.
**Theme Selected:** Family Nurse
Practitioner Certification Exam 2024
**Target Question Count:** 80
**The Primary Care Lens: NGN FNP Mastery**
---
1. 45-year-old, BMI 34, hypertension, fasting glucose 118 mg/dL. Next diagnostic?
💫RATIONALE✔️✔️: Impaired fasting glucose. Diagnose prediabetes with HbA1c or 2h OGTT.
💫ANSWER✔️✔️: C. Hemoglobin A1c
---
2. 30-year-old female, fatigue, weight gain, constipation, cold intolerance. TSH 12 mIU/L. Next?
💫RATIONALE✔️✔️: Hypothyroidism. Start levothyroxine 1.6 mcg/kg/day. Check free T4.
💫ANSWER✔️✔️: B. Levothyroxine 75 mcg daily
---
3. 55-year-old, episodic retrosternal chest pressure with exertion, relieved by rest. ECG normal. Next?
💫RATIONALE✔️✔️: Stable angina. Exercise stress test or coronary CTA.
💫ANSWER✔️✔️: D. Exercise treadmill test
---
,4. 8-year-old, sore throat, fever 101°F, exudative tonsils, anterior cervical lymphadenopathy, no cough.
Next?
💫RATIONALE✔️✔️: Centor criteria 4/4. Rapid strep test or throat culture.
💫ANSWER✔️✔️: A. Rapid antigen detection test
---
5. 25-year-old, dysuria, frequency, no vaginal discharge. Urinalysis: nitrites positive, WBCs. Next?
💫RATIONALE✔️✔️: Uncomplicated cystitis. Nitrofurantoin 100 mg BID x 5 days.
💫ANSWER✔️✔️: C. Nitrofurantoin
---
6. 65-year-old, acute confusion, fever, dysuria. Urinalysis: leukocyte esterase positive. Next?
💫RATIONALE✔️✔️: Delirium from UTI. Treat with antibiotics based on culture.
💫ANSWER✔️✔️: B. Obtain urine culture and start empiric antibiotics
---
7. 60-year-old, chronic cough, 40 pack-year smoking history. COPD on spirometry? FEV1/FVC ratio?
💫RATIONALE✔️✔️: GOLD criteria: post-bronchodilator FEV1/FVC <0.70.
💫ANSWER✔️✔️: A. <0.70
---
8. 35-year-old, acute asthma exacerbation, peak flow 50% personal best, no distress. Next?
💫RATIONALE✔️✔️: Moderate exacerbation. Albuterol 2-4 puffs q20min x 3, then reassess.
💫ANSWER✔️✔️: D. Albuterol via MDI with spacer
---
9. 50-year-old, knee pain, morning stiffness <30 min, crepitus, no swelling. X-ray joint space narrowing.
Diagnosis?
💫RATIONALE✔️✔️: Osteoarthritis. Mechanical symptoms, no inflammatory signs.
, 💫ANSWER✔️✔️: B. Osteoarthritis
---
10. 40-year-old, symmetric small joint pain, morning stiffness >60 min, fatigue. Rheumatoid factor
positive. Next?
💫RATIONALE✔️✔️: Rheumatoid arthritis. Start methotrexate, refer to rheumatology.
💫ANSWER✔️✔️: C. Methotrexate and rheumatology referral
---
11. 55-year-old, acute monoarticular gout, first metatarsophalangeal, painful, swollen. Next?
💫RATIONALE✔️✔️: Acute gout flare. NSAIDs, colchicine, or corticosteroids. Not allopurinol.
💫ANSWER✔️✔️: A. Indomethacin 50 mg TID
---
12. 28-year-old, low back pain for 2 weeks, mechanical, no red flags. Next?
💫RATIONALE✔️✔️: Acute nonspecific low back pain. NSAIDs, heat, remain active.
💫ANSWER✔️✔️: D. Ibuprofen and resume normal activities
---
13. 70-year-old, fall, hip pain, unable to bear weight. X-ray femoral neck fracture. Next?
💫RATIONALE✔️✔️: Hip fracture. Orthopedic consult, analgesia, surgery.
💫ANSWER✔️✔️: B. Orthopedic surgery referral
---
14. 8-year-old, limp, hip pain, low-grade fever, recent URI. X-ray normal, ESR 40. Suspect?
💫RATIONALE✔️✔️: Transient synovitis (irritable hip). Ultrasound for effusion.
💫ANSWER✔️✔️: A. Transient synovitis
**Theme Selected:** Family Nurse
Practitioner Certification Exam 2024
**Target Question Count:** 80
**The Primary Care Lens: NGN FNP Mastery**
---
1. 45-year-old, BMI 34, hypertension, fasting glucose 118 mg/dL. Next diagnostic?
💫RATIONALE✔️✔️: Impaired fasting glucose. Diagnose prediabetes with HbA1c or 2h OGTT.
💫ANSWER✔️✔️: C. Hemoglobin A1c
---
2. 30-year-old female, fatigue, weight gain, constipation, cold intolerance. TSH 12 mIU/L. Next?
💫RATIONALE✔️✔️: Hypothyroidism. Start levothyroxine 1.6 mcg/kg/day. Check free T4.
💫ANSWER✔️✔️: B. Levothyroxine 75 mcg daily
---
3. 55-year-old, episodic retrosternal chest pressure with exertion, relieved by rest. ECG normal. Next?
💫RATIONALE✔️✔️: Stable angina. Exercise stress test or coronary CTA.
💫ANSWER✔️✔️: D. Exercise treadmill test
---
,4. 8-year-old, sore throat, fever 101°F, exudative tonsils, anterior cervical lymphadenopathy, no cough.
Next?
💫RATIONALE✔️✔️: Centor criteria 4/4. Rapid strep test or throat culture.
💫ANSWER✔️✔️: A. Rapid antigen detection test
---
5. 25-year-old, dysuria, frequency, no vaginal discharge. Urinalysis: nitrites positive, WBCs. Next?
💫RATIONALE✔️✔️: Uncomplicated cystitis. Nitrofurantoin 100 mg BID x 5 days.
💫ANSWER✔️✔️: C. Nitrofurantoin
---
6. 65-year-old, acute confusion, fever, dysuria. Urinalysis: leukocyte esterase positive. Next?
💫RATIONALE✔️✔️: Delirium from UTI. Treat with antibiotics based on culture.
💫ANSWER✔️✔️: B. Obtain urine culture and start empiric antibiotics
---
7. 60-year-old, chronic cough, 40 pack-year smoking history. COPD on spirometry? FEV1/FVC ratio?
💫RATIONALE✔️✔️: GOLD criteria: post-bronchodilator FEV1/FVC <0.70.
💫ANSWER✔️✔️: A. <0.70
---
8. 35-year-old, acute asthma exacerbation, peak flow 50% personal best, no distress. Next?
💫RATIONALE✔️✔️: Moderate exacerbation. Albuterol 2-4 puffs q20min x 3, then reassess.
💫ANSWER✔️✔️: D. Albuterol via MDI with spacer
---
9. 50-year-old, knee pain, morning stiffness <30 min, crepitus, no swelling. X-ray joint space narrowing.
Diagnosis?
💫RATIONALE✔️✔️: Osteoarthritis. Mechanical symptoms, no inflammatory signs.
, 💫ANSWER✔️✔️: B. Osteoarthritis
---
10. 40-year-old, symmetric small joint pain, morning stiffness >60 min, fatigue. Rheumatoid factor
positive. Next?
💫RATIONALE✔️✔️: Rheumatoid arthritis. Start methotrexate, refer to rheumatology.
💫ANSWER✔️✔️: C. Methotrexate and rheumatology referral
---
11. 55-year-old, acute monoarticular gout, first metatarsophalangeal, painful, swollen. Next?
💫RATIONALE✔️✔️: Acute gout flare. NSAIDs, colchicine, or corticosteroids. Not allopurinol.
💫ANSWER✔️✔️: A. Indomethacin 50 mg TID
---
12. 28-year-old, low back pain for 2 weeks, mechanical, no red flags. Next?
💫RATIONALE✔️✔️: Acute nonspecific low back pain. NSAIDs, heat, remain active.
💫ANSWER✔️✔️: D. Ibuprofen and resume normal activities
---
13. 70-year-old, fall, hip pain, unable to bear weight. X-ray femoral neck fracture. Next?
💫RATIONALE✔️✔️: Hip fracture. Orthopedic consult, analgesia, surgery.
💫ANSWER✔️✔️: B. Orthopedic surgery referral
---
14. 8-year-old, limp, hip pain, low-grade fever, recent URI. X-ray normal, ESR 40. Suspect?
💫RATIONALE✔️✔️: Transient synovitis (irritable hip). Ultrasound for effusion.
💫ANSWER✔️✔️: A. Transient synovitis
