NURS 5432 FAMILY NURSE
PRACTITIONER I - MIDTERM AND
FINAL COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate visits.
He has no significant past medical history. According to the ACC/AHA guidelines, what is the
most appropriate initial management step?
A. Initiate lifestyle modifications only and recheck in 3-6 months.
B. Initiate lifestyle modifications and start two antihypertensive medications of different
classes.
C. Initiate lifestyle modifications and start one antihypertensive medication.
D. Order a 24-hour ambulatory blood pressure monitoring before starting therapy.
Answer: C
Conceptual Explanation: According to ACC/AHA guidelines, Stage 2 hypertension (SBP >=
140 or DBP >= 90) requires lifestyle modifications plus pharmacological therapy. For Stage
2, if the BP is >20/10 mmHg above target, two agents might be considered, but generally,
one agent is the starting point for lower-range Stage 2 without comorbidities.
,2. A 62-year-old female with Type 2 Diabetes Mellitus presents with an eGFR of 28
mL/min/1.73m2. She is currently taking Metformin 1000mg BID. What is the most
appropriate action regarding her Metformin therapy?
A. Continue the current dose but monitor renal function monthly.
B. Discontinue Metformin immediately.
C. Reduce the dose to 500mg BID.
D. Switch to a long-acting Metformin formulation.
Answer: B
Conceptual Explanation: Metformin is contraindicated when the eGFR falls below 30
mL/min/1.73m2 due to the increased risk of lactic acidosis.
3. During a well-child visit, a mother expresses concern that her 18-month-old child is not yet
talking. Which of the following developmental milestones should typically be achieved by 18
months?
A. Speaking in 2-4 word sentences.
B. Using at least 6-10 simple words.
C. Identifying at least five body parts.
D. Naming one color correctly.
Answer: B
, Conceptual Explanation: By 18 months, a child should typically use at least 6 to 10
individual words and be able to follow simple one-step commands.
4. A 30-year-old patient presents with symptoms of hypothyroidism. Laboratory results show
a high TSH and a low Free T4. What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Subclinical hypothyroidism
C. Secondary hypothyroidism
D. Grave’s disease
Answer: A
Conceptual Explanation: High TSH and low Free T4 indicate primary hypothyroidism.
Hashimoto thyroiditis is the most common cause of primary hypothyroidism in iodine-
sufficient regions.
5. A 55-year-old male smoker presents with a chronic cough and dyspnea on exertion.
Spirometry reveals an FEV1/FVC ratio of 0.62. This finding is diagnostic for:
A. Restrictive lung disease
B. Asthma
C. COPD
D. Congestive heart failure
Answer: C
PRACTITIONER I - MIDTERM AND
FINAL COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate visits.
He has no significant past medical history. According to the ACC/AHA guidelines, what is the
most appropriate initial management step?
A. Initiate lifestyle modifications only and recheck in 3-6 months.
B. Initiate lifestyle modifications and start two antihypertensive medications of different
classes.
C. Initiate lifestyle modifications and start one antihypertensive medication.
D. Order a 24-hour ambulatory blood pressure monitoring before starting therapy.
Answer: C
Conceptual Explanation: According to ACC/AHA guidelines, Stage 2 hypertension (SBP >=
140 or DBP >= 90) requires lifestyle modifications plus pharmacological therapy. For Stage
2, if the BP is >20/10 mmHg above target, two agents might be considered, but generally,
one agent is the starting point for lower-range Stage 2 without comorbidities.
,2. A 62-year-old female with Type 2 Diabetes Mellitus presents with an eGFR of 28
mL/min/1.73m2. She is currently taking Metformin 1000mg BID. What is the most
appropriate action regarding her Metformin therapy?
A. Continue the current dose but monitor renal function monthly.
B. Discontinue Metformin immediately.
C. Reduce the dose to 500mg BID.
D. Switch to a long-acting Metformin formulation.
Answer: B
Conceptual Explanation: Metformin is contraindicated when the eGFR falls below 30
mL/min/1.73m2 due to the increased risk of lactic acidosis.
3. During a well-child visit, a mother expresses concern that her 18-month-old child is not yet
talking. Which of the following developmental milestones should typically be achieved by 18
months?
A. Speaking in 2-4 word sentences.
B. Using at least 6-10 simple words.
C. Identifying at least five body parts.
D. Naming one color correctly.
Answer: B
, Conceptual Explanation: By 18 months, a child should typically use at least 6 to 10
individual words and be able to follow simple one-step commands.
4. A 30-year-old patient presents with symptoms of hypothyroidism. Laboratory results show
a high TSH and a low Free T4. What is the most likely diagnosis?
A. Hashimoto thyroiditis
B. Subclinical hypothyroidism
C. Secondary hypothyroidism
D. Grave’s disease
Answer: A
Conceptual Explanation: High TSH and low Free T4 indicate primary hypothyroidism.
Hashimoto thyroiditis is the most common cause of primary hypothyroidism in iodine-
sufficient regions.
5. A 55-year-old male smoker presents with a chronic cough and dyspnea on exertion.
Spirometry reveals an FEV1/FVC ratio of 0.62. This finding is diagnostic for:
A. Restrictive lung disease
B. Asthma
C. COPD
D. Congestive heart failure
Answer: C
