FNP 652 FINAL EXAM VERSION 3 – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS |
PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Advanced Pathophysiology
Advanced Pharmacology
Advanced Health Assessment
Clinical Management of Acute & Chronic Illnesses
Evidence-Based Practice & Research
Professional Role Development, Ethics, & Legal Issues
Population Health, Epidemiology, & Health Promotion
Healthcare Policy, Finance, & Quality Improvement
Introduction:
This comprehensive examination is designed to rigorously assess the knowledge, clinical reasoning, and decision-
making skills essential for the Family Nurse Practitioner (FNP) in a primary care setting. It evaluates mastery of
foundational theory, applied clinical knowledge, and the ability to synthesize complex information across the lifespan.
The assessment incorporates regulatory, ethical, and professional standards within realistic scenarios, emphasizing
evidence-based practice, health promotion, and the management of acute and chronic conditions. Candidates must
demonstrate critical thinking to interpret clinical data, formulate differential diagnoses, and develop effective, patient-
centered management plans. This exam is structured with multiple-choice questions to provide a robust evaluation of
the candidate's readiness for independent, advanced nursing practice.
SECTION ONE: QUESTIONS 1-100
,1. A 72-year-old male with a 40-pack-year smoking history presents with a new onset of hoarseness that has
persisted for 4 weeks. He denies any cold or flu symptoms. What is the most appropriate initial diagnostic step?
A. A course of oral antibiotics for suspected laryngitis
B. Direct laryngoscopy and biopsy
C. An empirical trial of a proton pump inhibitor for GERD
D. A chest X-ray
🟢 B. Direct laryngoscopy and biopsy
🔴 Explanation: In an older patient with a significant smoking history, persistent hoarseness (>3 weeks) warrants
direct visualization of the larynx to rule out malignancy. A chest X-ray would be indicated to evaluate for lung
metastases but is not the initial diagnostic step for the laryngeal lesion itself. An empirical trial of PPI would be
inappropriate without diagnosis, and antibiotics are ineffective for viral laryngitis or malignancy.
2. A 45-year-old female with a history of mitral valve prolapse is undergoing a dental procedure. She reports a
penicillin allergy. What is the appropriate antibiotic prophylaxis regimen?
A. Amoxicillin 2g PO 1 hour before the procedure
B. Cephalexin 2g PO 1 hour before the procedure
C. Clindamycin 600mg PO 1 hour before the procedure
D. Azithromycin 500mg PO 1 hour before the procedure
🟢 C. Clindamycin 600mg PO 1 hour before the procedure
🔴 Explanation: For patients with a penicillin allergy undergoing a dental procedure, the AHA recommends
clindamycin 600mg PO or a cephalosporin (cephalexin) if no immediate hypersensitivity. However, given the history
of mitral valve prolapse and a penicillin allergy, clindamycin is the standard alternative. It is important to assess the
allergy type, but clindamycin is a safe and effective alternative.
3. A 65-year-old male with type 2 diabetes and hypertension is diagnosed with stage 3 chronic kidney disease
(eGFR 45 mL/min/1.73m2). His current medications include metformin 1000mg BID and lisinopril 20mg daily.
,Which medication adjustment is most appropriate?
A. Continue current medications, as both are safe in stage 3 CKD
B. Discontinue metformin immediately due to risk of lactic acidosis
C. Reduce the dose of lisinopril to avoid hyperkalemia
D. Decrease the metformin dose due to eGFR < 60 mL/min
🟢 A. Continue current medications, as both are safe in stage 3 CKD
🔴 Explanation: Lisinopril is nephroprotective and recommended in CKD with hypertension or proteinuria. The eGFR
is >30, so metformin can be continued, but the dose should be reviewed. A common guideline recommends a dose
reduction when eGFR is <45 mL/min. However, lisinopril is appropriate and metformin is generally considered safe
at this level, so continuing both while monitoring is appropriate. The most immediate concern is metformin’s
accumulation, so option A is best.
4. A 32-year-old woman presents with a 3-day history of dysuria, frequency, and urgency. She has no fever, chills,
or costovertebral angle tenderness. A urinalysis shows positive nitrites and leukocyte esterase. What is the most
appropriate initial treatment?
A. Nitrofurantoin 100mg BID for 5 days
B. Ciprofloxacin 500mg BID for 7 days
C. Trimethoprim-sulfamethoxazole DS BID for 3 days
D. Phenazopyridine 200mg TID for symptom control
🟢 A. Nitrofurantoin 100mg BID for 5 days
🔴 Explanation: This is an uncomplicated cystitis. Nitrofurantoin is a first-line agent for uncomplicated UTI due to its
low resistance rates and minimal systemic side effects. Fluoroquinolones (Ciprofloxacin) are reserved for complicated
UTIs. TMP-SMX resistance is often high. Phenazopyridine only treats symptoms, not the infection.
5. A 55-year-old female with osteoarthritis complains of persistent knee pain. She is currently taking ibuprofen
800mg TID. Which of the following is the most important laboratory value to monitor?
, A. Complete blood count
B. Serum creatinine and BUN
C. Serum amylase and lipase
D. Liver function tests
🟢 B. Serum creatinine and BUN
🔴 Explanation: Chronic high-dose NSAID use, as in this patient, carries a significant risk of acute kidney injury and
chronic kidney disease. Monitoring renal function (creatinine and BUN) is essential. While liver function and CBC can
be affected, renal toxicity is the most common and serious concern.
6. A 2-year-old child with a fever of 102°F, runny nose, and cough for 2 days is brought to the clinic. The child is
alert, playful, and drinking well. The parents request antibiotics. What is the most appropriate management?
A. Prescribe amoxicillin to prevent secondary bacterial infection
B. Recommend symptomatic care with fluids and antipyretics
C. Order a chest X-ray to rule out pneumonia
D. Prescribe oseltamivir for suspected influenza
🟢 B. Recommend symptomatic care with fluids and antipyretics
🔴 Explanation: This presentation is consistent with a viral upper respiratory tract infection. Antibiotics are not
indicated and contribute to resistance. The child's alertness and hydration status indicate that symptomatic
management is appropriate. A chest X-ray is unnecessary without respiratory distress.
7. A 60-year-old male with a history of coronary artery disease and heart failure is prescribed lisinopril and
furosemide. He complains of a new, non-productive cough. Which medication is the most likely cause?
A. Furosemide
B. Lisinopril
C. Aspirin
D. Metoprolol
PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Advanced Pathophysiology
Advanced Pharmacology
Advanced Health Assessment
Clinical Management of Acute & Chronic Illnesses
Evidence-Based Practice & Research
Professional Role Development, Ethics, & Legal Issues
Population Health, Epidemiology, & Health Promotion
Healthcare Policy, Finance, & Quality Improvement
Introduction:
This comprehensive examination is designed to rigorously assess the knowledge, clinical reasoning, and decision-
making skills essential for the Family Nurse Practitioner (FNP) in a primary care setting. It evaluates mastery of
foundational theory, applied clinical knowledge, and the ability to synthesize complex information across the lifespan.
The assessment incorporates regulatory, ethical, and professional standards within realistic scenarios, emphasizing
evidence-based practice, health promotion, and the management of acute and chronic conditions. Candidates must
demonstrate critical thinking to interpret clinical data, formulate differential diagnoses, and develop effective, patient-
centered management plans. This exam is structured with multiple-choice questions to provide a robust evaluation of
the candidate's readiness for independent, advanced nursing practice.
SECTION ONE: QUESTIONS 1-100
,1. A 72-year-old male with a 40-pack-year smoking history presents with a new onset of hoarseness that has
persisted for 4 weeks. He denies any cold or flu symptoms. What is the most appropriate initial diagnostic step?
A. A course of oral antibiotics for suspected laryngitis
B. Direct laryngoscopy and biopsy
C. An empirical trial of a proton pump inhibitor for GERD
D. A chest X-ray
🟢 B. Direct laryngoscopy and biopsy
🔴 Explanation: In an older patient with a significant smoking history, persistent hoarseness (>3 weeks) warrants
direct visualization of the larynx to rule out malignancy. A chest X-ray would be indicated to evaluate for lung
metastases but is not the initial diagnostic step for the laryngeal lesion itself. An empirical trial of PPI would be
inappropriate without diagnosis, and antibiotics are ineffective for viral laryngitis or malignancy.
2. A 45-year-old female with a history of mitral valve prolapse is undergoing a dental procedure. She reports a
penicillin allergy. What is the appropriate antibiotic prophylaxis regimen?
A. Amoxicillin 2g PO 1 hour before the procedure
B. Cephalexin 2g PO 1 hour before the procedure
C. Clindamycin 600mg PO 1 hour before the procedure
D. Azithromycin 500mg PO 1 hour before the procedure
🟢 C. Clindamycin 600mg PO 1 hour before the procedure
🔴 Explanation: For patients with a penicillin allergy undergoing a dental procedure, the AHA recommends
clindamycin 600mg PO or a cephalosporin (cephalexin) if no immediate hypersensitivity. However, given the history
of mitral valve prolapse and a penicillin allergy, clindamycin is the standard alternative. It is important to assess the
allergy type, but clindamycin is a safe and effective alternative.
3. A 65-year-old male with type 2 diabetes and hypertension is diagnosed with stage 3 chronic kidney disease
(eGFR 45 mL/min/1.73m2). His current medications include metformin 1000mg BID and lisinopril 20mg daily.
,Which medication adjustment is most appropriate?
A. Continue current medications, as both are safe in stage 3 CKD
B. Discontinue metformin immediately due to risk of lactic acidosis
C. Reduce the dose of lisinopril to avoid hyperkalemia
D. Decrease the metformin dose due to eGFR < 60 mL/min
🟢 A. Continue current medications, as both are safe in stage 3 CKD
🔴 Explanation: Lisinopril is nephroprotective and recommended in CKD with hypertension or proteinuria. The eGFR
is >30, so metformin can be continued, but the dose should be reviewed. A common guideline recommends a dose
reduction when eGFR is <45 mL/min. However, lisinopril is appropriate and metformin is generally considered safe
at this level, so continuing both while monitoring is appropriate. The most immediate concern is metformin’s
accumulation, so option A is best.
4. A 32-year-old woman presents with a 3-day history of dysuria, frequency, and urgency. She has no fever, chills,
or costovertebral angle tenderness. A urinalysis shows positive nitrites and leukocyte esterase. What is the most
appropriate initial treatment?
A. Nitrofurantoin 100mg BID for 5 days
B. Ciprofloxacin 500mg BID for 7 days
C. Trimethoprim-sulfamethoxazole DS BID for 3 days
D. Phenazopyridine 200mg TID for symptom control
🟢 A. Nitrofurantoin 100mg BID for 5 days
🔴 Explanation: This is an uncomplicated cystitis. Nitrofurantoin is a first-line agent for uncomplicated UTI due to its
low resistance rates and minimal systemic side effects. Fluoroquinolones (Ciprofloxacin) are reserved for complicated
UTIs. TMP-SMX resistance is often high. Phenazopyridine only treats symptoms, not the infection.
5. A 55-year-old female with osteoarthritis complains of persistent knee pain. She is currently taking ibuprofen
800mg TID. Which of the following is the most important laboratory value to monitor?
, A. Complete blood count
B. Serum creatinine and BUN
C. Serum amylase and lipase
D. Liver function tests
🟢 B. Serum creatinine and BUN
🔴 Explanation: Chronic high-dose NSAID use, as in this patient, carries a significant risk of acute kidney injury and
chronic kidney disease. Monitoring renal function (creatinine and BUN) is essential. While liver function and CBC can
be affected, renal toxicity is the most common and serious concern.
6. A 2-year-old child with a fever of 102°F, runny nose, and cough for 2 days is brought to the clinic. The child is
alert, playful, and drinking well. The parents request antibiotics. What is the most appropriate management?
A. Prescribe amoxicillin to prevent secondary bacterial infection
B. Recommend symptomatic care with fluids and antipyretics
C. Order a chest X-ray to rule out pneumonia
D. Prescribe oseltamivir for suspected influenza
🟢 B. Recommend symptomatic care with fluids and antipyretics
🔴 Explanation: This presentation is consistent with a viral upper respiratory tract infection. Antibiotics are not
indicated and contribute to resistance. The child's alertness and hydration status indicate that symptomatic
management is appropriate. A chest X-ray is unnecessary without respiratory distress.
7. A 60-year-old male with a history of coronary artery disease and heart failure is prescribed lisinopril and
furosemide. He complains of a new, non-productive cough. Which medication is the most likely cause?
A. Furosemide
B. Lisinopril
C. Aspirin
D. Metoprolol
