FNP654 | FNP654 Family Primary Care II Exam 1
v1 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 62-year-old male presents for a follow-up visit. His blood pressure readings today
are 144/92 mmHg and 146/90 mmHg. According to the 2017 ACC/AHA guidelines, how
should this patient’s hypertension be classified?
A. Elevated Blood Pressure
B. Stage 1 Hypertension
C. Hypertensive Emergency
D. Stage 2 Hypertension
Correct Answer: D
Expert Explanation: Stage 2 hypertension is defined by a systolic blood pressure of
140 mmHg or higher or a diastolic pressure of 90 mmHg or higher. This patient’s
readings consistently exceed both of these thresholds. Proper management at this
stage usually requires the initiation of two different classes of antihypertensive
medications.
2. Which of the following findings is the gold standard for confirming a diagnosis of
Chronic Obstructive Pulmonary Disease (COPD)?
A. A chest X-ray showing hyperinflation of the lungs
,B. A post-bronchodilator FEV1/FVC ratio of less than 0.70
C. An oxygen saturation of less than 92% on room air
D. A history of smoking more than 20 pack-years
Correct Answer: B
Expert Explanation: Spirometry is the essential tool required to make a clinical
diagnosis of COPD. A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms
persistent airflow limitation. While imaging and history are supportive, they cannot
independently confirm the diagnosis of COPD.
3. A 45-year-old patient with Type 2 Diabetes Mellitus has a current HbA1c of 8.2%.
Which of the following is the most appropriate next step in management according to
the ADA standards?
A. Maintain current therapy and recheck in 6 months
B. Discontinue Metformin and start insulin immediately
C. Initiate or adjust glucose-lowering medication to reach a target of <7.0%
D. Start high-intensity statin therapy only
Correct Answer: C
Expert Explanation: The standard HbA1c goal for most non-pregnant adults is less
than 7.0% to prevent microvascular complications. Since the patient’s current level
,is 8.2%, therapy intensification is required through lifestyle modifications or
medication adjustments. Regular monitoring every 3 months is necessary until the
target is achieved.
4. An 18-year-old female presents with intermittent wheezing and chest tightness
occurring 3 times per week. She wakes up at night due to symptoms about 3 times per
month. How should her asthma severity be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Expert Explanation: Mild persistent asthma is characterized by symptoms
occurring more than 2 days per week but not daily, and nighttime awakenings 3 to 4
times per month. This patient fits the criteria for mild persistent based on both
symptom frequency and nocturnal episodes. Initial treatment typically involves a
daily low-dose inhaled corticosteroid.
5. Which medication class is considered the first-line treatment for a patient newly
diagnosed with heart failure with reduced ejection fraction (HFrEF)?
A. ACE Inhibitors or ARBs
, B. Calcium Channel Blockers
C. Loop Diuretics as monotherapy
D. Centrally acting alpha-agonists
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are foundational therapies for HFrEF
because they improve survival and reduce hospitalizations. They work by inhibiting
the renin-angiotensin-aldosterone system, which prevents maladaptive cardiac
remodeling. These should be titrated to the maximum tolerated dose alongside beta-
blockers.
6. A patient’s laboratory results show a TSH level of 12.4 mIU/L (High) and a Free T4
level of 0.6 ng/dL (Low). What is the most likely diagnosis?
A. Primary Hypothyroidism
B. Secondary Hypothyroidism
C. Subclinical Hypothyroidism
D. Hyperthyroidism
Correct Answer: A
Expert Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4 as the pituitary attempts to stimulate a failing thyroid gland.
v1 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 62-year-old male presents for a follow-up visit. His blood pressure readings today
are 144/92 mmHg and 146/90 mmHg. According to the 2017 ACC/AHA guidelines, how
should this patient’s hypertension be classified?
A. Elevated Blood Pressure
B. Stage 1 Hypertension
C. Hypertensive Emergency
D. Stage 2 Hypertension
Correct Answer: D
Expert Explanation: Stage 2 hypertension is defined by a systolic blood pressure of
140 mmHg or higher or a diastolic pressure of 90 mmHg or higher. This patient’s
readings consistently exceed both of these thresholds. Proper management at this
stage usually requires the initiation of two different classes of antihypertensive
medications.
2. Which of the following findings is the gold standard for confirming a diagnosis of
Chronic Obstructive Pulmonary Disease (COPD)?
A. A chest X-ray showing hyperinflation of the lungs
,B. A post-bronchodilator FEV1/FVC ratio of less than 0.70
C. An oxygen saturation of less than 92% on room air
D. A history of smoking more than 20 pack-years
Correct Answer: B
Expert Explanation: Spirometry is the essential tool required to make a clinical
diagnosis of COPD. A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms
persistent airflow limitation. While imaging and history are supportive, they cannot
independently confirm the diagnosis of COPD.
3. A 45-year-old patient with Type 2 Diabetes Mellitus has a current HbA1c of 8.2%.
Which of the following is the most appropriate next step in management according to
the ADA standards?
A. Maintain current therapy and recheck in 6 months
B. Discontinue Metformin and start insulin immediately
C. Initiate or adjust glucose-lowering medication to reach a target of <7.0%
D. Start high-intensity statin therapy only
Correct Answer: C
Expert Explanation: The standard HbA1c goal for most non-pregnant adults is less
than 7.0% to prevent microvascular complications. Since the patient’s current level
,is 8.2%, therapy intensification is required through lifestyle modifications or
medication adjustments. Regular monitoring every 3 months is necessary until the
target is achieved.
4. An 18-year-old female presents with intermittent wheezing and chest tightness
occurring 3 times per week. She wakes up at night due to symptoms about 3 times per
month. How should her asthma severity be classified?
A. Mild Persistent
B. Intermittent
C. Moderate Persistent
D. Severe Persistent
Correct Answer: A
Expert Explanation: Mild persistent asthma is characterized by symptoms
occurring more than 2 days per week but not daily, and nighttime awakenings 3 to 4
times per month. This patient fits the criteria for mild persistent based on both
symptom frequency and nocturnal episodes. Initial treatment typically involves a
daily low-dose inhaled corticosteroid.
5. Which medication class is considered the first-line treatment for a patient newly
diagnosed with heart failure with reduced ejection fraction (HFrEF)?
A. ACE Inhibitors or ARBs
, B. Calcium Channel Blockers
C. Loop Diuretics as monotherapy
D. Centrally acting alpha-agonists
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are foundational therapies for HFrEF
because they improve survival and reduce hospitalizations. They work by inhibiting
the renin-angiotensin-aldosterone system, which prevents maladaptive cardiac
remodeling. These should be titrated to the maximum tolerated dose alongside beta-
blockers.
6. A patient’s laboratory results show a TSH level of 12.4 mIU/L (High) and a Free T4
level of 0.6 ng/dL (Low). What is the most likely diagnosis?
A. Primary Hypothyroidism
B. Secondary Hypothyroidism
C. Subclinical Hypothyroidism
D. Hyperthyroidism
Correct Answer: A
Expert Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4 as the pituitary attempts to stimulate a failing thyroid gland.
