20 free FNP-BC practice questions

Correct answer: C · Chlamydia and gonorrhea NAAT on urine or a vaginal swab

The USPSTF's 2021 recommendation (grade B) is to screen all sexually active women aged 24 or younger for chlamydia and for gonorrhea, with or without symptoms, because women aged 15 to 24 have the highest infection rates. It recommends a nucleic acid amplification test (NAAT), which can use urine or a vaginal swab and test for both infections from the same specimen. Having no symptoms and using condoms most of the time do not remove her from the screened group, so skipping the test is wrong. Waiting until she turns 21 has no basis in this recommendation, which covers sexually active adolescents. A culture every 3 months is neither the recommended test nor a recommended interval; the USPSTF suggests rescreening when the sexual history shows new or continuing risk.

Look for this next time: Screen every sexually active woman aged 24 or younger for chlamydia and gonorrhea with a NAAT, even without symptoms (USPSTF 2021).

Correct answer: A · Vision screening now for amblyopia or its risk factors

The USPSTF's 2017 recommendation (grade B) is vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors, such as strabismus and refractive errors. All children in this age range are considered at risk, so a term birth and no family history do not remove the indication, and waiting for parents to notice a problem is not screening. Primary care screening uses tools such as symbol or letter acuity charts, ocular alignment tests, or instrument-based photoscreening; children with positive findings are then referred for a complete eye examination, so a specialist exam follows a positive screen rather than replacing it. Waiting until age 6 misses the age range in which the USPSTF found that treating amblyopia improves visual acuity.

Look for this next time: Screen every child's vision at least once between ages 3 and 5 to detect amblyopia or its risk factors (USPSTF 2017).

Correct answer: D · Use a brief familial risk tool; refer if it is positive

The USPSTF's 2019 recommendation (grade B) is that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer, or an ancestry linked to BRCA1/2 mutations, with a brief familial risk assessment tool, such as the Ontario Family History Assessment Tool or the Pedigree Assessment Tool. Women with a positive result should receive genetic counseling and, if indicated after counseling, genetic testing. Ordering the gene test first skips both the risk assessment and the counseling step. Her family history already calls for assessment now, so deferring it to a later age has no basis. Breast imaging does not assess inherited risk and is not a substitute for the familial risk tool.

Look for this next time: With a family history of breast or ovarian cancer, start with a brief familial risk tool; a positive result leads to genetic counseling (USPSTF 2019).

Correct answer: B · Resolved past infection; counsel on reactivation risk

CDC's hepatitis B testing guidance reads HBsAg negative, total anti-HBc positive, and anti-HBs positive as a resolved infection, and its recommended action is to counsel the patient about the risk of HBV reactivation. In CDC's table, immunity from vaccination shows a positive anti-HBs with a negative anti-HBc, so his positive core antibody rules out a vaccine-only pattern. Chronic infection shows a positive HBsAg and anti-HBc with a negative anti-HBs, and acute infection shows a positive HBsAg with a positive IgM anti-HBc. His negative HBsAg and positive surface antibody fit neither active form, which is why the result calls for counseling rather than linkage to hepatitis B care.

Look for this next time: HBsAg negative with positive total anti-HBc and anti-HBs means a resolved hepatitis B infection; counsel on reactivation risk (CDC).

Correct answer: B · Send a throat culture, and treat if the culture is positive

CDC's clinical guidance for group A strep pharyngitis says that for children older than 3 years, a negative rapid antigen detection test should be followed by a throat culture, with a way to reach the family and start antibiotics if the culture is positive. Rapid tests are highly specific but vary in sensitivity compared with culture, so a negative result alone does not rule out strep in a child. Her exudate and the absence of cough, rhinorrhea, and hoarseness also fit strep better than a clearly viral illness, which CDC says needs no strep testing. Starting antibiotics regardless of the result ignores the purpose of the back-up culture, and an antistreptolysin O titer is not part of CDC's approach, which relies on the rapid test and culture.

Look for this next time: In a child older than 3, back up a negative rapid strep test with a throat culture and treat if it is positive (CDC).

Correct answer: A · Right acute otitis media

CDC's outpatient guidance for children lists the criteria for a definitive diagnosis of acute otitis media: moderate or severe bulging of the tympanic membrane, new otorrhea not caused by otitis externa, or mild bulging with ear pain of recent onset (under 48 hours) or intense redness of the membrane. A red, moderately bulging membrane after a day of ear pulling meets the first criterion. Otitis media with effusion describes middle ear fluid without these acute signs, so a bulging, inflamed membrane points away from it. Otitis externa is an infection of the ear canal, and nothing here involves the canal. A viral infection alone does not explain a bulging membrane, and CDC adds that AOM is not diagnosed without a middle ear effusion.

Look for this next time: Moderate or severe bulging of the tympanic membrane is a diagnostic criterion for acute otitis media (CDC).

Correct answer: D · Recombinant zoster vaccine, 2 doses 2 to 6 months apart

CDC recommends 2 doses of recombinant zoster vaccine (RZV), separated by 2 to 6 months, for immunocompetent adults aged 50 and older. A past episode of shingles is not a reason to skip it: RZV can be given with no specific waiting period after herpes zoster, though not during an acute episode. Not remembering chickenpox does not change the recommendation, because more than 99% of adults in this age group have been exposed to varicella-zoster virus. CDC also says serologic testing for varicella immunity is not recommended before vaccination, because it can become a barrier and false negatives are common. The series has two doses, so a single dose leaves it incomplete.

Look for this next time: Offer immunocompetent adults 50 and older two doses of RZV 2 to 6 months apart, even after a past episode of shingles (CDC).

Correct answer: C · Catch-up HPV vaccination, recommended through age 26

CDC's HPV vaccine recommendations call for routine vaccination at 11 or 12 years and catch-up vaccination for everyone through age 26 who was not adequately vaccinated when younger, so at 24 she is still in the recommended group. Shared clinical decision-making applies to adults aged 27 through 45, not to her. CDC notes that most sexually active adults have already been exposed to HPV, but not necessarily to all the types the vaccine targets, so past sexual activity is not a reason to withhold it, although the vaccine does not treat existing infections. HPV vaccine is not recommended during pregnancy, but CDC says pregnancy testing before vaccination is not needed.

Look for this next time: Recommend catch-up HPV vaccination for anyone through age 26 who was not adequately vaccinated; ages 27 to 45 use shared decision-making (CDC).

Correct answer: A · On her back on a firm, flat surface in her own crib in their room

NICHD's Safe to Sleep campaign, based on the AAP's 2022 recommendations, says to place all babies, including those with reflux, on their backs for naps and at night until age 1, because side and stomach positions raise the risk of SIDS. The sleep surface should be firm, flat, level, and covered only with a fitted sheet. Sharing a room for at least the first 6 months, with the baby in her own crib or bassinet rather than the parents' bed, is safer than sharing a bed. Inclined sleepers are not safe sleep surfaces, because the baby's head can slump forward and block the airway, and soft items such as rolled blankets do not belong in the sleep area.

Look for this next time: Teach back sleeping on a firm, flat surface for every sleep, even for infants with reflux, with room-sharing but not bed-sharing (AAP 2022).

Correct answer: B · About 20, from the absolute reduction of 5 points

The number needed to treat is the reciprocal of the absolute risk difference, rounded up to a whole number, as the Cochrane Handbook describes. Here the absolute risk reduction is 15% minus 10%, or 5 percentage points (0.05), so the NNT is 1 divided by 0.05, which is 20: about 20 patients treated for 3 years to prevent one hospitalization. The relative risk reduction is 5 divided by 15, about one-third; it describes the proportional effect, but it is not an NNT, so 3 is wrong. Reading either group's event rate as a count of patients, giving 15 or 10, ignores the difference between the groups that the NNT is built on.

Look for this next time: NNT = 1 ÷ absolute risk reduction: a drop from 15% to 10% is 0.05, so about 20 patients must be treated.

Correct answer: D · Decline to share, since she objected to the disclosure

Under the HIPAA Privacy Rule (45 CFR 164.510(b)(2)), when a patient is present for, or otherwise available before, a disclosure and has the capacity to make health care decisions, a provider may share information relevant to a family member's involvement in her care only if she agrees, is given the chance to object and does not, or the provider reasonably infers from the circumstances that she does not object. She was given that chance and objected, so none of those conditions is met. Being next of kin does not override her objection, and confirming her date of birth checks his identity, not her permission. A general summary of her results is still a disclosure of her health information.

Look for this next time: When a patient with capacity objects, HIPAA does not permit sharing her information with family, even next of kin (45 CFR 164.510(b)).

Correct answer: C · Report the suspicion to the state's child protective agency

According to the Child Welfare Information Gateway's summary of state laws, every state identifies in statute who must report suspected child maltreatment; physicians, nurses, and other health care workers are named in almost every state, and the few states that list no professions require every person to report. A report is typically required when the reporter suspects or has reason to believe that a child has been abused or neglected, and mandatory reporters do not carry the burden of proving that abuse occurred. The NP already suspects abuse, which meets that threshold now. Waiting for proof, seeking a confession, or rechecking at a later visit delays the report and does not meet the duty.

Look for this next time: Report a suspicion of child abuse as state law requires; mandated reporters do not need proof that abuse occurred.

Correct answer: D · Delete the unperformed exam finding before signing the note

ANA's position statement on the ethical use of artificial intelligence in nursing practice says AI does not replace a nurse's judgment or assessment, and it quotes the Code of Ethics: technologies are adjuncts to, not replacements for, the nurse's knowledge and skill, so nurses remain accountable for their practice even when a system fails. The NP who signs the note is responsible for what it says, so the draft has to be checked against what actually happened and the exam that was never done removed before signing. Shifting responsibility to the vendor, keeping a false entry because it looks harmless, or having someone else correct the note after signing all leave an inaccurate record.

Look for this next time: An AI-drafted note is the clinician's note: review it and correct anything that was not done or said before signing.

Correct answer: B · Review benefits and harms, then support his own decision

The USPSTF's 2018 recommendation (grade C) says that for men aged 55 to 69, periodic PSA-based screening should be an individual decision: before deciding, a man should have the chance to discuss the potential benefits and harms with his clinician and bring his own values and preferences to the choice. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men, while many men experience harms such as false-positive results, biopsies, overdiagnosis and overtreatment, and treatment complications. Ordering the test as routine skips that discussion, and saying screening never helps overstates the evidence. Leaving him to choose without information is not shared decision-making either, and the USPSTF adds that clinicians should not screen men who express no preference for screening.

Look for this next time: For men aged 55 to 69, PSA screening is an individual decision made after discussing its benefits and harms (USPSTF 2018, grade C).

Correct answer: A · Skip imaging; advise staying active; recheck for red flags

The VA/DoD low back pain guideline (2022) recommends against routinely obtaining imaging or invasive diagnostic tests for acute low back pain without focal neurologic deficits or other red flags. It reserves imaging for neurologic deficits that are progressive or otherwise serious, or for red flags linked to serious underlying disease such as malignancy, fracture, or infection. He has none of these, so the recommendation applies to him, and the guideline's self-care advice for acute pain is to remain active. Ordering an MRI for reassurance, or starting with x-rays, still images a back with no red flags. Strict bed rest runs against the advice to stay active.

Look for this next time: For acute low back pain without neurologic deficits or red flags, skip routine imaging and advise staying active (VA/DoD 2022).

Correct answer: C · Use another antibiotic or pause simvastatin during treatment

Simvastatin's FDA labeling lists concomitant use of strong CYP3A4 inhibitors, including the macrolides clarithromycin and erythromycin, as a contraindication, because they raise simvastatin exposure and the risk of myopathy and rhabdomyolysis. If short-term treatment with a strong CYP3A4 inhibitor is unavoidable, the label says to suspend simvastatin for the duration of that treatment. So the NP either chooses an antibiotic without this interaction or pauses simvastatin during the course. Keeping the usual dose ignores the contraindication. Teaching him to report muscle aches is useful but does not make a contraindicated combination safe, and a lipid panel does not monitor the risk of muscle injury.

Look for this next time: Clarithromycin and other strong CYP3A4 inhibitors are contraindicated with simvastatin; choose another drug or suspend simvastatin during the course.

Correct answer: B · Take the missed pill now, then continue the pack as usual

CDC's U.S. Selected Practice Recommendations for Contraceptive Use (2024) treat a combined pill as missed when 24 to less than 48 hours have passed since it should have been taken. For one missed pill, the advice is to take it as soon as possible and keep taking the remaining pills at the usual time, even if that means two pills in one day, and no additional contraceptive protection is needed. Emergency contraception is not usually needed in this situation, though CDC says it may be considered in some cases. Discarding pills and using a backup method for 7 days is the advice for two or more consecutive missed pills, and stopping the pack is not part of either rule.

Look for this next time: One missed combined pill (24 to <48 hours late): take it now and continue the pack on schedule; no backup method is needed (CDC 2024).

Correct answer: D · Check a vitamin B12 level, which metformin can lower

Metformin's FDA labeling warns that it may lower vitamin B12 levels, reports subnormal levels in about 7% of patients in 29-week trials, and advises measuring hematologic parameters annually and vitamin B12 at 2- to 3-year intervals, managing any abnormality. After 9 years with no B12 check and new symptoms in both feet, a B12 level is the missing evaluation of her drug therapy. The label describes the decrease as rapidly reversible with stopping metformin or with B12 supplementation, so stopping a drug that controls her glucose before testing is premature, and metformin is not described as damaging nerves directly. Raising the dose does not address the symptom, and nerve studies do not check for this drug-related cause.

Look for this next time: Long-term metformin can lower vitamin B12; the FDA label advises checking B12 at 2- to 3-year intervals and managing any deficiency.

Correct answer: A · Discontinue the lisinopril as soon as possible

Lisinopril's FDA labeling carries a boxed warning for fetal toxicity: drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus, and when pregnancy is detected, lisinopril should be discontinued as soon as possible. A positive pregnancy test at follow-up is exactly the new information that changes her plan. Her hypertension still needs ongoing management, but continuing lisinopril for any part of the pregnancy contradicts the warning. Lowering the dose does not remove the risk the warning describes, and adding a diuretic leaves the drug that should be stopped in place.

Look for this next time: When pregnancy is detected in a patient taking an ACE inhibitor such as lisinopril, discontinue it as soon as possible (FDA boxed warning).

Correct answer: C · Not well controlled; step up 1 step and reassess in 2–6 weeks

In the NHLBI asthma guideline's control table for ages 12 and older, the level of control is set by the most severe component. Symptoms and rescue inhaler use on more than 2 days a week, and an Asthma Control Test score of 16 to 19, each mark asthma as not well controlled, even though one night awakening a month is in the well-controlled range. For asthma that is not well controlled, the guideline says to step up one step and reevaluate in 2 to 6 weeks, after first checking adherence, inhaler technique, and environmental control, which are good here. A short oral steroid course with a step-up of 1 to 2 steps is for very poorly controlled asthma (ACT 15 or below), and stepping down requires at least 3 months of good control.

Look for this next time: Rescue inhaler use on more than 2 days a week or an ACT of 16 to 19 means not well controlled: step up one step and reassess in 2 to 6 weeks (NHLBI EPR-3).