Premium
PDF
PDF
Download Download
EXAMS
(2026) Primary Care Exam Questions | FNP Success Guide (PDF) |
Questions & Answers (Verified Answers) With Rationales (
Update)
This Document Contains:
NRNP 6531 Final Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Final Exam (2026) Primary Care Exam Questions | FNP
Success Guide (PDF) - 2026/2027 Update
Page 1
,Question 1
A patient with a history of recurrent calcium oxalate nephrolithiasis is found to have a 24-hour
urine calcium of 350 mg (normal <250 mg), urine oxalate of 30 mg (normal <40 mg), and urine
citrate of 200 mg (normal >320 mg). Serum calcium and uric acid are normal. Which of the
following dietary modifications is most likely to reduce stone recurrence in this patient?
A) Increase dietary calcium intake to 1200 mg/day
B) Restrict dietary calcium to 400 mg/day
C) Increase animal protein consumption
D) Supplement with vitamin C 1000 mg daily
Answer: A) Increase dietary calcium intake to 1200 mg/day
Explanation: In idiopathic hypercalciuria with low urine citrate, increasing dietary calcium binds
oxalate in the gut, reducing oxalate absorption and urinary oxalate excretion. Restricting
calcium paradoxically increases oxalate absorption and stone risk. Animal protein
increases acid load and decreases citrate. Vitamin C is metabolized to oxalate,
worsening stone formation.
Question 2
A patient presents with acute onset of vertigo, nausea, and imbalance that began 6 hours ago. The
patient has no hearing loss or tinnitus. On examination, the patient has horizontal nystagmus that
changes direction with gaze; a head impulse test is normal; and there is no skew deviation. Which
of the following is the most likely diagnosis?
A) Benign paroxysmal positional vertigo (BPPV)
B) Vestibular neuritis
C) Central vertigo due to brainstem stroke
D) Meniere's disease
Answer: C) Central vertigo due to brainstem stroke
Explanation: The triad of direction-changing nystagmus, normal head impulse test, and absence of
skew deviation suggests central vertigo, most commonly from vertebrobasilar ischemia.
BPPV has position-provoked nystagmus with latency and fatiguability. Vestibular
neuritis shows a positive head impulse test and direction-fixed nystagmus. Meniere's
includes hearing loss and tinnitus.
Page 2
,Question 3
A patient with type 2 diabetes and chronic kidney disease stage 3b (eGFR 35 mL/min/1.73m²) has
persistent albuminuria (UACR 450 mg/g). Despite maximal tolerated doses of an ACE inhibitor
and an SGLT2 inhibitor, the patient's blood pressure remains 142/88 mm Hg. Which additional
antihypertensive agent is most appropriate?
A) Hydrochlorothiazide 25 mg daily
B) Spironolactone 25 mg daily
C) Amlodipine 5 mg daily
D) Furosemide 40 mg twice daily
Answer: C) Amlodipine 5 mg daily
Explanation: In CKD with albuminuria, a non-dihydropyridine calcium channel blocker (e.g.,
amlodipine) is preferred as add-on therapy for its neutral effects on renal
hemodynamics. Hydrochlorothiazide is ineffective at eGFR <45. Spironolactone
increases hyperkalemia risk with ACE inhibitor. Furosemide is reserved for volume
overload, not as routine add-on.
Question 4
A patient with a BMI of 32 kg/m² and prediabetes (HbA1c 6.2%) is interested in pharmacotherapy
to prevent progression to diabetes. The patient has a history of gastroparesis and is currently
taking metformin. Which of the following medications is most appropriate to consider?
A) Liraglutide
B) Pioglitazone
C) Acarbose
D) Semaglutide
Answer: C) Acarbose
Explanation: Acarbose, an alpha-glucosidase inhibitor, delays carbohydrate absorption and has been
shown to reduce diabetes incidence in prediabetes. It does not exacerbate gastroparesis.
Liraglutide and semaglutide (GLP-1 agonists) slow gastric emptying and can worsen
gastroparesis. Pioglitazone carries risks of weight gain, fluid retention, and potential
bladder cancer.
Page 3
, Question 5
A patient with a recent diagnosis of primary open-angle glaucoma (POAG) has an intraocular
pressure (IOP) of 30 mm Hg in the right eye and 28 mm Hg in the left eye. The patient has a
history of asthma and bradycardia. Which of the following first-line therapies is safest for this
patient?
A) Latanoprost 0.005% once daily
B) Timolol 0.5% twice daily
C) Brimonidine 0.2% twice daily
D) Dorzolamide 2% three times daily
Answer: A) Latanoprost 0.005% once daily
Explanation: Latanoprost, a prostaglandin analog, is first-line for POAG and has minimal systemic
side effects. Timolol, a beta-blocker, can exacerbate asthma and cause bradycardia.
Brimonidine (alpha-agonist) may cause systemic hypotension and fatigue. Dorzolamide
(carbonic anhydrase inhibitor) is less effective first-line and can cause metabolic
acidosis.
Question 6
A patient with a history of hypothyroidism (on levothyroxine 100 mcg daily) presents with
palpitations, weight loss, and heat intolerance. TSH is <0.01 mIU/L, free T4 is 2.8 ng/dL (normal
0.8-1.8), and free T3 is 6.5 pg/mL (normal 2.0-4.4). The patient is not on any other medications.
Which of the following is the most likely cause?
A) Poor adherence to levothyroxine
B) Concurrent use of biotin supplements
C) Graves' disease
D) Thyroiditis with thyrotoxicosis
Answer: A) Poor adherence to levothyroxine
Explanation: Suppressed TSH with elevated free T4 and T3 in a patient on levothyroxine suggests
exogenous thyrotoxicosis due to excessive levothyroxine intake (e.g., intentional or
unintentional overuse). Biotin can cause assay interference but typically yields falsely
high T4 and T3 with normal TSH. Graves' disease usually presents with elevated T4 and
T3 and suppressed TSH, but the patient is already on replacement. Thyroiditis would
show low radioactive iodine uptake.
Page 4
Download Download
EXAMS
(2026) Primary Care Exam Questions | FNP Success Guide (PDF) |
Questions & Answers (Verified Answers) With Rationales (
Update)
This Document Contains:
NRNP 6531 Final Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Final Exam (2026) Primary Care Exam Questions | FNP
Success Guide (PDF) - 2026/2027 Update
Page 1
,Question 1
A patient with a history of recurrent calcium oxalate nephrolithiasis is found to have a 24-hour
urine calcium of 350 mg (normal <250 mg), urine oxalate of 30 mg (normal <40 mg), and urine
citrate of 200 mg (normal >320 mg). Serum calcium and uric acid are normal. Which of the
following dietary modifications is most likely to reduce stone recurrence in this patient?
A) Increase dietary calcium intake to 1200 mg/day
B) Restrict dietary calcium to 400 mg/day
C) Increase animal protein consumption
D) Supplement with vitamin C 1000 mg daily
Answer: A) Increase dietary calcium intake to 1200 mg/day
Explanation: In idiopathic hypercalciuria with low urine citrate, increasing dietary calcium binds
oxalate in the gut, reducing oxalate absorption and urinary oxalate excretion. Restricting
calcium paradoxically increases oxalate absorption and stone risk. Animal protein
increases acid load and decreases citrate. Vitamin C is metabolized to oxalate,
worsening stone formation.
Question 2
A patient presents with acute onset of vertigo, nausea, and imbalance that began 6 hours ago. The
patient has no hearing loss or tinnitus. On examination, the patient has horizontal nystagmus that
changes direction with gaze; a head impulse test is normal; and there is no skew deviation. Which
of the following is the most likely diagnosis?
A) Benign paroxysmal positional vertigo (BPPV)
B) Vestibular neuritis
C) Central vertigo due to brainstem stroke
D) Meniere's disease
Answer: C) Central vertigo due to brainstem stroke
Explanation: The triad of direction-changing nystagmus, normal head impulse test, and absence of
skew deviation suggests central vertigo, most commonly from vertebrobasilar ischemia.
BPPV has position-provoked nystagmus with latency and fatiguability. Vestibular
neuritis shows a positive head impulse test and direction-fixed nystagmus. Meniere's
includes hearing loss and tinnitus.
Page 2
,Question 3
A patient with type 2 diabetes and chronic kidney disease stage 3b (eGFR 35 mL/min/1.73m²) has
persistent albuminuria (UACR 450 mg/g). Despite maximal tolerated doses of an ACE inhibitor
and an SGLT2 inhibitor, the patient's blood pressure remains 142/88 mm Hg. Which additional
antihypertensive agent is most appropriate?
A) Hydrochlorothiazide 25 mg daily
B) Spironolactone 25 mg daily
C) Amlodipine 5 mg daily
D) Furosemide 40 mg twice daily
Answer: C) Amlodipine 5 mg daily
Explanation: In CKD with albuminuria, a non-dihydropyridine calcium channel blocker (e.g.,
amlodipine) is preferred as add-on therapy for its neutral effects on renal
hemodynamics. Hydrochlorothiazide is ineffective at eGFR <45. Spironolactone
increases hyperkalemia risk with ACE inhibitor. Furosemide is reserved for volume
overload, not as routine add-on.
Question 4
A patient with a BMI of 32 kg/m² and prediabetes (HbA1c 6.2%) is interested in pharmacotherapy
to prevent progression to diabetes. The patient has a history of gastroparesis and is currently
taking metformin. Which of the following medications is most appropriate to consider?
A) Liraglutide
B) Pioglitazone
C) Acarbose
D) Semaglutide
Answer: C) Acarbose
Explanation: Acarbose, an alpha-glucosidase inhibitor, delays carbohydrate absorption and has been
shown to reduce diabetes incidence in prediabetes. It does not exacerbate gastroparesis.
Liraglutide and semaglutide (GLP-1 agonists) slow gastric emptying and can worsen
gastroparesis. Pioglitazone carries risks of weight gain, fluid retention, and potential
bladder cancer.
Page 3
, Question 5
A patient with a recent diagnosis of primary open-angle glaucoma (POAG) has an intraocular
pressure (IOP) of 30 mm Hg in the right eye and 28 mm Hg in the left eye. The patient has a
history of asthma and bradycardia. Which of the following first-line therapies is safest for this
patient?
A) Latanoprost 0.005% once daily
B) Timolol 0.5% twice daily
C) Brimonidine 0.2% twice daily
D) Dorzolamide 2% three times daily
Answer: A) Latanoprost 0.005% once daily
Explanation: Latanoprost, a prostaglandin analog, is first-line for POAG and has minimal systemic
side effects. Timolol, a beta-blocker, can exacerbate asthma and cause bradycardia.
Brimonidine (alpha-agonist) may cause systemic hypotension and fatigue. Dorzolamide
(carbonic anhydrase inhibitor) is less effective first-line and can cause metabolic
acidosis.
Question 6
A patient with a history of hypothyroidism (on levothyroxine 100 mcg daily) presents with
palpitations, weight loss, and heat intolerance. TSH is <0.01 mIU/L, free T4 is 2.8 ng/dL (normal
0.8-1.8), and free T3 is 6.5 pg/mL (normal 2.0-4.4). The patient is not on any other medications.
Which of the following is the most likely cause?
A) Poor adherence to levothyroxine
B) Concurrent use of biotin supplements
C) Graves' disease
D) Thyroiditis with thyrotoxicosis
Answer: A) Poor adherence to levothyroxine
Explanation: Suppressed TSH with elevated free T4 and T3 in a patient on levothyroxine suggests
exogenous thyrotoxicosis due to excessive levothyroxine intake (e.g., intentional or
unintentional overuse). Biotin can cause assay interference but typically yields falsely
high T4 and T3 with normal TSH. Graves' disease usually presents with elevated T4 and
T3 and suppressed TSH, but the patient is already on replacement. Thyroiditis would
show low radioactive iodine uptake.
Page 4
