NR511 Midterm Exam Week 4-2026/2027- EDITION -80
QUESTIONS & VERIFIED ANSWERS 100% PASS
INTRODUCTION:
This 80-question practice set evaluates foundational primary care knowledge for FNP
students. It covers health assessment, differential diagnosis, clinical reasoning, SOAP
documentation, and evidence-based management of common conditions across the
lifespan. Emphasis is on distinguishing similar presentations, interpreting
subjective/objective data and diagnostics, selecting first-line pharmacology per
guidelines, identifying red flags, and determining referral. Correct answers in bold Green.
TOPICS COVERED
1. Assessment/ROS/SOAP
2. Clinical reasoning/Differentials
3. HEENT - pharyngitis, sinusitis, otitis, rhinitis, conjunctivitis
4. Respiratory - asthma, COPD, pneumonia, bronchitis
5. CV - HTN, hyperlipidemia, chest pain, HF
6. GI - GERD, H. pylori, appendicitis, cholecystitis, diverticulitis, IBS
7. GU - UTI, pyelo, BPH, stones, STI
8. MSK - OA, RA, gout, back pain
9. Derm - cellulitis, eczema, tinea, acne
10. Endo - DM, thyroid
11. Neuro - headache, vertigo/BPPV
12. Pharm/Guidelines/Red flags
1. A 22-year-old with sore throat, fever, tonsillar exudates, tender anterior cervical
nodes, no cough. Most likely?
A. Strep pharyngitis
B. Viral pharyngitis
C. Mononucleosis
D. GERD
Rationale: Centor 4 criteria - fever, exudates, tender nodes, absence of cough strongly
suggests Group A Strep.
2. First-line treatment for confirmed Group A strep pharyngitis in non-allergic adult?
A. Azithromycin
B. Penicillin V or Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Rationale: Penicillin remains first-line; effective, narrow-spectrum, low resistance.
3. A 35-year-old with recurrent sneezing, clear rhinorrhea, itchy eyes, worse in spring.
Diagnosis?
A. Acute bacterial sinusitis
, B. Vasomotor rhinitis
C. Allergic rhinitis
D. Viral rhinitis
Rationale: Pruritus, seasonal pattern, clear discharge, ocular involvement indicates
allergic rhinitis.
4. Hallmark of acute bacterial sinusitis vs viral URI?
A. Clear discharge for 2 days
B. Sneezing
C. Low-grade fever
D. Symptoms >10 days without improvement or double worsening
Rationale: Bacterial sinusitis defined by persistence >10 days, severe onset, or biphasic
course.
5. Best initial pharmacotherapy for allergic rhinitis?
A. Intranasal corticosteroid e.g., fluticasone
B. Oral decongestant alone
C. Oral antibiotic
D. Systemic corticosteroid
Rationale: Intranasal steroids are most effective for all symptoms of allergic rhinitis.
6. 5-year-old with fever, tugging ear, bulging erythematous tympanic membrane.
Treatment?
A. Antihistamine
B. Amoxicillin high-dose
C. Ciprofloxacin drops
D. Observation only in all cases
Rationale: Acute otitis media in <6yo with bulging TM requires high-dose amoxicillin
first-line.
7. Otitis externa typical pathogen and finding?
A. Strep, bulging TM
B. Pseudomonas, pain on tragal pressure
C. H. influenzae, vesicles
D. Candida, nasal polyps
Rationale: Swimmer's ear caused by Pseudomonas/ Staph aureus; tragal tenderness
and canal edema.
8. Management of otitis externa?
A. Oral amoxicillin
B. Systemic steroids
C. Antihistamine
D. Topical ciprofloxacin/dexamethasone drops + ear wick if needed
Rationale: Topical fluoroquinolone with steroid treats infection and inflammation.
9. Adult with acute conjunctivitis, purulent discharge, no pain, vision normal. Likely?
A. Bacterial conjunctivitis
B. Acute glaucoma
C. Uveitis
D. Keratitis
Rationale: Purulent discharge, normal vision, no pain suggests bacterial conjunctivitis.
QUESTIONS & VERIFIED ANSWERS 100% PASS
INTRODUCTION:
This 80-question practice set evaluates foundational primary care knowledge for FNP
students. It covers health assessment, differential diagnosis, clinical reasoning, SOAP
documentation, and evidence-based management of common conditions across the
lifespan. Emphasis is on distinguishing similar presentations, interpreting
subjective/objective data and diagnostics, selecting first-line pharmacology per
guidelines, identifying red flags, and determining referral. Correct answers in bold Green.
TOPICS COVERED
1. Assessment/ROS/SOAP
2. Clinical reasoning/Differentials
3. HEENT - pharyngitis, sinusitis, otitis, rhinitis, conjunctivitis
4. Respiratory - asthma, COPD, pneumonia, bronchitis
5. CV - HTN, hyperlipidemia, chest pain, HF
6. GI - GERD, H. pylori, appendicitis, cholecystitis, diverticulitis, IBS
7. GU - UTI, pyelo, BPH, stones, STI
8. MSK - OA, RA, gout, back pain
9. Derm - cellulitis, eczema, tinea, acne
10. Endo - DM, thyroid
11. Neuro - headache, vertigo/BPPV
12. Pharm/Guidelines/Red flags
1. A 22-year-old with sore throat, fever, tonsillar exudates, tender anterior cervical
nodes, no cough. Most likely?
A. Strep pharyngitis
B. Viral pharyngitis
C. Mononucleosis
D. GERD
Rationale: Centor 4 criteria - fever, exudates, tender nodes, absence of cough strongly
suggests Group A Strep.
2. First-line treatment for confirmed Group A strep pharyngitis in non-allergic adult?
A. Azithromycin
B. Penicillin V or Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Rationale: Penicillin remains first-line; effective, narrow-spectrum, low resistance.
3. A 35-year-old with recurrent sneezing, clear rhinorrhea, itchy eyes, worse in spring.
Diagnosis?
A. Acute bacterial sinusitis
, B. Vasomotor rhinitis
C. Allergic rhinitis
D. Viral rhinitis
Rationale: Pruritus, seasonal pattern, clear discharge, ocular involvement indicates
allergic rhinitis.
4. Hallmark of acute bacterial sinusitis vs viral URI?
A. Clear discharge for 2 days
B. Sneezing
C. Low-grade fever
D. Symptoms >10 days without improvement or double worsening
Rationale: Bacterial sinusitis defined by persistence >10 days, severe onset, or biphasic
course.
5. Best initial pharmacotherapy for allergic rhinitis?
A. Intranasal corticosteroid e.g., fluticasone
B. Oral decongestant alone
C. Oral antibiotic
D. Systemic corticosteroid
Rationale: Intranasal steroids are most effective for all symptoms of allergic rhinitis.
6. 5-year-old with fever, tugging ear, bulging erythematous tympanic membrane.
Treatment?
A. Antihistamine
B. Amoxicillin high-dose
C. Ciprofloxacin drops
D. Observation only in all cases
Rationale: Acute otitis media in <6yo with bulging TM requires high-dose amoxicillin
first-line.
7. Otitis externa typical pathogen and finding?
A. Strep, bulging TM
B. Pseudomonas, pain on tragal pressure
C. H. influenzae, vesicles
D. Candida, nasal polyps
Rationale: Swimmer's ear caused by Pseudomonas/ Staph aureus; tragal tenderness
and canal edema.
8. Management of otitis externa?
A. Oral amoxicillin
B. Systemic steroids
C. Antihistamine
D. Topical ciprofloxacin/dexamethasone drops + ear wick if needed
Rationale: Topical fluoroquinolone with steroid treats infection and inflammation.
9. Adult with acute conjunctivitis, purulent discharge, no pain, vision normal. Likely?
A. Bacterial conjunctivitis
B. Acute glaucoma
C. Uveitis
D. Keratitis
Rationale: Purulent discharge, normal vision, no pain suggests bacterial conjunctivitis.
