NP Family Practice Comprehensive Board-Style Final
Exam (150 Questions: Adult, Pediatric & Women’s
Health) Answers And Rationale Included
2025/2026
1. A 45-year-old male presents with intermittent chest pain relieved
by rest. Which diagnostic test is most appropriate initially?
A. Echocardiogram
B. Exercise stress test
C. Holter monitor
D. Cardiac MRI
Rationale: Stress testing is the first-line evaluation for stable
exertional angina, especially when symptoms are predictable and
relieved by rest.
2. A patient with newly diagnosed hypertension should first receive
which lifestyle recommendation?
A. Increase potassium supplements
B. Begin high-protein diet
C. Reduce sodium intake to <2,300 mg/day
D. Begin intermittent fasting
Rationale: Sodium reduction has the strongest evidence for lowering
blood pressure among lifestyle interventions.
3. A 6-year-old presents with a barky cough and inspiratory stridor.
What is the most likely diagnosis?
,A. Epiglottitis
B. Asthma
C. Croup
D. Pneumonia
Rationale: Croup presents with a seal-like barky cough and stridor
caused by parainfluenza viruses.
4. A 32-year-old woman presents with dysuria, frequency, and
urgency. UA shows positive leukocyte esterase and nitrites. What is
first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Rationale: Nitrofurantoin is recommended first-line for uncomplicated
cystitis due to high efficacy and low resistance.
5. Which vaccine is contraindicated in pregnancy?
A. Tdap
B. Inactivated influenza
C. MMR
D. Hepatitis B
Rationale: MMR is a live vaccine and is contraindicated during
pregnancy.
,6. A 68-year-old presents with progressive memory loss that
interferes with daily function. Which screening tool is most
appropriate?
A. PHQ-9
B. MMSE
C. GAD-7
D. CAGE
Rationale: The MMSE is a validated tool for cognitive impairment
evaluation.
7. The best test to confirm type 2 diabetes is:
A. Random glucose 150
B. A1C ≥6.5%
C. Fasting glucose 110
D. 1-hour glucose tolerance test
Rationale: A1C ≥6.5% is a diagnostic threshold for diabetes per ADA
guidelines.
8. First-line treatment for mild persistent asthma includes:
A. SABA only
B. Low-dose ICS
C. Oral steroids
D. LABA monotherapy
Rationale: Low-dose inhaled steroids are preferred for mild persistent
asthma.
, 9. A patient with hypothyroidism on levothyroxine shows TSH 9.0.
What is the appropriate action?
A. Decrease dose
B. Increase dose
C. Stop medication
D. Repeat labs in 6 months
Rationale: High TSH indicates inadequate thyroid replacement,
requiring dose increase.
10. A 70-year-old smoker with chronic cough producing sputum for 2
years meets criteria for diagnosis of:
A. Asthma
B. Bronchitis from infection
C. Chronic bronchitis (COPD)
D. Pneumonitis
Rationale: Chronic bronchitis requires cough with sputum for at least 3
months for 2 consecutive years.
11. Which heart murmur is best heard at the apex with the patient in
left lateral position?
A. Aortic stenosis
B. Aortic regurgitation
C. Pulmonic stenosis
D. Mitral regurgitation
Rationale: MR radiates to the axilla and is best heard at the apex in
left lateral decubitus.
Exam (150 Questions: Adult, Pediatric & Women’s
Health) Answers And Rationale Included
2025/2026
1. A 45-year-old male presents with intermittent chest pain relieved
by rest. Which diagnostic test is most appropriate initially?
A. Echocardiogram
B. Exercise stress test
C. Holter monitor
D. Cardiac MRI
Rationale: Stress testing is the first-line evaluation for stable
exertional angina, especially when symptoms are predictable and
relieved by rest.
2. A patient with newly diagnosed hypertension should first receive
which lifestyle recommendation?
A. Increase potassium supplements
B. Begin high-protein diet
C. Reduce sodium intake to <2,300 mg/day
D. Begin intermittent fasting
Rationale: Sodium reduction has the strongest evidence for lowering
blood pressure among lifestyle interventions.
3. A 6-year-old presents with a barky cough and inspiratory stridor.
What is the most likely diagnosis?
,A. Epiglottitis
B. Asthma
C. Croup
D. Pneumonia
Rationale: Croup presents with a seal-like barky cough and stridor
caused by parainfluenza viruses.
4. A 32-year-old woman presents with dysuria, frequency, and
urgency. UA shows positive leukocyte esterase and nitrites. What is
first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Doxycycline
Rationale: Nitrofurantoin is recommended first-line for uncomplicated
cystitis due to high efficacy and low resistance.
5. Which vaccine is contraindicated in pregnancy?
A. Tdap
B. Inactivated influenza
C. MMR
D. Hepatitis B
Rationale: MMR is a live vaccine and is contraindicated during
pregnancy.
,6. A 68-year-old presents with progressive memory loss that
interferes with daily function. Which screening tool is most
appropriate?
A. PHQ-9
B. MMSE
C. GAD-7
D. CAGE
Rationale: The MMSE is a validated tool for cognitive impairment
evaluation.
7. The best test to confirm type 2 diabetes is:
A. Random glucose 150
B. A1C ≥6.5%
C. Fasting glucose 110
D. 1-hour glucose tolerance test
Rationale: A1C ≥6.5% is a diagnostic threshold for diabetes per ADA
guidelines.
8. First-line treatment for mild persistent asthma includes:
A. SABA only
B. Low-dose ICS
C. Oral steroids
D. LABA monotherapy
Rationale: Low-dose inhaled steroids are preferred for mild persistent
asthma.
, 9. A patient with hypothyroidism on levothyroxine shows TSH 9.0.
What is the appropriate action?
A. Decrease dose
B. Increase dose
C. Stop medication
D. Repeat labs in 6 months
Rationale: High TSH indicates inadequate thyroid replacement,
requiring dose increase.
10. A 70-year-old smoker with chronic cough producing sputum for 2
years meets criteria for diagnosis of:
A. Asthma
B. Bronchitis from infection
C. Chronic bronchitis (COPD)
D. Pneumonitis
Rationale: Chronic bronchitis requires cough with sputum for at least 3
months for 2 consecutive years.
11. Which heart murmur is best heard at the apex with the patient in
left lateral position?
A. Aortic stenosis
B. Aortic regurgitation
C. Pulmonic stenosis
D. Mitral regurgitation
Rationale: MR radiates to the axilla and is best heard at the apex in
left lateral decubitus.
