FNP 654 FINAL EXAM / ACTUAL FNP 654 FAMILY PRIMARY
CARE II MIDTERM EXAM 2026/2027 AND PRACTICE
QUESTIONS COMPLETE ACCURATE EXAM REAL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES
(RELIABLE SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED PASS
Q1.A 57-year-old male with severe renal disease presents with acute coronary
syndrome. Which one of the following would most likely require a significant
dosage adjustment from the standard protocol? (check one)
A. Enoxaparin (Lovenox)
B. Metoprolol (Lopressor, Toprol)
C. Carvedilol (Coreg)
D. Clopidogrel (Plavix)
E. Tissue plasminogen activator (tPA)
A. Enoxaparin (Lovenox).
RATIONALES: Enoxaparin is eliminated mostly by the kidneys. When it is
used in patients with severe renal impairment the dosage must be
significantly reduced. For some indications the dose normally given every
12 hours is given only every 24 hours. Although some β-blockers require a
dosage adjustment, metoprolol and carvedilol are metabolized by the liver
and do not require dosage adjustment in patients with renal failure.
Clopidogrel is currently recommended at the standard dosage for patients
with renal failure and acute coronary syndrome. Thrombolytics like tPA are
given at the standard dosage in renal failure, although hemorrhagic
complications are increased.
,Q2. A 55-year-old male who has a long history of marginally-controlled
hypertension presents with gradually increasing shortness of breath and
reduced exercise tolerance. His physical examination is normal except for a
blood pressure of 140/90 mm Hg, bilateral basilar rales, and trace pitting
edema. Which one of the following ancillary studies would be the preferred
diagnostic tool for evaluating this patient? (check one)
A. 12-lead electrocardiography
B. Posteroanterior and lateral chest radiographs
C. 2-dimensional echocardiography with Doppler
D. Radionuclide ventriculography
E. Cardiac MRI
ANS: C.
RATIONALES: 2-dimensional echocardiography with Doppler. The most
useful diagnostic tool for evaluating patients with heart failure is two-
dimensional echocardiography with Doppler to assess left ventricular
ejection fraction (LVEF), left ventricular size, ventricular compliance, wall
thickness, and valve function. The test should be performed during the initial
evaluation. Radionuclide ventriculography can be used to assess LVEF and
volumes, and MRI or CT also may provide information in selected patients.
Chest radiography (posteroanterior and lateral) and 12-lead
electrocardiography should be performed in all patients presenting with
heart failure, but should not be used as the primary basis for determining
which abnormalities are responsible for the heart failure.
Q3. A 23-year-old female sees you with a complaint of intermittent irregular
heartbeats that occur once every week or two, but do not cause her to feel
lightheaded or fatigued. They last only a few seconds and resolve
spontaneously. She has never passed out, had chest pain, or had difficulty
with exertion. She is otherwise healthy, and a physical examination is normal.
Which one of the following cardiac studies should be ordered initially? (check
one)
A. 24-hour ambulatory EKG monitoring (Holter monitor)
B. 30-day continuous closed-loop event recording
C. Echocardiography
D. An EKG
E. Electrophysiologic studies
, ANSWERS: D.
RATIONALES: An EKG. The symptom of an increased or abnormal sensation
of one's heartbeat is referred to as palpitations. This condition is common to
primary care, but is often benign. Commonly, these sensations have their
basis in anxiety or panic. However, about 50% of those who complain of
palpitations will be found to have a diagnosable cardiac condition. It is
recommended to start the evaluation for cardiac causes with an EKG, which
will assess the baseline rhythm and screen for signs of chamber enlargement,
previous myocardial infarction, conduction disturbances, and a prolonged QT
interval.
Q4.Which one of the following is most appropriate for the initial treatment of
claudication? (check one)
A. Regular exercise
B. Chelation
C. Vasodilating agents
D. Warfarin (Coumadin)
ANSWERS:A
RATIONALES: Regular exercise. Claudication is exercise-induced lower-
extremity pain that is caused by ischemia and relieved by rest. It affects 10%
of persons over 70 years of age. However, up to 90% of patients with
peripheral vascular disease are asymptomatic. Initial treatment should consist
of vigorous risk factor modification and exercise. Patients who follow an
exercise regimen can increase their walking time by 150%. A supervised
program may produce better results. Risk factors include diabetes mellitus,
hypertension, smoking, and hyperlipidemia. Unconventional treatments such
as chelation have not been shown to be effective. Vasodilating agents are of
no benefit. There is no evidence that anticoagulants such as aspirin have a
role in the treatment of claudication.
, Q5. In a patient who presents with symptoms of acute myocardial infarction,
which one of the following would be an indication for thrombolytic therapy?
(check one)
A. New-onset ST-segment depression
B. New-onset left bundle branch block
C. New-onset first degree atrioventricular block
D. New-onset Wenckebach second degree heart block
E. Frequent unifocal ventricular ectopic beats
ANSWERS: B.
RATIONALES: New-onset left bundle branch block. In patients with ischemic
chest pain, the EKG is important for determining the need for fibrinolytic
therapy. Myocardial infarction is diagnosed by ST elevation ≥1 mm in two or
more limb leads and ≥2 mm in two or more contiguous precordial leads. In a
patient with an MI, new left bundle branch block suggests occlusion of the left
anterior descending artery, placing a significant portion of the left ventricle in
jeopardy. Thrombolytic therapy could be harmful in patients with ischemia but
not infarction - they will show ST-segment depression only. Frequent unifocal
ventricular ectopy may warrant antiarrhythmic therapy, but not thrombolytic
therapy.
Q6. A 68-year-old female has an average blood pressure of 150/70 mm Hg
despite appropriate lifestyle modification efforts. Her only other medical
problems are osteoporosis and mild depression. The most appropriate
treatment at this time would be (check one)
A. lisinopril (Prinivil, Zestril)
B. clonidine (Catapres)
C. propranolol (Inderal)
D. amlodipine (Norvasc)
E. hydrochlorothiazide
ANSWERS: E.
RATIONALES: hydrochlorothiazide. Randomized, placebo-controlled trials
have shown that isolated systolic hypertension in the elderly responds best
to diuretics and to a lesser extent, β-blockers. Diuretics are preferred,
although long-acting dihydropyridine calcium channel blockers may also be
used. In the case described, β-blockers or clonidine may worsen the
depression. Thiazide diuretics may also improve osteoporosis, and would
be the most cost-effective and useful agent in this instance.
CARE II MIDTERM EXAM 2026/2027 AND PRACTICE
QUESTIONS COMPLETE ACCURATE EXAM REAL QUESTIONS
AND CORRECT DETAILED ANSWERS WITH RATIONALES
(RELIABLE SOLUTIONS) CURRENTLY UPDATED VERSION 2026
EDITION |GUARANTEED PASS
Q1.A 57-year-old male with severe renal disease presents with acute coronary
syndrome. Which one of the following would most likely require a significant
dosage adjustment from the standard protocol? (check one)
A. Enoxaparin (Lovenox)
B. Metoprolol (Lopressor, Toprol)
C. Carvedilol (Coreg)
D. Clopidogrel (Plavix)
E. Tissue plasminogen activator (tPA)
A. Enoxaparin (Lovenox).
RATIONALES: Enoxaparin is eliminated mostly by the kidneys. When it is
used in patients with severe renal impairment the dosage must be
significantly reduced. For some indications the dose normally given every
12 hours is given only every 24 hours. Although some β-blockers require a
dosage adjustment, metoprolol and carvedilol are metabolized by the liver
and do not require dosage adjustment in patients with renal failure.
Clopidogrel is currently recommended at the standard dosage for patients
with renal failure and acute coronary syndrome. Thrombolytics like tPA are
given at the standard dosage in renal failure, although hemorrhagic
complications are increased.
,Q2. A 55-year-old male who has a long history of marginally-controlled
hypertension presents with gradually increasing shortness of breath and
reduced exercise tolerance. His physical examination is normal except for a
blood pressure of 140/90 mm Hg, bilateral basilar rales, and trace pitting
edema. Which one of the following ancillary studies would be the preferred
diagnostic tool for evaluating this patient? (check one)
A. 12-lead electrocardiography
B. Posteroanterior and lateral chest radiographs
C. 2-dimensional echocardiography with Doppler
D. Radionuclide ventriculography
E. Cardiac MRI
ANS: C.
RATIONALES: 2-dimensional echocardiography with Doppler. The most
useful diagnostic tool for evaluating patients with heart failure is two-
dimensional echocardiography with Doppler to assess left ventricular
ejection fraction (LVEF), left ventricular size, ventricular compliance, wall
thickness, and valve function. The test should be performed during the initial
evaluation. Radionuclide ventriculography can be used to assess LVEF and
volumes, and MRI or CT also may provide information in selected patients.
Chest radiography (posteroanterior and lateral) and 12-lead
electrocardiography should be performed in all patients presenting with
heart failure, but should not be used as the primary basis for determining
which abnormalities are responsible for the heart failure.
Q3. A 23-year-old female sees you with a complaint of intermittent irregular
heartbeats that occur once every week or two, but do not cause her to feel
lightheaded or fatigued. They last only a few seconds and resolve
spontaneously. She has never passed out, had chest pain, or had difficulty
with exertion. She is otherwise healthy, and a physical examination is normal.
Which one of the following cardiac studies should be ordered initially? (check
one)
A. 24-hour ambulatory EKG monitoring (Holter monitor)
B. 30-day continuous closed-loop event recording
C. Echocardiography
D. An EKG
E. Electrophysiologic studies
, ANSWERS: D.
RATIONALES: An EKG. The symptom of an increased or abnormal sensation
of one's heartbeat is referred to as palpitations. This condition is common to
primary care, but is often benign. Commonly, these sensations have their
basis in anxiety or panic. However, about 50% of those who complain of
palpitations will be found to have a diagnosable cardiac condition. It is
recommended to start the evaluation for cardiac causes with an EKG, which
will assess the baseline rhythm and screen for signs of chamber enlargement,
previous myocardial infarction, conduction disturbances, and a prolonged QT
interval.
Q4.Which one of the following is most appropriate for the initial treatment of
claudication? (check one)
A. Regular exercise
B. Chelation
C. Vasodilating agents
D. Warfarin (Coumadin)
ANSWERS:A
RATIONALES: Regular exercise. Claudication is exercise-induced lower-
extremity pain that is caused by ischemia and relieved by rest. It affects 10%
of persons over 70 years of age. However, up to 90% of patients with
peripheral vascular disease are asymptomatic. Initial treatment should consist
of vigorous risk factor modification and exercise. Patients who follow an
exercise regimen can increase their walking time by 150%. A supervised
program may produce better results. Risk factors include diabetes mellitus,
hypertension, smoking, and hyperlipidemia. Unconventional treatments such
as chelation have not been shown to be effective. Vasodilating agents are of
no benefit. There is no evidence that anticoagulants such as aspirin have a
role in the treatment of claudication.
, Q5. In a patient who presents with symptoms of acute myocardial infarction,
which one of the following would be an indication for thrombolytic therapy?
(check one)
A. New-onset ST-segment depression
B. New-onset left bundle branch block
C. New-onset first degree atrioventricular block
D. New-onset Wenckebach second degree heart block
E. Frequent unifocal ventricular ectopic beats
ANSWERS: B.
RATIONALES: New-onset left bundle branch block. In patients with ischemic
chest pain, the EKG is important for determining the need for fibrinolytic
therapy. Myocardial infarction is diagnosed by ST elevation ≥1 mm in two or
more limb leads and ≥2 mm in two or more contiguous precordial leads. In a
patient with an MI, new left bundle branch block suggests occlusion of the left
anterior descending artery, placing a significant portion of the left ventricle in
jeopardy. Thrombolytic therapy could be harmful in patients with ischemia but
not infarction - they will show ST-segment depression only. Frequent unifocal
ventricular ectopy may warrant antiarrhythmic therapy, but not thrombolytic
therapy.
Q6. A 68-year-old female has an average blood pressure of 150/70 mm Hg
despite appropriate lifestyle modification efforts. Her only other medical
problems are osteoporosis and mild depression. The most appropriate
treatment at this time would be (check one)
A. lisinopril (Prinivil, Zestril)
B. clonidine (Catapres)
C. propranolol (Inderal)
D. amlodipine (Norvasc)
E. hydrochlorothiazide
ANSWERS: E.
RATIONALES: hydrochlorothiazide. Randomized, placebo-controlled trials
have shown that isolated systolic hypertension in the elderly responds best
to diuretics and to a lesser extent, β-blockers. Diuretics are preferred,
although long-acting dihydropyridine calcium channel blockers may also be
used. In the case described, β-blockers or clonidine may worsen the
depression. Thiazide diuretics may also improve osteoporosis, and would
be the most cost-effective and useful agent in this instance.
