@Hooded-Tutor SARAH MICHELLE
FNP PRACTICE TEST
2026 | EXAM REVIEW
| PRACTICE
QUESTIONS,
ANSWERS &
DETAILED
RATIONALES
,1. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. TSH is 8.5
µIU/mL (0.4-4.0), free T4 is 0.6 ng/dL (0.8-1.8). Which is the most appropriate initial
treatment?
• A. Levothyroxine 25 mcg daily
• B. Levothyroxine 100 mcg daily
• C. Liothyronine (T3) therapy
• D. Repeat TSH in 6 weeks
Correct Answer: A
Rationale: Overt hypothyroidism (elevated TSH + low free T4) requires replacement therapy.
Starting dose is weight-based (1.6 mcg/kg/day); for a 70 kg patient, ~112 mcg daily, but many
clinicians start lower (25-50 mcg) in older adults or those with cardiac history, then titrate.
Option A is the safest initial approach.
2. A 60-year-old male with type 2 diabetes has a blood pressure of 148/92 mmHg. His A1C
is 7.2%. Which medication is preferred for initial hypertension management in this
patient?
• A. Lisinopril
• B. Metoprolol
• C. Hydrochlorothiazide
• D. Amlodipine
Correct Answer: A
Rationale: ACE inhibitors (lisinopril) are preferred in diabetic patients due to renal protective
effects. Target BP <130/80 for diabetics. Lifestyle modifications and medication titration are
needed.
3. A 28-year-old female with a history of migraines presents with acute, severe headache,
photophobia, and nausea. Which medication is most appropriate for acute migraine
treatment?
• A. Sumatriptan 50 mg PO
• B. Propranolol 40 mg BID
• C. Topiramate 25 mg daily
• D. Amitriptyline 25 mg at bedtime
Correct Answer: A
Rationale: Triptans (sumatriptan) are first-line for acute moderate-severe migraines.
Propranolol, topiramate, and amitriptyline are prophylactic agents, not acute treatments.
1|Page
,4. A 55-year-old with osteoarthritis in both knees reports persistent pain despite ibuprofen.
Which adjunct therapy is most appropriate?
• A. Acetaminophen 1000 mg TID
• B. Intra-articular corticosteroid injection
• C. Opioid analgesic
• D. Glucosamine sulfate
Correct Answer: B
Rationale: Intra-articular corticosteroids provide short-term relief for OA flares. Acetaminophen
is used for mild pain; opioids are not first-line. Glucosamine evidence is mixed.
5. A 32-year-old with asthma has been using albuterol daily. Which additional therapy is
indicated for long-term control?
• A. Montelukast
• B. Inhaled corticosteroid (ICS)
• C. Theophylline
• D. Oral corticosteroid burst
Correct Answer: B
Rationale: ICS is the cornerstone of asthma maintenance therapy. Montelukast is an alternative,
but ICS is preferred. Daily albuterol use indicates inadequate control.
6. A 70-year-old with chronic kidney disease (stage 3) has a serum potassium of 5.6 mEq/L.
Which medication should be avoided?
• A. Furosemide
• B. Spironolactone
• C. Metoprolol
• D. Lisinopril
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and can worsen hyperkalemia,
especially in CKD. ACE inhibitors (lisinopril) also increase K+ but are not as acutely
problematic; however, both may need adjustment.
2|Page
, 7. A 40-year-old with a positive tuberculin skin test (TST) and normal chest X-ray. Which
treatment is recommended?
• A. Isoniazid for 9 months
• B. Rifampin for 4 months
• C. No treatment, repeat TST in 1 year
• D. Four-drug regimen
Correct Answer: A
Rationale: Latent TB infection (LTBI) is treated with isoniazid (INH) for 9 months or rifampin
for 4 months. INH is standard. Four-drug regimen is for active TB.
8. A 50-year-old with GERD reports regurgitation and heartburn. Which lifestyle
modification is most effective?
• A. Elevate head of bed
• B. Avoid spicy foods
• C. Weight loss
• D. Avoid caffeine
Correct Answer: C
Rationale: Weight loss is the most effective lifestyle intervention for GERD, particularly in
overweight patients. Head elevation and dietary changes are also helpful but less impactful.
9. A 65-year-old with atrial fibrillation is started on warfarin. Which INR range is typical
for this indication?
• A. 1.5-2.0
• B. 2.0-3.0
• C. 3.0-4.0
• D. 4.0-5.0
Correct Answer: B
Rationale: For non-valvular atrial fibrillation, target INR is 2.0-3.0. Mechanical heart valves
require higher range (2.5-3.5).
10. A 22-year-old with a sore throat, fever, and no cough. Rapid strep test is positive. What
is the treatment of choice?
• A. Penicillin VK 500 mg BID for 10 days
3|Page
FNP PRACTICE TEST
2026 | EXAM REVIEW
| PRACTICE
QUESTIONS,
ANSWERS &
DETAILED
RATIONALES
,1. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. TSH is 8.5
µIU/mL (0.4-4.0), free T4 is 0.6 ng/dL (0.8-1.8). Which is the most appropriate initial
treatment?
• A. Levothyroxine 25 mcg daily
• B. Levothyroxine 100 mcg daily
• C. Liothyronine (T3) therapy
• D. Repeat TSH in 6 weeks
Correct Answer: A
Rationale: Overt hypothyroidism (elevated TSH + low free T4) requires replacement therapy.
Starting dose is weight-based (1.6 mcg/kg/day); for a 70 kg patient, ~112 mcg daily, but many
clinicians start lower (25-50 mcg) in older adults or those with cardiac history, then titrate.
Option A is the safest initial approach.
2. A 60-year-old male with type 2 diabetes has a blood pressure of 148/92 mmHg. His A1C
is 7.2%. Which medication is preferred for initial hypertension management in this
patient?
• A. Lisinopril
• B. Metoprolol
• C. Hydrochlorothiazide
• D. Amlodipine
Correct Answer: A
Rationale: ACE inhibitors (lisinopril) are preferred in diabetic patients due to renal protective
effects. Target BP <130/80 for diabetics. Lifestyle modifications and medication titration are
needed.
3. A 28-year-old female with a history of migraines presents with acute, severe headache,
photophobia, and nausea. Which medication is most appropriate for acute migraine
treatment?
• A. Sumatriptan 50 mg PO
• B. Propranolol 40 mg BID
• C. Topiramate 25 mg daily
• D. Amitriptyline 25 mg at bedtime
Correct Answer: A
Rationale: Triptans (sumatriptan) are first-line for acute moderate-severe migraines.
Propranolol, topiramate, and amitriptyline are prophylactic agents, not acute treatments.
1|Page
,4. A 55-year-old with osteoarthritis in both knees reports persistent pain despite ibuprofen.
Which adjunct therapy is most appropriate?
• A. Acetaminophen 1000 mg TID
• B. Intra-articular corticosteroid injection
• C. Opioid analgesic
• D. Glucosamine sulfate
Correct Answer: B
Rationale: Intra-articular corticosteroids provide short-term relief for OA flares. Acetaminophen
is used for mild pain; opioids are not first-line. Glucosamine evidence is mixed.
5. A 32-year-old with asthma has been using albuterol daily. Which additional therapy is
indicated for long-term control?
• A. Montelukast
• B. Inhaled corticosteroid (ICS)
• C. Theophylline
• D. Oral corticosteroid burst
Correct Answer: B
Rationale: ICS is the cornerstone of asthma maintenance therapy. Montelukast is an alternative,
but ICS is preferred. Daily albuterol use indicates inadequate control.
6. A 70-year-old with chronic kidney disease (stage 3) has a serum potassium of 5.6 mEq/L.
Which medication should be avoided?
• A. Furosemide
• B. Spironolactone
• C. Metoprolol
• D. Lisinopril
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and can worsen hyperkalemia,
especially in CKD. ACE inhibitors (lisinopril) also increase K+ but are not as acutely
problematic; however, both may need adjustment.
2|Page
, 7. A 40-year-old with a positive tuberculin skin test (TST) and normal chest X-ray. Which
treatment is recommended?
• A. Isoniazid for 9 months
• B. Rifampin for 4 months
• C. No treatment, repeat TST in 1 year
• D. Four-drug regimen
Correct Answer: A
Rationale: Latent TB infection (LTBI) is treated with isoniazid (INH) for 9 months or rifampin
for 4 months. INH is standard. Four-drug regimen is for active TB.
8. A 50-year-old with GERD reports regurgitation and heartburn. Which lifestyle
modification is most effective?
• A. Elevate head of bed
• B. Avoid spicy foods
• C. Weight loss
• D. Avoid caffeine
Correct Answer: C
Rationale: Weight loss is the most effective lifestyle intervention for GERD, particularly in
overweight patients. Head elevation and dietary changes are also helpful but less impactful.
9. A 65-year-old with atrial fibrillation is started on warfarin. Which INR range is typical
for this indication?
• A. 1.5-2.0
• B. 2.0-3.0
• C. 3.0-4.0
• D. 4.0-5.0
Correct Answer: B
Rationale: For non-valvular atrial fibrillation, target INR is 2.0-3.0. Mechanical heart valves
require higher range (2.5-3.5).
10. A 22-year-old with a sore throat, fever, and no cough. Rapid strep test is positive. What
is the treatment of choice?
• A. Penicillin VK 500 mg BID for 10 days
3|Page
