FNP654 | FNP654 Family Primary Care II Midterm
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 55-year-old African American male presents with a blood pressure of 152/94
mmHg. According to JNC 8 guidelines, which class of medication is the most
appropriate first-line treatment?
A. ACE Inhibitors
B. Beta-Blockers
C. Calcium Channel Blockers
D. Angiotensin Receptor Blockers
Correct Answer: C
Expert Explanation: For the general Black population, initial antihypertensive
treatment should include a thiazide-type diuretic or a calcium channel blocker.
These classes have been shown to be more effective in lowering blood pressure and
reducing the risk of stroke in this demographic compared to ACE inhibitors. The
clinician should monitor the patient’s response and adjust the dosage or add a
second agent if the target blood pressure is not reached within a month.
,2. Which of the following is considered the gold standard for diagnosing asthma in a
primary care setting?
A. Chest X-ray
B. Peak Flow Meter Monitoring
C. Spirometry
D. Methacholine Challenge Test
Correct Answer: C
Expert Explanation: Spirometry is the gold standard for diagnosing asthma by
demonstrating reversible airway obstruction. It measures the volume of air an
individual can inhale or exhale as a function of time. A significant increase in FEV1
after administration of a bronchodilator confirms the diagnosis and helps
differentiate asthma from COPD.
3. A 62-year-old patient with Type 2 Diabetes is currently taking Metformin 1000mg
BID. Their latest HbA1c is 8.2%. What is the most appropriate next step in
management according to ADA standards?
A. Increase Metformin to 1500mg BID
B. Add a second oral agent like a GLP-1 receptor agonist
C. Initiate basal insulin immediately
,D. Switch to a Sulfonylurea
Correct Answer: B
Expert Explanation: When a patient’s HbA1c remains above the target goal despite
maximal doses of Metformin, adding a second agent is recommended. For patients
with high cardiovascular risk or those needing significant weight loss, a GLP-1
receptor agonist or SGLT2 inhibitor is often preferred. This approach addresses
multiple pathophysiological pathways of the disease and provides better long-term
glycemic control.
4. A 24-year-old female presents for a routine physical. She reports her last menstrual
period was 2 weeks ago and she is sexually active. Which screening test is
recommended if she has never had one?
A. Mammogram
B. HPV DNA test alone
C. Pap smear for cervical cytology
D. Transvaginal ultrasound
Correct Answer: C
Expert Explanation: According to current USPSTF guidelines, cervical cancer
screening with a Pap smear alone should begin at age 21 for women with a cervix.
Screening is performed every three years for women aged 21 to 29 to detect
, precancerous changes. Routine HPV testing is generally not recommended for
women under the age of 30 unless used as a follow-up for abnormal cytology.
5. Which of the following physical exam findings is most suggestive of acute otitis
media in a pediatric patient?
A. Bulging of the tympanic membrane with impaired mobility
B. Clear fluid behind a neutral tympanic membrane
C. Tenderness when pulling on the pinna
D. Presence of earwax in the external canal
Correct Answer: A
Expert Explanation: Acute otitis media is characterized by the rapid onset of signs
and symptoms of inflammation in the middle ear. A bulging tympanic membrane
and limited or absent mobility upon pneumatic otoscopy are the most reliable
indicators. This condition typically requires assessment for antibiotic therapy
depending on the severity and age of the child.
6. A patient presents with a ‘curtain-like’ loss of vision in one eye. This finding is classic
for which of the following emergencies?
A. Retinal detachment
B. Glaucoma
v2 Questions with Correct Answers and Expert
Explanation for Each Question
1. A 55-year-old African American male presents with a blood pressure of 152/94
mmHg. According to JNC 8 guidelines, which class of medication is the most
appropriate first-line treatment?
A. ACE Inhibitors
B. Beta-Blockers
C. Calcium Channel Blockers
D. Angiotensin Receptor Blockers
Correct Answer: C
Expert Explanation: For the general Black population, initial antihypertensive
treatment should include a thiazide-type diuretic or a calcium channel blocker.
These classes have been shown to be more effective in lowering blood pressure and
reducing the risk of stroke in this demographic compared to ACE inhibitors. The
clinician should monitor the patient’s response and adjust the dosage or add a
second agent if the target blood pressure is not reached within a month.
,2. Which of the following is considered the gold standard for diagnosing asthma in a
primary care setting?
A. Chest X-ray
B. Peak Flow Meter Monitoring
C. Spirometry
D. Methacholine Challenge Test
Correct Answer: C
Expert Explanation: Spirometry is the gold standard for diagnosing asthma by
demonstrating reversible airway obstruction. It measures the volume of air an
individual can inhale or exhale as a function of time. A significant increase in FEV1
after administration of a bronchodilator confirms the diagnosis and helps
differentiate asthma from COPD.
3. A 62-year-old patient with Type 2 Diabetes is currently taking Metformin 1000mg
BID. Their latest HbA1c is 8.2%. What is the most appropriate next step in
management according to ADA standards?
A. Increase Metformin to 1500mg BID
B. Add a second oral agent like a GLP-1 receptor agonist
C. Initiate basal insulin immediately
,D. Switch to a Sulfonylurea
Correct Answer: B
Expert Explanation: When a patient’s HbA1c remains above the target goal despite
maximal doses of Metformin, adding a second agent is recommended. For patients
with high cardiovascular risk or those needing significant weight loss, a GLP-1
receptor agonist or SGLT2 inhibitor is often preferred. This approach addresses
multiple pathophysiological pathways of the disease and provides better long-term
glycemic control.
4. A 24-year-old female presents for a routine physical. She reports her last menstrual
period was 2 weeks ago and she is sexually active. Which screening test is
recommended if she has never had one?
A. Mammogram
B. HPV DNA test alone
C. Pap smear for cervical cytology
D. Transvaginal ultrasound
Correct Answer: C
Expert Explanation: According to current USPSTF guidelines, cervical cancer
screening with a Pap smear alone should begin at age 21 for women with a cervix.
Screening is performed every three years for women aged 21 to 29 to detect
, precancerous changes. Routine HPV testing is generally not recommended for
women under the age of 30 unless used as a follow-up for abnormal cytology.
5. Which of the following physical exam findings is most suggestive of acute otitis
media in a pediatric patient?
A. Bulging of the tympanic membrane with impaired mobility
B. Clear fluid behind a neutral tympanic membrane
C. Tenderness when pulling on the pinna
D. Presence of earwax in the external canal
Correct Answer: A
Expert Explanation: Acute otitis media is characterized by the rapid onset of signs
and symptoms of inflammation in the middle ear. A bulging tympanic membrane
and limited or absent mobility upon pneumatic otoscopy are the most reliable
indicators. This condition typically requires assessment for antibiotic therapy
depending on the severity and age of the child.
6. A patient presents with a ‘curtain-like’ loss of vision in one eye. This finding is classic
for which of the following emergencies?
A. Retinal detachment
B. Glaucoma
