1
NURS 5433 FNP II Midterm Exam Review 2026/2027
– 180 Detailed Questions & Answers with
Explanations
Question 1
A 56-year-old African American male presents for a follow-up visit. His blood
pressure readings at two separate visits were 154/96 mmHg and 150/92 mmHg. He
has no history of diabetes, chronic kidney disease, or cardiovascular disease. His
BMI is 32 kg/m². Basic metabolic panel is normal.
What is the most appropriate initial antihypertensive medication?
Answer
Thiazide diuretic
Explanation
According to evidence-based hypertension guidelines, African American patients
without CKD or diabetes respond better to thiazide diuretics and calcium channel
blockers compared to ACE inhibitors or ARBs. This population has lower renin
activity, making RAAS-based medications less effective as first-line monotherapy.
Beta-blockers are not recommended unless there is a compelling indication such as
coronary artery disease or heart failure. A thiazide diuretic is therefore the most
appropriate initial choice.
Question 2
A 62-year-old woman with type 2 diabetes has been taking metformin 1,000 mg
twice daily for 14 months. Her most recent hemoglobin A1C is 8.7%. She has a
history of myocardial infarction and normal renal function. She reports adherence
to medication and lifestyle recommendations.
What is the best next step in pharmacologic management?
, 2
Answer
Add a GLP-1 receptor agonist
Explanation
In patients with type 2 diabetes and established atherosclerotic cardiovascular
disease, GLP-1 receptor agonists are recommended because they reduce major
adverse cardiovascular events while improving glycemic control. Insulin is
reserved for severe hyperglycemia (A1C ≥10% or symptomatic). Sulfonylureas
increase hypoglycemia risk and weight gain without cardiovascular benefit. DPP-4
inhibitors provide modest glucose lowering but no proven cardiovascular benefit.
Question 3
A 24-year-old patient presents with asthma symptoms occurring 4–5 days per
week and nighttime awakenings twice per month. She uses her albuterol inhaler
frequently but has no hospitalizations or oral steroid use. Lung exam reveals mild
expiratory wheezing.
What is the most appropriate next step in management?
Answer
Initiate a low-dose inhaled corticosteroid
Explanation
Symptoms occurring more than twice weekly and nighttime awakenings indicate
mild persistent asthma. Inhaled corticosteroids are the cornerstone of asthma
control and reduce airway inflammation. Short-acting beta agonists alone are
insufficient at this stage. Long-acting beta agonists must never be used without an
inhaled corticosteroid due to increased asthma-related mortality. Oral
corticosteroids are reserved for severe exacerbations.
Question 4
A 69-year-old former smoker presents with chronic cough and exertional dyspnea.
, 3
Spirometry shows a post-bronchodilator FEV1/FVC ratio of 65%. He has no prior
COPD exacerbations.
What is the most appropriate initial maintenance therapy?
Answer
Long-acting bronchodilator
Explanation
A post-bronchodilator FEV1/FVC <70% confirms COPD. For initial maintenance
treatment, guidelines recommend a long-acting bronchodilator (LABA or LAMA)
to improve symptoms and reduce airflow limitation. Inhaled corticosteroids are not
first-line and are reserved for patients with frequent exacerbations or elevated
eosinophils. Short-acting bronchodilators are used for rescue only.
Question 5
A 48-year-old woman presents with fatigue, cold intolerance, constipation, and
weight gain. Laboratory results show an elevated TSH and a decreased free T4.
What is the correct diagnosis and management?
Answer
Overt hypothyroidism treated with levothyroxine
Explanation
Elevated TSH with low free T4 confirms overt hypothyroidism, indicating failure
of the thyroid gland to produce adequate hormone. This condition requires
treatment with levothyroxine to normalize thyroid hormone levels and alleviate
symptoms. Subclinical hypothyroidism would show elevated TSH with normal T4
and may not always require treatment.
Question 6
A 45-year-old man with long-standing hypertension presents for routine follow-
, 4
up. His estimated GFR is 48 mL/min/1.73 m² and urine albumin is elevated. Blood
pressure today is 142/88 mmHg.
What antihypertensive medication provides the greatest renal protection?
Answer
ACE inhibitor
Explanation
In patients with chronic kidney disease and albuminuria, ACE inhibitors reduce
intraglomerular pressure and slow progression of renal disease. Even if BP control
is similar with other agents, ACE inhibitors offer superior renal protection.
Question 7
A 29-year-old woman presents with dysuria and urinary urgency. She is pregnant
at 14 weeks. Urinalysis confirms bacteriuria.
What is the most appropriate management?
Answer
Treat with antibiotics even if asymptomatic
Explanation
Asymptomatic bacteriuria must be treated in pregnancy because untreated
infection increases the risk of pyelonephritis, preterm labor, and low birth weight.
This is an exception to the general rule of not treating asymptomatic bacteriuria.
Question 8
A 60-year-old man presents with epigastric pain relieved by eating. He takes
NSAIDs daily for arthritis.
What is the most likely diagnosis?
Answer
Duodenal ulcer
NURS 5433 FNP II Midterm Exam Review 2026/2027
– 180 Detailed Questions & Answers with
Explanations
Question 1
A 56-year-old African American male presents for a follow-up visit. His blood
pressure readings at two separate visits were 154/96 mmHg and 150/92 mmHg. He
has no history of diabetes, chronic kidney disease, or cardiovascular disease. His
BMI is 32 kg/m². Basic metabolic panel is normal.
What is the most appropriate initial antihypertensive medication?
Answer
Thiazide diuretic
Explanation
According to evidence-based hypertension guidelines, African American patients
without CKD or diabetes respond better to thiazide diuretics and calcium channel
blockers compared to ACE inhibitors or ARBs. This population has lower renin
activity, making RAAS-based medications less effective as first-line monotherapy.
Beta-blockers are not recommended unless there is a compelling indication such as
coronary artery disease or heart failure. A thiazide diuretic is therefore the most
appropriate initial choice.
Question 2
A 62-year-old woman with type 2 diabetes has been taking metformin 1,000 mg
twice daily for 14 months. Her most recent hemoglobin A1C is 8.7%. She has a
history of myocardial infarction and normal renal function. She reports adherence
to medication and lifestyle recommendations.
What is the best next step in pharmacologic management?
, 2
Answer
Add a GLP-1 receptor agonist
Explanation
In patients with type 2 diabetes and established atherosclerotic cardiovascular
disease, GLP-1 receptor agonists are recommended because they reduce major
adverse cardiovascular events while improving glycemic control. Insulin is
reserved for severe hyperglycemia (A1C ≥10% or symptomatic). Sulfonylureas
increase hypoglycemia risk and weight gain without cardiovascular benefit. DPP-4
inhibitors provide modest glucose lowering but no proven cardiovascular benefit.
Question 3
A 24-year-old patient presents with asthma symptoms occurring 4–5 days per
week and nighttime awakenings twice per month. She uses her albuterol inhaler
frequently but has no hospitalizations or oral steroid use. Lung exam reveals mild
expiratory wheezing.
What is the most appropriate next step in management?
Answer
Initiate a low-dose inhaled corticosteroid
Explanation
Symptoms occurring more than twice weekly and nighttime awakenings indicate
mild persistent asthma. Inhaled corticosteroids are the cornerstone of asthma
control and reduce airway inflammation. Short-acting beta agonists alone are
insufficient at this stage. Long-acting beta agonists must never be used without an
inhaled corticosteroid due to increased asthma-related mortality. Oral
corticosteroids are reserved for severe exacerbations.
Question 4
A 69-year-old former smoker presents with chronic cough and exertional dyspnea.
, 3
Spirometry shows a post-bronchodilator FEV1/FVC ratio of 65%. He has no prior
COPD exacerbations.
What is the most appropriate initial maintenance therapy?
Answer
Long-acting bronchodilator
Explanation
A post-bronchodilator FEV1/FVC <70% confirms COPD. For initial maintenance
treatment, guidelines recommend a long-acting bronchodilator (LABA or LAMA)
to improve symptoms and reduce airflow limitation. Inhaled corticosteroids are not
first-line and are reserved for patients with frequent exacerbations or elevated
eosinophils. Short-acting bronchodilators are used for rescue only.
Question 5
A 48-year-old woman presents with fatigue, cold intolerance, constipation, and
weight gain. Laboratory results show an elevated TSH and a decreased free T4.
What is the correct diagnosis and management?
Answer
Overt hypothyroidism treated with levothyroxine
Explanation
Elevated TSH with low free T4 confirms overt hypothyroidism, indicating failure
of the thyroid gland to produce adequate hormone. This condition requires
treatment with levothyroxine to normalize thyroid hormone levels and alleviate
symptoms. Subclinical hypothyroidism would show elevated TSH with normal T4
and may not always require treatment.
Question 6
A 45-year-old man with long-standing hypertension presents for routine follow-
, 4
up. His estimated GFR is 48 mL/min/1.73 m² and urine albumin is elevated. Blood
pressure today is 142/88 mmHg.
What antihypertensive medication provides the greatest renal protection?
Answer
ACE inhibitor
Explanation
In patients with chronic kidney disease and albuminuria, ACE inhibitors reduce
intraglomerular pressure and slow progression of renal disease. Even if BP control
is similar with other agents, ACE inhibitors offer superior renal protection.
Question 7
A 29-year-old woman presents with dysuria and urinary urgency. She is pregnant
at 14 weeks. Urinalysis confirms bacteriuria.
What is the most appropriate management?
Answer
Treat with antibiotics even if asymptomatic
Explanation
Asymptomatic bacteriuria must be treated in pregnancy because untreated
infection increases the risk of pyelonephritis, preterm labor, and low birth weight.
This is an exception to the general rule of not treating asymptomatic bacteriuria.
Question 8
A 60-year-old man presents with epigastric pain relieved by eating. He takes
NSAIDs daily for arthritis.
What is the most likely diagnosis?
Answer
Duodenal ulcer
