FNP-BC 2026 Study Guide: Family Nurse
Practitioner Certification Practice Questions
Answer Explanations & Primary Care
Assessment, Diagnosis & Treatment Exam
Preparation
Section 1: Assessment (Questions 1–19)
Question 1: A 45-year-old female presents for an annual physical. She reports
fatigue, weight gain, and cold intolerance over the past 3 months. Her TSH is 8.2
mIU/L (normal 0.4–4.0) and Free T4 is 0.6 ng/dL (normal 0.8–1.8). What is the
most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hashimoto thyroiditis with hyperthyroid phase
Rationale: The elevated TSH with low Free T4 indicates primary hypothyroidism,
where the thyroid gland fails to produce sufficient thyroid hormone, causing TSH
to rise. Subclinical hypothyroidism (A) would have a normal Free T4. Secondary
hypothyroidism (C) would present with low or normal TSH. Hashimoto thyroiditis
(D) is the most common cause but the question asks for the diagnosis based on lab
interpretation, which is primary hypothyroidism.
Question 2: A nurse practitioner is performing a comprehensive health history
using the OLDCARTS mnemonic. Which component of OLDCARTS assesses
what provokes or worsens the symptom?
A. Onset
B. Location
C. Aggravating factors
D. Timing
Rationale: OLDCARTS stands for Onset, Location, Duration, Characteristics,
Aggravating/Alleviating factors, Relieving factors, Timing, and Severity. The "A"
,component assesses what provokes or worsens the symptom, while "R" assesses
what relieves it.
Question 3: A 55-year-old man with type 2 diabetes mellitus presents with severe
right foot pain that started suddenly in the middle of the night after he had a steak
dinner with friends. Physical examination shows swelling and tenderness of the
first metatarsophalangeal joint. Joint aspiration is performed, and microscopic
findings from the synovial fluid reveal the presence of monosodium urate crystals.
Which of the following is the best initial treatment?
A. Allopurinol
B. Non-steroidal anti-inflammatory drugs (NSAIDs)
C. Prednisone
D. Probenecid
Rationale: This patient has acute gouty arthritis confirmed by the presence of
monosodium urate crystals in the synovial fluid. The best initial treatment for an
acute gout flare is NSAIDs (unless contraindicated). Allopurinol (A) and
probenecid (D) are used for chronic management (urine-lowering therapy) and
should not be started during an acute flare. Prednisone (C) is an alternative for
patients who cannot take NSAIDs but is not first-line.
Question 4: A 21-year-old woman has had urinary frequency and urgency for the
past 2 days. She has also noticed scant vaginal discharge. The patient has never
had these symptoms before. A urine sample is sent for urinalysis and culture.
Which of the following additional findings would be most suggestive of a
diagnosis of pyelonephritis?
A. Bacteriuria
B. Leukocytosis
C. Microscopic hematuria
D. White blood cell casts
Rationale: Both upper (e.g., pyelonephritis) and lower (e.g., cystitis) urinary tract
infections can show microscopic hematuria, pyuria, and bacteriuria on urinalysis.
However, the presence of white blood cell (WBC) casts can confirm the diagnosis
of pyelonephritis because WBC casts form only in the renal tubules, indicating
intrarenal pathology.
Question 5: A 72-year-old woman with a history of hypertension and type 2
diabetes presents for a routine visit. Her blood pressure today is 148/86 mm Hg.
,She has no symptoms of chest pain or shortness of breath. Which action is most
appropriate based on JNC 8 guidelines?
A. Start a thiazide diuretic immediately
B. Arrange for additional blood pressure measurements within the next four
weeks
C. Admit to the hospital for hypertensive urgency
D. Start an ACE inhibitor and a beta-blocker simultaneously
Rationale: For a patient with diabetes and hypertension, the target blood pressure
is <140/90 mm Hg. This patient's blood pressure is 148/86 mm Hg, which requires
confirmation with additional measurements before initiating or adjusting therapy.
Starting medication without confirmation is premature. Hospital admission is not
indicated for asymptomatic hypertension.
Question 6: A 28-year-old student is seen in the school health clinic with
complaints of a hacking cough that is productive of small amounts of sputum and a
runny nose. He does not take any medications and denies fever. The bacterium
responsible for the highest mortality in patients with community-acquired
pneumonia (CAP) is:
A. Mycoplasma pneumoniae
B. Moraxella catarrhalis
C. Streptococcus pneumoniae
D. Haemophilus influenzae
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia and is associated with the highest mortality rate. Mycoplasma
pneumoniae (A) typically causes milder "walking pneumonia." Moraxella
catarrhalis (B) and Haemophilus influenzae (D) are less common and typically less
severe.
Question 7: A 55-year-old man with a history of chronic obstructive pulmonary
disease (COPD) presents with worsening dyspnea and increased sputum
production. He is a current smoker with a 40-pack-year history. Which pulmonary
function test finding is most consistent with COPD?
A. FEV1/FVC ratio of 85%
B. FEV1/FVC ratio of 60%
C. FEV1/FVC ratio of 95%
D. Normal FEV1/FVC ratio with decreased diffusing capacity
, Rationale: COPD is characterized by an obstructive pattern on spirometry, defined
as an FEV1/FVC ratio of less than 70%. An FEV1/FVC ratio of 60% indicates
obstruction. A ratio of 85% or 95% (A, C) is normal. A normal ratio with
decreased diffusing capacity (D) suggests a restrictive pattern or early emphysema
without obstruction.
Question 8: A 62-year-old woman presents with a 3-week history of fatigue,
dyspnea on exertion, and palpitations. Her hemoglobin is 9.2 g/dL, MCV is 72 fL,
and ferritin is 8 ng/mL. What is the most likely diagnosis?
A. Vitamin B12 deficiency anemia
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Hemolytic anemia
Rationale: The combination of low hemoglobin, low MCV (microcytic), and low
ferritin is diagnostic of iron deficiency anemia. Vitamin B12 deficiency (A)
presents with macrocytic anemia (high MCV). Anemia of chronic disease (C)
typically has normal or slightly low MCV with elevated ferritin. Hemolytic anemia
(D) would have elevated reticulocytes and indirect bilirubin.
Question 9: A 35-year-old woman presents with a painless, firm, solitary thyroid
nodule found on routine examination. She has no symptoms of hypo- or
hyperthyroidism. What is the most appropriate next step in evaluation?
A. Thyroid function tests only
B. Thyroid ultrasound and fine-needle aspiration (FNA)
C. Radioactive iodine uptake scan
D. Immediate surgical referral
Rationale: A solitary thyroid nodule requires evaluation to rule out malignancy.
Thyroid ultrasound is used to characterize the nodule, and FNA is the gold
standard for cytologic evaluation. Thyroid function tests (A) alone are insufficient.
Radioactive iodine uptake (C) is used for hyperthyroid conditions. Surgical referral
(D) is premature without cytologic diagnosis.
Question 10: A 68-year-old man presents with gradual onset of urinary hesitancy,
weak stream, and nocturia. Digital rectal examination reveals a smooth, enlarged
prostate without nodules. What is the most likely diagnosis?
Practitioner Certification Practice Questions
Answer Explanations & Primary Care
Assessment, Diagnosis & Treatment Exam
Preparation
Section 1: Assessment (Questions 1–19)
Question 1: A 45-year-old female presents for an annual physical. She reports
fatigue, weight gain, and cold intolerance over the past 3 months. Her TSH is 8.2
mIU/L (normal 0.4–4.0) and Free T4 is 0.6 ng/dL (normal 0.8–1.8). What is the
most likely diagnosis?
A. Subclinical hypothyroidism
B. Primary hypothyroidism
C. Secondary hypothyroidism
D. Hashimoto thyroiditis with hyperthyroid phase
Rationale: The elevated TSH with low Free T4 indicates primary hypothyroidism,
where the thyroid gland fails to produce sufficient thyroid hormone, causing TSH
to rise. Subclinical hypothyroidism (A) would have a normal Free T4. Secondary
hypothyroidism (C) would present with low or normal TSH. Hashimoto thyroiditis
(D) is the most common cause but the question asks for the diagnosis based on lab
interpretation, which is primary hypothyroidism.
Question 2: A nurse practitioner is performing a comprehensive health history
using the OLDCARTS mnemonic. Which component of OLDCARTS assesses
what provokes or worsens the symptom?
A. Onset
B. Location
C. Aggravating factors
D. Timing
Rationale: OLDCARTS stands for Onset, Location, Duration, Characteristics,
Aggravating/Alleviating factors, Relieving factors, Timing, and Severity. The "A"
,component assesses what provokes or worsens the symptom, while "R" assesses
what relieves it.
Question 3: A 55-year-old man with type 2 diabetes mellitus presents with severe
right foot pain that started suddenly in the middle of the night after he had a steak
dinner with friends. Physical examination shows swelling and tenderness of the
first metatarsophalangeal joint. Joint aspiration is performed, and microscopic
findings from the synovial fluid reveal the presence of monosodium urate crystals.
Which of the following is the best initial treatment?
A. Allopurinol
B. Non-steroidal anti-inflammatory drugs (NSAIDs)
C. Prednisone
D. Probenecid
Rationale: This patient has acute gouty arthritis confirmed by the presence of
monosodium urate crystals in the synovial fluid. The best initial treatment for an
acute gout flare is NSAIDs (unless contraindicated). Allopurinol (A) and
probenecid (D) are used for chronic management (urine-lowering therapy) and
should not be started during an acute flare. Prednisone (C) is an alternative for
patients who cannot take NSAIDs but is not first-line.
Question 4: A 21-year-old woman has had urinary frequency and urgency for the
past 2 days. She has also noticed scant vaginal discharge. The patient has never
had these symptoms before. A urine sample is sent for urinalysis and culture.
Which of the following additional findings would be most suggestive of a
diagnosis of pyelonephritis?
A. Bacteriuria
B. Leukocytosis
C. Microscopic hematuria
D. White blood cell casts
Rationale: Both upper (e.g., pyelonephritis) and lower (e.g., cystitis) urinary tract
infections can show microscopic hematuria, pyuria, and bacteriuria on urinalysis.
However, the presence of white blood cell (WBC) casts can confirm the diagnosis
of pyelonephritis because WBC casts form only in the renal tubules, indicating
intrarenal pathology.
Question 5: A 72-year-old woman with a history of hypertension and type 2
diabetes presents for a routine visit. Her blood pressure today is 148/86 mm Hg.
,She has no symptoms of chest pain or shortness of breath. Which action is most
appropriate based on JNC 8 guidelines?
A. Start a thiazide diuretic immediately
B. Arrange for additional blood pressure measurements within the next four
weeks
C. Admit to the hospital for hypertensive urgency
D. Start an ACE inhibitor and a beta-blocker simultaneously
Rationale: For a patient with diabetes and hypertension, the target blood pressure
is <140/90 mm Hg. This patient's blood pressure is 148/86 mm Hg, which requires
confirmation with additional measurements before initiating or adjusting therapy.
Starting medication without confirmation is premature. Hospital admission is not
indicated for asymptomatic hypertension.
Question 6: A 28-year-old student is seen in the school health clinic with
complaints of a hacking cough that is productive of small amounts of sputum and a
runny nose. He does not take any medications and denies fever. The bacterium
responsible for the highest mortality in patients with community-acquired
pneumonia (CAP) is:
A. Mycoplasma pneumoniae
B. Moraxella catarrhalis
C. Streptococcus pneumoniae
D. Haemophilus influenzae
Rationale: Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia and is associated with the highest mortality rate. Mycoplasma
pneumoniae (A) typically causes milder "walking pneumonia." Moraxella
catarrhalis (B) and Haemophilus influenzae (D) are less common and typically less
severe.
Question 7: A 55-year-old man with a history of chronic obstructive pulmonary
disease (COPD) presents with worsening dyspnea and increased sputum
production. He is a current smoker with a 40-pack-year history. Which pulmonary
function test finding is most consistent with COPD?
A. FEV1/FVC ratio of 85%
B. FEV1/FVC ratio of 60%
C. FEV1/FVC ratio of 95%
D. Normal FEV1/FVC ratio with decreased diffusing capacity
, Rationale: COPD is characterized by an obstructive pattern on spirometry, defined
as an FEV1/FVC ratio of less than 70%. An FEV1/FVC ratio of 60% indicates
obstruction. A ratio of 85% or 95% (A, C) is normal. A normal ratio with
decreased diffusing capacity (D) suggests a restrictive pattern or early emphysema
without obstruction.
Question 8: A 62-year-old woman presents with a 3-week history of fatigue,
dyspnea on exertion, and palpitations. Her hemoglobin is 9.2 g/dL, MCV is 72 fL,
and ferritin is 8 ng/mL. What is the most likely diagnosis?
A. Vitamin B12 deficiency anemia
B. Iron deficiency anemia
C. Anemia of chronic disease
D. Hemolytic anemia
Rationale: The combination of low hemoglobin, low MCV (microcytic), and low
ferritin is diagnostic of iron deficiency anemia. Vitamin B12 deficiency (A)
presents with macrocytic anemia (high MCV). Anemia of chronic disease (C)
typically has normal or slightly low MCV with elevated ferritin. Hemolytic anemia
(D) would have elevated reticulocytes and indirect bilirubin.
Question 9: A 35-year-old woman presents with a painless, firm, solitary thyroid
nodule found on routine examination. She has no symptoms of hypo- or
hyperthyroidism. What is the most appropriate next step in evaluation?
A. Thyroid function tests only
B. Thyroid ultrasound and fine-needle aspiration (FNA)
C. Radioactive iodine uptake scan
D. Immediate surgical referral
Rationale: A solitary thyroid nodule requires evaluation to rule out malignancy.
Thyroid ultrasound is used to characterize the nodule, and FNA is the gold
standard for cytologic evaluation. Thyroid function tests (A) alone are insufficient.
Radioactive iodine uptake (C) is used for hyperthyroid conditions. Surgical referral
(D) is premature without cytologic diagnosis.
Question 10: A 68-year-old man presents with gradual onset of urinary hesitancy,
weak stream, and nocturia. Digital rectal examination reveals a smooth, enlarged
prostate without nodules. What is the most likely diagnosis?
