderness suggests pyelonephritis.
7. A 45-year-old woman reports fatigue, cold intolerance, and weight gain. TSH
is 8.5 mIU/L and free T4 is low. What is the most likely diagnosis?
A) Graves disease
B) Primary hypothyroidism
C) Subclinical hyperthyroidism
D) Secondary hyperthyroidism
Answer: B
Rationale: An elevated TSH with a low free T4 indicates primary hypothyroidism,
most commonly due to Hashimoto thyroiditis in this age group. The pituitary
appropriately increases TSH in an attempt to stimulate an underactive thyroid
gland. Graves disease would present with low TSH and elevated free T4/T3.
8. Which medication is considered first-line for an otherwise healthy patient
newly diagnosed with hypertension and no compelling comorbid indications?
A) Clonidine
B) Thiazide diuretic, ACE inhibitor/ARB, or calcium channel blocker
C) Beta-blocker
D) Alpha-1 blocker
, Answer: B
Rationale: Per JNC 8 and subsequent guidelines, first-line agents for
uncomplicated essential hypertension include thiazide diuretics, ACE inhibitors,
ARBs, and calcium channel blockers. Beta-blockers are no longer considered first-
line therapy for uncomplicated hypertension unless a compelling indication (such
as coronary disease or heart failure) exists.
9. A patient presents with sudden vision loss described as a curtain coming
down over one eye. What is the most likely diagnosis?
A) Retinal detachment
B) Acute angle-closure glaucoma
C) Cataract
D) Conjunctivitis
Answer: A
Rationale: A painless, sudden 'curtain' or 'shade' descending over the visual field is
classic for retinal detachment, often preceded by floaters and flashes of light. This
is an ophthalmologic emergency requiring immediate referral. Angle-closure
glaucoma typically presents with severe eye pain, headache, and nausea.
10. Which vaccine is contraindicated in a patient with a history of Guillain-Barre
syndrome within 6 weeks of a prior influenza vaccination?
A) Pneumococcal vaccine
B) Influenza vaccine (relative contraindication requiring risk-benefit discussion)
C) Tetanus vaccine
D) Hepatitis B vaccine
Answer: B
Rationale: A history of Guillain-Barre syndrome occurring within 6 weeks of a
previous influenza vaccination is considered a precaution; the decision to
revaccinate should weigh the risk of recurrence against the benefit of influenza
protection, often in consultation with a specialist. It is not an absolute
contraindication in all cases but warrants careful discussion.
11. A 3-year-old presents with a barky cough, inspiratory stridor, and low-grade
fever that worsens at night. What is the most likely diagnosis?
