NUR 509 - FNP ADULTS FINAL EXAM | ST. THOMAS
UNIVERSITY EXAM WITH VERIFIED RATIONALES
PRACTICE QUESTIONS AND ANSWERS 2026 WITH
COMPLETE SOLUTION
Core Domains
• Health Promotion and Disease Prevention
• Cardiovascular Disorders
• Respiratory Disorders
• Endocrine and Metabolic Disorders
• Gastrointestinal and Renal Disorders
• Musculoskeletal and Neurologic Disorders
• Integumentary and HEENT Disorders
• Mental Health and Psychosocial Issues
• Pharmacotherapeutics and Prescriptive Authority
• Ethics, Legal, and Professional Practice
Introduction
This comprehensive final examination assesses the family nurse
practitioner's readiness for autonomous adult primary care practice at St.
Thomas University. It evaluates clinical reasoning, diagnostic interpretation,
and evidence-based management across acute and chronic conditions.
The multiple-choice and scenario-based items test real-world application,
patient safety, and adherence to regulatory standards. Emphasis is placed
on differential diagnosis, pharmacologic decision-making, and culturally
competent care. Successful completion demonstrates the advanced
knowledge required for certification and independent practice.
SECTION ONE: QUESTIONS 1–100
, 1. A 62-year-old male presents with a blood pressure of 158/96 mmHg
on two separate visits. He has diabetes mellitus type 2. According to
JNC 8 guidelines, the most appropriate initial antihypertensive
medication is:
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Beta-blocker
D. Calcium channel blocker
B. ACE inhibitor or ARB
RATIONALE: JNC 8 recommends ACE inhibitors or ARBs as first-line
therapy for patients with diabetes and hypertension to provide renal
protection.
2. A 55-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. TSH is elevated at 12 mIU/L, and free
T4 is low. The most appropriate initial treatment is:
A. Levothyroxine 1.6 mcg/kg/day
B. Methimazole 10 mg daily
C. Propranolol 20 mg twice daily
D. Radioactive iodine ablation
A. Levothyroxine 1.6 mcg/kg/day
RATIONALE: Primary hypothyroidism is treated with levothyroxine
replacement at a weight-based dose of approximately 1.6 mcg/kg/day.
3. A 45-year-old male presents with a 3-day history of severe left flank
pain radiating to the groin, nausea, and hematuria. The most
appropriate initial diagnostic test is:
A. Abdominal ultrasound
B. Non-contrast CT scan of the abdomen and pelvis
C. Intravenous pyelogram
D. MRI of the abdomen
, B. Non-contrast CT scan of the abdomen and pelvis
RATIONALE: Non-contrast CT is the gold standard for diagnosing
nephrolithiasis with high sensitivity and specificity.
4. A 68-year-old female presents with sudden onset of severe, tearing
chest pain radiating to the back. Blood pressure is 190/110 mmHg in
the right arm and 150/90 mmHg in the left arm. The most critical
immediate action is:
A. Administer aspirin 325 mg
B. Obtain an ECG
C. Activate emergency transfer for surgical evaluation
D. Administer a beta-blocker
C. Activate emergency transfer for surgical evaluation
RATIONALE: Aortic dissection is a surgical emergency. Immediate
transfer to a facility with cardiothoracic surgery is critical for survival.
5. A 30-year-old female presents with a 2-day history of dysuria, urinary
frequency, and urgency. She is afebrile with no flank pain. The most
appropriate management is:
A. Empiric antibiotics for uncomplicated UTI
B. Urine culture and sensitivity before treatment
C. Renal ultrasound
D. Intravenous antibiotics
A. Empiric antibiotics for uncomplicated UTI
RATIONALE: Uncomplicated lower UTI in a healthy female can be
treated empirically with oral antibiotics without requiring culture first.
6. A 58-year-old male with a 40-pack-year smoking history presents with
a chronic cough and 20-pound weight loss over 3 months. The most
concerning diagnosis is:
A. COPD
B. Lung cancer
, C. Tuberculosis
D. Chronic bronchitis
B. Lung cancer
RATIONALE: Chronic cough with significant unintentional weight loss in
a heavy smoker is highly suspicious for lung cancer and warrants urgent
evaluation.
7. A 42-year-old female presents with a malar rash, photosensitivity, oral
ulcers, and polyarthralgias. The most likely diagnosis is:
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Psoriatic arthritis
B. Systemic lupus erythematosus
RATIONALE: Malar rash, photosensitivity, oral ulcers, and arthralgias
are classic clinical criteria for SLE.
8. A 70-year-old male presents with a painless, pulsatile abdominal
mass palpated slightly left of midline. The most appropriate initial
diagnostic test is:
A. Abdominal ultrasound
B. CT scan of the abdomen
C. MRI of the abdomen
D. Abdominal X-ray
A. Abdominal ultrasound
RATIONALE: Abdominal ultrasound is the initial screening test of choice
for suspected abdominal aortic aneurysm due to its non-invasive nature
and high sensitivity.
9. A 50-year-old female presents with a 3-month history of heartburn,
regurgitation, and a chronic cough. Lifestyle modifications have failed.
The most appropriate pharmacologic management is:
UNIVERSITY EXAM WITH VERIFIED RATIONALES
PRACTICE QUESTIONS AND ANSWERS 2026 WITH
COMPLETE SOLUTION
Core Domains
• Health Promotion and Disease Prevention
• Cardiovascular Disorders
• Respiratory Disorders
• Endocrine and Metabolic Disorders
• Gastrointestinal and Renal Disorders
• Musculoskeletal and Neurologic Disorders
• Integumentary and HEENT Disorders
• Mental Health and Psychosocial Issues
• Pharmacotherapeutics and Prescriptive Authority
• Ethics, Legal, and Professional Practice
Introduction
This comprehensive final examination assesses the family nurse
practitioner's readiness for autonomous adult primary care practice at St.
Thomas University. It evaluates clinical reasoning, diagnostic interpretation,
and evidence-based management across acute and chronic conditions.
The multiple-choice and scenario-based items test real-world application,
patient safety, and adherence to regulatory standards. Emphasis is placed
on differential diagnosis, pharmacologic decision-making, and culturally
competent care. Successful completion demonstrates the advanced
knowledge required for certification and independent practice.
SECTION ONE: QUESTIONS 1–100
, 1. A 62-year-old male presents with a blood pressure of 158/96 mmHg
on two separate visits. He has diabetes mellitus type 2. According to
JNC 8 guidelines, the most appropriate initial antihypertensive
medication is:
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Beta-blocker
D. Calcium channel blocker
B. ACE inhibitor or ARB
RATIONALE: JNC 8 recommends ACE inhibitors or ARBs as first-line
therapy for patients with diabetes and hypertension to provide renal
protection.
2. A 55-year-old female presents with fatigue, weight gain, cold
intolerance, and constipation. TSH is elevated at 12 mIU/L, and free
T4 is low. The most appropriate initial treatment is:
A. Levothyroxine 1.6 mcg/kg/day
B. Methimazole 10 mg daily
C. Propranolol 20 mg twice daily
D. Radioactive iodine ablation
A. Levothyroxine 1.6 mcg/kg/day
RATIONALE: Primary hypothyroidism is treated with levothyroxine
replacement at a weight-based dose of approximately 1.6 mcg/kg/day.
3. A 45-year-old male presents with a 3-day history of severe left flank
pain radiating to the groin, nausea, and hematuria. The most
appropriate initial diagnostic test is:
A. Abdominal ultrasound
B. Non-contrast CT scan of the abdomen and pelvis
C. Intravenous pyelogram
D. MRI of the abdomen
, B. Non-contrast CT scan of the abdomen and pelvis
RATIONALE: Non-contrast CT is the gold standard for diagnosing
nephrolithiasis with high sensitivity and specificity.
4. A 68-year-old female presents with sudden onset of severe, tearing
chest pain radiating to the back. Blood pressure is 190/110 mmHg in
the right arm and 150/90 mmHg in the left arm. The most critical
immediate action is:
A. Administer aspirin 325 mg
B. Obtain an ECG
C. Activate emergency transfer for surgical evaluation
D. Administer a beta-blocker
C. Activate emergency transfer for surgical evaluation
RATIONALE: Aortic dissection is a surgical emergency. Immediate
transfer to a facility with cardiothoracic surgery is critical for survival.
5. A 30-year-old female presents with a 2-day history of dysuria, urinary
frequency, and urgency. She is afebrile with no flank pain. The most
appropriate management is:
A. Empiric antibiotics for uncomplicated UTI
B. Urine culture and sensitivity before treatment
C. Renal ultrasound
D. Intravenous antibiotics
A. Empiric antibiotics for uncomplicated UTI
RATIONALE: Uncomplicated lower UTI in a healthy female can be
treated empirically with oral antibiotics without requiring culture first.
6. A 58-year-old male with a 40-pack-year smoking history presents with
a chronic cough and 20-pound weight loss over 3 months. The most
concerning diagnosis is:
A. COPD
B. Lung cancer
, C. Tuberculosis
D. Chronic bronchitis
B. Lung cancer
RATIONALE: Chronic cough with significant unintentional weight loss in
a heavy smoker is highly suspicious for lung cancer and warrants urgent
evaluation.
7. A 42-year-old female presents with a malar rash, photosensitivity, oral
ulcers, and polyarthralgias. The most likely diagnosis is:
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Psoriatic arthritis
B. Systemic lupus erythematosus
RATIONALE: Malar rash, photosensitivity, oral ulcers, and arthralgias
are classic clinical criteria for SLE.
8. A 70-year-old male presents with a painless, pulsatile abdominal
mass palpated slightly left of midline. The most appropriate initial
diagnostic test is:
A. Abdominal ultrasound
B. CT scan of the abdomen
C. MRI of the abdomen
D. Abdominal X-ray
A. Abdominal ultrasound
RATIONALE: Abdominal ultrasound is the initial screening test of choice
for suspected abdominal aortic aneurysm due to its non-invasive nature
and high sensitivity.
9. A 50-year-old female presents with a 3-month history of heartburn,
regurgitation, and a chronic cough. Lifestyle modifications have failed.
The most appropriate pharmacologic management is:
