1
NURS 5433 FNP II Final Exam Actual Exam
2026/2027 | University of Texas at Arlington | Family
Nurse Practitioner II Clinical Management Across the
Lifespan | Questions with Complete Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (15 Questions)
Case Study 1: Hypertension Management
Scenario: A 58-year-old African American male presents for follow-up. BP 152/94 mmHg
(average of three readings). No diabetes, CKD, or CVD. BMI 31. He has adhered to DASH diet
and daily walking for 3 months without BP improvement. Current medications: None.
Q1: According to JNC 8 guidelines, what is the most appropriate initial pharmacologic
treatment?
A. Lisinopril 10 mg daily
B. Hydrochlorothiazide 25 mg daily
C. Amlodipine 5 mg daily
D. Losartan 50 mg daily
Correct Answer: C [CORRECT] Rationale: JNC 8 guidelines specifically recommend thiazide
diuretics or calcium channel blockers (CCBs) as first-line therapy in African American patients
without CKD or diabetes, due to superior BP reduction compared to ACE inhibitors/ARBs as
monotherapy. Amlodipine, a dihydropyridine CCB, is equally effective as thiazides with better
metabolic profile.
Q2: The patient returns in 6 weeks with BP 138/88 mmHg on amlodipine 5 mg. He reports mild
bilateral ankle edema. What is the next appropriate step?
A. Switch to lisinopril
B. Increase amlodipine to 10 mg
C. Add hydrochlorothiazide 12.5 mg
D. Discontinue amlodipine; start chlorthalidone
,2
Correct Answer: B [CORRECT] Rationale: BP 138/88 is approaching but not at goal (<140/90
for this patient). Mild peripheral edema is a common, dose-dependent side effect of
dihydropyridine CCBs that often improves with continued use. Guidelines recommend
maximizing first agent before adding second. Increasing to 10 mg is appropriate with follow-up
in 2-4 weeks.
Q3: Eight weeks later on amlodipine 10 mg, BP is 132/84 mmHg. The patient asks about adding
"water pills" to get to "perfect numbers." What is your response?
A. Add hydrochlorothiazide 25 mg to achieve optimal control
B. Continue current therapy; recheck in 6 months
C. Switch to combination amlodipine/benazepril
D. Add spironolactone 25 mg daily
Correct Answer: B [CORRECT] Rationale: BP 132/84 meets goal (<140/90) for a patient
without diabetes, CKD, or established CVD. JNC 8 defines controlled hypertension as <140/90
for this population. Adding medications unnecessarily increases cost, pill burden, and adverse
effects without proven outcome benefit for this BP range.
Case Study 2: Heart Failure Management
Scenario: A 72-year-old female with HFrEF (EF 35%) presents with worsening dyspnea and
peripheral edema. Current medications: Lisinopril 20 mg, metoprolol succinate 100 mg,
furosemide 40 mg daily. Labs: K+ 4.2, Cr 1.3, BNP 850.
Q4: Which medication addition would provide the greatest mortality benefit?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily
C. Hydralazine/isosorbide dinitrate
D. Ivabradine 5 mg BID
Correct Answer: B [CORRECT] Rationale: The RALES trial demonstrated that spironolactone
(an aldosterone antagonist) reduces mortality by 30% in HFrEF patients (NYHA Class III-IV)
already on ACE inhibitor and beta-blocker. This patient has symptomatic HFrEF with preserved
renal function and normal potassium, making her an ideal candidate. Current guidelines
recommend aldosterone antagonists for all HFrEF patients with EF ≤35% unless contraindicated.
,3
Q5: Three months later, the patient reports improved symptoms but mentions her husband has
been checking her BP at home, noting readings around 98/62 mmHg. She feels lightheaded when
standing. What adjustment is indicated?
A. Reduce lisinopril to 10 mg
B. Reduce metoprolol to 50 mg
C. Reduce furosemide to 20 mg
D. Discontinue spironolactone
Correct Answer: C [CORRECT] Rationale: Symptomatic hypotension with diuretic therapy in
a euvolemic, compensated heart failure patient suggests over-diuresis. Reducing the loop diuretic
(furosemide) is preferred over reducing neurohormonal antagonists (ACE inhibitor, beta-blocker,
MRA) that provide mortality benefit. Target dry weight should be reassessed with clinical
volume assessment.
Q6: A 65-year-old male with HFpEF (EF 55%) presents with exertional dyspnea and lower
extremity edema. Which therapeutic intervention has demonstrated outcome benefit in HFpEF?
A. Sacubitril/valsartan
B. SGLT-2 inhibitor (dapagliflozin)
C. Spironolactone
D. Digoxin
Correct Answer: B [CORRECT] Rationale: The DELIVER and EMPEROR-Preserved trials
demonstrated that SGLT-2 inhibitors (dapagliflozin, empagliflozin) reduce cardiovascular death
and heart failure hospitalizations in HFpEF (EF >40%), representing the first class with proven
outcome benefit in this population. Other therapies shown to improve symptoms include
diuretics for congestion and management of comorbidities (hypertension, atrial fibrillation).
Case Study 3: Atrial Fibrillation
Scenario: A 70-year-old male presents with new-onset atrial fibrillation. HR 110-130, irregularly
irregular. BP 128/78. No heart failure symptoms. CHA₂DS₂-VASc score 3, HAS-BLED score 2.
Q7: What is the most appropriate initial rate control strategy?
A. Immediate electrical cardioversion
B. Metoprolol tartrate 25 mg BID
C. Digoxin loading dose
D. Diltiazem IV bolus
, 4
Correct Answer: B [CORRECT] Rationale: For hemodynamically stable atrial fibrillation with
rapid ventricular response, oral beta-blockers are first-line for rate control, particularly in patients
without acute decompensated heart failure. Metoprolol provides effective rate control with once-
daily extended-release or twice-daily immediate-release dosing. Electrical cardioversion is
unnecessary without hemodynamic compromise; digoxin is less effective during high adrenergic
states.
Q8: Regarding anticoagulation, which statement aligns with current guidelines?
A. Anticoagulation optional given HAS-BLED score of 2
B. Apixaban 5 mg BID indicated given CHA₂DS₂-VASc ≥2 in males
C. Aspirin 325 mg daily acceptable alternative to anticoagulation
D. Warfarin with INR 2.0-3.0 preferred over DOACs
Correct Answer: B [CORRECT] Rationale: For non-valvular AF, DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for stroke prevention when
CHA₂DS₂-VASc ≥2 in men or ≥3 in women. This patient's score of 3 (age 65-74: 1 point,
hypertension/diabetes/vascular disease likely: 2 additional points) mandates anticoagulation.
HAS-BLED identifies bleeding risk factors to modify, not contraindications. Aspirin is not
recommended for stroke prevention in AF.
Standalone Cardiovascular Questions
Q9: A 55-year-old male with ASCVD (prior MI 2 years ago) presents for follow-up. On
atorvastatin 40 mg. LDL 96 mg/dL, HDL 42 mg/dL. What is the appropriate LDL target?
A. <100 mg/dL (current goal achieved)
B. <70 mg/dL on maximally tolerated statin
C. <130 mg/dL for secondary prevention
D. Non-HDL <160 mg/dL
Correct Answer: B [CORRECT] Rationale: 2018 ACC/AHA cholesterol guidelines
recommend LDL <70 mg/dL for very high-risk ASCVD patients (history of MI). High-intensity
statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) is indicated; if LDL remains ≥70 mg/dL
on maximally tolerated statin, add ezetimibe. Recent evidence supports "lower is better" for
secondary prevention with PCSK9 inhibitors considered for very high risk with LDL ≥70 despite
statin/ezetimibe.
Q10: A 68-year-old female with peripheral arterial disease (ABI 0.72) reports claudication after
walking 2 blocks. Which intervention provides the greatest symptom improvement?
NURS 5433 FNP II Final Exam Actual Exam
2026/2027 | University of Texas at Arlington | Family
Nurse Practitioner II Clinical Management Across the
Lifespan | Questions with Complete Solutions | Pass
Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (15 Questions)
Case Study 1: Hypertension Management
Scenario: A 58-year-old African American male presents for follow-up. BP 152/94 mmHg
(average of three readings). No diabetes, CKD, or CVD. BMI 31. He has adhered to DASH diet
and daily walking for 3 months without BP improvement. Current medications: None.
Q1: According to JNC 8 guidelines, what is the most appropriate initial pharmacologic
treatment?
A. Lisinopril 10 mg daily
B. Hydrochlorothiazide 25 mg daily
C. Amlodipine 5 mg daily
D. Losartan 50 mg daily
Correct Answer: C [CORRECT] Rationale: JNC 8 guidelines specifically recommend thiazide
diuretics or calcium channel blockers (CCBs) as first-line therapy in African American patients
without CKD or diabetes, due to superior BP reduction compared to ACE inhibitors/ARBs as
monotherapy. Amlodipine, a dihydropyridine CCB, is equally effective as thiazides with better
metabolic profile.
Q2: The patient returns in 6 weeks with BP 138/88 mmHg on amlodipine 5 mg. He reports mild
bilateral ankle edema. What is the next appropriate step?
A. Switch to lisinopril
B. Increase amlodipine to 10 mg
C. Add hydrochlorothiazide 12.5 mg
D. Discontinue amlodipine; start chlorthalidone
,2
Correct Answer: B [CORRECT] Rationale: BP 138/88 is approaching but not at goal (<140/90
for this patient). Mild peripheral edema is a common, dose-dependent side effect of
dihydropyridine CCBs that often improves with continued use. Guidelines recommend
maximizing first agent before adding second. Increasing to 10 mg is appropriate with follow-up
in 2-4 weeks.
Q3: Eight weeks later on amlodipine 10 mg, BP is 132/84 mmHg. The patient asks about adding
"water pills" to get to "perfect numbers." What is your response?
A. Add hydrochlorothiazide 25 mg to achieve optimal control
B. Continue current therapy; recheck in 6 months
C. Switch to combination amlodipine/benazepril
D. Add spironolactone 25 mg daily
Correct Answer: B [CORRECT] Rationale: BP 132/84 meets goal (<140/90) for a patient
without diabetes, CKD, or established CVD. JNC 8 defines controlled hypertension as <140/90
for this population. Adding medications unnecessarily increases cost, pill burden, and adverse
effects without proven outcome benefit for this BP range.
Case Study 2: Heart Failure Management
Scenario: A 72-year-old female with HFrEF (EF 35%) presents with worsening dyspnea and
peripheral edema. Current medications: Lisinopril 20 mg, metoprolol succinate 100 mg,
furosemide 40 mg daily. Labs: K+ 4.2, Cr 1.3, BNP 850.
Q4: Which medication addition would provide the greatest mortality benefit?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily
C. Hydralazine/isosorbide dinitrate
D. Ivabradine 5 mg BID
Correct Answer: B [CORRECT] Rationale: The RALES trial demonstrated that spironolactone
(an aldosterone antagonist) reduces mortality by 30% in HFrEF patients (NYHA Class III-IV)
already on ACE inhibitor and beta-blocker. This patient has symptomatic HFrEF with preserved
renal function and normal potassium, making her an ideal candidate. Current guidelines
recommend aldosterone antagonists for all HFrEF patients with EF ≤35% unless contraindicated.
,3
Q5: Three months later, the patient reports improved symptoms but mentions her husband has
been checking her BP at home, noting readings around 98/62 mmHg. She feels lightheaded when
standing. What adjustment is indicated?
A. Reduce lisinopril to 10 mg
B. Reduce metoprolol to 50 mg
C. Reduce furosemide to 20 mg
D. Discontinue spironolactone
Correct Answer: C [CORRECT] Rationale: Symptomatic hypotension with diuretic therapy in
a euvolemic, compensated heart failure patient suggests over-diuresis. Reducing the loop diuretic
(furosemide) is preferred over reducing neurohormonal antagonists (ACE inhibitor, beta-blocker,
MRA) that provide mortality benefit. Target dry weight should be reassessed with clinical
volume assessment.
Q6: A 65-year-old male with HFpEF (EF 55%) presents with exertional dyspnea and lower
extremity edema. Which therapeutic intervention has demonstrated outcome benefit in HFpEF?
A. Sacubitril/valsartan
B. SGLT-2 inhibitor (dapagliflozin)
C. Spironolactone
D. Digoxin
Correct Answer: B [CORRECT] Rationale: The DELIVER and EMPEROR-Preserved trials
demonstrated that SGLT-2 inhibitors (dapagliflozin, empagliflozin) reduce cardiovascular death
and heart failure hospitalizations in HFpEF (EF >40%), representing the first class with proven
outcome benefit in this population. Other therapies shown to improve symptoms include
diuretics for congestion and management of comorbidities (hypertension, atrial fibrillation).
Case Study 3: Atrial Fibrillation
Scenario: A 70-year-old male presents with new-onset atrial fibrillation. HR 110-130, irregularly
irregular. BP 128/78. No heart failure symptoms. CHA₂DS₂-VASc score 3, HAS-BLED score 2.
Q7: What is the most appropriate initial rate control strategy?
A. Immediate electrical cardioversion
B. Metoprolol tartrate 25 mg BID
C. Digoxin loading dose
D. Diltiazem IV bolus
, 4
Correct Answer: B [CORRECT] Rationale: For hemodynamically stable atrial fibrillation with
rapid ventricular response, oral beta-blockers are first-line for rate control, particularly in patients
without acute decompensated heart failure. Metoprolol provides effective rate control with once-
daily extended-release or twice-daily immediate-release dosing. Electrical cardioversion is
unnecessary without hemodynamic compromise; digoxin is less effective during high adrenergic
states.
Q8: Regarding anticoagulation, which statement aligns with current guidelines?
A. Anticoagulation optional given HAS-BLED score of 2
B. Apixaban 5 mg BID indicated given CHA₂DS₂-VASc ≥2 in males
C. Aspirin 325 mg daily acceptable alternative to anticoagulation
D. Warfarin with INR 2.0-3.0 preferred over DOACs
Correct Answer: B [CORRECT] Rationale: For non-valvular AF, DOACs (apixaban,
rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for stroke prevention when
CHA₂DS₂-VASc ≥2 in men or ≥3 in women. This patient's score of 3 (age 65-74: 1 point,
hypertension/diabetes/vascular disease likely: 2 additional points) mandates anticoagulation.
HAS-BLED identifies bleeding risk factors to modify, not contraindications. Aspirin is not
recommended for stroke prevention in AF.
Standalone Cardiovascular Questions
Q9: A 55-year-old male with ASCVD (prior MI 2 years ago) presents for follow-up. On
atorvastatin 40 mg. LDL 96 mg/dL, HDL 42 mg/dL. What is the appropriate LDL target?
A. <100 mg/dL (current goal achieved)
B. <70 mg/dL on maximally tolerated statin
C. <130 mg/dL for secondary prevention
D. Non-HDL <160 mg/dL
Correct Answer: B [CORRECT] Rationale: 2018 ACC/AHA cholesterol guidelines
recommend LDL <70 mg/dL for very high-risk ASCVD patients (history of MI). High-intensity
statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) is indicated; if LDL remains ≥70 mg/dL
on maximally tolerated statin, add ezetimibe. Recent evidence supports "lower is better" for
secondary prevention with PCSK9 inhibitors considered for very high risk with LDL ≥70 despite
statin/ezetimibe.
Q10: A 68-year-old female with peripheral arterial disease (ABI 0.72) reports claudication after
walking 2 blocks. Which intervention provides the greatest symptom improvement?
