FNP654 | FNP654 Family Primary Care II Exam 2
v1 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 65-year-old patient is diagnosed with Bipolar I disorder. Which medication
requires consistent monitoring of serum levels, renal function, and thyroid function?
A. Sertraline
B. Quetiapine
C. Lithium
D. Lamotrigine
Correct Answer: C
Expert Explanation: Lithium has a narrow therapeutic index and requires regular
serum level checks to prevent toxicity. It is primarily excreted by the kidneys,
making renal function monitoring essential for patient safety. Additionally, long-
term lithium use can cause hypothyroidism, necessitating periodic thyroid-
stimulating hormone (TSH) testing.
2. A 45-year-old female presents with frequent migraine headaches. Which of the
following conditions is a contraindication for prescribing triptans?
A. Osteoarthritis
,B. Type 2 Diabetes
C. Hypothyroidism
D. Coronary Artery Disease
Correct Answer: D
Expert Explanation: Triptans act as selective serotonin receptor agonists that
cause vasoconstriction of cranial blood vessels. This vasoconstrictive effect can also
occur in the coronary arteries, posing a risk for myocardial infarction in patients
with pre-existing CAD. Therefore, they are strictly contraindicated in patients with a
history of ischemic heart disease or uncontrolled hypertension.
3. A 72-year-old male complains of knee pain that is worse at the end of the day and
relieved by rest. What is the first-line pharmacological treatment for this patient?
A. Oral Prednisone
B. Intra-articular Hyaluronic Acid
C. Acetaminophen or Topical NSAIDs
D. High-dose Methotrexate
Correct Answer: C
Expert Explanation: Osteoarthritis typically presents with pain that increases with
activity and decreases with rest. For older adults, topical NSAIDs or acetaminophen
,are recommended as first-line agents to minimize systemic side effects. Oral NSAIDs
may be used with caution, but systemic steroids and DMARDs like methotrexate are
not appropriate for osteoarthritis.
4. Using the CURB-65 criteria for community-acquired pneumonia, which factor would
warrant inpatient admission?
A. Confusion or altered mental status
B. Age under 50
C. Diastolic blood pressure of 85 mmHg
D. Respiratory rate of 20 breaths per minute
Correct Answer: A
Expert Explanation: The CURB-65 score is a clinical prediction rule used to
determine the severity of pneumonia. Confusion is one of the five criteria, alongside
Urea, Respiratory rate, Blood pressure, and Age over 65. A score of 2 or higher
generally suggests that inpatient management should be considered for the patient.
5. An 80-year-old female is brought to the clinic for a sudden change in mental status
and increased falls. What is the most likely underlying cause?
A. Urinary Tract Infection
B. Normal Age-related decline
, C. Early-onset Alzheimer’s
D. Vitamin D excess
Correct Answer: A
Expert Explanation: In the geriatric population, infections like UTIs often present
atypically with confusion or delirium rather than traditional symptoms like dysuria.
Sudden changes in mental status should always trigger a search for acute
physiological stressors. Prompt diagnosis and treatment of the infection often
return the patient to their baseline cognitive function.
6. Which mechanism of action is associated with Donepezil (Aricept) when used in the
treatment of Alzheimer’s disease?
A. Dopamine agonist
B. NMDA receptor antagonist
C. Acetylcholinesterase inhibitor
D. Serotonin reuptake inhibitor
Correct Answer: C
Expert Explanation: Donepezil works by inhibiting the enzyme
acetylcholinesterase, which breaks down acetylcholine in the synaptic cleft. This
increases the availability of acetylcholine, which is crucial for memory and cognitive
v1 | Questions with Correct Answers and Expert
Explanation for Each Question | Grand Canyon
University
1. A 65-year-old patient is diagnosed with Bipolar I disorder. Which medication
requires consistent monitoring of serum levels, renal function, and thyroid function?
A. Sertraline
B. Quetiapine
C. Lithium
D. Lamotrigine
Correct Answer: C
Expert Explanation: Lithium has a narrow therapeutic index and requires regular
serum level checks to prevent toxicity. It is primarily excreted by the kidneys,
making renal function monitoring essential for patient safety. Additionally, long-
term lithium use can cause hypothyroidism, necessitating periodic thyroid-
stimulating hormone (TSH) testing.
2. A 45-year-old female presents with frequent migraine headaches. Which of the
following conditions is a contraindication for prescribing triptans?
A. Osteoarthritis
,B. Type 2 Diabetes
C. Hypothyroidism
D. Coronary Artery Disease
Correct Answer: D
Expert Explanation: Triptans act as selective serotonin receptor agonists that
cause vasoconstriction of cranial blood vessels. This vasoconstrictive effect can also
occur in the coronary arteries, posing a risk for myocardial infarction in patients
with pre-existing CAD. Therefore, they are strictly contraindicated in patients with a
history of ischemic heart disease or uncontrolled hypertension.
3. A 72-year-old male complains of knee pain that is worse at the end of the day and
relieved by rest. What is the first-line pharmacological treatment for this patient?
A. Oral Prednisone
B. Intra-articular Hyaluronic Acid
C. Acetaminophen or Topical NSAIDs
D. High-dose Methotrexate
Correct Answer: C
Expert Explanation: Osteoarthritis typically presents with pain that increases with
activity and decreases with rest. For older adults, topical NSAIDs or acetaminophen
,are recommended as first-line agents to minimize systemic side effects. Oral NSAIDs
may be used with caution, but systemic steroids and DMARDs like methotrexate are
not appropriate for osteoarthritis.
4. Using the CURB-65 criteria for community-acquired pneumonia, which factor would
warrant inpatient admission?
A. Confusion or altered mental status
B. Age under 50
C. Diastolic blood pressure of 85 mmHg
D. Respiratory rate of 20 breaths per minute
Correct Answer: A
Expert Explanation: The CURB-65 score is a clinical prediction rule used to
determine the severity of pneumonia. Confusion is one of the five criteria, alongside
Urea, Respiratory rate, Blood pressure, and Age over 65. A score of 2 or higher
generally suggests that inpatient management should be considered for the patient.
5. An 80-year-old female is brought to the clinic for a sudden change in mental status
and increased falls. What is the most likely underlying cause?
A. Urinary Tract Infection
B. Normal Age-related decline
, C. Early-onset Alzheimer’s
D. Vitamin D excess
Correct Answer: A
Expert Explanation: In the geriatric population, infections like UTIs often present
atypically with confusion or delirium rather than traditional symptoms like dysuria.
Sudden changes in mental status should always trigger a search for acute
physiological stressors. Prompt diagnosis and treatment of the infection often
return the patient to their baseline cognitive function.
6. Which mechanism of action is associated with Donepezil (Aricept) when used in the
treatment of Alzheimer’s disease?
A. Dopamine agonist
B. NMDA receptor antagonist
C. Acetylcholinesterase inhibitor
D. Serotonin reuptake inhibitor
Correct Answer: C
Expert Explanation: Donepezil works by inhibiting the enzyme
acetylcholinesterase, which breaks down acetylcholine in the synaptic cleft. This
increases the availability of acetylcholine, which is crucial for memory and cognitive
