NRNP 6665 EXAM / FAMILY NURSE PRACTITIONER PRIMARY CARE
ACROSS THE LIFESPAN NRNP 6665 FINAL EXAM 2026
1. A 4-year-old child is brought to the primary care clinic because the parents
report persistent difficulty following instructions, frequent tantrums, and
problems interacting with peers. The clinician wants to establish a
developmentally appropriate baseline before determining whether the
behavior represents normal variation or a developmental disorder. Which
approach is most appropriate during the initial evaluation?
A. Begin stimulant medication immediately because the symptoms suggest
ADHD
B. Obtain a comprehensive developmental, behavioral, medical, family, and
psychosocial history while assessing functioning across settings
C. Diagnose oppositional defiant disorder solely from the parents'
description
D. Reassure the parents that behavioral concerns are never clinically
significant before school age
Answer: B
2. A 7-year-old child is evaluated during a routine health visit. The parent
reports that the child recently became more independent, prefers
completing tasks without assistance, and becomes frustrated when adults
take over activities the child believes can be completed independently.
According to Erikson's theory, which developmental conflict best
corresponds to this stage?
A. Initiative versus guilt
B. Trust versus mistrust
C. Industry versus inferiority
D. Identity versus role confusion
Answer: C
3. A 15-year-old adolescent presents for a confidential preventive visit. The
adolescent's parent answers most questions for the patient and remains in
the examination room despite the adolescent appearing uncomfortable.
1
, Which approach is most appropriate for the primary care provider?
A. Allow the parent to remain because adolescents cannot participate
independently in healthcare decisions
B. Refuse to evaluate the adolescent unless the parent leaves the practice
C. Establish developmentally appropriate confidential time with the
adolescent while explaining confidentiality and its safety-related limits
D. Discuss all sensitive issues exclusively with the parent
Answer: C
4. A 2-year-old child has limited vocabulary, does not consistently use two-
word phrases, and rarely points to share interest with caregivers. The
parents report that the child responds inconsistently when spoken to and
often plays alone. Which action is most appropriate?
A. Wait until kindergarten because language variation is always normal at
age 2
B. Begin antidepressant therapy for possible childhood depression
C. Refer immediately for psychiatric hospitalization
D. Perform standardized developmental and autism screening and arrange
appropriate early-intervention evaluation
Answer: D
5. A 16-year-old adolescent presents for a routine physical examination and
denies sexual activity when the parent is present. After private discussion,
the adolescent reports having sexual intercourse and requests
contraception. Which principle should guide the provider's management?
A. Provide confidential, developmentally appropriate reproductive health
counseling while explaining applicable confidentiality limitations
B. Immediately disclose the entire conversation to the parent regardless of
circumstances
C. Refuse contraception unless the parent signs written authorization
D. Avoid discussing sexually transmitted infection prevention because the
adolescent denied sexual activity initially
Answer: A
2
, 6. A 68-year-old patient reports increasing difficulty remembering
appointments but remains independent with finances, medications, driving,
cooking, and personal hygiene. The clinician wants to distinguish normal
age-associated changes from a major neurocognitive disorder. Which
finding would most strongly suggest a pathologic cognitive disorder?
A. Occasionally forgetting a person's name and remembering it later
B. Needing more time to learn unfamiliar technology
C. Progressive cognitive decline that interferes with independent daily
functioning
D. Taking longer to recall recently learned information but maintaining
independence
Answer: C
7. A 72-year-old patient reports several months of depressed mood,
decreased interest in activities, fatigue, insomnia, and poor concentration.
The patient denies suicidal thoughts. Which assessment should be
performed before initiating treatment?
A. Screen only for bipolar disorder
B. Conduct a comprehensive psychiatric assessment including symptom
severity, medical contributors, medications, substance use, and suicide risk
C. Assume the symptoms are a normal consequence of aging
D. Diagnose dementia because depression is uncommon in older adults
Answer: B
8. A 55-year-old patient presents for a preventive visit and reports fatigue,
decreased libido, and difficulty sleeping. The patient requests testosterone
therapy after seeing advertisements describing treatment for "low T."
Which approach is most appropriate?
A. Prescribe testosterone based solely on symptoms
B. Obtain appropriate morning testosterone measurements and evaluate
alternative causes before considering treatment
C. Begin testosterone immediately if the patient reports decreased libido
D. Order testosterone only after starting treatment
Answer: B
3
, 9. A 45-year-old patient reports intermittent palpitations, tremulousness, heat
intolerance, increased sweating, and unintentional weight loss despite
increased appetite. The thyroid examination reveals a diffusely enlarged
gland. Which diagnosis is most consistent with this presentation?
A. Primary hypothyroidism
B. Graves disease
C. Addison disease
D. Hypoparathyroidism
Answer: B
10. A 32-year-old patient reports fatigue, constipation, cold intolerance, dry
skin, and gradual weight gain. Laboratory testing demonstrates an elevated
TSH and decreased free T4. Which diagnosis best explains these findings?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Thyroid hormone resistance
Answer: A
11. A patient with newly diagnosed type 2 diabetes has an A1C of 7.8%, normal
renal function, no symptoms of hyperglycemia, and no contraindication to
metformin. The patient asks why medication and lifestyle modification are
both recommended. Which explanation is most appropriate?
A. Lifestyle modification is unnecessary once medication is started
B. Diabetes is caused only by excessive dietary sugar
C. Lifestyle interventions improve insulin sensitivity and cardiometabolic risk
while medication addresses glycemic control
D. Medication completely prevents all diabetes-related complications
Answer: C
12. A patient with type 2 diabetes is taking metformin and has developed
progressive chronic kidney disease. The clinician reviews renal function
before continuing therapy. Which concern is most important when renal
function becomes significantly impaired?
4
ACROSS THE LIFESPAN NRNP 6665 FINAL EXAM 2026
1. A 4-year-old child is brought to the primary care clinic because the parents
report persistent difficulty following instructions, frequent tantrums, and
problems interacting with peers. The clinician wants to establish a
developmentally appropriate baseline before determining whether the
behavior represents normal variation or a developmental disorder. Which
approach is most appropriate during the initial evaluation?
A. Begin stimulant medication immediately because the symptoms suggest
ADHD
B. Obtain a comprehensive developmental, behavioral, medical, family, and
psychosocial history while assessing functioning across settings
C. Diagnose oppositional defiant disorder solely from the parents'
description
D. Reassure the parents that behavioral concerns are never clinically
significant before school age
Answer: B
2. A 7-year-old child is evaluated during a routine health visit. The parent
reports that the child recently became more independent, prefers
completing tasks without assistance, and becomes frustrated when adults
take over activities the child believes can be completed independently.
According to Erikson's theory, which developmental conflict best
corresponds to this stage?
A. Initiative versus guilt
B. Trust versus mistrust
C. Industry versus inferiority
D. Identity versus role confusion
Answer: C
3. A 15-year-old adolescent presents for a confidential preventive visit. The
adolescent's parent answers most questions for the patient and remains in
the examination room despite the adolescent appearing uncomfortable.
1
, Which approach is most appropriate for the primary care provider?
A. Allow the parent to remain because adolescents cannot participate
independently in healthcare decisions
B. Refuse to evaluate the adolescent unless the parent leaves the practice
C. Establish developmentally appropriate confidential time with the
adolescent while explaining confidentiality and its safety-related limits
D. Discuss all sensitive issues exclusively with the parent
Answer: C
4. A 2-year-old child has limited vocabulary, does not consistently use two-
word phrases, and rarely points to share interest with caregivers. The
parents report that the child responds inconsistently when spoken to and
often plays alone. Which action is most appropriate?
A. Wait until kindergarten because language variation is always normal at
age 2
B. Begin antidepressant therapy for possible childhood depression
C. Refer immediately for psychiatric hospitalization
D. Perform standardized developmental and autism screening and arrange
appropriate early-intervention evaluation
Answer: D
5. A 16-year-old adolescent presents for a routine physical examination and
denies sexual activity when the parent is present. After private discussion,
the adolescent reports having sexual intercourse and requests
contraception. Which principle should guide the provider's management?
A. Provide confidential, developmentally appropriate reproductive health
counseling while explaining applicable confidentiality limitations
B. Immediately disclose the entire conversation to the parent regardless of
circumstances
C. Refuse contraception unless the parent signs written authorization
D. Avoid discussing sexually transmitted infection prevention because the
adolescent denied sexual activity initially
Answer: A
2
, 6. A 68-year-old patient reports increasing difficulty remembering
appointments but remains independent with finances, medications, driving,
cooking, and personal hygiene. The clinician wants to distinguish normal
age-associated changes from a major neurocognitive disorder. Which
finding would most strongly suggest a pathologic cognitive disorder?
A. Occasionally forgetting a person's name and remembering it later
B. Needing more time to learn unfamiliar technology
C. Progressive cognitive decline that interferes with independent daily
functioning
D. Taking longer to recall recently learned information but maintaining
independence
Answer: C
7. A 72-year-old patient reports several months of depressed mood,
decreased interest in activities, fatigue, insomnia, and poor concentration.
The patient denies suicidal thoughts. Which assessment should be
performed before initiating treatment?
A. Screen only for bipolar disorder
B. Conduct a comprehensive psychiatric assessment including symptom
severity, medical contributors, medications, substance use, and suicide risk
C. Assume the symptoms are a normal consequence of aging
D. Diagnose dementia because depression is uncommon in older adults
Answer: B
8. A 55-year-old patient presents for a preventive visit and reports fatigue,
decreased libido, and difficulty sleeping. The patient requests testosterone
therapy after seeing advertisements describing treatment for "low T."
Which approach is most appropriate?
A. Prescribe testosterone based solely on symptoms
B. Obtain appropriate morning testosterone measurements and evaluate
alternative causes before considering treatment
C. Begin testosterone immediately if the patient reports decreased libido
D. Order testosterone only after starting treatment
Answer: B
3
, 9. A 45-year-old patient reports intermittent palpitations, tremulousness, heat
intolerance, increased sweating, and unintentional weight loss despite
increased appetite. The thyroid examination reveals a diffusely enlarged
gland. Which diagnosis is most consistent with this presentation?
A. Primary hypothyroidism
B. Graves disease
C. Addison disease
D. Hypoparathyroidism
Answer: B
10. A 32-year-old patient reports fatigue, constipation, cold intolerance, dry
skin, and gradual weight gain. Laboratory testing demonstrates an elevated
TSH and decreased free T4. Which diagnosis best explains these findings?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. Hyperthyroidism
D. Thyroid hormone resistance
Answer: A
11. A patient with newly diagnosed type 2 diabetes has an A1C of 7.8%, normal
renal function, no symptoms of hyperglycemia, and no contraindication to
metformin. The patient asks why medication and lifestyle modification are
both recommended. Which explanation is most appropriate?
A. Lifestyle modification is unnecessary once medication is started
B. Diabetes is caused only by excessive dietary sugar
C. Lifestyle interventions improve insulin sensitivity and cardiometabolic risk
while medication addresses glycemic control
D. Medication completely prevents all diabetes-related complications
Answer: C
12. A patient with type 2 diabetes is taking metformin and has developed
progressive chronic kidney disease. The clinician reviews renal function
before continuing therapy. Which concern is most important when renal
function becomes significantly impaired?
4
