FNP654 | FNP654 Family Primary Care II Exam 1
v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two
separate occasions. According to JNC 8 guidelines, what is the most appropriate initial
management for this patient?
A. Initiate lifestyle modifications and start a thiazide-type diuretic
B. Immediate referral to a cardiologist for diagnostic workup
C. Wait six months and recheck the blood pressure
D. Prescribe a high-dose beta-blocker immediately
Correct Answer: A
Expert Explanation: The JNC 8 guidelines recommend initiating pharmacological
treatment for adults aged 18-59 with a systolic BP of 140 or higher or diastolic BP of
90 or higher. Thiazide-type diuretics are considered one of the first-line options for
the general non-black population. Lifestyle modifications including diet and exercise
should always be implemented concurrently with pharmacotherapy.
2. Which of the following physical exam findings is most indicative of acute otitis
media (AOM) in a pediatric patient?
A. Presence of a translucent tympanic membrane
,B. Bulging of the tympanic membrane with impaired mobility
C. Pain when pulling the pinna or tragus
D. Absence of fluid in the middle ear space
Correct Answer: B
Expert Explanation: Acute otitis media is characterized by the rapid onset of signs
and symptoms of middle ear inflammation. A bulging tympanic membrane is the
most specific sign of middle ear effusion and inflammation. Impaired mobility of the
membrane during pneumatic otoscopy further confirms the presence of fluid.
3. A 62-year-old female smoker presents with a chronic cough and dyspnea on
exertion. Spirometry reveals an FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Restrictive lung disease
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Acute Bronchitis
D. Congestive Heart Failure
Correct Answer: B
Expert Explanation: An FEV1/FVC ratio of less than 0.70 post-bronchodilator
confirms the presence of persistent airflow limitation. This finding is the gold
,standard for diagnosing COPD in the appropriate clinical context of exposure to
irritants. The patient’s history of smoking and symptoms of chronic cough and
dyspnea align with this diagnosis.
4. In the treatment of community-acquired pneumonia (CAP) in a healthy adult with
no recent antibiotic use, which is the first-line antibiotic choice?
A. Amoxicillin or Doxycycline
B. Ciprofloxacin
C. Vancomycin
D. Metronidazole
Correct Answer: A
Expert Explanation: For healthy outpatients with CAP and no risk factors for MRSA
or Pseudomonas, monotherapy with amoxicillin or doxycycline is recommended.
These agents effectively target common pathogens like Streptococcus pneumoniae.
Current guidelines emphasize choosing narrow-spectrum agents to prevent
antibiotic resistance when appropriate.
5. A patient presents with a ‘strawberry tongue’ and a sandpaper-like rash. These
findings are classic for which condition?
A. Scarlet Fever
B. Mononucleosis
, C. Roseola
D. Hand-Foot-Mouth Disease
Correct Answer: A
Expert Explanation: Scarlet fever is caused by a Group A Streptococcus infection
that produces an erythrogenic toxin. The characteristic sandpaper rash typically
starts on the trunk and spreads to the extremities. The ‘strawberry tongue’ occurs as
the white coating on the tongue sloughs off, leaving red, prominent papillae.
6. Which of the following medications is considered the gold standard for long-term
control of persistent asthma?
A. Short-acting beta-agonists (SABA)
B. Inhaled corticosteroids (ICS)
C. Oral prednisone
D. Antihistamines
Correct Answer: B
Expert Explanation: Inhaled corticosteroids are the most effective long-term
medications for controlling the airway inflammation associated with asthma. They
help reduce the frequency and severity of exacerbations when used consistently.
v3 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two
separate occasions. According to JNC 8 guidelines, what is the most appropriate initial
management for this patient?
A. Initiate lifestyle modifications and start a thiazide-type diuretic
B. Immediate referral to a cardiologist for diagnostic workup
C. Wait six months and recheck the blood pressure
D. Prescribe a high-dose beta-blocker immediately
Correct Answer: A
Expert Explanation: The JNC 8 guidelines recommend initiating pharmacological
treatment for adults aged 18-59 with a systolic BP of 140 or higher or diastolic BP of
90 or higher. Thiazide-type diuretics are considered one of the first-line options for
the general non-black population. Lifestyle modifications including diet and exercise
should always be implemented concurrently with pharmacotherapy.
2. Which of the following physical exam findings is most indicative of acute otitis
media (AOM) in a pediatric patient?
A. Presence of a translucent tympanic membrane
,B. Bulging of the tympanic membrane with impaired mobility
C. Pain when pulling the pinna or tragus
D. Absence of fluid in the middle ear space
Correct Answer: B
Expert Explanation: Acute otitis media is characterized by the rapid onset of signs
and symptoms of middle ear inflammation. A bulging tympanic membrane is the
most specific sign of middle ear effusion and inflammation. Impaired mobility of the
membrane during pneumatic otoscopy further confirms the presence of fluid.
3. A 62-year-old female smoker presents with a chronic cough and dyspnea on
exertion. Spirometry reveals an FEV1/FVC ratio of 0.65. What is the most likely
diagnosis?
A. Restrictive lung disease
B. Chronic Obstructive Pulmonary Disease (COPD)
C. Acute Bronchitis
D. Congestive Heart Failure
Correct Answer: B
Expert Explanation: An FEV1/FVC ratio of less than 0.70 post-bronchodilator
confirms the presence of persistent airflow limitation. This finding is the gold
,standard for diagnosing COPD in the appropriate clinical context of exposure to
irritants. The patient’s history of smoking and symptoms of chronic cough and
dyspnea align with this diagnosis.
4. In the treatment of community-acquired pneumonia (CAP) in a healthy adult with
no recent antibiotic use, which is the first-line antibiotic choice?
A. Amoxicillin or Doxycycline
B. Ciprofloxacin
C. Vancomycin
D. Metronidazole
Correct Answer: A
Expert Explanation: For healthy outpatients with CAP and no risk factors for MRSA
or Pseudomonas, monotherapy with amoxicillin or doxycycline is recommended.
These agents effectively target common pathogens like Streptococcus pneumoniae.
Current guidelines emphasize choosing narrow-spectrum agents to prevent
antibiotic resistance when appropriate.
5. A patient presents with a ‘strawberry tongue’ and a sandpaper-like rash. These
findings are classic for which condition?
A. Scarlet Fever
B. Mononucleosis
, C. Roseola
D. Hand-Foot-Mouth Disease
Correct Answer: A
Expert Explanation: Scarlet fever is caused by a Group A Streptococcus infection
that produces an erythrogenic toxin. The characteristic sandpaper rash typically
starts on the trunk and spreads to the extremities. The ‘strawberry tongue’ occurs as
the white coating on the tongue sloughs off, leaving red, prominent papillae.
6. Which of the following medications is considered the gold standard for long-term
control of persistent asthma?
A. Short-acting beta-agonists (SABA)
B. Inhaled corticosteroids (ICS)
C. Oral prednisone
D. Antihistamines
Correct Answer: B
Expert Explanation: Inhaled corticosteroids are the most effective long-term
medications for controlling the airway inflammation associated with asthma. They
help reduce the frequency and severity of exacerbations when used consistently.
