FNP 652 Final Exam Newest Actual Exam With Complete Questions And Correct
Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 54-year-old female presents for a follow-up of fasting laboratory results. She initially
requested the workup due to increased fatigue. Her results are as follows: Hgb 13, Hct 40,
Platelets 250, Na 140, K 3.8, Cl 100 , BUN 20, Creatinine 0.9, Glucose 85. Her lipid panel is
normal. Thyroid studies show: TSH 3.8, T4 1.8, and T3 1.0. Based on these findings and the
clinical context provided, what is the most likely diagnosis?
A) Primary Hypothyroidism
B) Hashimoto's Thyroiditis
C) Subclinical Hypothyroidism
D) Graves' Disease
E) Euthyroid Sick Syndrome
Correct Answer: C) subclinical hypothyroidism
Rationale: Subclinical hypothyroidism is typically characterized by a serum TSH above the
upper reference limit (often >4.0) with a normal free T4. While this patient's TSH of 3.8 is
within the broader "normal" range of many labs, in the specific context of this exam and
the patient's symptoms of fatigue, it is classified as subclinical hypothyroidism.
Question 2
A primary care nurse practitioner is initiating basal insulin therapy with Insulin Glargine (Lantus)
for a patient who weighs 100 kilograms. What is the appropriate starting dose based on standard
starting guidelines of 0.1 units/kg?
A) 5 units
B) 10 units
C) 20 units
D) 40 units
E) 100 units
Correct Answer: B) 10 units
Rationale: For the initiation of basal insulin in type 2 diabetes, a common starting dose is
0.1 to 0.2 units/kg/day. For a patient weighing 100 kg, 0.1 units/kg equals 10 units of
Lantus.
Question 3
Which of the following classes of medication should be used with extreme caution in a patient
with poorly controlled type 2 diabetes due to the high risk of drug-induced hyperglycemia?
A) Beta-blockers
B) ACE Inhibitors
C) Glucocorticoids
D) H2 Antagonists
E) Biguanides
Correct Answer: C) glucocorticoids
, 2
Rationale: Glucocorticoids (steroids) significantly increase blood glucose levels by
promoting gluconeogenesis and inducing peripheral insulin resistance. They can lead to
severe hyperglycemia and may necessitate a temporary adjustment in diabetic therapy.
Question 4
A mother brings in her 3-week-old infant complaining of excessive crying. She states the child
cries 4 to 5 days a week, usually starting in the late afternoon. She ensures all his needs (hunger,
diaper) are met, but the crying persists. The physical examination is entirely normal. What is the
most appropriate response to the mother?
A) Recommend switching to soy-based formula immediately
B) Prescribe a low-dose sedative for the infant
C) Provide reassurance to the mother and acknowledge her stress
D) Refer the infant for an immediate abdominal ultrasound
E) Advise the mother to let the child "cry it out" for 2 hours
Correct Answer: C) Provide reassurance to mother as well as acknowledge stress
Rationale: This infant's presentation is classic for "Colic" or normal infant crying patterns
(Wessel's Rule of Threes). Because the physical exam is normal and the infant is growing
well, the NP's priority is to support the mother, provide soothing techniques, and
emphasize that the condition is self-limiting.
Question 5
A 54-year-old male presents with a multi-year history of constipation. He reports having one
bowel movement every 5 days, which he describes as "small, hard rabbit pellets." He had a
normal screening colonoscopy at age 50. What is the most appropriate first-line plan of action?
A) Prescribe daily stimulant laxatives
B) Order a repeat colonoscopy immediately
C) Increase fluids and dietary fiber
D) Refer to a gastroenterologist for surgery
E) Prescribe a daily enema
Correct Answer: C) increase fluids and fiber in the diet
Rationale: For chronic, non-emergency constipation where there are no "red flag"
symptoms (weight loss, blood, anemia) and the patient has had a recent normal
colonoscopy, the first-line management is lifestyle modification through increased
hydration and fiber intake.
Question 6
An 18-month-old child presents with a 1-day history of intermittent, severe cramping abdominal
pain and non-bilious vomiting. The child's mother notes that the child cries and draws his knees
up to his chest during painful episodes, but appears very lethargic in between them. What
diagnosis is most likely?
A) Pyloric Stenosis
, 3
B) Appendicitis
C) Intussusception
D) Hirschsprung Disease
E) Gastroenteritis
Correct Answer: C) Intussusception
Rationale: Intussusception is the most common cause of intestinal obstruction in children
between 6 and 36 months. The classic triad includes intermittent colicky pain (knee-to-
chest), a "sausage-shaped" abdominal mass, and "currant jelly" stools. Lethargy between
episodes is a common neurologic manifestation.
Question 7
A 45-year-old obese perimenopausal female presents with indigestion, flatulence, and right upper
quadrant abdominal pain that radiates to her right scapula. She notes the pain is significantly
worse after eating fried chicken. What is the most likely diagnosis?
A) Peptic Ulcer Disease
B) GERD
C) Cholelithiasis
D) Pancreatitis
E) Appendicitis
Correct Answer: C) choliathiasis
Rationale: The "4 F's" (Female, Forty, Fat, Fertile) are classic risk factors for cholelithiasis
(gallstones). Radiating pain to the right scapula (Boas' sign) and symptom exacerbation
with high-fat meals are hallmark indicators of gallbladder disease.
Question 8
A 68-year-old patient presents with chronic bloating, abdominal cramping, and irregular bowel
habits. The NP is considering a diagnosis of Irritable Bowel Syndrome (IBS). Which of the
following is a core requirement for diagnosing IBS based on standard criteria?
A) The presence of blood in the stool
B) Symptoms must have started at least 6 months ago
C) Weight loss of more than 10 pounds
D) Fever and leukocytosis
E) Pain that is worsened by defecation
Correct Answer: B) symptoms started at least 6 months ago
Rationale: According to the Rome IV criteria, IBS requires recurrent abdominal pain at
least 1 day per week in the last 3 months, with symptoms beginning at least 6 months prior
to diagnosis.
Question 9
A Family Nurse Practitioner (FNP) performs a well-child exam on a 12-month-old who had a
surgical repair of a congenital heart defect at 8 months of age. The child is currently healthy and
, 4
taking no medications. Before the child undergoes any invasive dental procedures, the NP should
consult a cardiologist regarding the need for which medication?
A) Warfarin
B) Digoxin
C) Amoxicillin
D) Furosemide
E) Aspirin
Correct Answer: C) Amoxicillin
Rationale: AHA guidelines recommend antibiotic prophylaxis (usually Amoxicillin) for
patients with certain congenital heart defects who have had a surgical repair with
prosthetic material/devices for the first 6 months after the procedure, or for life if there is a
residual defect, to prevent infective endocarditis.
Question 10
A 5-year-old child who had a repair for Transposition of the Great Arteries (TGA) presents for a
well-check. The child has been asymptomatic since surgery but the NP now notices mild
shortness of breath with exertion and the child complains of dizziness. What is the next step?
A) Schedule a follow-up in 2 weeks
B) Reassure the parent this is normal growth
C) Refer for a same-day evaluation
D) Prescribe an albuterol inhaler
E) Order a CBC and iron panel
Correct Answer: C) Refer for a same-day eval
Rationale: Dizziness and shortness of breath in a child with a history of complex congenital
heart disease (like TGA) are red flags for potential arrhythmias or heart failure and
require an urgent cardiac evaluation.
Question 11
A school-aged child who had a complete repair of Tetralogy of Fallot presents for a sports
physical. What is a critical component of this child’s health maintenance regimen before
participation?
A) A nutritional plan for weight gain
B) Mandatory use of a heart rate monitor
C) Cardiology clearance to play sports
D) Daily aspirin therapy
E) Pulmonary function testing
Correct Answer: C) Cardiology clearance to play sports
Rationale: While many children post-Tetralogy of Fallot repair can participate in sports,
they require formal clearance from a pediatric cardiologist to assess for residual shunts,
pulmonary regurgitation, or exercise-induced arrhythmias.
Detailed Answers (Verified Answers) |Already Graded A+
Question 1
A 54-year-old female presents for a follow-up of fasting laboratory results. She initially
requested the workup due to increased fatigue. Her results are as follows: Hgb 13, Hct 40,
Platelets 250, Na 140, K 3.8, Cl 100 , BUN 20, Creatinine 0.9, Glucose 85. Her lipid panel is
normal. Thyroid studies show: TSH 3.8, T4 1.8, and T3 1.0. Based on these findings and the
clinical context provided, what is the most likely diagnosis?
A) Primary Hypothyroidism
B) Hashimoto's Thyroiditis
C) Subclinical Hypothyroidism
D) Graves' Disease
E) Euthyroid Sick Syndrome
Correct Answer: C) subclinical hypothyroidism
Rationale: Subclinical hypothyroidism is typically characterized by a serum TSH above the
upper reference limit (often >4.0) with a normal free T4. While this patient's TSH of 3.8 is
within the broader "normal" range of many labs, in the specific context of this exam and
the patient's symptoms of fatigue, it is classified as subclinical hypothyroidism.
Question 2
A primary care nurse practitioner is initiating basal insulin therapy with Insulin Glargine (Lantus)
for a patient who weighs 100 kilograms. What is the appropriate starting dose based on standard
starting guidelines of 0.1 units/kg?
A) 5 units
B) 10 units
C) 20 units
D) 40 units
E) 100 units
Correct Answer: B) 10 units
Rationale: For the initiation of basal insulin in type 2 diabetes, a common starting dose is
0.1 to 0.2 units/kg/day. For a patient weighing 100 kg, 0.1 units/kg equals 10 units of
Lantus.
Question 3
Which of the following classes of medication should be used with extreme caution in a patient
with poorly controlled type 2 diabetes due to the high risk of drug-induced hyperglycemia?
A) Beta-blockers
B) ACE Inhibitors
C) Glucocorticoids
D) H2 Antagonists
E) Biguanides
Correct Answer: C) glucocorticoids
, 2
Rationale: Glucocorticoids (steroids) significantly increase blood glucose levels by
promoting gluconeogenesis and inducing peripheral insulin resistance. They can lead to
severe hyperglycemia and may necessitate a temporary adjustment in diabetic therapy.
Question 4
A mother brings in her 3-week-old infant complaining of excessive crying. She states the child
cries 4 to 5 days a week, usually starting in the late afternoon. She ensures all his needs (hunger,
diaper) are met, but the crying persists. The physical examination is entirely normal. What is the
most appropriate response to the mother?
A) Recommend switching to soy-based formula immediately
B) Prescribe a low-dose sedative for the infant
C) Provide reassurance to the mother and acknowledge her stress
D) Refer the infant for an immediate abdominal ultrasound
E) Advise the mother to let the child "cry it out" for 2 hours
Correct Answer: C) Provide reassurance to mother as well as acknowledge stress
Rationale: This infant's presentation is classic for "Colic" or normal infant crying patterns
(Wessel's Rule of Threes). Because the physical exam is normal and the infant is growing
well, the NP's priority is to support the mother, provide soothing techniques, and
emphasize that the condition is self-limiting.
Question 5
A 54-year-old male presents with a multi-year history of constipation. He reports having one
bowel movement every 5 days, which he describes as "small, hard rabbit pellets." He had a
normal screening colonoscopy at age 50. What is the most appropriate first-line plan of action?
A) Prescribe daily stimulant laxatives
B) Order a repeat colonoscopy immediately
C) Increase fluids and dietary fiber
D) Refer to a gastroenterologist for surgery
E) Prescribe a daily enema
Correct Answer: C) increase fluids and fiber in the diet
Rationale: For chronic, non-emergency constipation where there are no "red flag"
symptoms (weight loss, blood, anemia) and the patient has had a recent normal
colonoscopy, the first-line management is lifestyle modification through increased
hydration and fiber intake.
Question 6
An 18-month-old child presents with a 1-day history of intermittent, severe cramping abdominal
pain and non-bilious vomiting. The child's mother notes that the child cries and draws his knees
up to his chest during painful episodes, but appears very lethargic in between them. What
diagnosis is most likely?
A) Pyloric Stenosis
, 3
B) Appendicitis
C) Intussusception
D) Hirschsprung Disease
E) Gastroenteritis
Correct Answer: C) Intussusception
Rationale: Intussusception is the most common cause of intestinal obstruction in children
between 6 and 36 months. The classic triad includes intermittent colicky pain (knee-to-
chest), a "sausage-shaped" abdominal mass, and "currant jelly" stools. Lethargy between
episodes is a common neurologic manifestation.
Question 7
A 45-year-old obese perimenopausal female presents with indigestion, flatulence, and right upper
quadrant abdominal pain that radiates to her right scapula. She notes the pain is significantly
worse after eating fried chicken. What is the most likely diagnosis?
A) Peptic Ulcer Disease
B) GERD
C) Cholelithiasis
D) Pancreatitis
E) Appendicitis
Correct Answer: C) choliathiasis
Rationale: The "4 F's" (Female, Forty, Fat, Fertile) are classic risk factors for cholelithiasis
(gallstones). Radiating pain to the right scapula (Boas' sign) and symptom exacerbation
with high-fat meals are hallmark indicators of gallbladder disease.
Question 8
A 68-year-old patient presents with chronic bloating, abdominal cramping, and irregular bowel
habits. The NP is considering a diagnosis of Irritable Bowel Syndrome (IBS). Which of the
following is a core requirement for diagnosing IBS based on standard criteria?
A) The presence of blood in the stool
B) Symptoms must have started at least 6 months ago
C) Weight loss of more than 10 pounds
D) Fever and leukocytosis
E) Pain that is worsened by defecation
Correct Answer: B) symptoms started at least 6 months ago
Rationale: According to the Rome IV criteria, IBS requires recurrent abdominal pain at
least 1 day per week in the last 3 months, with symptoms beginning at least 6 months prior
to diagnosis.
Question 9
A Family Nurse Practitioner (FNP) performs a well-child exam on a 12-month-old who had a
surgical repair of a congenital heart defect at 8 months of age. The child is currently healthy and
, 4
taking no medications. Before the child undergoes any invasive dental procedures, the NP should
consult a cardiologist regarding the need for which medication?
A) Warfarin
B) Digoxin
C) Amoxicillin
D) Furosemide
E) Aspirin
Correct Answer: C) Amoxicillin
Rationale: AHA guidelines recommend antibiotic prophylaxis (usually Amoxicillin) for
patients with certain congenital heart defects who have had a surgical repair with
prosthetic material/devices for the first 6 months after the procedure, or for life if there is a
residual defect, to prevent infective endocarditis.
Question 10
A 5-year-old child who had a repair for Transposition of the Great Arteries (TGA) presents for a
well-check. The child has been asymptomatic since surgery but the NP now notices mild
shortness of breath with exertion and the child complains of dizziness. What is the next step?
A) Schedule a follow-up in 2 weeks
B) Reassure the parent this is normal growth
C) Refer for a same-day evaluation
D) Prescribe an albuterol inhaler
E) Order a CBC and iron panel
Correct Answer: C) Refer for a same-day eval
Rationale: Dizziness and shortness of breath in a child with a history of complex congenital
heart disease (like TGA) are red flags for potential arrhythmias or heart failure and
require an urgent cardiac evaluation.
Question 11
A school-aged child who had a complete repair of Tetralogy of Fallot presents for a sports
physical. What is a critical component of this child’s health maintenance regimen before
participation?
A) A nutritional plan for weight gain
B) Mandatory use of a heart rate monitor
C) Cardiology clearance to play sports
D) Daily aspirin therapy
E) Pulmonary function testing
Correct Answer: C) Cardiology clearance to play sports
Rationale: While many children post-Tetralogy of Fallot repair can participate in sports,
they require formal clearance from a pediatric cardiologist to assess for residual shunts,
pulmonary regurgitation, or exercise-induced arrhythmias.
