FNP Practice Questions (2026) — Free Sample Questions with Answers

Answer: A

Left sensorineural hearing loss: Correct. In sensorineural loss, the Weber test lateralizes to the better (unaffected) ear, here the right, and the Rinne test stays normal (AC > BC) on both sides. Combined with his left-sided complaint, this indicates left sensorineural hearing loss. Asymmetric sensorineural loss warrants audiometry and ENT referral to exclude a retrocochlear lesion.

Left conductive hearing loss: Left conductive loss would lateralize the Weber test to the left and show BC > AC on the left Rinne.

Right conductive hearing loss: Right conductive loss would lateralize to the right but would show BC > AC on the right Rinne.

Right sensorineural hearing loss: Right sensorineural loss would lateralize the Weber test to the left, the better ear.

Weber lateralizes toward a conductive-loss ear and away from a sensorineural-loss ear; Rinne BC > AC marks conductive loss.

Answer: A

Explain confidentiality limits, then interview her alone: Correct. Bright Futures advises explaining confidentiality and its limits (risk of serious harm to self or others, abuse) to the teen and parent together, then interviewing the adolescent privately to get honest answers about sexual activity, substances and mood.

Promise that everything stays confidential: Unconditional confidentiality cannot be guaranteed when there is risk of harm or abuse.

Have her mother complete the HEADSS form: A parent cannot reliably report the teen's private behaviors; HEADSS is an adolescent interview.

Interview her with her mother present: A parent in the room reduces disclosure of sensitive behaviors.

HEADSS works only with private time: explain the limits of confidentiality, then interview the adolescent alone.

Answer: D

Bright transillumination of the scrotum: Transillumination suggests a hydrocele (fluid). It does not support torsion.

Pain relief when the testis is elevated: This is a positive Prehn sign, which favors epididymitis. In torsion, elevation does not relieve the pain.

A tender blue dot at the upper pole: The blue dot sign points to torsion of the appendix testis, a self-limited condition that is the closest differential in this age group.

Absent left cremasteric reflex: Correct. Sudden severe pain with vomiting in an adolescent is torsion until proven otherwise, and an absent cremasteric reflex on the affected side is the single most sensitive bedside sign. Other supporting findings are a high-riding testis with a horizontal lie. Torsion requires emergent urology consultation; do not delay surgery for imaging when suspicion is high.

In acute scrotal pain, an absent cremasteric reflex and a high-riding, horizontal testis point to torsion; a positive Prehn sign points to epididymitis.

Answer: D

1. Pack-years = packs per day × years smoked = 1.5 × (52 − 20) = 1.5 × 32 = 48.
2. Age 68 is within 50–80 and 48 ≥ 20 pack-years.
3. Years since quitting = 68 − 52 = 16, which exceeds the 15-year limit.
4. She is not eligible for LDCT screening.

Annual low-dose CT of the chest: Meets the age and pack-year criteria but ignores the quit-time limit; she quit more than 15 years ago.

Annual posteroanterior chest radiograph: Chest radiography is not an effective lung cancer screening test at any risk level.

One baseline low-dose CT, then stop: A single LDCT is not a recommended strategy; screening is annual when indicated and not indicated here.

No screening is indicated now: Correct. She has 48 pack-years (1.5 × 32 years), but she quit 16 years ago. USPSTF 2021 limits annual LDCT to adults 50–80 with ≥20 pack-years who currently smoke or quit within the past 15 years, so she no longer qualifies.

LDCT eligibility needs all three: age 50–80, ≥20 pack-years, and current smoking or quitting within 15 years.

Answer: D

Delirium: Delirium starts acutely over hours to days; this course has been progressive over more than a year.

Parkinson disease dementia: Closest differential, but this diagnosis requires parkinsonism for more than 1 year before the dementia; here cognition declined first.

Alzheimer disease: Begins with memory loss, and early hallucinations, fluctuations, and parkinsonism are not typical.

Dementia with Lewy bodies: Correct. Fluctuating cognition, recurrent well-formed visual hallucinations, REM sleep behavior disorder, and parkinsonism are core features. Cognitive decline began before or within 1 year of the motor signs, which defines Lewy body dementia rather than Parkinson disease dementia.

Fluctuations, visual hallucinations, REM sleep behavior disorder and parkinsonism within a year of cognitive decline indicate dementia with Lewy bodies; avoid antipsychotics.

Answer: D

Erythema infectiosum: Starts with "slapped cheek" facial erythema followed by a lacy rash on the extremities, usually with little fever.

Measles: The rash appears while fever peaks, starts on the face and spreads downward, and follows cough, coryza and conjunctivitis.

Scarlet fever: Causes a sandpaper rash with pharyngitis and fever that persists with the rash.

Roseola infantum: Correct. Several days of high fever in a child aged 6 months to 3 years followed by a truncal rash as the fever breaks is classic roseola (HHV-6 or HHV-7); care is supportive.

Roseola: rash appears after the fever breaks; measles and scarlet fever: rash with ongoing fever.

Answer: C

Hereditary spherocytosis: Also causes early hemolysis with spherocytes, but the DAT is negative and there is often a family history; a positive DAT points to antibody-mediated hemolysis.

G6PD deficiency: Causes DAT-negative hemolysis, often with bite or blister cells, triggered by oxidant stress.

ABO hemolytic disease of the newborn: Correct. Jaundice before 24 hours is never physiologic. An O mother, an A infant, a positive DAT, reticulocytosis and microspherocytes indicate isoimmune hemolysis, which the AAP 2022 hyperbilirubinemia guideline treats as a neurotoxicity risk factor that lowers the phototherapy threshold.

Rh (anti-D) hemolytic disease of the newborn: Requires an Rh-negative mother sensitized to D antigen; this mother is Rh positive.

Jaundice in the first 24 hours with a positive DAT in an A or B infant of an O mother is ABO hemolytic disease; spherocytes alone do not separate it from hereditary spherocytosis, but the DAT does.

Answer: C

Gestational hypertension: Closest differential, but it requires the absence of proteinuria; her UPCR of 0.4 is diagnostic of proteinuria.

Chronic hypertension: Chronic hypertension is present before pregnancy or before 20 weeks; she was normotensive at 12 weeks.

Preeclampsia without severe features: Correct. New BP ≥140/90 on two readings at least 4 hours apart after 20 weeks plus proteinuria (UPCR ≥0.3) defines preeclampsia (ACOG). Her BP is below 160/110, and she has no symptoms, thrombocytopenia, renal or hepatic dysfunction, so there are no severe features.

Preeclampsia with severe features: Requires BP ≥160/110, symptoms, platelets <100,000, creatinine >1.1, doubled transaminases or pulmonary edema; she has none.

After 20 weeks, new hypertension plus proteinuria (or end-organ dysfunction) is preeclampsia; severe features hinge on BP ≥160/110 or specific end-organ findings.

Answer: B

Humoral hypercalcemia of malignancy: PTHrP-mediated hypercalcemia suppresses intact PTH; her PTH is high.

Primary hyperparathyroidism: Correct. High calcium with an elevated (not suppressed) PTH, low phosphorus and high urinary calcium is primary hyperparathyroidism, usually a single adenoma. The stone and cortical (forearm) bone loss are end-organ effects that meet criteria for parathyroidectomy referral.

Secondary hyperparathyroidism from vitamin D deficiency: Secondary hyperparathyroidism raises PTH in response to low or low-normal calcium; her calcium is high and her vitamin D is sufficient.

Familial hypocalciuric hypercalcemia: FHH also causes high calcium with normal-to-high PTH, but urinary calcium is low. Her 24-hour urine calcium is elevated.

Hypercalcemia plus an elevated or inappropriately normal PTH is primary hyperparathyroidism; a low urine calcium suggests FHH instead, and a suppressed PTH suggests malignancy.

Answer: D

Stop atorvastatin: A statin is not on the Beers list, and stopping it is not the main safety issue raised by the new anticoagulant.

Reduce apixaban to 2.5 mg twice daily: Dose reduction requires 2 of 3 criteria: age ≥80, weight ≤60 kg, or creatinine ≥1.5 mg/dL. He meets only age, so the full dose is right.

Replace apixaban with warfarin: DOACs are preferred over warfarin for nonvalvular AF (2023 ACC/AHA/ACCP/HRS) unless he has a mechanical valve or moderate–severe mitral stenosis.

Stop aspirin: Correct. Medication reconciliation finds aspirin with no current indication. Adding it to a DOAC raises major bleeding without benefit, and Beers 2023 advises against starting aspirin for primary prevention in older adults. His apixaban dose is correct.

At transitions of care, reconcile discharge and home lists; stop aspirin taken only for primary prevention when an older adult starts a DOAC.

Answer: A

Same-day emergency department evaluation: Correct. A transient focal deficit with unilateral weakness and speech disturbance is a TIA, and stroke risk is highest in the first 48 hours. His ABCD2 score is 6 (age ≥60, BP ≥140/90, unilateral weakness, 10–59 minutes, diabetes). AHA guidance calls for emergency evaluation with brain and vascular imaging within 24 hours for high-risk TIA.

Outpatient carotid duplex within 1 week: Carotid imaging is needed, but within an urgent same-day workup; a week is too late for high-risk TIA.

Outpatient neurology appointment in 2 weeks: A 2-week delay misses the window when stroke risk after TIA is highest.

Start aspirin and recheck in 1 month: Antiplatelet therapy alone with delayed follow-up under-treats a high-risk TIA.

TIA with high ABCD2 score: same-day emergency evaluation with brain and vascular imaging, not routine outpatient referral.

Answer: A

Switch to a levonorgestrel IUD: Correct. Under US MEC 2024, combined hormonal contraception is category 4 for women ≥35 who smoke ≥15 cigarettes/day; a levonorgestrel IUD is category 1 for smokers, highly effective and lasts years.

Switch to a 20-mcg ethinyl estradiol pill: A lower estrogen dose does not change the category 4 rating for smokers ≥35 years old.

Continue the current pill with cessation counseling: Counseling is appropriate, but she continues to smoke, so the estrogen risk remains category 4.

Switch to the combined vaginal ring: The ring contains estrogen and carries the same category 4 restriction as the pill.

Stop all estrogen-containing methods in women ≥35 who smoke ≥15 cigarettes/day; offer progestin-only or copper methods.

Answer: C

Pioglitazone 15 mg daily: Contraindicated by the stem: thiazolidinediones cause fluid retention and worsen heart failure.

Saxagliptin 5 mg daily: DPP-4 inhibitors have no heart-failure benefit, and saxagliptin increased HF hospitalizations in trials.

Empagliflozin 10 mg daily: Correct. ADA Standards of Care 2026 and the 2022 AHA/ACC/HFSA guideline recommend an SGLT2 inhibitor for people with HF regardless of A1C. It reduces HF hospitalization and cardiovascular death, is the fourth pillar of HFrEF therapy, and his eGFR allows it.

Glipizide 5 mg twice daily: Lowers glucose but has no cardiorenal benefit and adds hypoglycemia risk in an older adult.

In type 2 diabetes with HF, ASCVD or CKD, choose an agent with proven cardiorenal benefit; for HFrEF that is an SGLT2 inhibitor, whatever the A1C.

Answer: C

Continue albuterol as needed alone: SABA-only therapy increases exacerbation and death risk and is not recommended by GINA.

Salmeterol inhaler twice daily: LABA monotherapy without ICS is contraindicated in asthma.

As-needed low-dose budesonide-formoterol: Correct. GINA 2025 no longer recommends SABA-only treatment for adolescents or adults; as-needed low-dose ICS-formoterol (Track 1) is the preferred reliever even in mild asthma because it lowers severe exacerbation risk.

Daily montelukast 10 mg: Less effective than ICS-containing therapy and carries a boxed warning for neuropsychiatric effects.

GINA: every adolescent and adult with asthma should receive ICS-containing therapy; as-needed ICS-formoterol is preferred for mild asthma.

Answer: A

1. Average ≈ 134/85 mm Hg → stage 1 (130–139 or 80–89).
2. No CVD, diabetes or CKD.
3. PREVENT 10-year CVD risk 4.2% < 7.5% threshold.
4. Plan: nonpharmacologic therapy for 3–6 months, then reassess.

Lifestyle changes and reassess in 3–6 months: Correct. Averages of about 134/85 are stage 1 hypertension. Under the 2025 AHA/ACC BP guideline, stage 1 without CVD, diabetes or CKD and with PREVENT 10-year CVD risk <7.5% is treated first with lifestyle measures for 3–6 months.

Start a two-drug single-pill combination: Reserved for stage 2 BP more than 20/10 mm Hg above goal.

No intervention until BP exceeds 140/90: Uses an outdated threshold; BP ≥130/80 is hypertension and warrants lifestyle therapy now.

Start amlodipine 5 mg daily: Drug therapy for stage 1 is indicated only with CVD, diabetes, CKD or PREVENT risk ≥7.5%.

Stage 1 hypertension gets drugs only with CVD, diabetes, CKD or PREVENT risk ≥7.5%; otherwise lifestyle first.