FNP BARKLEY POST-TEST FALL 2026/2027 COMPREHENSIVE
FINAL EXAM PRACTICE QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED RATIONALES
Q1. A 58-year-old postmenopausal woman presents for a routine
health maintenance visit. She has no significant past medical history
and takes no medications. Her FRAX score indicates a 10-year
probability of a major osteoporotic fracture of 22%. According to
standard guidelines, what is the most appropriate next step in
management?
A) Initiate calcium and vitamin D supplementation only
B) Initiate bisphosphonate therapy
C) Reassure the patient and repeat FRAX in 2 years
D) Order a DEXA scan to confirm the diagnosis
Correct Answer: B) Initiate bisphosphonate therapy
Rationale: A FRAX 10-year probability of a major osteoporotic fracture
of 20% or greater (or hip fracture probability of 3% or greater) warrants
initiation of pharmacological therapy in postmenopausal women
without prior fracture. While calcium and vitamin D are important, they
are not sufficient as monotherapy for this high-risk patient.
Q2. A 45-year-old man with a history of type 2 diabetes mellitus
presents with a 3-day history of a painful, swollen great toe. He denies
trauma. Examination reveals erythema, warmth, and exquisite
tenderness at the first metatarsophalangeal joint. His serum uric acid
level is 8.5 mg/dL. What is the most appropriate initial treatment for
,this acute attack?
A) Allopurinol 300 mg daily
B) Colchicine 0.6 mg twice daily
C) Indomethacin 50 mg three times daily
D) Probenecid 500 mg twice daily
Correct Answer: C) Indomethacin 50 mg three times daily
Rationale: The patient is presenting with acute gouty arthritis. First-line
treatment for an acute flare includes nonsteroidal anti-inflammatory
drugs (NSAIDs), colchicine, or corticosteroids. Indomethacin is a classic
NSAID used for this purpose. Allopurinol and probenecid are used for
chronic urate-lowering therapy and should not be initiated during an
acute flare due to the risk of exacerbation.
Q3. A 6-year-old child is brought to the clinic by his mother due to a 2-
day history of fever, irritability, and pulling at his right ear. Otoscopic
examination reveals a bulging, erythematous tympanic membrane
with decreased mobility. The child has no allergies and is up to date
on vaccinations. What is the most appropriate first-line antibiotic
therapy?
A) Amoxicillin
B) Azithromycin
C) Cefdinir
D) Trimethoprim-sulfamethoxazole
Correct Answer: A) Amoxicillin
Rationale: Acute otitis media (AOM) is the most common diagnosis for
which antibiotics are prescribed in children. Amoxicillin remains the
first-line agent for uncomplicated AOM in children without a history of
penicillin allergy or recent antibiotic use, due to its efficacy against
Streptococcus pneumoniae and Haemophilus influenzae.
,Q4. A 32-year-old woman presents with a 3-month history of
persistent sadness, anhedonia, insomnia, and a 10-pound weight loss.
She denies suicidal ideation. She has no significant medical history.
What is the most appropriate first-line pharmacologic treatment?
A) Alprazolam
B) Sertraline
C) Lithium
D) Haloperidol
Correct Answer: B) Sertraline
Rationale: The patient's symptoms are consistent with major depressive
disorder (MDD). Selective serotonin reuptake inhibitors (SSRIs) such as
sertraline are considered first-line pharmacotherapy for MDD due to
their favorable side effect profile and safety in overdose compared to
tricyclic antidepressants or monoamine oxidase inhibitors.
Benzodiazepines like alprazolam are not indicated for MDD
monotherapy.
Q5. A 24-year-old man presents with a 2-day history of severe, sharp,
left-sided chest pain that worsens with deep inspiration and is
relieved by leaning forward. He reports a recent upper respiratory
infection. Vital signs are stable. ECG shows diffuse ST-segment
elevation. What is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pneumothorax
D) Pulmonary embolism
Correct Answer: B) Pericarditis
Rationale: The patient's presentation of pleuritic chest pain that
improves with leaning forward, combined with a recent viral illness and
, diffuse ST-segment elevation on ECG, is classic for acute pericarditis.
Myocardial infarction typically presents with localized ST elevation or
depression and reciprocal changes, and is less likely in a 24-year-old
without risk factors.
Q6. A 70-year-old man with a history of hypertension and benign
prostatic hyperplasia presents for a routine follow-up. He is currently
taking lisinopril and tamsulosin. He reports new-onset dizziness upon
standing. His blood pressure is 110/65 mmHg. What is the most
appropriate initial intervention?
A) Discontinue lisinopril
B) Increase tamsulosin dose
C) Add a diuretic
D) Reassure the patient and monitor
Correct Answer: A) Discontinue lisinopril
Rationale: The patient is experiencing orthostatic hypotension, likely
due to the combined effects of an ACE inhibitor (lisinopril) and an
alpha-blocker (tamsulosin). The most appropriate initial step is to
discontinue or reduce the offending agent, starting with the
antihypertensive that is most likely contributing to the hypotension, and
reassess.
Q7. A 28-year-old woman presents with a 3-day history of dysuria,
urinary frequency, and urgency. She denies fever, flank pain, or vaginal
discharge. Urinalysis is positive for leukocyte esterase and nitrites.
What is the most appropriate treatment?
A) Nitrofurantoin monohydrate/macrocrystals
B) Ciprofloxacin
C) Azithromycin
D) Metronidazole
FINAL EXAM PRACTICE QUESTIONS WITH VERIFIED ANSWERS
AND DETAILED RATIONALES
Q1. A 58-year-old postmenopausal woman presents for a routine
health maintenance visit. She has no significant past medical history
and takes no medications. Her FRAX score indicates a 10-year
probability of a major osteoporotic fracture of 22%. According to
standard guidelines, what is the most appropriate next step in
management?
A) Initiate calcium and vitamin D supplementation only
B) Initiate bisphosphonate therapy
C) Reassure the patient and repeat FRAX in 2 years
D) Order a DEXA scan to confirm the diagnosis
Correct Answer: B) Initiate bisphosphonate therapy
Rationale: A FRAX 10-year probability of a major osteoporotic fracture
of 20% or greater (or hip fracture probability of 3% or greater) warrants
initiation of pharmacological therapy in postmenopausal women
without prior fracture. While calcium and vitamin D are important, they
are not sufficient as monotherapy for this high-risk patient.
Q2. A 45-year-old man with a history of type 2 diabetes mellitus
presents with a 3-day history of a painful, swollen great toe. He denies
trauma. Examination reveals erythema, warmth, and exquisite
tenderness at the first metatarsophalangeal joint. His serum uric acid
level is 8.5 mg/dL. What is the most appropriate initial treatment for
,this acute attack?
A) Allopurinol 300 mg daily
B) Colchicine 0.6 mg twice daily
C) Indomethacin 50 mg three times daily
D) Probenecid 500 mg twice daily
Correct Answer: C) Indomethacin 50 mg three times daily
Rationale: The patient is presenting with acute gouty arthritis. First-line
treatment for an acute flare includes nonsteroidal anti-inflammatory
drugs (NSAIDs), colchicine, or corticosteroids. Indomethacin is a classic
NSAID used for this purpose. Allopurinol and probenecid are used for
chronic urate-lowering therapy and should not be initiated during an
acute flare due to the risk of exacerbation.
Q3. A 6-year-old child is brought to the clinic by his mother due to a 2-
day history of fever, irritability, and pulling at his right ear. Otoscopic
examination reveals a bulging, erythematous tympanic membrane
with decreased mobility. The child has no allergies and is up to date
on vaccinations. What is the most appropriate first-line antibiotic
therapy?
A) Amoxicillin
B) Azithromycin
C) Cefdinir
D) Trimethoprim-sulfamethoxazole
Correct Answer: A) Amoxicillin
Rationale: Acute otitis media (AOM) is the most common diagnosis for
which antibiotics are prescribed in children. Amoxicillin remains the
first-line agent for uncomplicated AOM in children without a history of
penicillin allergy or recent antibiotic use, due to its efficacy against
Streptococcus pneumoniae and Haemophilus influenzae.
,Q4. A 32-year-old woman presents with a 3-month history of
persistent sadness, anhedonia, insomnia, and a 10-pound weight loss.
She denies suicidal ideation. She has no significant medical history.
What is the most appropriate first-line pharmacologic treatment?
A) Alprazolam
B) Sertraline
C) Lithium
D) Haloperidol
Correct Answer: B) Sertraline
Rationale: The patient's symptoms are consistent with major depressive
disorder (MDD). Selective serotonin reuptake inhibitors (SSRIs) such as
sertraline are considered first-line pharmacotherapy for MDD due to
their favorable side effect profile and safety in overdose compared to
tricyclic antidepressants or monoamine oxidase inhibitors.
Benzodiazepines like alprazolam are not indicated for MDD
monotherapy.
Q5. A 24-year-old man presents with a 2-day history of severe, sharp,
left-sided chest pain that worsens with deep inspiration and is
relieved by leaning forward. He reports a recent upper respiratory
infection. Vital signs are stable. ECG shows diffuse ST-segment
elevation. What is the most likely diagnosis?
A) Myocardial infarction
B) Pericarditis
C) Pneumothorax
D) Pulmonary embolism
Correct Answer: B) Pericarditis
Rationale: The patient's presentation of pleuritic chest pain that
improves with leaning forward, combined with a recent viral illness and
, diffuse ST-segment elevation on ECG, is classic for acute pericarditis.
Myocardial infarction typically presents with localized ST elevation or
depression and reciprocal changes, and is less likely in a 24-year-old
without risk factors.
Q6. A 70-year-old man with a history of hypertension and benign
prostatic hyperplasia presents for a routine follow-up. He is currently
taking lisinopril and tamsulosin. He reports new-onset dizziness upon
standing. His blood pressure is 110/65 mmHg. What is the most
appropriate initial intervention?
A) Discontinue lisinopril
B) Increase tamsulosin dose
C) Add a diuretic
D) Reassure the patient and monitor
Correct Answer: A) Discontinue lisinopril
Rationale: The patient is experiencing orthostatic hypotension, likely
due to the combined effects of an ACE inhibitor (lisinopril) and an
alpha-blocker (tamsulosin). The most appropriate initial step is to
discontinue or reduce the offending agent, starting with the
antihypertensive that is most likely contributing to the hypotension, and
reassess.
Q7. A 28-year-old woman presents with a 3-day history of dysuria,
urinary frequency, and urgency. She denies fever, flank pain, or vaginal
discharge. Urinalysis is positive for leukocyte esterase and nitrites.
What is the most appropriate treatment?
A) Nitrofurantoin monohydrate/macrocrystals
B) Ciprofloxacin
C) Azithromycin
D) Metronidazole
