Prevention is where a nurse practitioner adds the most value over a lifetime of care, and the exam tests whether you know what to offer and when. These questions cover screening recommendations by age and risk factor, the intervals that matter, how to weigh benefits against harms, and how to have the conversation when guidance is genuinely uncertain.
Question 1
A patient at her 6-week postpartum visit has a score of 18 on the EPDS, though her item 10 is 0. She reports poor appetite and daily crying that prevents her from leaving the house. Which management plan is most appropriate?
- A) Reassure her and repeat the screening next month.
- B) Refer her to the emergency department for evaluation.
- C) Recommend joining a local new mother support group.
- D) Discuss initiating psychotherapy and an antidepressant medication plan.✓
💡 Key Takeaway
An EPDS score above 13 without suicidality warrants prompt initiation of evidence-based depression treatment.
Show rationale
An EPDS score greater than 13 strongly suggests a major depressive episode. Given her high score and functional impairment, standard of care dictates initiating active treatment, which typically includes psychotherapy and pharmacotherapy like an SSRI. Option A is negligent, as it ignores a clearly positive depression screen. Option B is unnecessary because her item 10 score is 0, indicating no acute suicidal ideation requiring emergency care. Option C is a helpful adjunct but is entirely insufficient as monotherapy for severe postpartum depression.
Question 2
A 45-year-old female who underwent a Roux-en-Y gastric bypass three years ago presents with fatigue and progressive numbness in both feet. Laboratory results reveal a mean corpuscular volume (MCV) of 112 fL and a significantly decreased serum vitamin B12 level. Which intervention is most appropriate?
- A) Initiate intramuscular cyanocobalamin replacement therapy✓
- B) Prescribe daily oral cyanocobalamin replacement therapy
- C) Recommend daily oral folic acid replacement therapy
- D) Start sublingual methylcobalamin replacement therapy
💡 Key Takeaway
Intramuscular B12 is required for acute neurological symptoms in patients lacking intrinsic factor due to gastric bypass.
Show rationale
Gastric bypass surgery removes the primary site of intrinsic factor production, making oral and sublingual absorption highly unreliable. Because this patient is experiencing active neurological symptoms, guaranteed and immediate systemic delivery via the intramuscular route is essential to prevent permanent nerve damage. High-dose oral or sublingual therapies are inadequate for acute neurological deficits in malabsorptive states. Folic acid would inappropriately mask the underlying B12 deficiency without correcting the neurological decline.
Question 3
A 19-year-old female with moderate persistent asthma reports that her daily fluticasone inhaler causes oral thrush. She requests a switch to a daily salmeterol inhaler alone to prevent this side effect while maintaining asthma symptom control. What is the appropriate response?
- A) Prescribe the salmeterol and monitor her lung function.
- B) Recommend switching to daily formoterol instead of salmeterol.
- C) Explain that salmeterol alone increases asthma-related death risk.✓
- D) Advise that salmeterol requires concurrent short-acting bronchodilator use.
💡 Key Takeaway
Long-acting beta-agonist monotherapy is strictly contraindicated in asthma due to the risk of severe exacerbations and death.
Show rationale
Using a long-acting beta-agonist without a concurrent inhaled corticosteroid is strictly contraindicated in asthma because it masks underlying airway inflammation and significantly increases the risk of severe exacerbations and asthma-related death. Option C accurately reflects this critical black box warning. Option A is dangerous and directly violates established prescribing guidelines for asthma management. Option B is incorrect because formoterol is also a long-acting beta-agonist and carries the exact same monotherapy risks as salmeterol. Option D is incorrect because concurrent use of a short-acting bronchodilator does not provide the necessary anti-inflammatory action to mitigate the severe risks of long-acting beta-agonist monotherapy.
Question 4
A 45-year-old female with a calculated ASCVD risk of 8% was prescribed simvastatin 20 mg daily ten weeks ago. Her baseline LDL was 150 mg/dL, and today it is 100 mg/dL. She denies any muscle aches.
- A) Continue the current regimen because this is an expected therapeutic response.✓
- B) Increase the simvastatin dosage to achieve a fifty percent lipid reduction.
- C) Switch to atorvastatin therapy to maximize the patient's cardiovascular health benefits.
- D) Add a nonstatin medication to further lower the circulating cholesterol levels.
💡 Key Takeaway
Moderate-intensity statins are expected to reduce baseline LDL levels by 30 to 49 percent.
Show rationale
Simvastatin 20 mg is a moderate-intensity statin, which is expected to lower LDL by 30 to 49 percent. A drop from 150 mg/dL to 100 mg/dL is exactly a 33% reduction, indicating an appropriate and successful therapeutic response. Option A is correct because the medication is working exactly as intended for her risk category. Option B is incorrect because moderate-intensity statins do not target a 50% reduction. Options C and D are incorrect because they represent unnecessary pharmacological escalations for a primary prevention patient who is already meeting her expected risk-based therapeutic outcome without adverse effects.
Question 5
A 38-year-old female who is 18 months post-Roux-en-Y gastric bypass reports episodes of dizziness, diaphoresis, and palpitations that consistently occur 2 hours after eating meals heavy in carbohydrates. Her current BMI is 24. Which intervention should the provider recommend?
- A) Advise drinking fluids during all meals.
- B) Prescribe a rapid-acting insulin before meals.
- C) Recommend adding complex proteins to meals.✓
- D) Suggest increasing simple daily carbohydrate intake.
💡 Key Takeaway
Late dumping syndrome presents as reactive hypoglycemia and is managed by adding protein to delay gastric emptying.
Show rationale
The patient's symptoms occurring a few hours after carbohydrate ingestion are highly characteristic of late dumping syndrome, which is essentially a form of reactive hypoglycemia. The rapid transit of carbohydrates into the small intestine triggers an exaggerated insulin response, leading to subsequent hypoglycemia. Recommending the addition of complex proteins and healthy fats delays gastric emptying and stabilizes blood glucose levels. Advising the patient to drink fluids during meals would actually accelerate gastric emptying, significantly worsening the dumping symptoms. Prescribing rapid-acting insulin is contraindicated as it would dangerously exacerbate her hypoglycemic episodes. Suggesting an increase in simple daily carbohydrate intake would directly provoke the exaggerated insulin spikes, worsening the reactive hypoglycemia rather than preventing it.
Question 6
A 45-year-old male on CPAP therapy presents with his third sinus infection in four months. He reports excellent CPAP adherence and his device data shows an AHI of 2 events/hour. Which action is most appropriate?
- A) Prescribe a prophylactic daily oral antibiotic.
- B) Decrease the continuous positive pressure setting.
- C) Transition to a bilevel positive device.
- D) Review equipment cleaning and replacement schedules.✓
💡 Key Takeaway
Recurrent respiratory or sinus infections in compliant CPAP users often indicate poor equipment hygiene.
Show rationale
Evaluating the efficacy of CPAP therapy includes monitoring for complications related to device usage. Recurrent sinus infections in a patient with excellent adherence strongly suggest poor equipment hygiene or expired supplies harboring bacteria. Reviewing cleaning schedules directly addresses the most likely source of his recurrent infections. Prescribing prophylactic antibiotics promotes resistance and ignores the root cause of the problem. Decreasing the pressure setting or transitioning to a bilevel device does nothing to prevent contaminated equipment from causing ongoing mucosal infections.
Question 7
A patient with end-stage heart failure is currently enrolled in home hospice. During a routine visit, the patient's spouse reports severe physical and emotional exhaustion from providing round-the-clock care and expresses fear of being unable to continue. Which intervention should the nurse practitioner initiate?
- A) Revoke hospice status for permanent nursing facility placement.
- B) Arrange for temporary inpatient hospice facility respite care.✓
- C) Prescribe a daily antianxiety medication for the spouse.
- D) Discontinue hospice and resume standard home health services.
💡 Key Takeaway
Medicare hospice benefits include temporary respite care to relieve severe caregiver strain and prevent burnout.
Show rationale
Caregiver exhaustion is a common and critical issue in home hospice. The Medicare hospice benefit specifically includes respite care, which allows the patient to be temporarily admitted to an inpatient facility for up to five days to provide relief and prevent caregiver burnout. Option A is incorrect because nursing facility placement does not require revoking hospice; hospice can be provided in a facility, but temporary respite should be tried first. Option C inappropriately medicalizes the spouse's situational exhaustion without addressing the root cause of the physical burden. Option D is incorrect because discontinuing hospice would remove the essential end-of-life support the patient currently requires.
Question 8
A 45-year-old female is scheduled for a colonoscopy at 1:00 PM tomorrow. She is prescribed a split-dose polyethylene glycol regimen. How should the FNP instruct her to time the second dose?
- A) Complete the final dose by midnight tonight.
- B) Complete the final dose by eight tomorrow.
- C) Complete the final dose by nine tomorrow.✓
- D) Complete the final dose by noon tomorrow.
💡 Key Takeaway
The second portion of a split-dose bowel preparation must be completed two to four hours before the colonoscopy.
Show rationale
The split-dose regimen significantly improves colon cleansing and adenoma detection rates compared to taking the entire prep the night before. Guidelines require the second dose to be finished two to four hours before the scheduled procedure time. For a 1:00 PM procedure, completing the prep by 9:00 AM (Option C) perfectly aligns with this window. Option A is incorrect because finishing by midnight tonight negates the benefit of a split dose, allowing right-sided colon secretions to accumulate. Option B is incorrect because finishing at 8:00 AM is five hours before the procedure, falling outside the optimal two-to-four-hour window. Option D is incorrect because finishing at noon violates the strict minimum two-hour fasting requirement for anesthesia, placing the patient at severe risk for aspiration during the procedure.
Question 9
A 22-year-old patient taking TAF/FTC for PrEP presents for a routine 3-month follow-up. He is completely asymptomatic, but his laboratory-based positive HIV-1/2 Ag/Ab test results just returned. Which modification to his plan of care is required immediately?
- A) Discontinue the TAF/FTC and await confirmatory HIV differentiation testing results.
- B) Continue the TAF/FTC and add an integrase strand transfer inhibitor.✓
- C) Discontinue the TAF/FTC and initiate a two-drug antiretroviral therapy regimen.
- D) Continue the TAF/FTC and recheck the antigen/antibody test next week.
💡 Key Takeaway
A positive HIV test on PrEP requires immediate conversion to a fully suppressive three-drug ART regimen.
Show rationale
When a patient has a positive HIV test while on PrEP, you must immediately transition them to a fully suppressive ART regimen to prevent viral resistance while awaiting confirmatory testing and genotype results. Option B is correct because adding a third drug, such as an integrase strand transfer inhibitor (INSTI) or a boosted protease inhibitor, to the existing dual-NRTI backbone achieves this. Option A is incorrect because stopping antiretrovirals entirely risks rapid viral rebound and acute seroconversion symptoms. Option C is incorrect because a two-drug regimen is inadequate for acute HIV infection. Option D is incorrect because delaying treatment while rechecking the test increases the risk of developing drug-resistant HIV.
Question 10
A 50-year-old female recently diagnosed with rheumatoid arthritis has a high-titer positive anti-CCP and positive RF. She asks what these specific laboratory results mean for her future joint health.
- A) They indicate a lower likelihood of requiring biologic medication therapies.
- B) They suggest a mild disease course with minimal joint complications.
- C) They confirm that the disease is currently in spontaneous clinical remission.
- D) They predict a higher risk for aggressive, erosive joint damage.✓
💡 Key Takeaway
High-titer anti-CCP is a strong prognostic indicator for aggressive, erosive rheumatoid arthritis.
Show rationale
In patients with confirmed rheumatoid arthritis, a high-titer anti-CCP is a powerful prognostic marker that predicts a more aggressive disease course and a significantly higher risk for erosive joint damage. This makes option D the correct answer. Option A is incorrect because patients with high-titer anti-CCP often require more aggressive treatment, including biologic therapies, to prevent joint destruction. Option B is incorrect as it contradicts the established evidence that anti-CCP correlates with severe disease rather than a mild course. Option C is incorrect because serological markers like anti-CCP do not indicate clinical remission; remission is determined by the absence of active joint inflammation and normalized acute phase reactants, not the presence of autoantibodies.
