NURS 5432 FNP 1 FINAL EXAM
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no other comorbidities. According to JNC 8 guidelines, what is the most
appropriate initial pharmacological intervention?
A. Clonidine 0.1mg twice daily
B. Metoprolol Succinate 25mg daily
C. Spironolactone 25mg daily
D. Lisinopril 10mg daily
Answer: D
Conceptual Explanation: JNC 8 recommends ACE inhibitors, ARBs, CCBs, or thiazide-type
diuretics as first-line therapy for non-black patients. Lisinopril is an ACE inhibitor.
2. Which of the following physical exam findings is most indicative of Acute Otitis Media
(AOM) rather than Otitis Media with Effusion (OME)?
A. Visible air-fluid levels
,B. Retraction of the tympanic membrane
C. Presence of translucent fluid
D. Bulging of the tympanic membrane
Answer: D
Conceptual Explanation: Bulging of the tympanic membrane is a hallmark of AOM and
distinguishes it from OME, which typically presents with fluid without acute inflammation.
3. A 68-year-old smoker presents with chronic cough and exertional dyspnea. Spirometry
reveals an FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A. Chronic Obstructive Pulmonary Disease (COPD)
B. Restrictive Lung Disease
C. Asthma
D. Congestive Heart Failure
Answer: A
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
diagnostic gold standard for COPD.
4. Which screening test is recommended by the USPSTF for a 55-year-old adult with a 30
pack-year smoking history who currently smokes?
A. Annual low-dose computed tomography (LDCT)
B. Sputum cytology every 6 months
, C. Annual Chest X-ray
D. Peak flow monitoring
Answer: A
Conceptual Explanation: USPSTF recommends annual screening for lung cancer with
LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently
smoke or have quit within the past 15 years.
5. A 24-year-old female presents with a malodorous vaginal discharge. Clue cells are noted on
the wet mount. What is the first-line treatment?
A. Fluconazole 150mg PO once
B. Azithromycin 1g PO once
C. Ceftriaxone 500mg IM once
D. Metronidazole 500mg PO BID for 7 days
Answer: D
Conceptual Explanation: Clue cells are diagnostic for Bacterial Vaginosis (BV). The first-
line treatment for BV is Metronidazole.
6. In a patient with newly diagnosed Type 2 Diabetes, which of the following A1c levels would
justify starting dual therapy (Metformin + another agent) immediately?
A. 6.5%
B. 7.5%
COMPREHENSIVE REVIEW QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with a blood pressure of 152/94 mmHg on two separate
occasions. He has no other comorbidities. According to JNC 8 guidelines, what is the most
appropriate initial pharmacological intervention?
A. Clonidine 0.1mg twice daily
B. Metoprolol Succinate 25mg daily
C. Spironolactone 25mg daily
D. Lisinopril 10mg daily
Answer: D
Conceptual Explanation: JNC 8 recommends ACE inhibitors, ARBs, CCBs, or thiazide-type
diuretics as first-line therapy for non-black patients. Lisinopril is an ACE inhibitor.
2. Which of the following physical exam findings is most indicative of Acute Otitis Media
(AOM) rather than Otitis Media with Effusion (OME)?
A. Visible air-fluid levels
,B. Retraction of the tympanic membrane
C. Presence of translucent fluid
D. Bulging of the tympanic membrane
Answer: D
Conceptual Explanation: Bulging of the tympanic membrane is a hallmark of AOM and
distinguishes it from OME, which typically presents with fluid without acute inflammation.
3. A 68-year-old smoker presents with chronic cough and exertional dyspnea. Spirometry
reveals an FEV1/FVC ratio of 0.65. What is the most likely diagnosis?
A. Chronic Obstructive Pulmonary Disease (COPD)
B. Restrictive Lung Disease
C. Asthma
D. Congestive Heart Failure
Answer: A
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
diagnostic gold standard for COPD.
4. Which screening test is recommended by the USPSTF for a 55-year-old adult with a 30
pack-year smoking history who currently smokes?
A. Annual low-dose computed tomography (LDCT)
B. Sputum cytology every 6 months
, C. Annual Chest X-ray
D. Peak flow monitoring
Answer: A
Conceptual Explanation: USPSTF recommends annual screening for lung cancer with
LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently
smoke or have quit within the past 15 years.
5. A 24-year-old female presents with a malodorous vaginal discharge. Clue cells are noted on
the wet mount. What is the first-line treatment?
A. Fluconazole 150mg PO once
B. Azithromycin 1g PO once
C. Ceftriaxone 500mg IM once
D. Metronidazole 500mg PO BID for 7 days
Answer: D
Conceptual Explanation: Clue cells are diagnostic for Bacterial Vaginosis (BV). The first-
line treatment for BV is Metronidazole.
6. In a patient with newly diagnosed Type 2 Diabetes, which of the following A1c levels would
justify starting dual therapy (Metformin + another agent) immediately?
A. 6.5%
B. 7.5%
