Nursing / Family Nurse Practitioner Grand
Canyon University (GCU) FNP 652 – Family
Primary Care
GENERAL PRINCIPLES & PAIN MANAGEMENT (Q1–5)
Question 1
A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to
discomfort, along with a desire to quit working. What will the provider do?
A) Ask the patient about addiction issues
B) Consult with a social worker
C) Increase the dosage of prescribed pain medications
D) Order radiographic studies of the lower spine
Answer: B
Rationale: Patients who exhibit poor sleep and poor coping may be developing mental defeat as
a result of chronic pain and should be evaluated and treated early for this to prevent further
disability and improve functionality . Substance abuse may be a part of mental defeat and
should be evaluated based on assessment findings. Unless the symptoms are related to pain,
increasing analgesics or ordering diagnostic studies are not indicated.
Question 2
A patient with chronic leg pain describes the pain as "stabbing" and "throbbing." This is
characteristic of which type of pain?
A) Neuropathic pain
B) Referred pain
C) Somatic pain
D) Visceral pain
Answer: C
Rationale: Somatic pain is caused by the activation of nociceptors in peripheral tissues,
including skin, bones, muscles, and soft tissue, and is usually well‑localized and characterized
,as stabbing, aching, or throbbing . Neuropathic pain is described as burning, shooting, or
tingling. Referred pain is a type of visceral pain localized but not attributable to the involved
organ.
Question 3
A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal
anti‑inflammatory drugs (NSAIDs). What will the provider prescribe for this patient?
A) A mixed opiate product
B) A pure opioid compound
C) A referral for a nerve block procedure
D) A selective serotonin reuptake inhibitor (SSRI)
Answer: D
Rationale: Using the three-step analgesic ladder, step‑1 medications include NSAIDs, tricyclic
antidepressants, SSRIs, or anticonvulsants. Since the patient cannot tolerate NSAIDs, an SSRI
is an appropriate choice . If these fail, a mixed opiate product is used (step 2). Step 3 is a pure
opioid product.
Question 4
A patient with Type 2 diabetes becomes insulin dependent after a year of therapy with oral
diabetes medication. When explaining this change in therapy, the provider will tell the patient:
A) "You failed to control your diabetes with oral medications."
B) "This is because of the natural progression of the disease."
C) "You will need insulin for the rest of your life."
D) "Your diet and exercise were not adequate."
Answer: B
Rationale: Type 2 diabetes is a progressive disease characterized by gradual β‑cell failure.
Insulin dependence after years of oral therapy reflects natural disease progression, not patient
failure . This explanation reduces guilt and promotes acceptance of necessary therapy.
Question 5
A provider performs an eye examination during a health maintenance visit and notes a
difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate?
A) A relative afferent pupillary defect
B) Indication of a difference in intraocular pressure
,C) Likely underlying neurological abnormality
D) Probable benign, physiologic anisocoria
Answer: D
Rationale: A difference in pupil diameter of less than 1 mm is usually benign (physiologic
anisocoria) . Afferent pupillary defects are paradoxical dilations in response to light. A difference
of more than 1 mm is more likely to represent an underlying neurological abnormality.
OBESITY & WEIGHT MANAGEMENT (Q6–10)
Question 6
A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess
for complications of obesity in this patient based on this finding?
A) Electrocardiography
B) Gallbladder ultrasonography
C) Mammography
D) Polysomnography
Answer: D
Rationale: Women with a neck circumference greater than 16 cm have an increased risk of
obstructive sleep apnea and should have polysomnography to assess for this complication . The
other tests may be necessary for obese patients but are not specific to this finding.
Question 7
Which medications are associated with weight gain? (Select all that apply.)
A) Antibiotics
B) Antidepressants
C) Antihistamines
D) Insulin analogs
E) Anticonvulsants
Answer: B, C, D, E
Rationale: Antidepressants, antihistamines, insulin and insulin analogs, and seizure medications
are all associated with weight gain . Antibiotics are not associated with weight gain.
Question 8
, The primary care NP is providing nutritional counseling for a 9‑year‑old female whose weight is
at the 95th percentile for her age. What is the goal for this patient?
A) Rapid weight loss
B) Maintenance of her current weight
C) Reducing caloric intake by 50%
D) Referral for bariatric surgery
Answer: B
Rationale: For children with overweight/obesity who are still growing (pre‑puberty), the goal is
weight maintenance rather than weight loss . As the child grows in height, weight maintenance
leads to decreasing BMI percentile over time.
Question 9
The primary care NP is reviewing lab work and diabetes management with a school‑aged child
whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80‑90 mg/dL. The
NP will consult with the child's endocrinologist to consider which therapy?
A) Metformin
B) Continuous glucose monitoring
C) Insulin pump therapy
D) Dietary changes only
Answer: B
Rationale: The HbA1C of 7.6% is above target despite normal pre‑meal blood glucose readings,
suggesting possible undetected hyperglycemia at other times . Continuous glucose monitoring
(CGM) helps identify glycemic patterns not captured by intermittent fingersticks.
Question 10
Dietary changes should be recommended to parents at what age if obesity/overweight is
identified?
A) 6 months
B) 12 months
C) 24 months
D) 36 months
Answer: B
Canyon University (GCU) FNP 652 – Family
Primary Care
GENERAL PRINCIPLES & PAIN MANAGEMENT (Q1–5)
Question 1
A patient who has chronic lower back pain reports increased difficulty sleeping unrelated to
discomfort, along with a desire to quit working. What will the provider do?
A) Ask the patient about addiction issues
B) Consult with a social worker
C) Increase the dosage of prescribed pain medications
D) Order radiographic studies of the lower spine
Answer: B
Rationale: Patients who exhibit poor sleep and poor coping may be developing mental defeat as
a result of chronic pain and should be evaluated and treated early for this to prevent further
disability and improve functionality . Substance abuse may be a part of mental defeat and
should be evaluated based on assessment findings. Unless the symptoms are related to pain,
increasing analgesics or ordering diagnostic studies are not indicated.
Question 2
A patient with chronic leg pain describes the pain as "stabbing" and "throbbing." This is
characteristic of which type of pain?
A) Neuropathic pain
B) Referred pain
C) Somatic pain
D) Visceral pain
Answer: C
Rationale: Somatic pain is caused by the activation of nociceptors in peripheral tissues,
including skin, bones, muscles, and soft tissue, and is usually well‑localized and characterized
,as stabbing, aching, or throbbing . Neuropathic pain is described as burning, shooting, or
tingling. Referred pain is a type of visceral pain localized but not attributable to the involved
organ.
Question 3
A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal
anti‑inflammatory drugs (NSAIDs). What will the provider prescribe for this patient?
A) A mixed opiate product
B) A pure opioid compound
C) A referral for a nerve block procedure
D) A selective serotonin reuptake inhibitor (SSRI)
Answer: D
Rationale: Using the three-step analgesic ladder, step‑1 medications include NSAIDs, tricyclic
antidepressants, SSRIs, or anticonvulsants. Since the patient cannot tolerate NSAIDs, an SSRI
is an appropriate choice . If these fail, a mixed opiate product is used (step 2). Step 3 is a pure
opioid product.
Question 4
A patient with Type 2 diabetes becomes insulin dependent after a year of therapy with oral
diabetes medication. When explaining this change in therapy, the provider will tell the patient:
A) "You failed to control your diabetes with oral medications."
B) "This is because of the natural progression of the disease."
C) "You will need insulin for the rest of your life."
D) "Your diet and exercise were not adequate."
Answer: B
Rationale: Type 2 diabetes is a progressive disease characterized by gradual β‑cell failure.
Insulin dependence after years of oral therapy reflects natural disease progression, not patient
failure . This explanation reduces guilt and promotes acceptance of necessary therapy.
Question 5
A provider performs an eye examination during a health maintenance visit and notes a
difference of 0.5 mm in size between the patient’s pupils. What does this finding indicate?
A) A relative afferent pupillary defect
B) Indication of a difference in intraocular pressure
,C) Likely underlying neurological abnormality
D) Probable benign, physiologic anisocoria
Answer: D
Rationale: A difference in pupil diameter of less than 1 mm is usually benign (physiologic
anisocoria) . Afferent pupillary defects are paradoxical dilations in response to light. A difference
of more than 1 mm is more likely to represent an underlying neurological abnormality.
OBESITY & WEIGHT MANAGEMENT (Q6–10)
Question 6
A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess
for complications of obesity in this patient based on this finding?
A) Electrocardiography
B) Gallbladder ultrasonography
C) Mammography
D) Polysomnography
Answer: D
Rationale: Women with a neck circumference greater than 16 cm have an increased risk of
obstructive sleep apnea and should have polysomnography to assess for this complication . The
other tests may be necessary for obese patients but are not specific to this finding.
Question 7
Which medications are associated with weight gain? (Select all that apply.)
A) Antibiotics
B) Antidepressants
C) Antihistamines
D) Insulin analogs
E) Anticonvulsants
Answer: B, C, D, E
Rationale: Antidepressants, antihistamines, insulin and insulin analogs, and seizure medications
are all associated with weight gain . Antibiotics are not associated with weight gain.
Question 8
, The primary care NP is providing nutritional counseling for a 9‑year‑old female whose weight is
at the 95th percentile for her age. What is the goal for this patient?
A) Rapid weight loss
B) Maintenance of her current weight
C) Reducing caloric intake by 50%
D) Referral for bariatric surgery
Answer: B
Rationale: For children with overweight/obesity who are still growing (pre‑puberty), the goal is
weight maintenance rather than weight loss . As the child grows in height, weight maintenance
leads to decreasing BMI percentile over time.
Question 9
The primary care NP is reviewing lab work and diabetes management with a school‑aged child
whose HbA1C is 7.6% who reports usual blood sugars before meals as being 80‑90 mg/dL. The
NP will consult with the child's endocrinologist to consider which therapy?
A) Metformin
B) Continuous glucose monitoring
C) Insulin pump therapy
D) Dietary changes only
Answer: B
Rationale: The HbA1C of 7.6% is above target despite normal pre‑meal blood glucose readings,
suggesting possible undetected hyperglycemia at other times . Continuous glucose monitoring
(CGM) helps identify glycemic patterns not captured by intermittent fingersticks.
Question 10
Dietary changes should be recommended to parents at what age if obesity/overweight is
identified?
A) 6 months
B) 12 months
C) 24 months
D) 36 months
Answer: B
