AANPCB Family Nurse Practitioner (FNP) Exam — All Questions

A 22-year-old nonpregnant woman completed doxycycline for chlamydia and her symptoms have resolved. She took every dose. What follow-up testing does CDC recommend?

• a.No further chlamydia testing
• b.Retest about 3 months after treatment✓
• c.Test of cure 1 week after finishing doxycycline
• d.Monthly testing for 6 months

CDC does not advise a test of cure for nonpregnant persons treated with a recommended regimen unless adherence is in question, symptoms persist, or reinfection is suspected; testing too soon can detect nonviable organisms. Because reinfection is common, everyone treated for chlamydia should be retested about 3 months after treatment, whether or not partners were treated.

A 25-year-old at 14 weeks of gestation was treated for chlamydia with amoxicillin. What follow-up testing is recommended?

• a.No test of cure; retest only at delivery
• b.Retest only if her partner reports symptoms
• c.A test of cure 3 days after treatment
• d.Test of cure at 4 weeks, then retest at 3 months✓

In pregnancy CDC recommends a test of cure, preferably by NAAT, about 4 weeks after therapy because persistent infection can cause serious maternal and neonatal complications, followed by retesting 3 months after treatment and again in the third trimester or at delivery. Testing only at delivery or only if a partner has symptoms misses persistent infection, and testing after 3 days is too early for a reliable result.

A 28-year-old sexually active woman completed metronidazole for trichomoniasis 2 weeks ago and feels well. When should she be retested?

• a.About 3 months after treatment✓
• b.Only if her partner reports symptoms
• c.At her next cervical cancer screening
• d.Not at all, since her symptoms resolved

Because reinfection is common, CDC recommends retesting all sexually active women treated for trichomoniasis approximately 3 months after initial treatment, whether or not they believe their partners were treated. Relying on symptoms or on partner reports misses reinfection, and cervical cytology is not a diagnostic test for trichomoniasis.

A 58-year-old man was treated for primary syphilis with benzathine penicillin G. How should his response to treatment be evaluated?

• a.No follow-up once the chancre heals
• b.Repeat treponemal antibody test at 1 month
• c.Lumbar puncture at 3 months for all patients
• d.Nontreponemal titers at 6 and 12 months✓

CDC recommends clinical and serologic evaluation at 6 and 12 months after treatment for primary and secondary syphilis, comparing the nontreponemal titer with the titer at the time of treatment; failure to fall fourfold within 12 months may indicate treatment failure. Treponemal tests usually stay positive for life and are not used to follow response, a CSF exam is reserved for neurologic signs or suspected failure, and healing of the chancre does not prove cure.

A 20-year-old started outpatient oral and intramuscular treatment for pelvic inflammatory disease. At 72 hours she still has fever and unchanged adnexal and cervical motion tenderness. What is the next step?

• a.Hospitalize and reassess the diagnosis and regimen✓
• b.Stop antibiotics and observe at home
• c.Add a second oral antibiotic by phone
• d.Continue the regimen and recheck in 2 weeks

CDC states that women should show clinical improvement, such as defervescence and less tenderness, within 3 days of starting therapy. If there is no improvement within 72 hours of outpatient IM or oral therapy, hospitalization, review of the antibiotic regimen, and further diagnostics, including consideration of laparoscopy for other diagnoses, are recommended. Waiting 2 weeks, adjusting by phone, or stopping therapy do not address treatment failure.

A 70-year-old woman with type 2 diabetes has had a stable treatment plan and has met her A1C goal for 2 years. How often should her A1C be checked?

• a.Every 3 months, indefinitely
• b.Every month
• c.Once every 2 years
• d.At least twice a year✓

The ADA recommends assessing glycemic status at least twice a year in people who are meeting goals, and more often, such as every 3 months, for people not meeting goals or with recent treatment changes. Monthly testing adds nothing because A1C reflects about 3 months of glucose, and every 2 years is too infrequent.

An 81-year-old woman with type 2 diabetes, mild cognitive impairment, and falls takes glipizide and metformin. Her A1C is 6.4%, and she has had two episodes of glucose in the 50s this month. What is the best change?

• a.Increase glipizide to prevent afternoon highs
• b.Continue the same regimen, since her A1C is at goal
• c.Stop or reduce the glipizide✓
• d.Add basal insulin to lower her A1C further

The ADA recommends deintensifying hypoglycemia-causing medications, such as sulfonylureas, or switching to a class with low hypoglycemia risk for people at high risk, and using less stringent goals (for example, A1C below 8.0%) for older adults with complex health. Her low A1C combined with recurrent hypoglycemia signals overtreatment, so adding insulin, increasing glipizide, or continuing unchanged would raise her risk.

A 69-year-old man with diabetes started a moderate-intensity statin. When should his lipid profile be rechecked?

• a.Only if he develops muscle aches
• b.1 week after starting
• c.4 to 12 weeks after starting✓
• d.Only after 5 years of therapy

The ADA recommends a lipid profile at statin initiation, 4 to 12 weeks after starting or changing the dose, and annually after that, to monitor response and adherence. One week is too soon to see the full effect, while waiting 5 years or for symptoms misses the chance to assess response and adjust therapy.

A 49-year-old woman has a confirmed average blood pressure of 136/84 mm Hg. She has no diabetes, CKD, or cardiovascular disease, and her PREVENT 10-year CVD risk is 4%. She has followed lifestyle changes for 6 months, and her average is now 134/82. What should happen next?

• a.Start antihypertensive medication✓
• b.Continue lifestyle changes alone and recheck in 1 year
• c.No change, because her PREVENT risk is below 7.5%
• d.Refer for renal denervation

Under the 2025 AHA/ACC guideline, adults with an average blood pressure of 130/80 or higher and a PREVENT 10-year risk below 7.5% start medication if their average remains at or above 130/80 after a 3- to 6-month trial of lifestyle modification. She has completed that trial and remains above goal, so medication is now indicated. Low risk only postpones medication, and renal denervation is not a next step after a lifestyle trial.

A 64-year-old man with type 2 diabetes and hypertension just started a thiazide-type diuretic. When should his serum potassium be checked?

• a.In 7 to 14 days, then at routine visits✓
• b.Only at his annual physical
• c.Daily for the first month
• d.Only if he develops muscle cramps

The ADA recommends monitoring for hypokalemia when diuretics are used, at routine visits and 7 to 14 days after starting or changing the dose. An annual check or waiting for symptoms could miss early hypokalemia, and daily testing is unnecessary.

A 61-year-old woman has blood pressure above goal despite adherence to full doses of a thiazide-type diuretic, an ACE inhibitor, and a dihydropyridine calcium channel blocker. Her potassium is normal. Which evaluation does the 2025 AHA/ACC guideline recommend?

• a.Stop all three drugs for 4 weeks before any testing
• b.Screen for primary aldosteronism✓
• c.Skip aldosteronism screening because potassium is normal
• d.Add a second ACE inhibitor

The 2025 guideline recommends screening for primary aldosteronism in patients with resistant hypertension regardless of whether hypokalemia is present, and continuing most antihypertensive medications, other than mineralocorticoid receptor antagonists, during screening. A normal potassium does not exclude the diagnosis, stopping all drugs is unnecessary and unsafe, and combining two drugs from the same class adds risk without benefit.

A 53-year-old man with chronic low back pain started immediate-release oxycodone after other therapies failed. According to the 2022 CDC guideline, when should benefits and risks first be reevaluated?

• a.After 3 months of therapy
• b.Within 1 to 4 weeks of starting✓
• c.Only when he requests a refill increase
• d.At his annual wellness visit

The 2022 CDC guideline recommends evaluating benefits and risks with patients within 1 to 4 weeks of starting opioids for subacute or chronic pain, or after a dose increase, and regularly thereafter. Waiting 3 months or a year, or until he asks for more, delays detecting harm or lack of benefit.

A 66-year-old woman taking isoniazid for latent TB infection has no symptoms. Her ALT at a monthly visit is 6 times the upper limit of normal. What should be done?

• a.Continue, since she has no symptoms
• b.Continue isoniazid and recheck ALT in 3 months
• c.Withhold the medication✓
• d.Double the dose to shorten the course

CDC advises withholding latent TB medication if transaminases exceed three times the upper limit of normal with symptoms, or five times the upper limit of normal in an asymptomatic patient. At 6 times normal she meets the asymptomatic threshold, so the drug should be held even though she feels well.

A 15-year-old with asthma on low-dose ICS-formoterol still has daytime symptoms three times a week. Before stepping up his treatment, what should the nurse practitioner do first?

• a.Give monthly oral corticosteroid bursts
• b.Add a biologic therapy
• c.Switch his reliever to albuterol alone
• d.Check his inhaler technique and adherence✓

GINA advises that when asthma is uncontrolled, the clinician should look for the cause before changing treatment and should always check inhaler technique and adherence first, since poor technique and missed doses are common reasons for poor control. Biologics are for severe asthma after these steps, SABA-only treatment is not recommended, and regular oral steroids carry substantial harm.

A 58-year-old man with type 2 diabetes has had no retinopathy on his last two annual dilated eye exams, and his glycemic indicators are within goal. What interval for eye screening may be considered?

• a.Only if he notices vision changes
• b.Every 5 years
• c.Every 1 to 2 years✓
• d.Every 3 months

The ADA says that if there is no evidence of retinopathy on one or more annual eye exams and glycemic indicators are within goal, screening every 1 to 2 years may be considered; once any retinopathy is present, exams should be at least annual. Five years is too long, every 3 months is unnecessary, and waiting for symptoms risks missing treatable disease.

The parents of a 4-month-old diagnosed with bronchiolitis on day 2 of illness ask what to expect. Which statement about the typical course is accurate?

• a.Symptoms should resolve within 24 hours
• b.Improvement on day 2 means it will not worsen
• c.Albuterol at home will shorten the illness
• d.It often worsens on days 3 to 5, then improves✓

CDC's pediatric guidance notes that children with bronchiolitis usually worsen between days 3 and 5 of illness before improving, so parents should know the warning signs and when to return. Resolution within a day is not expected, albuterol is not recommended for outpatient bronchiolitis, and early stability does not rule out the typical mid-course worsening.

A 26-year-old nonpregnant woman completed metronidazole for bacterial vaginosis, and her symptoms have fully resolved. What follow-up is recommended?

• a.Monthly metronidazole for 6 months
• b.None unless symptoms recur✓
• c.Test of cure 1 week after treatment
• d.Treat her male partner to prevent recurrence

CDC states that follow-up visits are unnecessary if symptoms resolve after BV treatment, but because recurrence is common, women should return if symptoms come back. Routine treatment of male partners has not been shown to prevent recurrence, and suppressive therapy is considered only for recurrent BV.

A 70-year-old woman with type 2 diabetes on lisinopril and spironolactone comes for a routine visit. Which laboratory monitoring does the ADA recommend for these medications?

• a.Liver enzymes and bilirubin
• b.eGFR and serum potassium✓
• c.Uric acid and fasting lipids
• d.Serum magnesium only

The ADA recommends monitoring for a drop in eGFR and a rise in serum potassium when ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists are used, at initiation and periodically. Both lisinopril and spironolactone can raise potassium, and the combination makes hyperkalemia more likely. Uric acid, liver enzymes, and magnesium are not the targeted safety labs for these drugs.