Latest LEIK FNP Exam verified with correct answers plus rationales 2026/2027
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1. A 45-year-old patient with type 2 diabetes is started on metformin. Which of the
following is the most important adverse effect to monitor for?
• A) Hypoglycemia
• B) Lactic acidosis
• C) Weight gain
• D) Upper respiratory infection
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but serious
complication. It is most common in patients with renal impairment, liver disease, or conditions
that predispose to hypoxia. Metformin does not typically cause hypoglycemia when used as
monotherapy. Weight loss is actually a potential benefit, and upper respiratory infections are not
a primary adverse effect.
2. A 72-year-old patient with chronic pain from osteoarthritis is prescribed celecoxib. A
history of which condition should raise a red flag for the use of this medication?
• A) Hypertension
• B) Gastroesophageal reflux disease
• C) Coronary artery disease
• D) Asthma
Correct Answer: C
Rationale: Celecoxib is a COX-2 selective NSAID that is associated with an increased risk of
thrombotic cardiovascular events, particularly in patients with existing cardiovascular disease.
While hypertension, GERD, and asthma are all important considerations with NSAIDs, a history
of coronary artery disease is a significant relative contraindication to celecoxib use.
3. A patient presents with symptoms of a urinary tract infection and is prescribed
trimethoprim-sulfamethoxazole. What is the most important counseling point regarding
this medication?
, • A) Take with food to avoid GI upset
• B) Avoid prolonged sun exposure due to photosensitivity risk
• C) Increase fluid intake to prevent crystalluria
• D) Take the medication at bedtime to reduce side effects
Correct Answer: C
Rationale: Trimethoprim-sulfamethoxazole can precipitate in the urine, leading to crystalluria.
Adequate fluid intake is essential to maintain urine output and prevent this complication. While
photosensitivity and GI upset can occur, crystalluria is a more specific and potentially serious
concern associated with this drug.
4. A 60-year-old patient with hypertension and type 2 diabetes is started on lisinopril.
Which of the following statements about this medication is true?
• A) It should be avoided in patients with a history of angioedema
• B) It is metabolized primarily by the liver
• C) It is contraindicated in patients with diabetic nephropathy
• D) It can be safely used with a potassium-sparing diuretic without risk
Correct Answer: A
Rationale: Angioedema is a rare but serious adverse effect of ACE inhibitors like lisinopril. It
should be avoided in patients with a history of this condition. Lisinopril is excreted renally, not
primarily metabolized by the liver, and is actually beneficial in diabetic nephropathy. Using it
with a potassium-sparing diuretic increases the risk of hyperkalemia.
5. A 35-year-old female with anxiety disorder is prescribed sertraline (Zoloft). What is the
most important counseling point regarding initiation of this medication?
• A) It will take 4-6 weeks for therapeutic effects to be fully realized
• B) It may cause immediate and significant weight loss
• C) It has a low risk of sexual dysfunction compared to other SSRIs
• D) It can be taken on an as-needed basis for anxiety symptoms
Correct Answer: A
Rationale: SSRIs like sertraline require a 4-6 week period to achieve full therapeutic benefit.
Patients need to understand that the medication is not immediately effective and requires
,consistent daily use. Sexual dysfunction is a common side effect of SSRIs, and they are not prn
medications for anxiety.
6. A patient with moderate COPD is prescribed tiotropium (Spiriva). What is the most
important patient education point regarding this medication?
• A) It is a rescue inhaler for acute exacerbations of dyspnea
• B) It should be used only when symptoms are severe
• C) It is a maintenance medication for daily use to manage symptoms
• D) It has a rapid onset of action similar to albuterol
Correct Answer: C
Rationale: Tiotropium is a long-acting anticholinergic (LAMA) used as a maintenance
medication for COPD. It should be taken daily, even when the patient is not experiencing
symptoms, to help keep the airways open and prevent exacerbations. It is not a rescue
medication; patients should not use it for acute relief.
7. The FDA has issued a black box warning for fluoroquinolone antibiotics like
ciprofloxacin. This warning is primarily due to the risk of:
• A) Hepatotoxicity
• B) Tendon rupture
• C) Hypoglycemia
• D) Photosensitivity
Correct Answer: B
Rationale: Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture.
The risk is increased in elderly patients, those on corticosteroids, and those with organ
transplants. Patients should be counseled to discontinue the medication and rest the affected
limb if they experience tendon pain.
8. A patient is prescribed warfarin for atrial fibrillation. Which of the following dietary
supplements is most likely to interfere with its anticoagulant effect?
• A) Fish oil
, • B) Vitamin C
• C) St. John's Wort
• D) St. John's Wort
Correct Answer: C
Rationale: St. John's Wort is a potent inducer of the cytochrome P450 system and reduces the
effectiveness of warfarin by increasing its metabolism. This can lead to subtherapeutic INR
levels and an increased risk of thromboembolism. Patients on warfarin should avoid this
supplement.
9. A patient is newly diagnosed with hypothyroidism and started on levothyroxine. Which
instruction is most important regarding the administration of this medication?
• A) Take with food to reduce GI upset
• B) Take on an empty stomach with water
• C) Take with a high-fiber breakfast
• D) Take with calcium supplements to enhance absorption
Correct Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach, typically 30-60 minutes before
breakfast. Food, especially calcium and iron supplements, and high-fiber meals can significantly
reduce its absorption, leading to inconsistent therapeutic levels.
10. A 50-year-old patient with asthma is prescribed inhaled fluticasone (Flovent). Which of
the following is an important side effect to monitor for?
• A) Tachycardia
• B) Oral thrush
• C) Wheezing
• D) Theophylline toxicity
Correct Answer: B
Rationale: Inhaled corticosteroids (ICS) like fluticasone can suppress local immunity in the
oropharynx, increasing the risk of oral candidiasis (thrush). Patients should be instructed to
rinse their mouth with water and spit after each use to minimize this risk.
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1. A 45-year-old patient with type 2 diabetes is started on metformin. Which of the
following is the most important adverse effect to monitor for?
• A) Hypoglycemia
• B) Lactic acidosis
• C) Weight gain
• D) Upper respiratory infection
Correct Answer: B
Rationale: Metformin carries a black box warning for lactic acidosis, a rare but serious
complication. It is most common in patients with renal impairment, liver disease, or conditions
that predispose to hypoxia. Metformin does not typically cause hypoglycemia when used as
monotherapy. Weight loss is actually a potential benefit, and upper respiratory infections are not
a primary adverse effect.
2. A 72-year-old patient with chronic pain from osteoarthritis is prescribed celecoxib. A
history of which condition should raise a red flag for the use of this medication?
• A) Hypertension
• B) Gastroesophageal reflux disease
• C) Coronary artery disease
• D) Asthma
Correct Answer: C
Rationale: Celecoxib is a COX-2 selective NSAID that is associated with an increased risk of
thrombotic cardiovascular events, particularly in patients with existing cardiovascular disease.
While hypertension, GERD, and asthma are all important considerations with NSAIDs, a history
of coronary artery disease is a significant relative contraindication to celecoxib use.
3. A patient presents with symptoms of a urinary tract infection and is prescribed
trimethoprim-sulfamethoxazole. What is the most important counseling point regarding
this medication?
, • A) Take with food to avoid GI upset
• B) Avoid prolonged sun exposure due to photosensitivity risk
• C) Increase fluid intake to prevent crystalluria
• D) Take the medication at bedtime to reduce side effects
Correct Answer: C
Rationale: Trimethoprim-sulfamethoxazole can precipitate in the urine, leading to crystalluria.
Adequate fluid intake is essential to maintain urine output and prevent this complication. While
photosensitivity and GI upset can occur, crystalluria is a more specific and potentially serious
concern associated with this drug.
4. A 60-year-old patient with hypertension and type 2 diabetes is started on lisinopril.
Which of the following statements about this medication is true?
• A) It should be avoided in patients with a history of angioedema
• B) It is metabolized primarily by the liver
• C) It is contraindicated in patients with diabetic nephropathy
• D) It can be safely used with a potassium-sparing diuretic without risk
Correct Answer: A
Rationale: Angioedema is a rare but serious adverse effect of ACE inhibitors like lisinopril. It
should be avoided in patients with a history of this condition. Lisinopril is excreted renally, not
primarily metabolized by the liver, and is actually beneficial in diabetic nephropathy. Using it
with a potassium-sparing diuretic increases the risk of hyperkalemia.
5. A 35-year-old female with anxiety disorder is prescribed sertraline (Zoloft). What is the
most important counseling point regarding initiation of this medication?
• A) It will take 4-6 weeks for therapeutic effects to be fully realized
• B) It may cause immediate and significant weight loss
• C) It has a low risk of sexual dysfunction compared to other SSRIs
• D) It can be taken on an as-needed basis for anxiety symptoms
Correct Answer: A
Rationale: SSRIs like sertraline require a 4-6 week period to achieve full therapeutic benefit.
Patients need to understand that the medication is not immediately effective and requires
,consistent daily use. Sexual dysfunction is a common side effect of SSRIs, and they are not prn
medications for anxiety.
6. A patient with moderate COPD is prescribed tiotropium (Spiriva). What is the most
important patient education point regarding this medication?
• A) It is a rescue inhaler for acute exacerbations of dyspnea
• B) It should be used only when symptoms are severe
• C) It is a maintenance medication for daily use to manage symptoms
• D) It has a rapid onset of action similar to albuterol
Correct Answer: C
Rationale: Tiotropium is a long-acting anticholinergic (LAMA) used as a maintenance
medication for COPD. It should be taken daily, even when the patient is not experiencing
symptoms, to help keep the airways open and prevent exacerbations. It is not a rescue
medication; patients should not use it for acute relief.
7. The FDA has issued a black box warning for fluoroquinolone antibiotics like
ciprofloxacin. This warning is primarily due to the risk of:
• A) Hepatotoxicity
• B) Tendon rupture
• C) Hypoglycemia
• D) Photosensitivity
Correct Answer: B
Rationale: Fluoroquinolones carry a black box warning for tendinopathy and tendon rupture.
The risk is increased in elderly patients, those on corticosteroids, and those with organ
transplants. Patients should be counseled to discontinue the medication and rest the affected
limb if they experience tendon pain.
8. A patient is prescribed warfarin for atrial fibrillation. Which of the following dietary
supplements is most likely to interfere with its anticoagulant effect?
• A) Fish oil
, • B) Vitamin C
• C) St. John's Wort
• D) St. John's Wort
Correct Answer: C
Rationale: St. John's Wort is a potent inducer of the cytochrome P450 system and reduces the
effectiveness of warfarin by increasing its metabolism. This can lead to subtherapeutic INR
levels and an increased risk of thromboembolism. Patients on warfarin should avoid this
supplement.
9. A patient is newly diagnosed with hypothyroidism and started on levothyroxine. Which
instruction is most important regarding the administration of this medication?
• A) Take with food to reduce GI upset
• B) Take on an empty stomach with water
• C) Take with a high-fiber breakfast
• D) Take with calcium supplements to enhance absorption
Correct Answer: B
Rationale: Levothyroxine is best absorbed on an empty stomach, typically 30-60 minutes before
breakfast. Food, especially calcium and iron supplements, and high-fiber meals can significantly
reduce its absorption, leading to inconsistent therapeutic levels.
10. A 50-year-old patient with asthma is prescribed inhaled fluticasone (Flovent). Which of
the following is an important side effect to monitor for?
• A) Tachycardia
• B) Oral thrush
• C) Wheezing
• D) Theophylline toxicity
Correct Answer: B
Rationale: Inhaled corticosteroids (ICS) like fluticasone can suppress local immunity in the
oropharynx, increasing the risk of oral candidiasis (thrush). Patients should be instructed to
rinse their mouth with water and spit after each use to minimize this risk.
