NURS 5433 FNP II Final Exam – Complete Test
Bank 400 Multiple Choice Questions with
Answers and Rationales
SECTION 1: MUSCULOSKELETAL & RHEUMATOLOGY (1-60)
1. Which of the following medications are considered first-line for
osteoarthritis?
A) NSAIDs
B) Proton pump inhibitors
C) Acetaminophen
D) Opioids
Answer: A (NSAIDs)
Rationale: NSAIDs (topical or oral) are first-line pharmacologic therapy for
osteoarthritis pain due to anti-inflammatory effects. Acetaminophen has minimal
efficacy. Opioids reserved for refractory severe pain.
2. How much vitamin D do all osteoporosis patients need?
A) 500-1000 IU daily
B) 1000-1500 IU daily
C) 1500-3000 IU daily
D) 2000-4000 IU daily
Answer: D (2000-4000 IU daily)
Rationale: Osteoporosis patients require higher vitamin D doses to maintain
serum 25(OH)D >30 ng/mL for optimal calcium absorption and bone health.
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,3. You have a patient with significant osteoporosis. Which drug is used to treat
osteoporosis and stimulate bone growth?
A) Teriparatide
B) Denosumab
C) Alendronate
D) Raloxifene
Answer: A (Teriparatide)
Rationale: Teriparatide (PTH analog) is an anabolic agent stimulating new bone
formation. Denosumab, alendronate, raloxifene are antiresorptive.
4. A 72-year-old with rheumatoid arthritis. Which lab finding is most specific for
RA?
A) Rheumatoid factor (RF)
B) Anti-CCP antibody
C) Elevated ESR
D) Positive ANA
Answer: B (Anti-CCP)
Rationale: Anti-CCP has 95-98% specificity for RA vs 85% for RF. It predicts more
erosive disease.
5. Acute gout of first MTP joint. Initial treatment?
A) Allopurinol
B) Febuxostat
C) Colchicine or NSAIDs
D) Probenecid
Answer: C (Colchicine or NSAIDs)
Rationale: Acute gout treated with NSAIDs, colchicine, or corticosteroids. Urate-
lowering therapy starts after flare resolves.
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,6. Risk factor for osteoporosis?
A) Obesity
B) Late menopause
C) African American race
D) Long-term corticosteroid use
Answer: D (Long-term corticosteroids)
Rationale: Chronic glucocorticoid use is major risk. Others: thin body, early
menopause, Caucasian/Asian race.
7. A 55-year-old with osteoporosis, T-score -3.0. First-line medication?
A) Calcium alone
B) Vitamin D alone
C) Alendronate
D) Teriparatide
Answer: C (Alendronate)
Rationale: Bisphosphonates are first-line for T-score ≤ -2.5 or prior fragility
fracture.
8. Pain pattern of fibromyalgia?
A) Localized joint pain with swelling
B) Widespread pain with tender points and fatigue
C) Unilateral back pain radiating down leg
D) Morning stiffness >1 hour
Answer: B (Widespread pain with tender points)
Rationale: Fibromyalgia: chronic widespread pain, tender points, fatigue, sleep
disturbance, cognitive issues.
9. Polymyalgia rheumatica (PMR) responds dramatically to:
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, A) NSAIDs
B) Low-dose prednisone
C) Methotrexate
D) Opioids
Answer: B (Low-dose prednisone)
Rationale: PMR shows rapid improvement with prednisone 10-20 mg daily;
response is almost diagnostic.
10. Typical x-ray finding in osteoarthritis?
A) Joint erosions
B) Periarticular osteopenia
C) Joint space narrowing and osteophytes
D) Ankylosis
Answer: C (Joint space narrowing and osteophytes)
Rationale: OA: asymmetric joint space narrowing, subchondral sclerosis,
osteophytes. Erosions suggest inflammatory arthritis.
11. A 45-year-old with low back pain worse in morning, improves with activity,
plus uveitis. Most likely?
A) Mechanical low back pain
B) Ankylosing spondylitis
C) Lumbar spinal stenosis
D) Herniated disc
Answer: B (Ankylosing spondylitis)
Rationale: Inflammatory back pain (morning stiffness improving with activity) +
extra-articular features (uveitis) suggests axial spondyloarthritis.
12. Most common side effect of oral bisphosphonates (alendronate)?
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Bank 400 Multiple Choice Questions with
Answers and Rationales
SECTION 1: MUSCULOSKELETAL & RHEUMATOLOGY (1-60)
1. Which of the following medications are considered first-line for
osteoarthritis?
A) NSAIDs
B) Proton pump inhibitors
C) Acetaminophen
D) Opioids
Answer: A (NSAIDs)
Rationale: NSAIDs (topical or oral) are first-line pharmacologic therapy for
osteoarthritis pain due to anti-inflammatory effects. Acetaminophen has minimal
efficacy. Opioids reserved for refractory severe pain.
2. How much vitamin D do all osteoporosis patients need?
A) 500-1000 IU daily
B) 1000-1500 IU daily
C) 1500-3000 IU daily
D) 2000-4000 IU daily
Answer: D (2000-4000 IU daily)
Rationale: Osteoporosis patients require higher vitamin D doses to maintain
serum 25(OH)D >30 ng/mL for optimal calcium absorption and bone health.
1|Page
,3. You have a patient with significant osteoporosis. Which drug is used to treat
osteoporosis and stimulate bone growth?
A) Teriparatide
B) Denosumab
C) Alendronate
D) Raloxifene
Answer: A (Teriparatide)
Rationale: Teriparatide (PTH analog) is an anabolic agent stimulating new bone
formation. Denosumab, alendronate, raloxifene are antiresorptive.
4. A 72-year-old with rheumatoid arthritis. Which lab finding is most specific for
RA?
A) Rheumatoid factor (RF)
B) Anti-CCP antibody
C) Elevated ESR
D) Positive ANA
Answer: B (Anti-CCP)
Rationale: Anti-CCP has 95-98% specificity for RA vs 85% for RF. It predicts more
erosive disease.
5. Acute gout of first MTP joint. Initial treatment?
A) Allopurinol
B) Febuxostat
C) Colchicine or NSAIDs
D) Probenecid
Answer: C (Colchicine or NSAIDs)
Rationale: Acute gout treated with NSAIDs, colchicine, or corticosteroids. Urate-
lowering therapy starts after flare resolves.
2|Page
,6. Risk factor for osteoporosis?
A) Obesity
B) Late menopause
C) African American race
D) Long-term corticosteroid use
Answer: D (Long-term corticosteroids)
Rationale: Chronic glucocorticoid use is major risk. Others: thin body, early
menopause, Caucasian/Asian race.
7. A 55-year-old with osteoporosis, T-score -3.0. First-line medication?
A) Calcium alone
B) Vitamin D alone
C) Alendronate
D) Teriparatide
Answer: C (Alendronate)
Rationale: Bisphosphonates are first-line for T-score ≤ -2.5 or prior fragility
fracture.
8. Pain pattern of fibromyalgia?
A) Localized joint pain with swelling
B) Widespread pain with tender points and fatigue
C) Unilateral back pain radiating down leg
D) Morning stiffness >1 hour
Answer: B (Widespread pain with tender points)
Rationale: Fibromyalgia: chronic widespread pain, tender points, fatigue, sleep
disturbance, cognitive issues.
9. Polymyalgia rheumatica (PMR) responds dramatically to:
3|Page
, A) NSAIDs
B) Low-dose prednisone
C) Methotrexate
D) Opioids
Answer: B (Low-dose prednisone)
Rationale: PMR shows rapid improvement with prednisone 10-20 mg daily;
response is almost diagnostic.
10. Typical x-ray finding in osteoarthritis?
A) Joint erosions
B) Periarticular osteopenia
C) Joint space narrowing and osteophytes
D) Ankylosis
Answer: C (Joint space narrowing and osteophytes)
Rationale: OA: asymmetric joint space narrowing, subchondral sclerosis,
osteophytes. Erosions suggest inflammatory arthritis.
11. A 45-year-old with low back pain worse in morning, improves with activity,
plus uveitis. Most likely?
A) Mechanical low back pain
B) Ankylosing spondylitis
C) Lumbar spinal stenosis
D) Herniated disc
Answer: B (Ankylosing spondylitis)
Rationale: Inflammatory back pain (morning stiffness improving with activity) +
extra-articular features (uveitis) suggests axial spondyloarthritis.
12. Most common side effect of oral bisphosphonates (alendronate)?
4|Page
