STI screening and evidence-based treatment are frequently tested FNP primary-care skills. Practice the chlamydia, gonorrhea, and syphilis screening/treatment scenarios below with full rationales.
Question 1
A 17-year-old male presents for a wellness visit. He reports having receptive anal intercourse with two older male partners over the past six months. He denies using condoms and reports a recent syphilis infection treated at a local clinic.
- A) Prescribe daily oral pre-exposure prophylaxis without further laboratory testing.
- B) Administer the human papillomavirus vaccine and defer additional STI screening.
- C) Recommend strict sexual abstinence and schedule a three-month follow-up visit.
- D) Assess readiness for pre-exposure prophylaxis and order baseline HIV testing.✓
Show rationale
This adolescent has multiple high-risk indicators including unprotected receptive anal intercourse and a recent bacterial STI. These factors strongly indicate the need for pre-exposure prophylaxis. Before prescribing this medication, the provider must confirm a negative baseline HIV status and assess renal function. Option A is dangerous because starting prophylaxis in an undiagnosed HIV-positive patient can cause drug resistance. Option B ignores the immediate high-risk behavior and the need for frequent STI screening. Option C is unrealistic and fails to utilize proven harm reduction strategies for an adolescent already engaging in high-risk sexual activity.
Question 2
A 22-year-old patient who is sixteen weeks pregnant presents for a routine prenatal visit. She is asymptomatic, but a routine screening reveals Trichomonas vaginalis on a wet mount. Which action should the nurse practitioner take?
- A) Delay pharmacological treatment until the third trimester of pregnancy.
- B) Prescribe oral fluconazole 150 mg as a single dose.
- C) Recommend topical clindamycin 2% vaginal cream for seven days.
- D) Initiate oral metronidazole 500 mg twice daily for seven days.✓
Show rationale
Trichomoniasis during pregnancy increases the risk of premature rupture of membranes and preterm delivery. Oral metronidazole is safe and indicated in all trimesters to eradicate the infection and reduce transmission risks. Delaying treatment increases obstetric complications. Topical clindamycin has poor efficacy for trichomoniasis and does not treat the urinary reservoir. Oral fluconazole is contraindicated in pregnancy and targets fungal pathogens, not protozoa.
Question 3
A 24-month-old boy is evaluated in the clinic. His parents report delayed speech. The M-CHAT-R screening yields a score of 9. Hearing screening is normal.
- A) Conduct the M-CHAT-R Follow-Up interview to clarify the failed screening items.
- B) Recommend intensive speech therapy and repeat the autism screening in three months.
- C) Reassure the parents that boys frequently experience benign expressive speech delays.
- D) Refer immediately for early intervention and a comprehensive autism diagnostic evaluation.✓
Show rationale
A score of 8 to 20 on the M-CHAT-R indicates a high-risk score for autism spectrum disorder. The correct action is an immediate referral for both early intervention and a formal diagnostic evaluation. Conducting the Follow-Up interview (Option A) is incorrect because it is only indicated for medium-risk scores (3 to 7). Recommending speech therapy while delaying further screening (Option B) or reassuring the parents about benign delays (Option C) ignores the validated high-risk screening result and unacceptably delays comprehensive autism diagnosis and specialized care.
Question 4
An 18-year-old female tests positive for Chlamydia trachomatis. She is asymptomatic. She states her 19-year-old boyfriend refuses to see a provider because he has no symptoms and lacks health insurance.
- A) Provide a doxycycline prescription for the patient and her untreated partner.✓
- B) Report the untreated partner to the local county health department immediately.
- C) Treat the patient with ceftriaxone and advise partner testing within weeks.
- D) Withhold the patient's treatment until the partner agrees to clinical evaluation.
Show rationale
When a partner is unlikely to seek clinical evaluation due to financial or personal barriers, expedited partner therapy is recommended to prevent reinfection of the index patient. Providing a prescription for doxycycline allows the partner to be treated concurrently. Option B is incorrect because while chlamydia is reportable, health departments typically do not mandate partner tracking for routine chlamydia cases in the same way they might for syphilis or HIV. Option C uses the wrong medication as ceftriaxone targets gonorrhea, not chlamydia. Option D is unethical because it delays necessary antibiotic treatment for the confirmed patient.
Question 5
A 24-year-old asymptomatic female presents for a routine wellness exam. She has no history of trauma and denies any current relationship issues. According to current guidelines, how should the FNP proceed?
- A) Defer intimate partner violence screening until symptoms arise.
- B) Screen for intimate partner violence only if she is married.
- C) Assess for intimate partner violence using a collateral source.
- D) Screen for intimate partner violence using a standardized tool.✓
Show rationale
The USPSTF recommends screening all women of reproductive age for IPV, even when they are asymptomatic or deny relationship issues. Option D is correct because universal screening with a validated tool is the standard of care. Option A is incorrect because screening is universal, regardless of symptoms, and waiting for signs of abuse misses early intervention opportunities. Option B is incorrect as marital status does not dictate the need for screening. Option C is inappropriate, breaches confidentiality, and is unsafe.
Question 6
A patient has a reactive result on a positive highly sensitive screening test for Hepatitis C. The FNP explains that the patient needs a confirmatory test to diagnose the active infection. What statistical characteristic must the confirmatory test possess to be effective?
- A) High sensitivity to ensure no false negatives occur.
- B) High prevalence to increase negative predictive values.
- C) High specificity to ensure true negatives are identified.✓
- D) High incidence to increase positive predictive values.
Show rationale
Once a highly sensitive screening test yields a positive result, a confirmatory test is needed to rule out false positives. This requires a test with high specificity, which accurately identifies those without the disease and reliably rules in the diagnosis when positive (the SpPin principle). Option A is incorrect because high sensitivity is the goal of the initial screen, not the confirmatory step. Options B and D are incorrect because prevalence and incidence are epidemiological characteristics of the population, not intrinsic characteristics of a diagnostic test.
Question 7
A 50-year-old male returns to the clinic after a positive fecal immunochemical test that was completed as part of routine annual screening. He reports no abdominal pain, changes in bowel habits, or visible blood in his stool. What is the most appropriate next step?
- A) Repeat the fecal immunochemical test in exactly six months from today.
- B) Order a multi-targeted stool DNA test to confirm the positive results.
- C) Refer the patient for a diagnostic colonoscopy to evaluate the findings.✓
- D) Schedule a computed tomography colonography to assess for any active bleeding.
Show rationale
Any positive result on a non-invasive stool-based screening test, including a fecal immunochemical test, requires a direct visual evaluation of the colon. A diagnostic colonoscopy is the only appropriate next step to locate the source of bleeding and remove potential polyps. Option A is incorrect because repeating the test delays necessary diagnostic evaluation and ignores a positive finding. Option B is incorrect because following up one stool test with a different stool test is never recommended and wastes clinical time. Option D is incorrect because while computed tomography colonography visualizes the colon, it does not allow for tissue biopsy or polyp removal, which is required after a positive stool test.
Question 8
A 32-year-old Asian American female presents for a physical. She has a BMI of 24 kg/m2, a blood pressure of 132/84 mmHg, and a maternal history of type 2 diabetes. She exercises twice weekly. Which action is most appropriate regarding diabetes screening?
- A) Reassure her that screening is unnecessary given her normal body weight.
- B) Order a hemoglobin A1c test due to her specific risk factors.✓
- C) Advise her to return for fasting glucose screening at age thirty-five.
- D) Instruct her to increase exercise and reevaluate in three full years.
Show rationale
The ADA recommends screening for diabetes in Asian American adults at a lower BMI threshold of 23 kg/m2 because they develop metabolic complications at lower weights. Combined with her maternal history, she requires immediate screening despite being under age 35. Reassuring her misses this ethnic-specific risk factor. Waiting until age 35 ignores her current high-risk status. Instructing her to exercise without screening fails to identify potential existing prediabetes or diabetes, which would dictate the intensity of the required intervention.
Question 9
A 22-year-old female presents with intense vulvar pruritus and a thick white discharge. Her vaginal pH is 4.0. The initial saline wet mount shows many white blood cells but no distinct organisms or clue cells. What is the most appropriate next step in the microscopic evaluation?
- A) Order a nucleic acid amplification test for chlamydia.
- B) Apply potassium hydroxide to the slide to reveal spores.✓
- C) Perform a whiff test to evaluate for amine release.
- D) Swab the lateral vaginal wall for a trichomonas screen.
Show rationale
This patient presents with classic signs of vulvovaginal candidiasis, including intense pruritus, thick white discharge, and a normal vaginal pH of 4.0. When a saline wet mount shows white blood cells but no distinct organisms, the next step is to apply 10% potassium hydroxide (KOH) to the slide. The KOH lyses cellular debris and epithelial cells, making it much easier to visualize the branching pseudohyphae and budding yeast spores characteristic of Candida. Option B is the best action. Option A is incorrect because chlamydia testing does not address the acute vulvovaginal symptoms. Option C is incorrect; a whiff test is used to detect the amines of bacterial vaginosis, which typically presents with an elevated pH. Option D is incorrect; trichomonas is best visualized on the initial saline wet mount, not via lateral wall culture.
Question 10
A 55-year-old male presents for a routine hypertension screening. His mid-upper arm circumference measures 39 centimeters. Which equipment selection is most appropriate to ensure an accurate blood pressure measurement for this patient?
- A) Utilize a standard adult cuff to prevent falsely elevated readings.
- B) Utilize a standard adult cuff to prevent falsely decreased readings.
- C) Utilize a large adult cuff to prevent falsely decreased readings.
- D) Utilize a large adult cuff to prevent falsely elevated readings.✓
Show rationale
A mid-upper arm circumference of 39 cm requires a large adult cuff. Using a cuff that is too small causes falsely elevated readings due to inadequate compression of the brachial artery. Therefore, a large adult cuff must be used to prevent falsely elevated readings, making Option D correct. Option A uses the wrong cuff size. Option B uses the wrong cuff size and identifies the wrong error direction. Option C identifies the wrong error direction for an undersized cuff.
Question 11
A 48-year-old with Stage 3b CKD is preparing for a routine screening colonoscopy and needs education on bowel preparation.
- A) Recommend a sodium phosphate-based oral laxative.
- B) Recommend a magnesium citrate-based oral laxative.
- C) Recommend a polyethylene glycol-based oral laxative.✓
- D) Recommend an aluminum hydroxide-based oral laxative.
Show rationale
In patients with compromised renal function, polyethylene glycol is the preferred osmotic laxative because it is non-absorbable and does not cause significant electrolyte shifts. Option C is correct. Option A is dangerous; sodium phosphate preparations can cause acute phosphate nephropathy and permanent renal damage in CKD. Option B is incorrect because magnesium is poorly cleared by failing kidneys, risking hypermagnesemia. Option D is incorrect as aluminum can also accumulate, causing toxicity, and is not typically used for bowel preparation.
Question 12
A 42-year-old non-smoker presents with progressive exertional dyspnea. Spirometry confirms a post-bronchodilator FEV1/FVC ratio of 0.62, and a chest radiograph reveals basilar hyperlucency. Which diagnostic test is most appropriate to determine the underlying etiology of this patient's airflow limitation?
- A) Sputum culture for acid-fast bacilli
- B) High-resolution chest computed tomography
- C) Serum alpha-1 antitrypsin level testing✓
- D) Transthoracic echocardiogram for heart failure
Show rationale
The World Health Organization and GOLD guidelines recommend alpha-1 antitrypsin screening for patients who develop COPD at a young age, typically under 45, or who have a minimal smoking history. The presence of basilar hyperlucency further supports this genetic etiology. Option A is incorrect because while tuberculosis can cause lung damage, it does not typically present with isolated basilar emphysema. Option B can visualize emphysema but will not identify the genetic cause. Option D evaluates for cardiac causes of dyspnea, but the spirometry already confirms an obstructive pulmonary defect.
Question 13
A 40-hour-old newborn has undergone two prior congenital heart disease screens that both showed 94% in the right hand and 94% in the foot. The third screening reveals 93% in the right hand and 94% in the foot. What is the next appropriate action?
- A) Repeat the screening for a fourth time today.
- B) Discharge the infant with close outpatient monitoring.
- C) Administer supplemental oxygen and retest the infant.
- D) Order an urgent echocardiogram for further assessment.✓
Show rationale
The screening algorithm for critical congenital heart disease allows for a maximum of three total screens. If the initial screen is borderline the practitioner repeats the test in one hour. If the second screen is still borderline a third and final screen is performed one hour later. If the infant fails to achieve a passing score of at least 95 percent on the third screening the result is considered a definitive fail. This requires ordering an urgent echocardiogram to evaluate for structural heart defects. Repeating the screening for a fourth time is incorrect because guidelines strictly limit testing to three attempts to prevent dangerous delays in care. Discharging the infant is unsafe given the failed screen. Administering supplemental oxygen is incorrect because it does not diagnose the underlying issue and may mask symptoms.
Question 14
An 81-year-old patient with severe macular degeneration and advanced rheumatoid arthritis in both hands requires a routine cognitive screening during a care transition. Which approach is most appropriate for assessing this patient's cognitive baseline?
- A) Administer the standard Montreal Cognitive Assessment screening tool.
- B) Administer the standard Mini-Mental State Examination screening tool.
- C) Administer a validated auditory-verbal cognitive screening assessment tool.✓
- D) Administer the standardized Clock Drawing Test screening tool.
Show rationale
Standard cognitive assessments like the MoCA, MMSE, and Clock Drawing Test require adequate visual acuity and fine motor skills to complete tasks such as drawing intersecting pentagons, copying a cube, or reading a sentence. Administering these standard tools (Options A, B, and D) to a patient with severe vision loss and advanced arthritis would yield a falsely low score that reflects physical limitations rather than cognitive deficits. An auditory-verbal screening tool, such as the MoCA-Blind or a similar validated alternative, removes the visual and motor requirements, providing an accurate reflection of the patient's actual cognitive status.
Question 15
A 40-year-old female presents for her well-woman exam. She had a normal Pap smear three years ago but now prefers a five-year screening interval to reduce clinic visits. She has no history of abnormal cervical screenings. Which action is most appropriate?
- A) Perform cervical cytology alone during this visit.
- B) Defer all screening until she turns forty-five.
- C) Schedule an immediate colposcopy with tissue biopsy.
- D) Perform human papillomavirus and cytology co-testing today.✓
Show rationale
For women aged 30 to 65, acceptable screening strategies include cytology alone every three years, primary hrHPV testing every five years, or co-testing every five years. Since she desires a five-year interval, performing co-testing today aligns perfectly with her preference and current guidelines. Performing cytology alone is acceptable but would restrict her to a three-year interval. Deferring screening is incorrect because she is currently due for screening based on her last cytology result. Colposcopy is strictly a diagnostic evaluation tool, not a routine screening method for asymptomatic women.
