FNP654 | FNP654 Family Primary Care II Final
Exam v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Grand
Canyon University
1. A 55-year-old patient with a history of hypertension and Type 2 Diabetes presents with a
blood pressure of 148/92. Which class of antihypertensive medication is most appropriate as
first-line therapy?
A. Calcium Channel Blockers
B. Loop Diuretics
C. Beta-Blockers
D. ACE Inhibitors
Correct Answer: D
Expert Explanation: ACE inhibitors are recommended as first-line therapy for patients
with diabetes because they provide renal protection. They work by inhibiting the
conversion of angiotensin I to angiotensin II, which reduces systemic vascular resistance.
This protective effect helps slow the progression of diabetic nephropathy over time.
2. When evaluating a 4-year-old child during a well-visit, which developmental milestone
should the nurse practitioner expect?
A. Naming four colors and drawing a person with three parts
B. Tying shoelaces independently
C. Understanding abstract concepts like time
D. Using complex sentences with more than 10 words
Correct Answer: A
Expert Explanation: At age four, children typically can name several colors and draw a
person with at least three body parts. This stage of development marks significant progress
in fine motor skills and cognitive recognition. It is a standard assessment point in pediatric
primary care to ensure proper neurodevelopmental growth.
3. A 68-year-old female presents with sudden onset of confusion, agitation, and visual
hallucinations. Her daughter reports that her symptoms started yesterday. What is the most
likely diagnosis?
A. Alzheimer’s Dementia
B. Vascular Dementia
,C. Major Depressive Disorder
D. Delirium
Correct Answer: D
Expert Explanation: Delirium is characterized by an acute onset of fluctuating cognitive
impairment and altered consciousness. Unlike dementia, which is progressive and chronic,
delirium often has an underlying medical cause such as infection or metabolic imbalance.
Identifying and treating the root cause is the primary goal of clinical management.
4. In the management of a patient with Chronic Obstructive Pulmonary Disease (COPD),
which medication is considered the gold standard for long-term maintenance of symptoms?
A. Long-acting muscarinic antagonists (LAMA)
B. Inhaled Corticosteroids (ICS) as monotherapy
C. Short-acting beta-agonists (SABA)
D. Oral Prednisone
Correct Answer: A
Expert Explanation: Long-acting muscarinic antagonists are a cornerstone of maintenance
therapy for COPD to reduce exacerbations and improve lung function. LAMAs work by
blocking the bronchoconstrictor effects of acetylcholine on M3 receptors in the airway
smooth muscle. This provides sustained bronchodilation compared to rescue medications.
5. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Psoriasis
B. Tinea Corporis
C. Pityriasis Rosea
D. Secondary Syphilis
Correct Answer: C
Expert Explanation: Pityriasis rosea typically begins with a single herald patch, which is
then followed by a generalized eruption in a cleavage line distribution. The condition is
usually self-limiting and may last six to eight weeks. Management is primarily supportive,
focusing on pruritus relief if needed.
6. Which of the following is the most appropriate screening tool for depression in the primary
care setting?
A. GAD-7
B. CAGE questionnaire
, C. MMSE
D. PHQ-9
Correct Answer: D
Expert Explanation: The Patient Health Questionnaire-9 (PHQ-9) is a validated and widely
used tool for screening and monitoring the severity of depression. It consists of nine
questions based on DSM-IV criteria for major depressive disorder. A higher score indicates
a greater severity of depressive symptoms, guiding treatment decisions.
7. A 24-year-old female presents with a foul-smelling vaginal discharge and ‘strawberry
cervix’ on examination. What is the most likely causative organism?
A. Gardnerella vaginalis
B. Candida albicans
C. Trichomonas vaginalis
D. Chlamydia trachomatis
Correct Answer: C
Expert Explanation: Trichomoniasis is caused by the protozoan Trichomonas vaginalis
and often presents with a malodorous, frothy yellow-green discharge. The presence of
punctate hemorrhages on the cervix, known as a ‘strawberry cervix,’ is a classic but not
always present clinical sign. Treatment involves nitroimidazole antibiotics for the patient
and their partners.
8. According to the American Heart Association (AHA), what is the definition of Stage 1
Hypertension?
A. 120-129 / <80 mmHg
B. >160 / >100 mmHg
C. 140--99 mmHg
D. 130--89 mmHg
Correct Answer: D
Expert Explanation: The AHA guidelines define Stage 1 Hypertension as a systolic blood
pressure between 130 and 139 mmHg or a diastolic pressure between 80 and 89 mmHg.
This classification emphasizes early intervention through lifestyle changes and potential
medication. Accurate diagnosis requires multiple readings over several visits.
9. A patient with a history of heart failure (HFrEF) is currently taking an ACE inhibitor and a
beta-blocker. Their BP is stable, but they remain symptomatic (NYHA Class II). Which
medication should be added next?
A. Amlodipine
Exam v3 | Questions with Correct Answers and
Expert Explanation for Each Question | Grand
Canyon University
1. A 55-year-old patient with a history of hypertension and Type 2 Diabetes presents with a
blood pressure of 148/92. Which class of antihypertensive medication is most appropriate as
first-line therapy?
A. Calcium Channel Blockers
B. Loop Diuretics
C. Beta-Blockers
D. ACE Inhibitors
Correct Answer: D
Expert Explanation: ACE inhibitors are recommended as first-line therapy for patients
with diabetes because they provide renal protection. They work by inhibiting the
conversion of angiotensin I to angiotensin II, which reduces systemic vascular resistance.
This protective effect helps slow the progression of diabetic nephropathy over time.
2. When evaluating a 4-year-old child during a well-visit, which developmental milestone
should the nurse practitioner expect?
A. Naming four colors and drawing a person with three parts
B. Tying shoelaces independently
C. Understanding abstract concepts like time
D. Using complex sentences with more than 10 words
Correct Answer: A
Expert Explanation: At age four, children typically can name several colors and draw a
person with at least three body parts. This stage of development marks significant progress
in fine motor skills and cognitive recognition. It is a standard assessment point in pediatric
primary care to ensure proper neurodevelopmental growth.
3. A 68-year-old female presents with sudden onset of confusion, agitation, and visual
hallucinations. Her daughter reports that her symptoms started yesterday. What is the most
likely diagnosis?
A. Alzheimer’s Dementia
B. Vascular Dementia
,C. Major Depressive Disorder
D. Delirium
Correct Answer: D
Expert Explanation: Delirium is characterized by an acute onset of fluctuating cognitive
impairment and altered consciousness. Unlike dementia, which is progressive and chronic,
delirium often has an underlying medical cause such as infection or metabolic imbalance.
Identifying and treating the root cause is the primary goal of clinical management.
4. In the management of a patient with Chronic Obstructive Pulmonary Disease (COPD),
which medication is considered the gold standard for long-term maintenance of symptoms?
A. Long-acting muscarinic antagonists (LAMA)
B. Inhaled Corticosteroids (ICS) as monotherapy
C. Short-acting beta-agonists (SABA)
D. Oral Prednisone
Correct Answer: A
Expert Explanation: Long-acting muscarinic antagonists are a cornerstone of maintenance
therapy for COPD to reduce exacerbations and improve lung function. LAMAs work by
blocking the bronchoconstrictor effects of acetylcholine on M3 receptors in the airway
smooth muscle. This provides sustained bronchodilation compared to rescue medications.
5. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Psoriasis
B. Tinea Corporis
C. Pityriasis Rosea
D. Secondary Syphilis
Correct Answer: C
Expert Explanation: Pityriasis rosea typically begins with a single herald patch, which is
then followed by a generalized eruption in a cleavage line distribution. The condition is
usually self-limiting and may last six to eight weeks. Management is primarily supportive,
focusing on pruritus relief if needed.
6. Which of the following is the most appropriate screening tool for depression in the primary
care setting?
A. GAD-7
B. CAGE questionnaire
, C. MMSE
D. PHQ-9
Correct Answer: D
Expert Explanation: The Patient Health Questionnaire-9 (PHQ-9) is a validated and widely
used tool for screening and monitoring the severity of depression. It consists of nine
questions based on DSM-IV criteria for major depressive disorder. A higher score indicates
a greater severity of depressive symptoms, guiding treatment decisions.
7. A 24-year-old female presents with a foul-smelling vaginal discharge and ‘strawberry
cervix’ on examination. What is the most likely causative organism?
A. Gardnerella vaginalis
B. Candida albicans
C. Trichomonas vaginalis
D. Chlamydia trachomatis
Correct Answer: C
Expert Explanation: Trichomoniasis is caused by the protozoan Trichomonas vaginalis
and often presents with a malodorous, frothy yellow-green discharge. The presence of
punctate hemorrhages on the cervix, known as a ‘strawberry cervix,’ is a classic but not
always present clinical sign. Treatment involves nitroimidazole antibiotics for the patient
and their partners.
8. According to the American Heart Association (AHA), what is the definition of Stage 1
Hypertension?
A. 120-129 / <80 mmHg
B. >160 / >100 mmHg
C. 140--99 mmHg
D. 130--89 mmHg
Correct Answer: D
Expert Explanation: The AHA guidelines define Stage 1 Hypertension as a systolic blood
pressure between 130 and 139 mmHg or a diastolic pressure between 80 and 89 mmHg.
This classification emphasizes early intervention through lifestyle changes and potential
medication. Accurate diagnosis requires multiple readings over several visits.
9. A patient with a history of heart failure (HFrEF) is currently taking an ACE inhibitor and a
beta-blocker. Their BP is stable, but they remain symptomatic (NYHA Class II). Which
medication should be added next?
A. Amlodipine
