FNP654 | FNP654 Family Primary Care II Exam 2
v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 55-year-old male with a history of hypertension and Stage 3 chronic kidney
disease (CKD) presents for a follow-up. According to current clinical guidelines, which
class of antihypertensive medication is preferred as first-line therapy?
A. ACE Inhibitors or ARBs
B. Thiazide Diuretics
C. Calcium Channel Blockers
D. Beta-Blockers
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are the preferred first-line agents for
patients with CKD because they provide renal protection. These medications help to
reduce intraglomerular pressure and decrease proteinuria, which slows the
progression of kidney disease. It is essential to monitor serum creatinine and
potassium levels shortly after initiating these agents.
,2. A 62-year-old patient with COPD presents with increased sputum purulence and
increased dyspnea. Which of the following is the most appropriate initial treatment
for an acute exacerbation?
A. Long-term oxygen therapy only
B. Oral corticosteroids and short-acting bronchodilators
C. High-dose inhaled corticosteroids
D. Intravenous antibiotics in the outpatient setting
Correct Answer: B
Expert Explanation: Acute COPD exacerbations are primarily managed with short-
acting bronchodilators to provide immediate relief of airflow obstruction. Oral
corticosteroids are added to reduce airway inflammation and improve recovery
time. Antibiotics should also be considered if the patient exhibits increased sputum
purulence and volume.
3. In the management of Type 2 Diabetes, what is the generally recommended
hemoglobin A1C goal for a healthy adult without significant comorbidities?
A. Less than 8.0%
B. Less than 6.0%
C. Less than 7.0%
,D. Less than 9.0%
Correct Answer: C
Expert Explanation: The American Diabetes Association (ADA) generally
recommends an A1C goal of less than 7.0% for most non-pregnant adults. Achieving
this target helps to reduce the risk of microvascular complications such as
retinopathy and nephropathy. However, targets should be individualized based on
age, life expectancy, and risk of hypoglycemia.
4. A 45-year-old female reports fatigue, cold intolerance, and weight gain. Her TSH is
12.5 mIU/L and Free T4 is low. What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Secondary Hypothyroidism
Correct Answer: B
Expert Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4 level, indicating the thyroid gland itself is failing to produce
adequate hormone. This condition often results from Hashimoto’s thyroiditis, an
autoimmune destruction of the gland. Symptoms typically include lethargy, weight
gain, and dry skin.
, 5. A patient with asthma is currently using a Short-Acting Beta Agonist (SABA) as
needed but reports using it more than twice a week. What is the next step in therapy
according to GINA guidelines?
A. Add a low-dose Inhaled Corticosteroid (ICS)
B. Increase SABA frequency
C. Add a Long-Acting Beta Agonist (LABA) only
D. Start oral prednisone maintenance
Correct Answer: A
Expert Explanation: According to the Global Initiative for Asthma (GINA), the use
of a SABA more than twice a week suggests poor control. The next step in
maintenance therapy is the addition of a low-dose inhaled corticosteroid to manage
underlying airway inflammation. This helps to reduce the frequency of
exacerbations and reliance on rescue inhalers.
6. Which physical exam finding is most suggestive of a rotator cuff tear?
A. Positive Drop Arm test
B. Positive Tinel’s sign
C. Positive McMurray’s test
D. Positive Phalen’s test
v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 55-year-old male with a history of hypertension and Stage 3 chronic kidney
disease (CKD) presents for a follow-up. According to current clinical guidelines, which
class of antihypertensive medication is preferred as first-line therapy?
A. ACE Inhibitors or ARBs
B. Thiazide Diuretics
C. Calcium Channel Blockers
D. Beta-Blockers
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are the preferred first-line agents for
patients with CKD because they provide renal protection. These medications help to
reduce intraglomerular pressure and decrease proteinuria, which slows the
progression of kidney disease. It is essential to monitor serum creatinine and
potassium levels shortly after initiating these agents.
,2. A 62-year-old patient with COPD presents with increased sputum purulence and
increased dyspnea. Which of the following is the most appropriate initial treatment
for an acute exacerbation?
A. Long-term oxygen therapy only
B. Oral corticosteroids and short-acting bronchodilators
C. High-dose inhaled corticosteroids
D. Intravenous antibiotics in the outpatient setting
Correct Answer: B
Expert Explanation: Acute COPD exacerbations are primarily managed with short-
acting bronchodilators to provide immediate relief of airflow obstruction. Oral
corticosteroids are added to reduce airway inflammation and improve recovery
time. Antibiotics should also be considered if the patient exhibits increased sputum
purulence and volume.
3. In the management of Type 2 Diabetes, what is the generally recommended
hemoglobin A1C goal for a healthy adult without significant comorbidities?
A. Less than 8.0%
B. Less than 6.0%
C. Less than 7.0%
,D. Less than 9.0%
Correct Answer: C
Expert Explanation: The American Diabetes Association (ADA) generally
recommends an A1C goal of less than 7.0% for most non-pregnant adults. Achieving
this target helps to reduce the risk of microvascular complications such as
retinopathy and nephropathy. However, targets should be individualized based on
age, life expectancy, and risk of hypoglycemia.
4. A 45-year-old female reports fatigue, cold intolerance, and weight gain. Her TSH is
12.5 mIU/L and Free T4 is low. What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Subclinical Hypothyroidism
D. Secondary Hypothyroidism
Correct Answer: B
Expert Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4 level, indicating the thyroid gland itself is failing to produce
adequate hormone. This condition often results from Hashimoto’s thyroiditis, an
autoimmune destruction of the gland. Symptoms typically include lethargy, weight
gain, and dry skin.
, 5. A patient with asthma is currently using a Short-Acting Beta Agonist (SABA) as
needed but reports using it more than twice a week. What is the next step in therapy
according to GINA guidelines?
A. Add a low-dose Inhaled Corticosteroid (ICS)
B. Increase SABA frequency
C. Add a Long-Acting Beta Agonist (LABA) only
D. Start oral prednisone maintenance
Correct Answer: A
Expert Explanation: According to the Global Initiative for Asthma (GINA), the use
of a SABA more than twice a week suggests poor control. The next step in
maintenance therapy is the addition of a low-dose inhaled corticosteroid to manage
underlying airway inflammation. This helps to reduce the frequency of
exacerbations and reliance on rescue inhalers.
6. Which physical exam finding is most suggestive of a rotator cuff tear?
A. Positive Drop Arm test
B. Positive Tinel’s sign
C. Positive McMurray’s test
D. Positive Phalen’s test
