LEIK FNP PRACTICE QUESTIONS AND ANSWERS A+
GRADED WITH EXPERT SOLUTIONS - 130 Questions
with Answers
Page 1
,Q1. A patient with type 2 diabetes and stage 3 chronic kidney disease is prescribed
metformin. Which pharmacogenetic variant significantly increases the risk of lactic
acidosis, warranting heightened vigilance?
A. Polymorphism in the OCT2 transporter gene (SLC22A2)
B. Polymorphism in the MATE1 transporter gene (SLC47A1)
C. Polymorphism in the CYP2C9 gene
D. Polymorphism in the OATP1B1 transporter gene (SLCO1B1)
Correct Answer: B. Polymorphism in the MATE1 transporter gene (SLC47A1)
Rationale: Metformin is primarily eliminated via the organic cation transporter 2 (OCT2)
in the proximal tubule and multidrug and toxin extrusion protein 1 (MATE1) on the apical
membrane. Reduced-function polymorphisms in MATE1 (SLC47A1) decrease metformin
secretion, increasing plasma levels and the risk of lactic acidosis. OCT2 variants also
affect transport, but MATE1 has a more pronounced impact on net renal clearance.
Why Wrong:
A - OCT2 variants affect metformin uptake into tubular cells, but MATE1 variants
have a stronger association with lactic acidosis risk due to their role in the final step of
secretion.
C - CYP2C9 is involved in the metabolism of warfarin and NSAIDs, not metformin,
which is renally excreted unchanged.
D - OATP1B1 is a hepatic uptake transporter for statins, not metformin, and its
variants are linked to statin myopathy.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 50;
Giacomini, K.M. et al. (2013). Pharmacogenomics, 14(12).
Q2. In a patient with suspected acute bacterial rhinosinusitis, which clinical criterion
most reliably distinguishes the need for antibiotic therapy from viral rhinosinusitis?
A. Symptoms persisting beyond 7 days
B. Purulent nasal discharge with facial pain
C. Double sickening (worsening after initial improvement)
D. Fever greater than 38°C for at least 3 consecutive days
Correct Answer: C. Double sickening (worsening after initial improvement)
Rationale: The Infectious Diseases Society of America (IDSA) guideline states that acute
bacterial rhinosinusitis is likely when symptoms persist 10 days, or worsen within 10 days
after initial improvement (double sickening), or are severe (fever 39°C, purulent
discharge, facial pain) for 3 consecutive days. Double sickening is a specific and reliable
indicator of bacterial superinfection, whereas the other options are less specific.
Why Wrong:
A - Symptoms persisting beyond 7 days are common in viral rhinosinusitis, which
typically resolves by 10 days; the IDSA threshold is 10 days.
Page 2
, B - Purulent discharge and facial pain can occur in viral infections and are not
independently diagnostic.
D - Fever 38°C for 3 days is not severe enough; IDSA requires 39°C for severe
criteria.
Reference: Rosenfeld, R.M. et al. (2015). Otolaryngology-Head and Neck Surgery, 152(2
Suppl).
Q3. Which of the following laboratory findings is most consistent with a diagnosis of
nephrogenic diabetes insipidus (NDI) in a patient with persistent polyuria and
hypernatremia?
A. Low serum ADH levels with high urine osmolality after water deprivation
B. High serum ADH levels with low urine osmolality after desmopressin
administration
C. Low serum ADH levels with low urine osmolality that increases after desmopressin
D. High serum ADH levels with high urine osmolality after water deprivation
Correct Answer: B. High serum ADH levels with low urine osmolality after
desmopressin administration
Rationale: In NDI, the kidneys are resistant to ADH; thus, ADH levels are high or normal,
and the urine remains dilute despite water deprivation. Administration of desmopressin
fails to concentrate the urine, confirming renal unresponsiveness. Option C describes
central DI, where ADH is low and desmopressin produces a response.
Why Wrong:
A - Low ADH with high urine osmolality after deprivation is not typical; in central
DI, ADH is low but urine osmolality remains low.
C - This is the classic pattern for central DI, not nephrogenic DI.
D - High ADH with high urine osmolality suggests normal or appropriate ADH
response, not DI.
Reference: Kumar, V., Abbas, A.K., & Aster, J.C. (2020). Robbins & Cotran Pathologic
Basis of Disease, 10th Ed., Ch. 24.
Q4. A patient on lithium for bipolar disorder presents with coarse tremor, confusion,
and ataxia. Which medication is most likely to have contributed to this presentation
by increasing lithium levels?
A. Ibuprofen
B. Acetaminophen
C. Sertraline
D. Metformin
Correct Answer: A. Ibuprofen
Page 3
, Rationale: NSAIDs, including ibuprofen, reduce renal blood flow and inhibit
prostaglandin synthesis, leading to decreased glomerular filtration rate and reduced
lithium clearance, thus increasing serum lithium levels. This can precipitate lithium
toxicity, presenting with tremor, ataxia, and confusion. Acetaminophen, sertraline, and
metformin do not significantly affect lithium clearance.
Why Wrong:
B - Acetaminophen does not affect renal prostaglandins or lithium clearance.
C - Sertraline may rarely cause hyponatremia, but it does not directly increase lithium
levels.
D - Metformin does not interact with lithium pharmacokinetics.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 31.
Q5. Which of the following ECG findings is most specific for hyperkalemia and
indicates imminent risk of cardiac arrest?
A. Prominent U waves
B. Sinus bradycardia with PR prolongation
C. Sine wave pattern
D. ST-segment depression with T-wave inversion
Correct Answer: C. Sine wave pattern
Rationale: A sine wave pattern (fusion of QRS and T waves) is a terminal ECG
manifestation of severe hyperkalemia and precedes ventricular fibrillation or asystole. It
requires immediate treatment with calcium gluconate. Prominent U waves are associated
with hypokalemia, not hyperkalemia. Sinus bradycardia and ST-T changes are non-specific
and may occur in other conditions.
Why Wrong:
A - Prominent U waves are characteristic of hypokalemia, not hyperkalemia.
B - Sinus bradycardia with PR prolongation can occur in hyperkalemia but is not
specific or immediately life-threatening.
D - ST depression and T-wave inversion are seen in ischemia, not specifically
hyperkalemia.
Reference: Marx, J.A. et al. (2014). Rosen's Emergency Medicine, 8th Ed., Ch. 106.
Q6. A patient with major depressive disorder has failed adequate trials of two SSRIs.
Which strategy is most consistent with current evidence-based guidelines for
treatment-resistant depression?
A. Augmentation with a second-generation antipsychotic
B. Switching to a monoamine oxidase inhibitor (MAOI)
C. Adding a benzodiazepine for anxiety
D. Increasing the SSRI dose beyond the maximum recommended
Page 4
GRADED WITH EXPERT SOLUTIONS - 130 Questions
with Answers
Page 1
,Q1. A patient with type 2 diabetes and stage 3 chronic kidney disease is prescribed
metformin. Which pharmacogenetic variant significantly increases the risk of lactic
acidosis, warranting heightened vigilance?
A. Polymorphism in the OCT2 transporter gene (SLC22A2)
B. Polymorphism in the MATE1 transporter gene (SLC47A1)
C. Polymorphism in the CYP2C9 gene
D. Polymorphism in the OATP1B1 transporter gene (SLCO1B1)
Correct Answer: B. Polymorphism in the MATE1 transporter gene (SLC47A1)
Rationale: Metformin is primarily eliminated via the organic cation transporter 2 (OCT2)
in the proximal tubule and multidrug and toxin extrusion protein 1 (MATE1) on the apical
membrane. Reduced-function polymorphisms in MATE1 (SLC47A1) decrease metformin
secretion, increasing plasma levels and the risk of lactic acidosis. OCT2 variants also
affect transport, but MATE1 has a more pronounced impact on net renal clearance.
Why Wrong:
A - OCT2 variants affect metformin uptake into tubular cells, but MATE1 variants
have a stronger association with lactic acidosis risk due to their role in the final step of
secretion.
C - CYP2C9 is involved in the metabolism of warfarin and NSAIDs, not metformin,
which is renally excreted unchanged.
D - OATP1B1 is a hepatic uptake transporter for statins, not metformin, and its
variants are linked to statin myopathy.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 50;
Giacomini, K.M. et al. (2013). Pharmacogenomics, 14(12).
Q2. In a patient with suspected acute bacterial rhinosinusitis, which clinical criterion
most reliably distinguishes the need for antibiotic therapy from viral rhinosinusitis?
A. Symptoms persisting beyond 7 days
B. Purulent nasal discharge with facial pain
C. Double sickening (worsening after initial improvement)
D. Fever greater than 38°C for at least 3 consecutive days
Correct Answer: C. Double sickening (worsening after initial improvement)
Rationale: The Infectious Diseases Society of America (IDSA) guideline states that acute
bacterial rhinosinusitis is likely when symptoms persist 10 days, or worsen within 10 days
after initial improvement (double sickening), or are severe (fever 39°C, purulent
discharge, facial pain) for 3 consecutive days. Double sickening is a specific and reliable
indicator of bacterial superinfection, whereas the other options are less specific.
Why Wrong:
A - Symptoms persisting beyond 7 days are common in viral rhinosinusitis, which
typically resolves by 10 days; the IDSA threshold is 10 days.
Page 2
, B - Purulent discharge and facial pain can occur in viral infections and are not
independently diagnostic.
D - Fever 38°C for 3 days is not severe enough; IDSA requires 39°C for severe
criteria.
Reference: Rosenfeld, R.M. et al. (2015). Otolaryngology-Head and Neck Surgery, 152(2
Suppl).
Q3. Which of the following laboratory findings is most consistent with a diagnosis of
nephrogenic diabetes insipidus (NDI) in a patient with persistent polyuria and
hypernatremia?
A. Low serum ADH levels with high urine osmolality after water deprivation
B. High serum ADH levels with low urine osmolality after desmopressin
administration
C. Low serum ADH levels with low urine osmolality that increases after desmopressin
D. High serum ADH levels with high urine osmolality after water deprivation
Correct Answer: B. High serum ADH levels with low urine osmolality after
desmopressin administration
Rationale: In NDI, the kidneys are resistant to ADH; thus, ADH levels are high or normal,
and the urine remains dilute despite water deprivation. Administration of desmopressin
fails to concentrate the urine, confirming renal unresponsiveness. Option C describes
central DI, where ADH is low and desmopressin produces a response.
Why Wrong:
A - Low ADH with high urine osmolality after deprivation is not typical; in central
DI, ADH is low but urine osmolality remains low.
C - This is the classic pattern for central DI, not nephrogenic DI.
D - High ADH with high urine osmolality suggests normal or appropriate ADH
response, not DI.
Reference: Kumar, V., Abbas, A.K., & Aster, J.C. (2020). Robbins & Cotran Pathologic
Basis of Disease, 10th Ed., Ch. 24.
Q4. A patient on lithium for bipolar disorder presents with coarse tremor, confusion,
and ataxia. Which medication is most likely to have contributed to this presentation
by increasing lithium levels?
A. Ibuprofen
B. Acetaminophen
C. Sertraline
D. Metformin
Correct Answer: A. Ibuprofen
Page 3
, Rationale: NSAIDs, including ibuprofen, reduce renal blood flow and inhibit
prostaglandin synthesis, leading to decreased glomerular filtration rate and reduced
lithium clearance, thus increasing serum lithium levels. This can precipitate lithium
toxicity, presenting with tremor, ataxia, and confusion. Acetaminophen, sertraline, and
metformin do not significantly affect lithium clearance.
Why Wrong:
B - Acetaminophen does not affect renal prostaglandins or lithium clearance.
C - Sertraline may rarely cause hyponatremia, but it does not directly increase lithium
levels.
D - Metformin does not interact with lithium pharmacokinetics.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 31.
Q5. Which of the following ECG findings is most specific for hyperkalemia and
indicates imminent risk of cardiac arrest?
A. Prominent U waves
B. Sinus bradycardia with PR prolongation
C. Sine wave pattern
D. ST-segment depression with T-wave inversion
Correct Answer: C. Sine wave pattern
Rationale: A sine wave pattern (fusion of QRS and T waves) is a terminal ECG
manifestation of severe hyperkalemia and precedes ventricular fibrillation or asystole. It
requires immediate treatment with calcium gluconate. Prominent U waves are associated
with hypokalemia, not hyperkalemia. Sinus bradycardia and ST-T changes are non-specific
and may occur in other conditions.
Why Wrong:
A - Prominent U waves are characteristic of hypokalemia, not hyperkalemia.
B - Sinus bradycardia with PR prolongation can occur in hyperkalemia but is not
specific or immediately life-threatening.
D - ST depression and T-wave inversion are seen in ischemia, not specifically
hyperkalemia.
Reference: Marx, J.A. et al. (2014). Rosen's Emergency Medicine, 8th Ed., Ch. 106.
Q6. A patient with major depressive disorder has failed adequate trials of two SSRIs.
Which strategy is most consistent with current evidence-based guidelines for
treatment-resistant depression?
A. Augmentation with a second-generation antipsychotic
B. Switching to a monoamine oxidase inhibitor (MAOI)
C. Adding a benzodiazepine for anxiety
D. Increasing the SSRI dose beyond the maximum recommended
Page 4
