NRNP 6568: Synthesis in Advanced Nursing Practice of Patients
in Family Care Settings - Final Exam Review | Complete
Questions and Verified Answers with Rationales | Walden
University - 2026/2027 Update.
Question 1. A 52-year-old patient presents for an annual primary care visit
and reports increasing fatigue, polyuria, and polydipsia for several months.
The patient has a BMI of 32 kg/m² and a parent with type 2 diabetes mellitus.
Which initial laboratory evaluation is most appropriate to assess for diabetes?
A. Serum insulin level
B. Hemoglobin A1C
C. C-peptide level
D. Serum cortisol level
Correct Answer: B. Hemoglobin A1C
Rationale: Hemoglobin A1C is an appropriate initial diagnostic test for type 2
diabetes because it reflects average blood glucose levels over approximately
the previous 2–3 months and does not require fasting. The patient's obesity,
polyuria, polydipsia, fatigue, and family history increase the likelihood of
diabetes.
Question 2. A 68-year-old patient with hypertension reports dizziness when
standing after recently starting an antihypertensive medication. Which
assessment finding most strongly supports orthostatic hypotension?
A. Blood pressure decreases by 20 mmHg systolic after standing
B. Heart rate decreases by 10 beats/minute after standing
C. Blood pressure increases by 15 mmHg systolic after standing
D. Oxygen saturation decreases by 2% after standing
Correct Answer: A. Blood pressure decreases by 20 mmHg systolic after
standing
Rationale: Orthostatic hypotension is characterized by a significant fall in
blood pressure after assuming an upright position, commonly defined as a
decrease of at least 20 mmHg systolic or 10 mmHg diastolic. Medication
1
,effects, dehydration, autonomic dysfunction, and older age can increase the
risk.
Question 3. A 34-year-old woman presents with dysuria, urinary frequency,
and urgency for 2 days. She denies fever, flank pain, nausea, or vaginal
symptoms. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Correct Answer: B. Acute uncomplicated cystitis
Rationale: Dysuria, frequency, and urgency without fever, flank pain, or
systemic illness are characteristic of acute uncomplicated cystitis.
Pyelonephritis is more likely when there is fever, flank pain, costovertebral-
angle tenderness, or systemic symptoms.
Question 4. A 45-year-old patient presents with persistent depressive
symptoms, including anhedonia, low energy, sleep disturbance, and difficulty
concentrating for 2 months. Which additional finding would most strongly
support a diagnosis of major depressive disorder?
A. Symptoms occurring only during periods of substance use
B. Symptoms causing clinically significant impairment in functioning
C. Occasional sadness lasting several hours
D. Increased energy and decreased need for sleep
Correct Answer: B. Symptoms causing clinically significant impairment
in functioning
Rationale: Major depressive disorder involves a persistent cluster of
depressive symptoms that causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning. Symptoms
must also meet the required duration and diagnostic criteria and cannot be
better explained by substances or another medical or psychiatric condition.
2
,Question 5. A 59-year-old patient with hypertension and diabetes has an
estimated 10-year cardiovascular risk that is elevated. Which intervention
provides the greatest overall benefit for reducing cardiovascular risk?
A. Treating isolated episodes of mild headache
B. Comprehensive management of blood pressure, lipids, glucose, and lifestyle
factors
C. Screening for food allergies
D. Restricting all dietary carbohydrates
Correct Answer: B. Comprehensive management of blood pressure,
lipids, glucose, and lifestyle factors
Rationale: Cardiovascular risk reduction requires a comprehensive approach
addressing modifiable risk factors. Blood-pressure control, appropriate lipid
management, diabetes control, smoking cessation when applicable, physical
activity, healthy nutrition, and weight management can substantially reduce
long-term cardiovascular morbidity and mortality.
Question 6. A 27-year-old woman presents with a painless breast lump
discovered during self-examination. Which characteristic should raise the
greatest concern for malignancy?
A. A tender, mobile mass that changes with the menstrual cycle
B. A soft mass that has been unchanged for several years
C. A firm, irregular, fixed mass
D. Bilateral breast tenderness before menstruation
Correct Answer: C. A firm, irregular, fixed mass
Rationale: A firm, irregular, poorly mobile or fixed breast mass is concerning
for malignancy and requires appropriate diagnostic evaluation. Cyclic breast
tenderness and mobile masses are more commonly associated with benign
conditions, although clinical assessment is still necessary.
3
, Question 7. A 71-year-old patient reports progressive difficulty swallowing
solid foods but has no difficulty swallowing liquids. Which condition should
the family nurse practitioner consider most strongly?
A. Mechanical esophageal obstruction
B. Neurologic dysphagia
C. Esophageal motility disorder
D. Acute viral pharyngitis
Correct Answer: A. Mechanical esophageal obstruction
Rationale: Dysphagia that initially affects solids more than liquids suggests a
mechanical obstruction because solid foods require a larger esophageal lumen
to pass. Progressive symptoms warrant evaluation for structural lesions,
including malignancy, strictures, or other obstructive processes.
Question 8. A patient with asthma reports using a short-acting beta-agonist
inhaler several times every day. What does this pattern most strongly
suggest?
A. Excellent asthma control
B. Inadequate asthma control
C. Resolution of airway inflammation
D. Medication intolerance only
Correct Answer: B. Inadequate asthma control
Rationale: Frequent reliance on a short-acting bronchodilator suggests that
underlying airway inflammation and asthma are not adequately controlled.
The clinician should reassess adherence, triggers, inhaler technique, severity,
and the need for appropriate controller therapy.
Question 9. A 63-year-old patient presents with fatigue and pallor.
Laboratory testing shows a low hemoglobin level and microcytosis. Which
additional laboratory finding is most consistent with iron-deficiency anemia?
4
in Family Care Settings - Final Exam Review | Complete
Questions and Verified Answers with Rationales | Walden
University - 2026/2027 Update.
Question 1. A 52-year-old patient presents for an annual primary care visit
and reports increasing fatigue, polyuria, and polydipsia for several months.
The patient has a BMI of 32 kg/m² and a parent with type 2 diabetes mellitus.
Which initial laboratory evaluation is most appropriate to assess for diabetes?
A. Serum insulin level
B. Hemoglobin A1C
C. C-peptide level
D. Serum cortisol level
Correct Answer: B. Hemoglobin A1C
Rationale: Hemoglobin A1C is an appropriate initial diagnostic test for type 2
diabetes because it reflects average blood glucose levels over approximately
the previous 2–3 months and does not require fasting. The patient's obesity,
polyuria, polydipsia, fatigue, and family history increase the likelihood of
diabetes.
Question 2. A 68-year-old patient with hypertension reports dizziness when
standing after recently starting an antihypertensive medication. Which
assessment finding most strongly supports orthostatic hypotension?
A. Blood pressure decreases by 20 mmHg systolic after standing
B. Heart rate decreases by 10 beats/minute after standing
C. Blood pressure increases by 15 mmHg systolic after standing
D. Oxygen saturation decreases by 2% after standing
Correct Answer: A. Blood pressure decreases by 20 mmHg systolic after
standing
Rationale: Orthostatic hypotension is characterized by a significant fall in
blood pressure after assuming an upright position, commonly defined as a
decrease of at least 20 mmHg systolic or 10 mmHg diastolic. Medication
1
,effects, dehydration, autonomic dysfunction, and older age can increase the
risk.
Question 3. A 34-year-old woman presents with dysuria, urinary frequency,
and urgency for 2 days. She denies fever, flank pain, nausea, or vaginal
symptoms. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Acute uncomplicated cystitis
C. Nephrolithiasis
D. Pelvic inflammatory disease
Correct Answer: B. Acute uncomplicated cystitis
Rationale: Dysuria, frequency, and urgency without fever, flank pain, or
systemic illness are characteristic of acute uncomplicated cystitis.
Pyelonephritis is more likely when there is fever, flank pain, costovertebral-
angle tenderness, or systemic symptoms.
Question 4. A 45-year-old patient presents with persistent depressive
symptoms, including anhedonia, low energy, sleep disturbance, and difficulty
concentrating for 2 months. Which additional finding would most strongly
support a diagnosis of major depressive disorder?
A. Symptoms occurring only during periods of substance use
B. Symptoms causing clinically significant impairment in functioning
C. Occasional sadness lasting several hours
D. Increased energy and decreased need for sleep
Correct Answer: B. Symptoms causing clinically significant impairment
in functioning
Rationale: Major depressive disorder involves a persistent cluster of
depressive symptoms that causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning. Symptoms
must also meet the required duration and diagnostic criteria and cannot be
better explained by substances or another medical or psychiatric condition.
2
,Question 5. A 59-year-old patient with hypertension and diabetes has an
estimated 10-year cardiovascular risk that is elevated. Which intervention
provides the greatest overall benefit for reducing cardiovascular risk?
A. Treating isolated episodes of mild headache
B. Comprehensive management of blood pressure, lipids, glucose, and lifestyle
factors
C. Screening for food allergies
D. Restricting all dietary carbohydrates
Correct Answer: B. Comprehensive management of blood pressure,
lipids, glucose, and lifestyle factors
Rationale: Cardiovascular risk reduction requires a comprehensive approach
addressing modifiable risk factors. Blood-pressure control, appropriate lipid
management, diabetes control, smoking cessation when applicable, physical
activity, healthy nutrition, and weight management can substantially reduce
long-term cardiovascular morbidity and mortality.
Question 6. A 27-year-old woman presents with a painless breast lump
discovered during self-examination. Which characteristic should raise the
greatest concern for malignancy?
A. A tender, mobile mass that changes with the menstrual cycle
B. A soft mass that has been unchanged for several years
C. A firm, irregular, fixed mass
D. Bilateral breast tenderness before menstruation
Correct Answer: C. A firm, irregular, fixed mass
Rationale: A firm, irregular, poorly mobile or fixed breast mass is concerning
for malignancy and requires appropriate diagnostic evaluation. Cyclic breast
tenderness and mobile masses are more commonly associated with benign
conditions, although clinical assessment is still necessary.
3
, Question 7. A 71-year-old patient reports progressive difficulty swallowing
solid foods but has no difficulty swallowing liquids. Which condition should
the family nurse practitioner consider most strongly?
A. Mechanical esophageal obstruction
B. Neurologic dysphagia
C. Esophageal motility disorder
D. Acute viral pharyngitis
Correct Answer: A. Mechanical esophageal obstruction
Rationale: Dysphagia that initially affects solids more than liquids suggests a
mechanical obstruction because solid foods require a larger esophageal lumen
to pass. Progressive symptoms warrant evaluation for structural lesions,
including malignancy, strictures, or other obstructive processes.
Question 8. A patient with asthma reports using a short-acting beta-agonist
inhaler several times every day. What does this pattern most strongly
suggest?
A. Excellent asthma control
B. Inadequate asthma control
C. Resolution of airway inflammation
D. Medication intolerance only
Correct Answer: B. Inadequate asthma control
Rationale: Frequent reliance on a short-acting bronchodilator suggests that
underlying airway inflammation and asthma are not adequately controlled.
The clinician should reassess adherence, triggers, inhaler technique, severity,
and the need for appropriate controller therapy.
Question 9. A 63-year-old patient presents with fatigue and pallor.
Laboratory testing shows a low hemoglobin level and microcytosis. Which
additional laboratory finding is most consistent with iron-deficiency anemia?
4
