FNP 654 Family Primary Care I Final Exam verified with correct answers
2026/2027 version /A+ Graded
1. A 52-year-old patient presents for a routine primary-care visit. Which intervention is an
example of primary prevention?
A. Mammography to detect breast cancer
B. Smoking cessation counseling
C. Physical therapy after a stroke
D. Rehabilitation after myocardial infarction
Correct answer: B. Smoking cessation counseling
Rationale: Primary prevention prevents disease before it occurs. Screening is secondary
prevention, while rehabilitation is tertiary prevention.
2. Which component of the patient history is most important when evaluating a new
symptom?
A. The patient's favorite foods
B. The onset, location, duration, and characteristics of the symptom
C. The patient's preferred pharmacy only
D. The patient's childhood hobbies
Correct answer: B. The onset, location, duration, and characteristics of the symptom
Rationale: A systematic symptom history helps establish a differential diagnosis.
3. A patient reports chest pain that occurs with exertion and resolves with rest. This is most
consistent with:
A. Stable angina
B. Pleurisy
C. Pericarditis
D. Gastroenteritis
Correct answer: A. Stable angina
Rationale: Stable angina is predictable chest discomfort caused by myocardial ischemia during
exertion and relieved by rest.
4. Which finding is most concerning for acute coronary syndrome?
A. Chest pain reproducible with palpation
B. Substernal pressure radiating to the left arm with diaphoresis
C. Brief pain lasting 2 seconds
D. Pain only after eating spicy foods
Correct answer: B. Substernal pressure radiating to the left arm with diaphoresis
Rationale: This presentation is highly concerning for myocardial ischemia and requires urgent
evaluation.
,5. A patient with hypertension has a blood pressure of 182/116 mm Hg and reports severe
headache and blurred vision. What is the priority?
A. Recheck the blood pressure in 6 months
B. Evaluate for acute end-organ damage
C. Recommend increased dietary sodium
D. Stop all antihypertensive medications
Correct answer: B. Evaluate for acute end-organ damage
Rationale: Severe hypertension with neurological or other symptoms may represent a
hypertensive emergency.
6. Which lifestyle intervention is most effective for reducing cardiovascular risk?
A. Smoking cessation
B. Increasing processed food intake
C. Avoiding all physical activity
D. Increasing trans-fat consumption
Correct answer: A. Smoking cessation
Rationale: Smoking cessation significantly reduces cardiovascular and overall mortality risk.
7. A patient with diabetes has a hemoglobin A1c of 9.2%. This indicates:
A. Excellent glycemic control
B. Poor glycemic control
C. Hypoglycemia
D. Normal glucose regulation
Correct answer: B. Poor glycemic control
Rationale: An elevated A1c reflects chronic hyperglycemia over approximately the preceding
2–3 months.
8. Which symptom is most suggestive of hypoglycemia?
A. Diaphoresis and tremors
B. Polyuria and polydipsia
C. Kussmaul respirations
D. Fruity breath
Correct answer: A. Diaphoresis and tremors
Rationale: Adrenergic symptoms of hypoglycemia include sweating, tremors, palpitations, and
anxiety.
9. A patient with type 2 diabetes reports polyuria, polydipsia, and fatigue. The NP should
first evaluate:
A. Blood glucose level
B. Hearing acuity
C. Visual fields only
D. Serum calcium only
, Correct answer: A. Blood glucose level
Rationale: These are classic symptoms of hyperglycemia.
10. Which finding is most consistent with hypothyroidism?
A. Weight loss and heat intolerance
B. Tremor and tachycardia
C. Fatigue, cold intolerance, and constipation
D. Exophthalmos
Correct answer: C. Fatigue, cold intolerance, and constipation
Rationale: Hypothyroidism causes decreased metabolic activity.
11. Which laboratory pattern is most consistent with primary hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. Low TSH and low free T4
D. Normal TSH and high free T4
Correct answer: B. High TSH and low free T4
Rationale: In primary thyroid failure, the pituitary increases TSH in response to low thyroid
hormone levels.
12. A patient with hyperthyroidism is most likely to report:
A. Weight gain and cold intolerance
B. Fatigue and constipation
C. Heat intolerance, anxiety, and palpitations
D. Bradycardia and dry skin
Correct answer: C. Heat intolerance, anxiety, and palpitations
Rationale: Excess thyroid hormone increases metabolic and sympathetic activity.
13. Which symptom is a red flag for lung cancer?
A. Persistent cough with hemoptysis
B. Occasional sneezing
C. Mild seasonal rhinorrhea
D. Brief hiccups
Correct answer: A. Persistent cough with hemoptysis
Rationale: Persistent cough and hemoptysis require evaluation for serious pulmonary disease,
including malignancy.
14. A patient with COPD presents with increased dyspnea, sputum volume, and sputum
purulence. This suggests:
A. COPD exacerbation
B. Stable disease
2026/2027 version /A+ Graded
1. A 52-year-old patient presents for a routine primary-care visit. Which intervention is an
example of primary prevention?
A. Mammography to detect breast cancer
B. Smoking cessation counseling
C. Physical therapy after a stroke
D. Rehabilitation after myocardial infarction
Correct answer: B. Smoking cessation counseling
Rationale: Primary prevention prevents disease before it occurs. Screening is secondary
prevention, while rehabilitation is tertiary prevention.
2. Which component of the patient history is most important when evaluating a new
symptom?
A. The patient's favorite foods
B. The onset, location, duration, and characteristics of the symptom
C. The patient's preferred pharmacy only
D. The patient's childhood hobbies
Correct answer: B. The onset, location, duration, and characteristics of the symptom
Rationale: A systematic symptom history helps establish a differential diagnosis.
3. A patient reports chest pain that occurs with exertion and resolves with rest. This is most
consistent with:
A. Stable angina
B. Pleurisy
C. Pericarditis
D. Gastroenteritis
Correct answer: A. Stable angina
Rationale: Stable angina is predictable chest discomfort caused by myocardial ischemia during
exertion and relieved by rest.
4. Which finding is most concerning for acute coronary syndrome?
A. Chest pain reproducible with palpation
B. Substernal pressure radiating to the left arm with diaphoresis
C. Brief pain lasting 2 seconds
D. Pain only after eating spicy foods
Correct answer: B. Substernal pressure radiating to the left arm with diaphoresis
Rationale: This presentation is highly concerning for myocardial ischemia and requires urgent
evaluation.
,5. A patient with hypertension has a blood pressure of 182/116 mm Hg and reports severe
headache and blurred vision. What is the priority?
A. Recheck the blood pressure in 6 months
B. Evaluate for acute end-organ damage
C. Recommend increased dietary sodium
D. Stop all antihypertensive medications
Correct answer: B. Evaluate for acute end-organ damage
Rationale: Severe hypertension with neurological or other symptoms may represent a
hypertensive emergency.
6. Which lifestyle intervention is most effective for reducing cardiovascular risk?
A. Smoking cessation
B. Increasing processed food intake
C. Avoiding all physical activity
D. Increasing trans-fat consumption
Correct answer: A. Smoking cessation
Rationale: Smoking cessation significantly reduces cardiovascular and overall mortality risk.
7. A patient with diabetes has a hemoglobin A1c of 9.2%. This indicates:
A. Excellent glycemic control
B. Poor glycemic control
C. Hypoglycemia
D. Normal glucose regulation
Correct answer: B. Poor glycemic control
Rationale: An elevated A1c reflects chronic hyperglycemia over approximately the preceding
2–3 months.
8. Which symptom is most suggestive of hypoglycemia?
A. Diaphoresis and tremors
B. Polyuria and polydipsia
C. Kussmaul respirations
D. Fruity breath
Correct answer: A. Diaphoresis and tremors
Rationale: Adrenergic symptoms of hypoglycemia include sweating, tremors, palpitations, and
anxiety.
9. A patient with type 2 diabetes reports polyuria, polydipsia, and fatigue. The NP should
first evaluate:
A. Blood glucose level
B. Hearing acuity
C. Visual fields only
D. Serum calcium only
, Correct answer: A. Blood glucose level
Rationale: These are classic symptoms of hyperglycemia.
10. Which finding is most consistent with hypothyroidism?
A. Weight loss and heat intolerance
B. Tremor and tachycardia
C. Fatigue, cold intolerance, and constipation
D. Exophthalmos
Correct answer: C. Fatigue, cold intolerance, and constipation
Rationale: Hypothyroidism causes decreased metabolic activity.
11. Which laboratory pattern is most consistent with primary hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. Low TSH and low free T4
D. Normal TSH and high free T4
Correct answer: B. High TSH and low free T4
Rationale: In primary thyroid failure, the pituitary increases TSH in response to low thyroid
hormone levels.
12. A patient with hyperthyroidism is most likely to report:
A. Weight gain and cold intolerance
B. Fatigue and constipation
C. Heat intolerance, anxiety, and palpitations
D. Bradycardia and dry skin
Correct answer: C. Heat intolerance, anxiety, and palpitations
Rationale: Excess thyroid hormone increases metabolic and sympathetic activity.
13. Which symptom is a red flag for lung cancer?
A. Persistent cough with hemoptysis
B. Occasional sneezing
C. Mild seasonal rhinorrhea
D. Brief hiccups
Correct answer: A. Persistent cough with hemoptysis
Rationale: Persistent cough and hemoptysis require evaluation for serious pulmonary disease,
including malignancy.
14. A patient with COPD presents with increased dyspnea, sputum volume, and sputum
purulence. This suggests:
A. COPD exacerbation
B. Stable disease
