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FNP: Urinary Tract Infections

UTIs are among the most common primary-care presentations. These FNP questions cover diagnosis, first-line antibiotics, complicated versus uncomplicated cases, and follow-up — each with a full rationale.

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  • 💡 Key Takeaways — the one transferable rule per question
  • 🔍 Hint highlights — the decisive cue phrases in each stem
  • 📖 Full rationales — why every option is right or wrong

Every FNP question is written to the current exam outline for quick learning and a clear pass strategy.

Written and reviewed by the LexPort exam-prep team, led by our Founder & Exam-Prep Lead. LexPort builds certification practice questions — this is exam-preparation material, not medical advice. Last reviewed August 2026.

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Test yourself: FNP: Urinary Tract Infections

Three FNP practice questions on fnp: urinary tract infections — tap an answer for instant feedback. The app has 3,000+, timed and scored.

Question 1

1 of 150. An 81-year-old frail female states she bathes and dresses independently. However, her daughter privately reports finding the patient in soiled clothes for several consecutive days. How should the FNP proceed to accurately assess her functional status?

▸ Why C is the answer

When there is a discrepancy between self-report and caregiver report regarding functional ability, the most reliable assessment method is direct observation of performance. Asking the patient to don a jacket evaluates upper extremity mobility, sequencing, and fine motor skills. Documenting only self-report ignores potential safety risks. Confronting the patient may cause defensiveness and damage rapport. Laboratory tests for delirium are premature without evidence of an acute, sudden change in baseline.

🔑 Key takeaway

Direct performance observation is the most reliable method to assess ADLs when patient and caregiver histories conflict.

Question 2

9 of 150. A 4-year-old male treated for his first febrile UTI has just completed a 10-day course of cefdinir. He is now afebrile and asymptomatic. The parents ask if a repeat urinalysis is necessary today. Which action is most appropriate?

▸ Why B is the answer

For a pediatric patient who has fully responded to treatment for a first febrile UTI, a routine post-treatment urinalysis or test-of-cure is not recommended by current pediatric guidelines. Option B is correct because it prevents unnecessary testing in an asymptomatic child. While a renal ultrasound is indicated after a first febrile UTI to check for anatomic abnormalities, repeating the urinalysis is not. Option A is incorrect because confirming bacterial clearance is only necessary if symptoms persist or recur. Option C is incorrect because a voiding cystourethrogram is no longer routinely recommended after a first UTI unless the renal ultrasound reveals hydronephrosis or scarring. Option D is incorrect because prophylactic antibiotics are not indicated following a single resolved UTI and contribute to antimicrobial resistance. Clinical resolution is the primary indicator of success.

🔑 Key takeaway

Routine post-treatment urinalysis is not recommended for pediatric patients who are asymptomatic after UTI treatment.

Question 3

12 of 150. 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?

▸ Why D is the answer

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.

🔑 Key takeaway

Oral metronidazole is safe and strongly indicated for treating trichomoniasis across all trimesters of pregnancy.

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Question 1

2 of 15. A 17-year-old female, 5 years post-menarche, reports cycles every 60 to 90 days. Physical examination reveals a BMI of 32 but no evidence of hirsutism or severe acne. Which finding is required to establish the diagnosis?

  • A) Documenting an elevated serum free testosterone laboratory level.✓
  • B) Identifying polycystic morphology on a transvaginal pelvic ultrasound.
  • C) Demonstrating an elevated luteinizing hormone to gonadotropin ratio.
  • D) Confirming severe insulin resistance via fasting glucose testing.

💡 Key Takeaway

Adolescent PCOS diagnosis requires both ovulatory dysfunction and evidence of hyperandrogenism, which can be clinical or biochemical.

Show rationale

In adolescents, diagnosing PCOS requires both ovulatory dysfunction (which this patient has, given her oligomenorrhea 5 years post-menarche) and hyperandrogenism. Because she lacks clinical signs like hirsutism or severe acne, you must demonstrate biochemical hyperandrogenism via elevated serum free or total testosterone, making Option A correct. Option B is incorrect; ultrasound is not recommended for diagnosis within eight years of menarche due to normal physiologic variations in ovarian morphology. Option C is incorrect; an elevated LH-to-FSH ratio is frequently seen in PCOS but is not a recognized diagnostic criterion. Option D is incorrect; while patients with PCOS and obesity often have insulin resistance, metabolic testing is used for risk stratification and management, not to establish the primary diagnosis.

Question 2

3 of 15. A 21-year-old female presents with dysuria and frequency. She reports a severe anaphylactic reaction to penicillin during childhood. The local E. coli resistance to TMP-SMX is 12%. Which of the following is the most appropriate antibiotic prescription?

  • A) Amoxicillin-clavulanate 500 mg orally twice daily for five days
  • B) Trimethoprim-sulfamethoxazole DS orally twice daily for three days✓
  • C) Ciprofloxacin 250 mg orally twice daily for three days
  • D) Cephalexin 500 mg orally twice daily for seven days

💡 Key Takeaway

TMP-SMX is a safe first-line UTI treatment for penicillin-allergic patients when local resistance is below 20 percent.

Show rationale

Choosing the right antibiotic here requires balancing local resistance data with a severe allergy history. A severe anaphylactic reaction to penicillin completely rules out amoxicillin-clavulanate and makes cephalexin a risky choice due to the potential for cross-reactivity. Because the local resistance rate to TMP-SMX is 12 percent, which is well below the 20 percent cutoff, it remains an excellent first-line option. You should hold off on prescribing ciprofloxacin, as fluoroquinolones are reserved for situations where absolutely no first-line agents can be safely used.

Question 3

4 of 15. A 25-year-old male with perennial allergic rhinitis uses fluticasone nasal spray daily with perfect technique. Despite adherence, he continues to complain of bothersome watery eyes and sneezing.

  • A) Switch the fluticasone to a daily oral systemic corticosteroid.
  • B) Discontinue the fluticasone and start an intranasal decongestant spray.
  • C) Increase the fluticasone frequency to three times every day.
  • D) Add a daily oral second-generation antihistamine to the regimen.✓

💡 Key Takeaway

Step-up therapy for allergic rhinitis uncontrolled by intranasal corticosteroids involves adding an oral or intranasal antihistamine.

Show rationale

When daily intranasal corticosteroid monotherapy is insufficient to control symptoms like sneezing and ocular irritation, adding an oral second-generation antihistamine or an intranasal antihistamine is the appropriate step-up therapy. Switching to systemic corticosteroids is inappropriate and carries significant risks for routine allergic rhinitis management. Discontinuing the steroid for an intranasal decongestant risks rebound congestion and fails to treat the allergic cascade. Increasing fluticasone beyond the maximum recommended daily dosing increases the risk of epistaxis and septal perforation.

Question 4

11 of 15. A 26-year-old male's scrotal ultrasound reveals a hypoechoic, hypervascular solid mass within the right testicular parenchyma. He denies any recent trauma, pain, or dysuria.

  • A) Order serum alpha-fetoprotein, beta-hCG, and lactate dehydrogenase✓
  • B) Prescribe a four-week course of empiric oral antibiotics
  • C) Schedule a repeat scrotal ultrasound in six months
  • D) Perform a percutaneous core needle biopsy of the mass

💡 Key Takeaway

Solid intra-testicular masses require serum tumor marker evaluation prior to definitive urologic surgical management.

Show rationale

A hypoechoic, hypervascular solid intra-testicular mass in a young adult is highly suspicious for testicular cancer. The next appropriate diagnostic step is to order serum tumor markers, including alpha-fetoprotein, beta-hCG, and lactate dehydrogenase, prior to urologic referral. Prescribing empiric antibiotics (Option B) is incorrect because the mass is solid and painless, not infectious. Scheduling a repeat ultrasound in six months (Option C) dangerously delays the diagnosis and treatment of a potential malignancy. Performing a percutaneous core needle biopsy (Option D) is strictly contraindicated due to the high risk of seeding tumor cells into the scrotal lymphatic drainage from an intra-testicular mass.

Question 5

14 of 15. A 22-year-old non-pregnant female presents with two days of dysuria and frequency. She reports no vaginal discharge or fever. She has no significant medical history and takes no daily medications. Which diagnostic action is most appropriate?

  • A) Order a comprehensive urine culture test.
  • B) Perform a point-of-care urine dipstick.✓
  • C) Obtain a nucleic acid amplification test.
  • D) Order a microscopic urinalysis laboratory test.

💡 Key Takeaway

Uncomplicated cystitis in healthy non-pregnant women can be diagnosed clinically or supported by a simple urine dipstick.

Show rationale

For a healthy young adult with classic symptoms of uncomplicated cystitis and no vaginal symptoms, a point-of-care urine dipstick is sufficient to support the diagnosis. A urine culture is not routinely indicated for initial uncomplicated episodes. A nucleic acid amplification test or microscopic urinalysis adds unnecessary cost and delay when the clinical picture and dipstick strongly align.

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FNP · Exam Simulator

2 of 15. A 17-year-old female, 5 years post-menarche, reports cycles every 60 to 90 days. Physical examination…

A) Documenting an elevated serum free testo
B) Identifying polycystic morphology on a t
C) Demonstrating an elevated luteinizing ho
D) Confirming severe insulin resistance via
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