FNP 654 – Family Nurse Practitioner Midterm 2026/2027 version with rationales
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1. A 56-year-old patient with hypertension presents for a routine follow-up. The
blood pressure is 148/92 mm Hg despite adherence to lifestyle modifications.
What is the most appropriate next step?
A. Continue lifestyle modifications only and recheck in one year.
B. Initiate or adjust antihypertensive medication while reinforcing lifestyle interventions.
C. Discontinue lifestyle modifications.
D. Repeat the blood pressure measurement in six months without further evaluation.
Correct Answer: B. Initiate or adjust antihypertensive medication while reinforcing lifestyle
interventions.
Rationale: Persistent hypertension despite lifestyle changes typically warrants pharmacologic
therapy in accordance with current hypertension guidelines, while continuing nonpharmacologic
interventions.
2. Which laboratory test is most useful for monitoring long-term glycemic
control in a patient with type 2 diabetes mellitus?
A. Random blood glucose
B. Hemoglobin A1C
C. Urine glucose
D. Serum insulin level
Correct Answer: B. Hemoglobin A1C.
Rationale: Hemoglobin A1C reflects average blood glucose over approximately the previous 2–
3 months and is commonly used to monitor diabetes management.
3. A patient presents with fever, productive cough, and crackles in the right
lower lung field. Which diagnosis is most likely?
A. Allergic rhinitis
,B. Community-acquired pneumonia
C. Gastroesophageal reflux disease
D. Migraine headache
Correct Answer: B. Community-acquired pneumonia.
Rationale: Fever, productive cough, focal crackles, and localized pulmonary findings are
characteristic of pneumonia.
4. Which finding is most consistent with iron deficiency anemia?
A. Elevated hemoglobin
B. Microcytic, hypochromic red blood cells
C. Increased mean corpuscular volume (MCV)
D. Elevated vitamin B12 level
Correct Answer: B. Microcytic, hypochromic red blood cells.
Rationale: Iron deficiency anemia commonly presents with microcytic, hypochromic
erythrocytes due to impaired hemoglobin synthesis.
5. A patient reports burning substernal chest discomfort that worsens after meals
and when lying down. Which diagnosis is most likely?
A. Peptic ulcer disease
B. Gastroesophageal reflux disease (GERD)
C. Cholecystitis
D. Acute appendicitis
Correct Answer: B. Gastroesophageal reflux disease (GERD).
Rationale: GERD commonly causes heartburn that worsens after meals and when supine.
6. Which lifestyle recommendation is most effective for reducing cardiovascular
disease risk?
A. Smoking cessation
, B. Increasing sodium intake
C. Eliminating all carbohydrates
D. Avoiding physical activity
Correct Answer: A. Smoking cessation.
Rationale: Smoking cessation is one of the most effective interventions for reducing
cardiovascular morbidity and mortality.
7. Which thyroid laboratory pattern is most consistent with primary
hypothyroidism?
A. Low TSH and elevated free T4
B. Elevated TSH and low free T4
C. Normal TSH and elevated T3 only
D. Suppressed TSH and elevated free T4
Correct Answer: B. Elevated TSH and low free T4.
Rationale: In primary hypothyroidism, decreased thyroid hormone production leads to
compensatory elevation of TSH.
8. A patient presents with dysuria, urinary frequency, and urgency without flank
pain or fever. Which diagnosis is most likely?
A. Acute cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Correct Answer: A. Acute cystitis.
Rationale: Lower urinary tract symptoms without systemic illness are characteristic of
uncomplicated cystitis.
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1. A 56-year-old patient with hypertension presents for a routine follow-up. The
blood pressure is 148/92 mm Hg despite adherence to lifestyle modifications.
What is the most appropriate next step?
A. Continue lifestyle modifications only and recheck in one year.
B. Initiate or adjust antihypertensive medication while reinforcing lifestyle interventions.
C. Discontinue lifestyle modifications.
D. Repeat the blood pressure measurement in six months without further evaluation.
Correct Answer: B. Initiate or adjust antihypertensive medication while reinforcing lifestyle
interventions.
Rationale: Persistent hypertension despite lifestyle changes typically warrants pharmacologic
therapy in accordance with current hypertension guidelines, while continuing nonpharmacologic
interventions.
2. Which laboratory test is most useful for monitoring long-term glycemic
control in a patient with type 2 diabetes mellitus?
A. Random blood glucose
B. Hemoglobin A1C
C. Urine glucose
D. Serum insulin level
Correct Answer: B. Hemoglobin A1C.
Rationale: Hemoglobin A1C reflects average blood glucose over approximately the previous 2–
3 months and is commonly used to monitor diabetes management.
3. A patient presents with fever, productive cough, and crackles in the right
lower lung field. Which diagnosis is most likely?
A. Allergic rhinitis
,B. Community-acquired pneumonia
C. Gastroesophageal reflux disease
D. Migraine headache
Correct Answer: B. Community-acquired pneumonia.
Rationale: Fever, productive cough, focal crackles, and localized pulmonary findings are
characteristic of pneumonia.
4. Which finding is most consistent with iron deficiency anemia?
A. Elevated hemoglobin
B. Microcytic, hypochromic red blood cells
C. Increased mean corpuscular volume (MCV)
D. Elevated vitamin B12 level
Correct Answer: B. Microcytic, hypochromic red blood cells.
Rationale: Iron deficiency anemia commonly presents with microcytic, hypochromic
erythrocytes due to impaired hemoglobin synthesis.
5. A patient reports burning substernal chest discomfort that worsens after meals
and when lying down. Which diagnosis is most likely?
A. Peptic ulcer disease
B. Gastroesophageal reflux disease (GERD)
C. Cholecystitis
D. Acute appendicitis
Correct Answer: B. Gastroesophageal reflux disease (GERD).
Rationale: GERD commonly causes heartburn that worsens after meals and when supine.
6. Which lifestyle recommendation is most effective for reducing cardiovascular
disease risk?
A. Smoking cessation
, B. Increasing sodium intake
C. Eliminating all carbohydrates
D. Avoiding physical activity
Correct Answer: A. Smoking cessation.
Rationale: Smoking cessation is one of the most effective interventions for reducing
cardiovascular morbidity and mortality.
7. Which thyroid laboratory pattern is most consistent with primary
hypothyroidism?
A. Low TSH and elevated free T4
B. Elevated TSH and low free T4
C. Normal TSH and elevated T3 only
D. Suppressed TSH and elevated free T4
Correct Answer: B. Elevated TSH and low free T4.
Rationale: In primary hypothyroidism, decreased thyroid hormone production leads to
compensatory elevation of TSH.
8. A patient presents with dysuria, urinary frequency, and urgency without flank
pain or fever. Which diagnosis is most likely?
A. Acute cystitis
B. Pyelonephritis
C. Nephrolithiasis
D. Glomerulonephritis
Correct Answer: A. Acute cystitis.
Rationale: Lower urinary tract symptoms without systemic illness are characteristic of
uncomplicated cystitis.
