Leik FNP Certification Review Family Nurse
Practitioner Exam Prep with Practice
Questions and Correct Answers 2026/2027
Question 1
A 55-year-old male with hypertension and diabetes has a blood pressure of 148/92 mmHg. His
A1c is 7.8%. Which medication class is first-line for hypertension in this patient?
A) Thiazide diuretic
B) ACE inhibitor
C) Beta-blocker
D) Calcium channel blocker
Answer
Answer: B
Rationale
ACE inhibitors or ARBs are first-line in diabetes with hypertension due to renal protection. Target BP
<130/80.
Question 2
A 28-year-old female presents with dysuria, frequency, and suprapubic pain. Urinalysis shows
nitrites and leukocyte esterase. She is not pregnant. What is the first-line antibiotic?
A) Ciprofloxacin 500 mg BID x3 days
B) Nitrofurantoin 100 mg BID x5 days
C) Amoxicillin 500 mg TID x7 days
D) TMP-SMX DS BID x3 days if resistance <20%
Answer
Answer: B
Rationale
Nitrofurantoin is first-line for uncomplicated cystitis. TMP-SMX is alternative if local resistance <20%.
,Question 3
A 62-year-old male with COPD (FEV1 55%) presents with increased dyspnea and purulent
sputum. He has had 2 exacerbations in the past year. Which antibiotic is appropriate?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Azithromycin
D) Levofloxacin
Answer
Answer: B
Rationale
For severe COPD or frequent exacerbations, amoxicillin-clavulanate or a fluoroquinolone is
recommended.
Question 4
A 45-year-old female with type 2 diabetes has an A1c of 9.0% on metformin 2000 mg/day. What
is the next step?
A) Add a sulfonylurea
B) Add a GLP-1 receptor agonist or SGLT2 inhibitor
C) Start basal insulin
D) Add a DPP-4 inhibitor
Answer
Answer: B
Rationale
For A1c >9% without symptoms, add a second agent with cardiovascular/renal benefits. Insulin if
symptomatic.
Question 5
A 30-year-old female requests contraception. She has a history of migraine with aura. Which
2
,contraceptive is contraindicated?
A) Progestin-only pill
B) Combined oral contraceptive
C) Copper IUD
D) Levonorgestrel IUD
Answer
Answer: B
Rationale
Estrogen-containing contraceptives increase stroke risk in women with migraine with aura.
Question 6
A 70-year-old male presents with a 2-week history of progressive confusion, gait disturbance,
and urinary incontinence. Head CT shows enlarged ventricles. What is the most likely
diagnosis?
A) Alzheimer’s disease
B) Normal pressure hydrocephalus
C) Parkinson’s disease
D) Vascular dementia
Answer
Answer: B
Rationale
NPH triad: gait apraxia, cognitive decline, urinary incontinence. Shunt may improve symptoms.
Question 7
A 25-year-old female presents with a 2-day history of severe sore throat, fever, and tonsillar
exudates. Rapid strep is positive. What is the treatment?
A) Amoxicillin 500 mg BID x10 days
B) Penicillin V 500 mg BID x10 days
C) Azithromycin 500 mg x1 then 250 mg x4 days
D) No antibiotics needed
3
, Answer
Answer: B
Rationale
Penicillin or amoxicillin is first-line for group A strep pharyngitis to prevent rheumatic fever.
Question 8
A 55-year-old female with GERD has persistent symptoms despite omeprazole 20 mg daily.
What is the next step?
A) Increase omeprazole to 40 mg daily
B) Increase omeprazole to 40 mg daily (yes)
C) Add metoclopramide
D) Refer for endoscopy
Answer
Answer: A
Rationale
For refractory GERD, double PPI dose or switch to another PPI before endoscopy, unless alarm
symptoms.
Question 9
A 68-year-old male with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the
recommended anticoagulation?
A) Aspirin 81 mg daily
B) Direct oral anticoagulant (apixaban, rivaroxaban) or warfarin
C) No anticoagulation
D) Clopidogrel
Answer
Answer: B
Rationale
4
Practitioner Exam Prep with Practice
Questions and Correct Answers 2026/2027
Question 1
A 55-year-old male with hypertension and diabetes has a blood pressure of 148/92 mmHg. His
A1c is 7.8%. Which medication class is first-line for hypertension in this patient?
A) Thiazide diuretic
B) ACE inhibitor
C) Beta-blocker
D) Calcium channel blocker
Answer
Answer: B
Rationale
ACE inhibitors or ARBs are first-line in diabetes with hypertension due to renal protection. Target BP
<130/80.
Question 2
A 28-year-old female presents with dysuria, frequency, and suprapubic pain. Urinalysis shows
nitrites and leukocyte esterase. She is not pregnant. What is the first-line antibiotic?
A) Ciprofloxacin 500 mg BID x3 days
B) Nitrofurantoin 100 mg BID x5 days
C) Amoxicillin 500 mg TID x7 days
D) TMP-SMX DS BID x3 days if resistance <20%
Answer
Answer: B
Rationale
Nitrofurantoin is first-line for uncomplicated cystitis. TMP-SMX is alternative if local resistance <20%.
,Question 3
A 62-year-old male with COPD (FEV1 55%) presents with increased dyspnea and purulent
sputum. He has had 2 exacerbations in the past year. Which antibiotic is appropriate?
A) Doxycycline
B) Amoxicillin-clavulanate
C) Azithromycin
D) Levofloxacin
Answer
Answer: B
Rationale
For severe COPD or frequent exacerbations, amoxicillin-clavulanate or a fluoroquinolone is
recommended.
Question 4
A 45-year-old female with type 2 diabetes has an A1c of 9.0% on metformin 2000 mg/day. What
is the next step?
A) Add a sulfonylurea
B) Add a GLP-1 receptor agonist or SGLT2 inhibitor
C) Start basal insulin
D) Add a DPP-4 inhibitor
Answer
Answer: B
Rationale
For A1c >9% without symptoms, add a second agent with cardiovascular/renal benefits. Insulin if
symptomatic.
Question 5
A 30-year-old female requests contraception. She has a history of migraine with aura. Which
2
,contraceptive is contraindicated?
A) Progestin-only pill
B) Combined oral contraceptive
C) Copper IUD
D) Levonorgestrel IUD
Answer
Answer: B
Rationale
Estrogen-containing contraceptives increase stroke risk in women with migraine with aura.
Question 6
A 70-year-old male presents with a 2-week history of progressive confusion, gait disturbance,
and urinary incontinence. Head CT shows enlarged ventricles. What is the most likely
diagnosis?
A) Alzheimer’s disease
B) Normal pressure hydrocephalus
C) Parkinson’s disease
D) Vascular dementia
Answer
Answer: B
Rationale
NPH triad: gait apraxia, cognitive decline, urinary incontinence. Shunt may improve symptoms.
Question 7
A 25-year-old female presents with a 2-day history of severe sore throat, fever, and tonsillar
exudates. Rapid strep is positive. What is the treatment?
A) Amoxicillin 500 mg BID x10 days
B) Penicillin V 500 mg BID x10 days
C) Azithromycin 500 mg x1 then 250 mg x4 days
D) No antibiotics needed
3
, Answer
Answer: B
Rationale
Penicillin or amoxicillin is first-line for group A strep pharyngitis to prevent rheumatic fever.
Question 8
A 55-year-old female with GERD has persistent symptoms despite omeprazole 20 mg daily.
What is the next step?
A) Increase omeprazole to 40 mg daily
B) Increase omeprazole to 40 mg daily (yes)
C) Add metoclopramide
D) Refer for endoscopy
Answer
Answer: A
Rationale
For refractory GERD, double PPI dose or switch to another PPI before endoscopy, unless alarm
symptoms.
Question 9
A 68-year-old male with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is the
recommended anticoagulation?
A) Aspirin 81 mg daily
B) Direct oral anticoagulant (apixaban, rivaroxaban) or warfarin
C) No anticoagulation
D) Clopidogrel
Answer
Answer: B
Rationale
4
