CMN 568 FAMILY NURSE PRACTITIONER FINAL EXAM
2026/2027 EDITION
FNP Role & Clinical Management | 75 Questions
Primary Care Across the Lifespan | NGN-Aligned Items
Verified Answers & Explained Rationales
Grade A+ | Guaranteed Pass Prep
DOMAIN 1: PRIMARY CARE MANAGEMENT ACROSS THE LIFESPAN
1. A 2-month-old infant presents for a well-child visit. The FNP anticipates which
immunizations are due per the CDC Advisory Committee on Immunization Practices
(ACIP) schedule?
A)) DTaP, IPV, HepB, PCV15, RV, Hib
B)) DTaP, MMR, Varicella, HepA
C)) DTaP, IPV, PCV15, RV only
D)) DTaP, IPV, MMR, HepB, RV
Rationale: Per the CDC ACIP recommended immunization schedule, the 2-month visit includes:
DTaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), HepB (hepatitis B, third dose if not
given at birth and 1 month), PCV15 or PCV20 (pneumococcal), RV (rotavirus), and Hib
(Haemophilus influenzae type b). MMR and varicella are not administered until 12 months. HepA
begins at 12 months. The FNP must also assess for contraindications and screen for adverse
reactions.
2. A 65-year-old male presents with acute onset of unilateral weakness, facial droop, and
slurred speech that began 45 minutes ago. The most appropriate immediate action by the
FNP is:
A)) Order a stat CT of the head without contrast and activate the stroke protocol
B)) Administer aspirin 325 mg and observe for improvement
C)) Schedule a follow-up appointment for neurology referral
D)) Obtain a detailed family history of cerebrovascular disease
Rationale: This patient presents with classic stroke symptoms. The FNP must recognize the
urgency: onset within 45 minutes places the patient within the thrombolytic window (tPA/alteplase
within 4.5 hours per AHA/ASA guidelines). The immediate priority is activating the stroke protocol
and obtaining a non-contrast CT head to differentiate ischemic from hemorrhagic stroke. Aspirin is
contraindicated until hemorrhagic stroke is ruled out. Time is brain — any delay in stroke
evaluation can result in irreversible neuronal death.
3. A 4-year-old child presents with fever, sore throat, and refusal to eat. The rapid strep
antigen test is positive. The first-line antibiotic of choice per the IDSA and AAFP guidelines
is:
A)) Amoxicillin 50 mg/kg/day divided twice daily for 10 days
B)) Azithromycin 10 mg/kg on day 1, then 5 mg/kg days 2–5
C)) Amoxicillin-clavulanate 45 mg/kg/day divided twice daily for 10 days
D)) Cephalexin 50 mg/kg/day divided four times daily for 10 days
Rationale: Per IDSA (2012, reaffirmed) and AAFP guidelines, amoxicillin at 50 mg/kg/day
(maximum 1000 mg/day) divided BID for 10 days is the first-line treatment for Group A
Streptococcal (GAS) pharyngitis in children. Amoxicillin is preferred over penicillin V due to better
, palatability, improved compliance, and equivalent efficacy. Azithromycin is reserved for penicillin-
allergic patients. Narrow-spectrum antibiotics are preferred to reduce resistance. A 10-day course
is standard to prevent rheumatic fever sequelae.
4. A 72-year-old female presents for her annual wellness visit. Her blood pressure is 148/88
mmHg on two separate occasions. Per the 2017 ACC/AHA hypertension guidelines, this
patient is classified as:
A)) Elevated blood pressure
B)) Stage 1 hypertension
C)) Stage 2 hypertension
D)) Hypertensive crisis
Rationale: Per the 2017 ACC/AHA guidelines, blood pressure is classified as: Normal (<120/80),
Elevated (120-129/<80), Stage 1 HTN (130-139/80-89), and Stage 2 HTN (>=140/90). This patient
at 148/88 meets Stage 2 criteria (systolic >=140). However, the question tests knowledge of the BP
at 148/88 — noting that the systolic component places it in Stage 2 while the diastolic is in Stage 1
range; the higher classification applies. Nonpharmacologic interventions (DASH diet, sodium
reduction, exercise, weight loss) plus pharmacotherapy are indicated. Target BP for adults >=65
per AHA is <130/80 if tolerated.
5. A 14-year-old female presents with her mother requesting a sports physical. The patient
reports her last menstrual period was 3 months ago. She is a competitive cross-country
runner. The most appropriate initial evaluation is:
A)) Reassurance that amenorrhea is normal in athletes and no further workup is needed
B)) Pregnancy test, comprehensive metabolic panel, and evaluation for the female
athlete triad (relative energy deficiency in sport)
C)) Referral to gynecology for oral contraceptive management
D)) Immediate bone density scan to evaluate for osteoporosis
Rationale: Secondary amenorrhea (absence of menses for >=3 cycles in a previously menstruating
female) in an athlete warrants evaluation for the Female Athlete Triad, now termed Relative
Energy Deficiency in Sport (RED-S). This condition involves low energy availability (with or
without disordered eating), menstrual dysfunction, and decreased bone mineral density. Initial
workup includes pregnancy test, CBC, CMP, TSH, prolactin, FSH/LH, and ESR. The FNP should
assess nutritional intake, training volume, and screen for disordered eating using validated tools.
6. A 55-year-old male with a history of T2DM, HTN, and hyperlipidemia presents for follow-
up. His most recent HbA1c is 8.2%, BP is 142/86, and LDL is 132 mg/dL. The FNP should
prioritize:
A)) Adding a third antihypertensive agent
B)) Intensifying glycemic management and initiating moderate-intensity statin
therapy
C)) Referring to bariatric surgery consultation
D)) Ordering a cardiac stress test immediately
Rationale: This patient has three uncontrolled cardiovascular risk factors. Per ADA Standards of
Care 2026, an HbA1c of 8.2% above the individualized target (<7.0% for most nonpregnant adults)
requires treatment intensification — adding a second agent or adjusting the current regimen. The
ACC/AHA 2018 cholesterol guidelines recommend a moderate-intensity statin for diabetic patients
aged 40-75 with LDL >70, and this patient qualifies for at least moderate-intensity statin regardless
of LDL level. BP at 142/86 warrants optimization as well, but glycemic control and statin initiation
are the highest-yield interventions to reduce cardiovascular risk.
7. A well-child visit for a 12-month-old should include developmental screening using which
validated tool per the AAP Bright Futures guidelines?
, A)) Denver Developmental Screening Test II (DDST-II)
B)) Ages and Stages Questionnaire (ASQ-3) or Parents' Evaluation of Developmental
Status (PEDS)
C)) Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
D)) Bayley Scales of Infant and Toddler Development
Rationale: The AAP Bright Futures guidelines (4th Edition) recommend standardized
developmental screening at 9, 18, and 30 months using validated instruments. The Ages and Stages
Questionnaire, 3rd Edition (ASQ-3) and Parents' Evaluation of Developmental Status (PEDS) are
the most commonly recommended parent-completed screening tools in primary care. They screen
communication, gross motor, fine motor, problem-solving, and personal-social domains. The
DDST-II, while historically used, has lower sensitivity and specificity than ASQ-3 or PEDS. The
Bayley and WPPSI are diagnostic, not screening tools.
8. An 80-year-old female presents with new onset of urinary incontinence. She reports
leakage of small amounts of urine when she coughs, sneezes, or laughs. This presentation is
most consistent with:
A)) Urge incontinence (overactive bladder)
B)) Stress urinary incontinence
C)) Functional incontinence
D)) Overflow incontinence
Rationale: Stress urinary incontinence (SUI) is characterized by involuntary urine leakage with
activities that increase intra-abdominal pressure (coughing, sneezing, laughing, lifting). It results
from weakness of the urethral sphincter and/or pelvic floor muscles. In contrast, urge incontinence
presents with a sudden, intense urge to void followed by leakage. Functional incontinence results
from physical or cognitive limitations preventing timely toileting. Overflow incontinence presents
with frequent dribbling from bladder outlet obstruction. First-line management of SUI includes
pelvic floor muscle exercises (Kegels), lifestyle modifications, and weight reduction.
DOMAIN 2: DIFFERENTIAL DIAGNOSIS & CLINICAL REASONING FRAMEWORKS
9. A 35-year-old female presents with acute onset of right lower quadrant abdominal pain,
nausea, and a white blood cell count of 14,500/uL. On examination, she has rebound
tenderness at McBurney's point. The leading diagnosis is:
A)) Ectopic pregnancy
B)) Acute appendicitis
C)) Ovarian torsion
D)) Pelvic inflammatory disease
Rationale: Acute appendicitis is the leading diagnosis given the classic presentation of RLQ pain,
nausea, leukocytosis (WBC 14,500), and rebound tenderness at McBurney's point. While ectopic
pregnancy, ovarian torsion, and PID are important differential diagnoses (especially in women of
childbearing age), the localized peritoneal signs at McBurney's point strongly suggest appendicitis.
A pregnancy test (beta-hCG) should be obtained to rule out ectopic pregnancy. CT abdomen/pelvis
(or ultrasound in pregnancy) is the diagnostic imaging of choice with sensitivity >95%.
10. In applying Bayesian reasoning, the pretest probability of a disease combined with the
sensitivity and specificity of a diagnostic test is used to calculate:
A)) The positive predictive value (PPV) and negative predictive value (NPV) of the test
in the specific patient population
B)) The absolute risk reduction of a treatment
C)) The number needed to treat (NNT)
D)) The hazard ratio of disease progression
2026/2027 EDITION
FNP Role & Clinical Management | 75 Questions
Primary Care Across the Lifespan | NGN-Aligned Items
Verified Answers & Explained Rationales
Grade A+ | Guaranteed Pass Prep
DOMAIN 1: PRIMARY CARE MANAGEMENT ACROSS THE LIFESPAN
1. A 2-month-old infant presents for a well-child visit. The FNP anticipates which
immunizations are due per the CDC Advisory Committee on Immunization Practices
(ACIP) schedule?
A)) DTaP, IPV, HepB, PCV15, RV, Hib
B)) DTaP, MMR, Varicella, HepA
C)) DTaP, IPV, PCV15, RV only
D)) DTaP, IPV, MMR, HepB, RV
Rationale: Per the CDC ACIP recommended immunization schedule, the 2-month visit includes:
DTaP (diphtheria, tetanus, pertussis), IPV (inactivated polio), HepB (hepatitis B, third dose if not
given at birth and 1 month), PCV15 or PCV20 (pneumococcal), RV (rotavirus), and Hib
(Haemophilus influenzae type b). MMR and varicella are not administered until 12 months. HepA
begins at 12 months. The FNP must also assess for contraindications and screen for adverse
reactions.
2. A 65-year-old male presents with acute onset of unilateral weakness, facial droop, and
slurred speech that began 45 minutes ago. The most appropriate immediate action by the
FNP is:
A)) Order a stat CT of the head without contrast and activate the stroke protocol
B)) Administer aspirin 325 mg and observe for improvement
C)) Schedule a follow-up appointment for neurology referral
D)) Obtain a detailed family history of cerebrovascular disease
Rationale: This patient presents with classic stroke symptoms. The FNP must recognize the
urgency: onset within 45 minutes places the patient within the thrombolytic window (tPA/alteplase
within 4.5 hours per AHA/ASA guidelines). The immediate priority is activating the stroke protocol
and obtaining a non-contrast CT head to differentiate ischemic from hemorrhagic stroke. Aspirin is
contraindicated until hemorrhagic stroke is ruled out. Time is brain — any delay in stroke
evaluation can result in irreversible neuronal death.
3. A 4-year-old child presents with fever, sore throat, and refusal to eat. The rapid strep
antigen test is positive. The first-line antibiotic of choice per the IDSA and AAFP guidelines
is:
A)) Amoxicillin 50 mg/kg/day divided twice daily for 10 days
B)) Azithromycin 10 mg/kg on day 1, then 5 mg/kg days 2–5
C)) Amoxicillin-clavulanate 45 mg/kg/day divided twice daily for 10 days
D)) Cephalexin 50 mg/kg/day divided four times daily for 10 days
Rationale: Per IDSA (2012, reaffirmed) and AAFP guidelines, amoxicillin at 50 mg/kg/day
(maximum 1000 mg/day) divided BID for 10 days is the first-line treatment for Group A
Streptococcal (GAS) pharyngitis in children. Amoxicillin is preferred over penicillin V due to better
, palatability, improved compliance, and equivalent efficacy. Azithromycin is reserved for penicillin-
allergic patients. Narrow-spectrum antibiotics are preferred to reduce resistance. A 10-day course
is standard to prevent rheumatic fever sequelae.
4. A 72-year-old female presents for her annual wellness visit. Her blood pressure is 148/88
mmHg on two separate occasions. Per the 2017 ACC/AHA hypertension guidelines, this
patient is classified as:
A)) Elevated blood pressure
B)) Stage 1 hypertension
C)) Stage 2 hypertension
D)) Hypertensive crisis
Rationale: Per the 2017 ACC/AHA guidelines, blood pressure is classified as: Normal (<120/80),
Elevated (120-129/<80), Stage 1 HTN (130-139/80-89), and Stage 2 HTN (>=140/90). This patient
at 148/88 meets Stage 2 criteria (systolic >=140). However, the question tests knowledge of the BP
at 148/88 — noting that the systolic component places it in Stage 2 while the diastolic is in Stage 1
range; the higher classification applies. Nonpharmacologic interventions (DASH diet, sodium
reduction, exercise, weight loss) plus pharmacotherapy are indicated. Target BP for adults >=65
per AHA is <130/80 if tolerated.
5. A 14-year-old female presents with her mother requesting a sports physical. The patient
reports her last menstrual period was 3 months ago. She is a competitive cross-country
runner. The most appropriate initial evaluation is:
A)) Reassurance that amenorrhea is normal in athletes and no further workup is needed
B)) Pregnancy test, comprehensive metabolic panel, and evaluation for the female
athlete triad (relative energy deficiency in sport)
C)) Referral to gynecology for oral contraceptive management
D)) Immediate bone density scan to evaluate for osteoporosis
Rationale: Secondary amenorrhea (absence of menses for >=3 cycles in a previously menstruating
female) in an athlete warrants evaluation for the Female Athlete Triad, now termed Relative
Energy Deficiency in Sport (RED-S). This condition involves low energy availability (with or
without disordered eating), menstrual dysfunction, and decreased bone mineral density. Initial
workup includes pregnancy test, CBC, CMP, TSH, prolactin, FSH/LH, and ESR. The FNP should
assess nutritional intake, training volume, and screen for disordered eating using validated tools.
6. A 55-year-old male with a history of T2DM, HTN, and hyperlipidemia presents for follow-
up. His most recent HbA1c is 8.2%, BP is 142/86, and LDL is 132 mg/dL. The FNP should
prioritize:
A)) Adding a third antihypertensive agent
B)) Intensifying glycemic management and initiating moderate-intensity statin
therapy
C)) Referring to bariatric surgery consultation
D)) Ordering a cardiac stress test immediately
Rationale: This patient has three uncontrolled cardiovascular risk factors. Per ADA Standards of
Care 2026, an HbA1c of 8.2% above the individualized target (<7.0% for most nonpregnant adults)
requires treatment intensification — adding a second agent or adjusting the current regimen. The
ACC/AHA 2018 cholesterol guidelines recommend a moderate-intensity statin for diabetic patients
aged 40-75 with LDL >70, and this patient qualifies for at least moderate-intensity statin regardless
of LDL level. BP at 142/86 warrants optimization as well, but glycemic control and statin initiation
are the highest-yield interventions to reduce cardiovascular risk.
7. A well-child visit for a 12-month-old should include developmental screening using which
validated tool per the AAP Bright Futures guidelines?
, A)) Denver Developmental Screening Test II (DDST-II)
B)) Ages and Stages Questionnaire (ASQ-3) or Parents' Evaluation of Developmental
Status (PEDS)
C)) Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
D)) Bayley Scales of Infant and Toddler Development
Rationale: The AAP Bright Futures guidelines (4th Edition) recommend standardized
developmental screening at 9, 18, and 30 months using validated instruments. The Ages and Stages
Questionnaire, 3rd Edition (ASQ-3) and Parents' Evaluation of Developmental Status (PEDS) are
the most commonly recommended parent-completed screening tools in primary care. They screen
communication, gross motor, fine motor, problem-solving, and personal-social domains. The
DDST-II, while historically used, has lower sensitivity and specificity than ASQ-3 or PEDS. The
Bayley and WPPSI are diagnostic, not screening tools.
8. An 80-year-old female presents with new onset of urinary incontinence. She reports
leakage of small amounts of urine when she coughs, sneezes, or laughs. This presentation is
most consistent with:
A)) Urge incontinence (overactive bladder)
B)) Stress urinary incontinence
C)) Functional incontinence
D)) Overflow incontinence
Rationale: Stress urinary incontinence (SUI) is characterized by involuntary urine leakage with
activities that increase intra-abdominal pressure (coughing, sneezing, laughing, lifting). It results
from weakness of the urethral sphincter and/or pelvic floor muscles. In contrast, urge incontinence
presents with a sudden, intense urge to void followed by leakage. Functional incontinence results
from physical or cognitive limitations preventing timely toileting. Overflow incontinence presents
with frequent dribbling from bladder outlet obstruction. First-line management of SUI includes
pelvic floor muscle exercises (Kegels), lifestyle modifications, and weight reduction.
DOMAIN 2: DIFFERENTIAL DIAGNOSIS & CLINICAL REASONING FRAMEWORKS
9. A 35-year-old female presents with acute onset of right lower quadrant abdominal pain,
nausea, and a white blood cell count of 14,500/uL. On examination, she has rebound
tenderness at McBurney's point. The leading diagnosis is:
A)) Ectopic pregnancy
B)) Acute appendicitis
C)) Ovarian torsion
D)) Pelvic inflammatory disease
Rationale: Acute appendicitis is the leading diagnosis given the classic presentation of RLQ pain,
nausea, leukocytosis (WBC 14,500), and rebound tenderness at McBurney's point. While ectopic
pregnancy, ovarian torsion, and PID are important differential diagnoses (especially in women of
childbearing age), the localized peritoneal signs at McBurney's point strongly suggest appendicitis.
A pregnancy test (beta-hCG) should be obtained to rule out ectopic pregnancy. CT abdomen/pelvis
(or ultrasound in pregnancy) is the diagnostic imaging of choice with sensitivity >95%.
10. In applying Bayesian reasoning, the pretest probability of a disease combined with the
sensitivity and specificity of a diagnostic test is used to calculate:
A)) The positive predictive value (PPV) and negative predictive value (NPV) of the test
in the specific patient population
B)) The absolute risk reduction of a treatment
C)) The number needed to treat (NNT)
D)) The hazard ratio of disease progression
