Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
26.5% of the scored exam asks what you will do next. NPCB lists prescribing, referral and education under this one task, so the right answer to a plan question is often a referral or a conversation rather than a prescription.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
A care plan: patient-centered and evidence-based, matched to what the patient will do.
A referral or consultation: specialist, emergency department, or another member of the team.
A treatment: pharmacologic, non-pharmacologic or integrative.
Teaching: education, counseling and health promotion.
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15 Plan questions
0 / 15 answered15 questions
Tap an option: why each one is right or wrong appears under it.
Plan · 26.5%
A 28-year-old nonpregnant woman has an expanding 8-cm erythematous lesion with central clearing on her thigh, along with fatigue and myalgia. She camped in Connecticut 10 days ago but recalls no tick bite. Which is the most appropriate management?
Erythema migrans after time outdoors in an endemic state is early Lyme disease, treated with doxycycline for 10 days (IDSA 2020); a recalled tick bite is not required.
Erythema migrans in an endemic area is a clinical diagnosis; serology is often negative this early and should not delay treatment.
Amoxicillin is an alternative, but the course is 14 days; 28 days is the regimen for Lyme arthritis.
A single 200-mg dose of doxycycline is prophylaxis after a recognized high-risk tick bite, not treatment of established infection.
A 63-year-old man has 1 year of bothersome weak stream, frequency, and nocturia, with an IPSS of 15. He also has erectile dysfunction. DRE shows a smooth, mildly enlarged prostate. Urinalysis is normal, PSA is 1.2 ng/mL, and post-void residual is 50 mL. He takes no nitrates. Which single medication best treats both problems?
Tamsulosin improves urinary symptoms but does nothing for erectile dysfunction and can cause ejaculatory problems.
As-needed sildenafil treats erectile dysfunction but is not approved for BPH symptoms.
Finasteride works best in large prostates and can worsen erectile function.
Daily tadalafil 5 mg is FDA-approved for both BPH symptoms and erectile dysfunction and is contraindicated only with nitrates.
A 50-year-old man has had nasal congestion, facial pain, and postnasal drainage for four months despite intranasal steroids, saline rinses, and multiple antibiotic courses. What is the next appropriate step in his management plan?
Over-the-counter decongestants give short relief and cause rebound congestion; they do not address chronic sinusitis.
Repeated long antibiotic courses add resistance and adverse effects without addressing the underlying disease.
Symptoms lasting more than 12 weeks despite topical steroids, saline, and antibiotics need ENT referral for nasal endoscopy and sinus CT to confirm chronic rhinosinusitis and plan treatment.
Surgery is planned only after endoscopy and CT define the disease.
A 65-year-old man has profuse clear, watery rhinorrhea that is worse when eating hot or spicy food and in cold air, without itching, sneezing, or congestion. Allergy testing is negative. Which treatment is most appropriate?
Daily oxymetazoline causes rebound congestion (rhinitis medicamentosa) and does not treat watery rhinorrhea.
Oral antihistamines help itching and sneezing in allergic rhinitis, not nonallergic watery rhinorrhea.
Watery rhinorrhea triggered by hot food or cold air without allergy is gustatory or nonallergic rhinitis, and intranasal ipratropium treats the cholinergic secretion.
Pseudoephedrine addresses congestion, which he does not have, and raises blood pressure.
A 42-year-old woman with chronic spontaneous urticaria still has daily hives after 4 weeks of cetirizine 40 mg daily (four times the standard dose), taken consistently. She has no airway angioedema. Which is the most appropriate next step?
Chronic spontaneous urticaria is rarely caused by food, so elimination diets are not recommended without a clear trigger.
Long-term prednisone causes serious adverse effects and is used only briefly for severe flares.
Switching to a sedating first-generation antihistamine adds sedation and anticholinergic effects without better control.
When hives persist despite second-generation antihistamines at up to four times the standard dose, omalizumab is the next step.
A 42-year-old nonpregnant woman has had four urinary tract infections in the past year despite adequate hydration and voiding hygiene. She has no anatomic abnormality. What is the most appropriate plan?
Indefinite weekly broad-spectrum antibiotics promote resistance and are not a recommended regimen.
Three or more UTIs a year despite behavioral measures justify low-dose prophylaxis, continuous at night or after intercourse when episodes follow it.
Treating each episode helps symptoms but does not reduce recurrence once behavioral measures have failed.
Cranberry products modestly lower recurrence (Cochrane 2023) and AUA allows offering them, but after four infections in a year they are less effective than antimicrobial prophylaxis, and she already keeps up her fluids.
A 40-year-old woman who wears soft contact lenses has 1 day of a red, irritated right eye with mucopurulent discharge. Visual acuity is normal, and fluorescein staining shows no corneal defect or infiltrate. Which management is most appropriate?
Topical steroids worsen bacterial and herpetic infections and are not prescribed in primary care for a red eye.
An antihistamine treats allergic conjunctivitis, which causes itching and watery discharge, not mucopurulent discharge in a lens wearer.
In a contact lens wearer, bacterial conjunctivitis is treated with a fluoroquinolone drop for Pseudomonas coverage, and lenses are stopped until it resolves.
Continuing lenses risks keratitis, and erythromycin does not cover Pseudomonas.
A 71-year-old woman with overactive bladder has persistent urgency incontinence despite 3 months of behavioral therapy and 8-week trials of mirabegron and trospium, each at full dose. Urinalysis is normal and post-void residual is 40 mL. Which is the most appropriate next step?
Combining two antimuscarinics adds anticholinergic harm, especially in older adults, without more benefit.
Failure of behavioral therapy and two drug classes calls for third-line therapy (onabotulinumtoxinA, tibial nerve stimulation, or sacral neuromodulation) through urology.
An indwelling catheter is a last resort for urinary retention, not for urgency incontinence with a low residual volume.
Desmopressin treats nocturnal polyuria and causes hyponatremia in older adults.
A 68-year-old man has 4 days of gradually worsening left scrotal pain and swelling with dysuria and frequency. He is married and monogamous. The left epididymis is tender and swollen, the testis lies normally, and the cremasteric reflex is present. Urinalysis shows pyuria and nitrites, and a urine culture is sent. Which treatment is most appropriate?
Ceftriaxone plus doxycycline targets gonorrhea and chlamydia, which are likely in sexually acquired epididymitis in younger men.
Single-dose azithromycin covers neither enteric organisms nor gonorrhea adequately.
Nitrofurantoin does not reach adequate levels in the epididymis or prostate.
In a man over 35 with epididymitis and urinary signs, enteric organisms are likely, and levofloxacin for 10 days is recommended (CDC STI 2021).
A 58-year-old man with benign prostatic hyperplasia presents with gross hematuria for 8 hours. He reports passing large clots and feeling dizzy when standing. He takes tamsulosin and aspirin. Vital signs: BP 96/58 mmHg (sitting), 82/52 mmHg (standing), HR 112 bpm, RR 18/min. Physical exam shows pale conjunctivae and mild suprapubic tenderness. Lab results from 2 hours ago: Hgb 9.2 g/dL (baseline 14.5 g/dL 3 months ago). What is the most appropriate immediate management?
Hypotension, tachycardia, and a large hemoglobin drop with clots need emergency transfer for resuscitation, transfusion, catheter irrigation, and urologic evaluation.
Outpatient urology in days is appropriate for a stable patient, not for one who is hypotensive with clot-passing hematuria.
Oral fluids cannot correct hemorrhagic shock, and clinic observation delays transfusion and bladder irrigation.
Orthostatic hypotension, tachycardia, and a hemoglobin drop of more than 5 g/dL are hemorrhagic shock; waiting 4 hours in the clinic is unsafe.
A 68-year-old man presents with a 6 lb unintentional weight loss over 2 months, progressive fatigue, and blood in his stool for the past 3 weeks. He has not seen a provider in 5 years. Physical exam reveals conjunctival pallor and a palpable left lower quadrant abdominal mass. Hemoglobin is 9.2 g/dL (baseline unknown). Which action is most appropriate?
Waiting for imaging before referring adds 1 to 2 weeks; the specialist can order staging.
A palpable mass with rectal bleeding, anemia, and weight loss suggests colorectal cancer, and urgent referral with direct clinician contact avoids delay.
A routine referral with a PPI misreads lower GI alarm features as an upper GI problem and delays diagnosis.
Routine outpatient colonoscopy with a 4-week review treats this as low risk, though a palpable mass with bleeding, anemia, and weight loss suggests colorectal cancer.
A 58-year-old African American man with a family history of prostate cancer (father diagnosed at age 62) presents for discussion of prostate cancer screening. He has researched PSA testing online and states, "I read that screening reduces my risk of dying from prostate cancer by 50%, so I definitely want to be screened." Vital signs are normal. Physical exam is unremarkable. Which of the following responses best applies shared decision-making principles and addresses risk communication?
For men 55 to 69, USPSTF calls PSA screening an individual decision; correcting the 50% figure with absolute numbers, reviewing harms, and asking about his values is shared decision-making, and his race and family history raise his risk.
Screening is not ruled out at 58, and his race and family history are reasons to offer the discussion, not to decline.
Testing first and discussing afterward skips the decision; the harms (false positives, biopsy, overdiagnosis) need discussion before the test.
The 50% figure confuses relative with absolute benefit; the absolute benefit is about 1 prostate cancer death prevented per 1,000 men screened over about 13 years.
A 22-year-old man has had lighter, finely scaly patches on his upper chest and back since the summer. They do not itch. A KOH preparation shows short hyphae and round yeast cells ('spaghetti and meatballs'). Which is the most appropriate treatment?
Oral terbinafine is not effective against Malassezia, the yeast that causes tinea versicolor.
'Spaghetti and meatballs' on KOH means tinea versicolor (Malassezia), and topical azoles such as ketoconazole or selenium sulfide are first-line.
Doxycycline treats acne and rosacea; it has no antifungal activity.
Hydrocortisone does not treat a fungal infection and may make it worse.
A 58-year-old man with hypertension ran out of his amlodipine and losartan 5 days ago. In the clinic his BP is 186/112 mm Hg on repeat. He has no headache, chest pain, dyspnea, neurologic or visual symptoms, and his exam, ECG, creatinine, and urinalysis are unchanged from baseline. Which is the most appropriate management?
IV therapy in the ED is for hypertensive emergency with acute organ damage; he has none, and rapid lowering can cause ischemia.
Rapid lowering to normal in chronic hypertension risks cerebral, coronary, and renal hypoperfusion; BP is lowered gradually over days.
Severe hypertension without acute target-organ damage is not an emergency; restarting or adjusting oral therapy and rechecking within days to a week lowers BP safely (AHA/ACC).
Short-acting nifedipine causes abrupt, unpredictable drops in BP and has caused strokes and myocardial infarctions; it is not used.
A 63-year-old man who has smoked for 40 years noticed painless red urine twice last week. He has no dysuria, fever, flank pain, or recent trauma, and he takes no anticoagulants. Urinalysis confirms red blood cells without leukocytes, nitrites, or casts. What is the most appropriate next step?
Painless gross hematuria in a 63-year-old smoker is high risk for urothelial cancer; CT urography images the upper tracts, and cystoscopy examines the bladder (AUA 2025 microhematuria/hematuria guidance).
Ultrasound misses many small upper tract tumors and cannot see the bladder lining, so skipping cystoscopy leaves a likely bladder cancer undiagnosed.
No pyuria or nitrites means infection does not explain the bleeding, and antibiotics would delay the cancer workup.
Repeating a urinalysis in 6 months delays the diagnosis of a likely bladder or kidney cancer.
A running total sits here; it fills in after your last pick.
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One patient, step three: the plan
The patient: a 58-year-old woman started lisinopril for hypertension four months ago. She now reports a dry, tickling cough of six weeks that keeps her awake. The same case runs through all four task pages. The differential points to the ACE inhibitor.
Stop lisinopril. The cough is a class effect, so switching to another ACE inhibitor does not help.
Keep the blood pressure treated. An angiotensin receptor blocker rarely causes cough and suits a patient who needed renin-angiotensin blockade; another first-line class works if not.
Skip cough suppressants as the fix. They quiet the symptom while the cause keeps acting.
Teach the timeline. The cough usually settles within weeks of stopping, occasionally longer, and she should return sooner for fever, hemoptysis or breathlessness.
The family exam stops at first-contact mental health care, and so does this section.
Screening: the PHQ-9 and GAD-7 find patients to assess. A positive screen leads to a diagnostic interview, not straight to a prescription.
Before an antidepressant: ask about past mania or hypomania, because an antidepressant alone can destabilize bipolar disorder, and ask directly about suicidal thoughts.
First line: for moderate to severe major depression the ACP 2023 guideline puts cognitive behavioral therapy and a second-generation antidepressant side by side as initial options.
Younger adults: antidepressants carry an FDA boxed warning for suicidal thinking up to age 24, which shapes follow-up.
A prescription where teaching was asked. Look at the stem's verb; educate, counsel and refer are plans too.
Office care for an emergency. Unstable vital signs or a time-critical diagnosis means the emergency department.
Antibiotics for a viral illness. Most acute bronchitis, colds and viral pharyngitis need none (CDC antibiotic stewardship).
Forgetting pregnancy potential. Valproate, isotretinoin and warfarin are among the drugs whose plan includes contraception; reproductive planning itself is on WHNP-BC contraception.
Adult plans for children. Pediatric dosing and management are on CPNP-PC management.
At primary-care depth: screening, a diagnostic interview, a first-line option and safety planning. Psychiatric management beyond that belongs to the psychiatric NP exam.
Is referral really a correct answer that often?
It is one of the four task statements NPCB lists under Plan, so a stem built on it can have a referral as the key.