NURS 5433 FNP II FINAL EXAM ACTUAL QUESTIONS
AND ANSWERS - LATEST AND COMPLETE UPDATE
WITH VERIFIED SOLUTIONS – ASSURED PASS WITH
INSTANT DOWNLOAD PDF.
1. A 58-year-old man with hypertension and type 2 diabetes presents for
routine follow-up. His BP is 148/92 mmHg despite adherence to lisinopril
40 mg daily. According to current primary care guidelines, the most
appropriate next step is to:
A. Continue the same dose and recheck in 6 months
B. Switch lisinopril to a beta-blocker
C. Add a thiazide-type diuretic
D. Discontinue ACE inhibitor and start an ARB
Rationale: For patients with hypertension not at goal on maximized ACE
inhibitor therapy, adding a thiazide-type diuretic is evidence-based and
improves BP control, particularly in patients with diabetes.
2. A 35-year-old woman presents with fatigue, weight gain, and cold
intolerance. TSH is elevated and free T4 is low. The most appropriate initial
management is:
A. Order thyroid ultrasound
B. Start levothyroxine therapy
C. Repeat labs in 3 months
D. Refer immediately to endocrinology
Rationale: Primary hypothyroidism with symptomatic elevation in TSH and
low free T4 warrants treatment with levothyroxine without delay.
3. A 67-year-old man with COPD presents with increased dyspnea and
purulent sputum. He is afebrile and stable. Which management is most
, appropriate?
A. Oral corticosteroids only
B. Short-acting bronchodilator plus antibiotics
C. Immediate hospitalization
D. Discontinue inhaled therapy
Rationale: COPD exacerbations with increased sputum purulence benefit
from bronchodilators and antibiotics per current standards.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. The FNP
should recommend:
A. Aspirin therapy only
B. No antithrombotic therapy
C. Oral anticoagulation
D. Dual antiplatelet therapy
Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates
need for oral anticoagulation to reduce stroke risk.
5. A 24-year-old sexually active woman requests contraception. She has
migraines with aura. Which option is contraindicated?
A. Copper IUD
B. Progestin-only pill
C. Combined estrogen-progestin oral contraceptive
D. Levonorgestrel IUD
Rationale: Estrogen-containing contraceptives are contraindicated in
patients with migraines with aura due to increased stroke risk.
6. A 72-year-old woman presents with confusion and dysuria. Urinalysis shows
bacteriuria but no leukocytes. The best approach is to:
A. Treat empirically with antibiotics
B. Assess for alternative causes of confusion
, C. Admit for IV antibiotics
D. Repeat urinalysis after antibiotics
Rationale: Asymptomatic bacteriuria should not be treated; confusion in
older adults requires evaluation for other causes.
7. A patient with type 2 diabetes has an A1C of 8.5% on metformin alone.
According to current guidelines, the next step is to:
A. Increase metformin beyond maximum dose
B. Add a second agent such as GLP-1 receptor agonist
C. Stop metformin and start insulin
D. Delay treatment changes
Rationale: When A1C remains above target on metformin, adding another
agent with cardiovascular benefit is recommended.
8. A 45-year-old man presents with episodic chest pain relieved by rest. ECG is
normal at rest. Next best test is:
A. Chest X-ray
B. Exercise stress test
C. Cardiac catheterization
D. Holter monitor
Rationale: Stable angina with normal resting ECG is evaluated initially with
stress testing.
9. A child presents with sore throat, fever, and tender anterior cervical nodes.
Rapid strep test is positive. Appropriate management is:
A. Supportive care only
B. Start appropriate antibiotic therapy
C. Order throat culture before treatment
D. Prescribe antiviral medication
, Rationale: Confirmed streptococcal pharyngitis requires antibiotics to
prevent complications.
10.A pregnant patient at 28 weeks has a glucose tolerance test diagnostic of
gestational diabetes. Initial management includes:
A. Immediate insulin therapy
B. Dietary modification and glucose monitoring
C. Oral hypoglycemic agents only
D. Early induction of labor
Rationale: First-line management of gestational diabetes is lifestyle
modification and monitoring.
11.A 60-year-old smoker presents with chronic cough and weight loss. Chest
X-ray reveals a lung mass. The FNP’s priority is to:
A. Start empiric antibiotics
B. Arrange urgent diagnostic evaluation
C. Prescribe bronchodilators
D. Reassure and observe
Rationale: Red-flag symptoms and imaging findings require prompt
diagnostic workup for malignancy.
12.A patient on warfarin presents with INR of 5.5 and no bleeding. Appropriate
action is to:
A. Continue same dose
B. Give vitamin K IV
C. Hold warfarin and monitor INR
D. Admit to hospital
Rationale: For supratherapeutic INR without bleeding, holding warfarin
and close monitoring is recommended.
AND ANSWERS - LATEST AND COMPLETE UPDATE
WITH VERIFIED SOLUTIONS – ASSURED PASS WITH
INSTANT DOWNLOAD PDF.
1. A 58-year-old man with hypertension and type 2 diabetes presents for
routine follow-up. His BP is 148/92 mmHg despite adherence to lisinopril
40 mg daily. According to current primary care guidelines, the most
appropriate next step is to:
A. Continue the same dose and recheck in 6 months
B. Switch lisinopril to a beta-blocker
C. Add a thiazide-type diuretic
D. Discontinue ACE inhibitor and start an ARB
Rationale: For patients with hypertension not at goal on maximized ACE
inhibitor therapy, adding a thiazide-type diuretic is evidence-based and
improves BP control, particularly in patients with diabetes.
2. A 35-year-old woman presents with fatigue, weight gain, and cold
intolerance. TSH is elevated and free T4 is low. The most appropriate initial
management is:
A. Order thyroid ultrasound
B. Start levothyroxine therapy
C. Repeat labs in 3 months
D. Refer immediately to endocrinology
Rationale: Primary hypothyroidism with symptomatic elevation in TSH and
low free T4 warrants treatment with levothyroxine without delay.
3. A 67-year-old man with COPD presents with increased dyspnea and
purulent sputum. He is afebrile and stable. Which management is most
, appropriate?
A. Oral corticosteroids only
B. Short-acting bronchodilator plus antibiotics
C. Immediate hospitalization
D. Discontinue inhaled therapy
Rationale: COPD exacerbations with increased sputum purulence benefit
from bronchodilators and antibiotics per current standards.
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 3. The FNP
should recommend:
A. Aspirin therapy only
B. No antithrombotic therapy
C. Oral anticoagulation
D. Dual antiplatelet therapy
Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates
need for oral anticoagulation to reduce stroke risk.
5. A 24-year-old sexually active woman requests contraception. She has
migraines with aura. Which option is contraindicated?
A. Copper IUD
B. Progestin-only pill
C. Combined estrogen-progestin oral contraceptive
D. Levonorgestrel IUD
Rationale: Estrogen-containing contraceptives are contraindicated in
patients with migraines with aura due to increased stroke risk.
6. A 72-year-old woman presents with confusion and dysuria. Urinalysis shows
bacteriuria but no leukocytes. The best approach is to:
A. Treat empirically with antibiotics
B. Assess for alternative causes of confusion
, C. Admit for IV antibiotics
D. Repeat urinalysis after antibiotics
Rationale: Asymptomatic bacteriuria should not be treated; confusion in
older adults requires evaluation for other causes.
7. A patient with type 2 diabetes has an A1C of 8.5% on metformin alone.
According to current guidelines, the next step is to:
A. Increase metformin beyond maximum dose
B. Add a second agent such as GLP-1 receptor agonist
C. Stop metformin and start insulin
D. Delay treatment changes
Rationale: When A1C remains above target on metformin, adding another
agent with cardiovascular benefit is recommended.
8. A 45-year-old man presents with episodic chest pain relieved by rest. ECG is
normal at rest. Next best test is:
A. Chest X-ray
B. Exercise stress test
C. Cardiac catheterization
D. Holter monitor
Rationale: Stable angina with normal resting ECG is evaluated initially with
stress testing.
9. A child presents with sore throat, fever, and tender anterior cervical nodes.
Rapid strep test is positive. Appropriate management is:
A. Supportive care only
B. Start appropriate antibiotic therapy
C. Order throat culture before treatment
D. Prescribe antiviral medication
, Rationale: Confirmed streptococcal pharyngitis requires antibiotics to
prevent complications.
10.A pregnant patient at 28 weeks has a glucose tolerance test diagnostic of
gestational diabetes. Initial management includes:
A. Immediate insulin therapy
B. Dietary modification and glucose monitoring
C. Oral hypoglycemic agents only
D. Early induction of labor
Rationale: First-line management of gestational diabetes is lifestyle
modification and monitoring.
11.A 60-year-old smoker presents with chronic cough and weight loss. Chest
X-ray reveals a lung mass. The FNP’s priority is to:
A. Start empiric antibiotics
B. Arrange urgent diagnostic evaluation
C. Prescribe bronchodilators
D. Reassure and observe
Rationale: Red-flag symptoms and imaging findings require prompt
diagnostic workup for malignancy.
12.A patient on warfarin presents with INR of 5.5 and no bleeding. Appropriate
action is to:
A. Continue same dose
B. Give vitamin K IV
C. Hold warfarin and monitor INR
D. Admit to hospital
Rationale: For supratherapeutic INR without bleeding, holding warfarin
and close monitoring is recommended.
