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The first-line treatments and safety rules that recur on the FNP exam. Skim before test day, then prove
it with practice questions.
Exam facts
- 150 questions (135 scored); 100% clinical
- Process: Assess 32% · Diagnose 26.5% · Plan 26.5% · Evaluate 15%
Chronic-disease first-lines
- Type 2 diabetes — metformin first-line (unless eGFR <30); BP goal
generally <130/80, ACE/ARB preferred - Hypertension — thiazide, ACE/ARB, or CCB first-line; ACE/ARB if diabetic or
CKD - Asthma — inhaled corticosteroid is the controller cornerstone
Safety & contraindications
- Migraine with aura — avoid estrogen-containing contraceptives (stroke
risk) - ACE inhibitors — contraindicated in pregnancy; watch for cough/angioedema and
hyperkalemia - Tinea — topical antifungal; do not treat with a steroid alone
Pediatrics quick hits
- MMR & varicella — start at 12 months
- HPV — begins at 11–12 years
- Lifespan focus is adult-heavy, but peds milestones and the vaccine schedule are testable
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Frequently asked questions
What is the first-line treatment for type 2 diabetes on the FNP exam?
Metformin, absent contraindications such as an eGFR below 30. The blood-pressure goal is generally below 130/80, with an ACE inhibitor or ARB preferred in diabetic patients.
When are MMR and varicella vaccines given?
Both start at 12 months of age on the standard childhood schedule; HPV vaccination begins at 11–12 years.
Why avoid estrogen contraceptives with migraine with aura?
Migraine with aura raises stroke risk, so estrogen-containing contraceptives are contraindicated — switch to a progestin-only or non-hormonal method.
Sources & references
The exam facts on this page are drawn from official certifying-body materials, reviewed 2026-06-18 by the DrCertifications exam-prep team (10+ years in exam preparation and publishing).