MIDTERM EXAM: FNP654/FNP 654 (LATEST
2026/2027 UPDATE) FAMILY PRIMARY
CARE II EXAM REVIEW| QUESTIONS AND
VERIFIED ANSWERS| 100% CORRECT|
GRADE A - GCU 2026/2027 – Verified Q&As
with Detailed Rationales (Test Bank Bundle
- 79 Questions)
---
*QUESTION 1:*
A 55-year-old male with a 30-year smoking history presents with a new-onset cough and hemoptysis.
The most appropriate initial imaging study is:
A) Chest CT with contrast
B) Chest X-ray (PA and lateral)
C) MRI of the chest
D) PET scan
> 🎯 *CORRECT ANSWER:* B) Chest X-ray (PA and lateral)
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Initial screening.
> * *Why Distractors Fail:* CT/MRI/PET are secondary.
> * *Core Takeaway:* CXR = initial imaging.
,---
*QUESTION 2:*
Which of the following is a first-line treatment for a newly diagnosed hypertensive patient with
diabetes?
A) Hydrochlorothiazide
B) Lisinopril (ACE inhibitor)
C) Amlodipine
D) Clonidine
> 🎯 *CORRECT ANSWER:* B) Lisinopril (ACE inhibitor)
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Renoprotective.
> * *Why Distractors Fail:* HCTZ is alternative; amlodipine is second-line; clonidine not first.
> * *Core Takeaway:* ACEi = diabetic HTN.
---
*QUESTION 3:*
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH 8.5 mIU/L
and free T4 0.6 ng/dL. The most likely diagnosis is:
A) Subclinical hypothyroidism
B) Overt hypothyroidism
C) Euthyroid sick syndrome
D) Secondary hypothyroidism
> 🎯 *CORRECT ANSWER:* B) Overt hypothyroidism
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* High TSH + low T4.
,> * *Why Distractors Fail:* Subclinical has normal T4; sick has low TSH/T4; secondary low TSH/T4.
> * *Core Takeaway:* Overt = high TSH + low T4.
---
*QUESTION 4:*
A 65-year-old female with osteoporosis is started on alendronate. Which instruction is most important
to prevent esophageal injury?
A) Take with food
B) Take with a full glass of water and remain upright for 30 minutes
C) Take at bedtime
D) Take with orange juice
> 🎯 *CORRECT ANSWER:* B) Take with a full glass of water and remain upright for 30 minutes
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Prevents esophagitis.
> * *Why Distractors Fail:* Food/juice/bedtime are incorrect.
> * *Core Takeaway:* Alendronate = water + upright.
---
*QUESTION 5:*
The most common cause of chronic cough in adults is:
A) Asthma
B) Postnasal drip
C) GERD
D) Smoking
> 🎯 *CORRECT ANSWER:* B) Postnasal drip
> 💡 *CLINICAL RATIONALE:*
, > * *Why It's Right:* Most frequent etiology.
> * *Why Distractors Fail:* Asthma/GERD/smoking are common but less.
> * *Core Takeaway:* Chronic cough = postnasal drip.
---
*QUESTION 6:*
A 60-year-old male with a history of COPD presents with worsening dyspnea and purulent sputum. The
most appropriate antibiotic is:
A) Azithromycin
B) Amoxicillin-clavulanate
C) Cephalexin
D) Ciprofloxacin
> 🎯 *CORRECT ANSWER:* B) Amoxicillin-clavulanate
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Covers typical pathogens.
> * *Why Distractors Fail:* Azithromycin is atypical; cephalexin is narrow; cipro is alternative.
> * *Core Takeaway:* COPD exacerbation = amoxicillin-clavulanate.
---
*QUESTION 7:*
A 50-year-old female with a family history of breast cancer presents with a new, painless breast mass.
The most appropriate next step is:
A) Mammogram and ultrasound
B) Fine needle aspiration
C) Excisional biopsy
D) MRI
2026/2027 UPDATE) FAMILY PRIMARY
CARE II EXAM REVIEW| QUESTIONS AND
VERIFIED ANSWERS| 100% CORRECT|
GRADE A - GCU 2026/2027 – Verified Q&As
with Detailed Rationales (Test Bank Bundle
- 79 Questions)
---
*QUESTION 1:*
A 55-year-old male with a 30-year smoking history presents with a new-onset cough and hemoptysis.
The most appropriate initial imaging study is:
A) Chest CT with contrast
B) Chest X-ray (PA and lateral)
C) MRI of the chest
D) PET scan
> 🎯 *CORRECT ANSWER:* B) Chest X-ray (PA and lateral)
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Initial screening.
> * *Why Distractors Fail:* CT/MRI/PET are secondary.
> * *Core Takeaway:* CXR = initial imaging.
,---
*QUESTION 2:*
Which of the following is a first-line treatment for a newly diagnosed hypertensive patient with
diabetes?
A) Hydrochlorothiazide
B) Lisinopril (ACE inhibitor)
C) Amlodipine
D) Clonidine
> 🎯 *CORRECT ANSWER:* B) Lisinopril (ACE inhibitor)
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Renoprotective.
> * *Why Distractors Fail:* HCTZ is alternative; amlodipine is second-line; clonidine not first.
> * *Core Takeaway:* ACEi = diabetic HTN.
---
*QUESTION 3:*
A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show TSH 8.5 mIU/L
and free T4 0.6 ng/dL. The most likely diagnosis is:
A) Subclinical hypothyroidism
B) Overt hypothyroidism
C) Euthyroid sick syndrome
D) Secondary hypothyroidism
> 🎯 *CORRECT ANSWER:* B) Overt hypothyroidism
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* High TSH + low T4.
,> * *Why Distractors Fail:* Subclinical has normal T4; sick has low TSH/T4; secondary low TSH/T4.
> * *Core Takeaway:* Overt = high TSH + low T4.
---
*QUESTION 4:*
A 65-year-old female with osteoporosis is started on alendronate. Which instruction is most important
to prevent esophageal injury?
A) Take with food
B) Take with a full glass of water and remain upright for 30 minutes
C) Take at bedtime
D) Take with orange juice
> 🎯 *CORRECT ANSWER:* B) Take with a full glass of water and remain upright for 30 minutes
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Prevents esophagitis.
> * *Why Distractors Fail:* Food/juice/bedtime are incorrect.
> * *Core Takeaway:* Alendronate = water + upright.
---
*QUESTION 5:*
The most common cause of chronic cough in adults is:
A) Asthma
B) Postnasal drip
C) GERD
D) Smoking
> 🎯 *CORRECT ANSWER:* B) Postnasal drip
> 💡 *CLINICAL RATIONALE:*
, > * *Why It's Right:* Most frequent etiology.
> * *Why Distractors Fail:* Asthma/GERD/smoking are common but less.
> * *Core Takeaway:* Chronic cough = postnasal drip.
---
*QUESTION 6:*
A 60-year-old male with a history of COPD presents with worsening dyspnea and purulent sputum. The
most appropriate antibiotic is:
A) Azithromycin
B) Amoxicillin-clavulanate
C) Cephalexin
D) Ciprofloxacin
> 🎯 *CORRECT ANSWER:* B) Amoxicillin-clavulanate
> 💡 *CLINICAL RATIONALE:*
> * *Why It's Right:* Covers typical pathogens.
> * *Why Distractors Fail:* Azithromycin is atypical; cephalexin is narrow; cipro is alternative.
> * *Core Takeaway:* COPD exacerbation = amoxicillin-clavulanate.
---
*QUESTION 7:*
A 50-year-old female with a family history of breast cancer presents with a new, painless breast mass.
The most appropriate next step is:
A) Mammogram and ultrasound
B) Fine needle aspiration
C) Excisional biopsy
D) MRI
