FNP654 | FNP654 Family Primary Care II Exam 1
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 62-year-old male with a history of hypertension and diabetes presents with a
blood pressure of 148/92 mmHg. According to JNC 8 guidelines, what is the target
blood pressure for this patient?
A. <130/80 mmHg
B. <140/90 mmHg
C. <150/90 mmHg
D. <120/80 mmHg
Correct Answer: B
Expert Explanation: For patients aged 18 years or older with diabetes or chronic
kidney disease, the JNC 8 goal blood pressure is less than 140/90 mmHg. This
recommendation aims to balance the benefits of blood pressure control with the
risks of polypharmacy and side effects. Maintaining this target helps reduce the
incidence of macrovascular and microvascular complications in diabetic patients.
,2. Which of the following is considered the first-line pharmacologic treatment for a
patient newly diagnosed with Stage C Heart Failure with Reduced Ejection Fraction
(HFrEF)?
A. ACE inhibitor or ARB
B. Loop diuretic alone
C. Calcium channel blocker
D. Digoxin
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are foundational therapy for HFrEF
because they block the renin-angiotensin-aldosterone system. These medications
have been shown to improve survival and reduce hospitalizations in clinical trials.
They are typically initiated at low doses and titrated upward as tolerated by the
patient.
3. A 45-year-old female presents with symptoms of fatigue, weight gain, and cold
intolerance. Her TSH is 12.4 mIU/L and her Free T4 is low. What is the most
appropriate initial treatment?
A. Methimazole
B. Levothyroxine 25-50 mcg daily
,C. Radioactive iodine
D. Liothyronine (T3) monotherapy
Correct Answer: B
Expert Explanation: The patient’s lab results indicate primary hypothyroidism, for
which Levothyroxine is the standard replacement therapy. In a middle-aged adult
without heart disease, starting with 1.6 mcg/kg/day or a conservative dose like 25-
50 mcg is common. Monitoring TSH levels every 6-8 weeks is essential until a stable
euthyroid state is achieved.
4. According to the GOLD criteria for COPD, which diagnostic finding is required to
confirm the diagnosis of COPD?
A. FEV1/FVC ratio > 0.70 post-bronchodilator
B. FEV1/FVC ratio < 0.70 post-bronchodilator
C. TLC < 80% predicted
D. Oxygen saturation < 88%
Correct Answer: B
Expert Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the presence of persistent airflow limitation, which is the hallmark of
COPD. This objective measure distinguishes COPD from reversible conditions like
, some forms of asthma. Once confirmed, further assessment of FEV1 is used to grade
the severity of airflow obstruction.
5. A 30-year-old patient with no significant medical history is diagnosed with
community-acquired pneumonia (CAP). He has no known drug allergies and has not
used antibiotics in the last 3 months. What is the preferred first-line treatment?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Vancomycin IV
Correct Answer: C
Expert Explanation: Recent ATS/IDSA guidelines recommend high-dose
amoxicillin, doxycycline, or a macrolide (if local resistance is low) for healthy
outpatients with CAP. Amoxicillin provides excellent coverage against Streptococcus
pneumoniae, the most common causative organism. This approach prioritizes
narrow-spectrum agents to prevent the development of antibiotic resistance.
6. Which physical exam finding is most suggestive of an acute exacerbation of heart
failure?
A. Peripheral pulses 2+
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 62-year-old male with a history of hypertension and diabetes presents with a
blood pressure of 148/92 mmHg. According to JNC 8 guidelines, what is the target
blood pressure for this patient?
A. <130/80 mmHg
B. <140/90 mmHg
C. <150/90 mmHg
D. <120/80 mmHg
Correct Answer: B
Expert Explanation: For patients aged 18 years or older with diabetes or chronic
kidney disease, the JNC 8 goal blood pressure is less than 140/90 mmHg. This
recommendation aims to balance the benefits of blood pressure control with the
risks of polypharmacy and side effects. Maintaining this target helps reduce the
incidence of macrovascular and microvascular complications in diabetic patients.
,2. Which of the following is considered the first-line pharmacologic treatment for a
patient newly diagnosed with Stage C Heart Failure with Reduced Ejection Fraction
(HFrEF)?
A. ACE inhibitor or ARB
B. Loop diuretic alone
C. Calcium channel blocker
D. Digoxin
Correct Answer: A
Expert Explanation: ACE inhibitors or ARBs are foundational therapy for HFrEF
because they block the renin-angiotensin-aldosterone system. These medications
have been shown to improve survival and reduce hospitalizations in clinical trials.
They are typically initiated at low doses and titrated upward as tolerated by the
patient.
3. A 45-year-old female presents with symptoms of fatigue, weight gain, and cold
intolerance. Her TSH is 12.4 mIU/L and her Free T4 is low. What is the most
appropriate initial treatment?
A. Methimazole
B. Levothyroxine 25-50 mcg daily
,C. Radioactive iodine
D. Liothyronine (T3) monotherapy
Correct Answer: B
Expert Explanation: The patient’s lab results indicate primary hypothyroidism, for
which Levothyroxine is the standard replacement therapy. In a middle-aged adult
without heart disease, starting with 1.6 mcg/kg/day or a conservative dose like 25-
50 mcg is common. Monitoring TSH levels every 6-8 weeks is essential until a stable
euthyroid state is achieved.
4. According to the GOLD criteria for COPD, which diagnostic finding is required to
confirm the diagnosis of COPD?
A. FEV1/FVC ratio > 0.70 post-bronchodilator
B. FEV1/FVC ratio < 0.70 post-bronchodilator
C. TLC < 80% predicted
D. Oxygen saturation < 88%
Correct Answer: B
Expert Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70
confirms the presence of persistent airflow limitation, which is the hallmark of
COPD. This objective measure distinguishes COPD from reversible conditions like
, some forms of asthma. Once confirmed, further assessment of FEV1 is used to grade
the severity of airflow obstruction.
5. A 30-year-old patient with no significant medical history is diagnosed with
community-acquired pneumonia (CAP). He has no known drug allergies and has not
used antibiotics in the last 3 months. What is the preferred first-line treatment?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Vancomycin IV
Correct Answer: C
Expert Explanation: Recent ATS/IDSA guidelines recommend high-dose
amoxicillin, doxycycline, or a macrolide (if local resistance is low) for healthy
outpatients with CAP. Amoxicillin provides excellent coverage against Streptococcus
pneumoniae, the most common causative organism. This approach prioritizes
narrow-spectrum agents to prevent the development of antibiotic resistance.
6. Which physical exam finding is most suggestive of an acute exacerbation of heart
failure?
A. Peripheral pulses 2+
