2026 UPDATED QUESTIONS DOWNLOAD
NURS 5433 Family II Midterm Prep: 450+ High-Yield Practice Questions & Detailed
Rationales | FNP Board-Style (2024-2026 Edition)
Prepare for your NURS 5433 Family II Midterm with 450+ high-yield practice questions
covering chronic disease management in adults and geriatrics. This guide includes
detailed rationales in italics and verified answers in bold based on current clinical
guidelines for cardiology, pulmonology, and chronic acute care. Perfect for FNP students
seeking a comprehensive study resource for complex primary care diagnostics.
1. A 65-year-old male with a 40-pack-year smoking history presents with "painless"
gross hematuria. What is the priority differential?
A. Acute Prostatitis
B. Nephrolithiasis (Kidney Stones)
C. Bladder Cancer
D. Interstitial Cystitis
Answer: C. Bladder Cancer
Rationale: Painless gross hematuria in an older adult, especially a smoker, is malignancy of the
urinary tract until proven otherwise.
2. Which heart murmur is described as a harsh, crescendo-decrescendo systolic
murmur heard best at the 2nd right intercostal space?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B. Aortic Stenosis
Rationale: Aortic Stenosis is a systolic murmur that often radiates to the carotid arteries and is
best heard at the base of the heart (right 2nd ICS).
3. According to GOLD guidelines, which FEV1/FVC ratio is diagnostic for COPD?
A. <0.80
B. <0.75
C. <0.70
D. <0.65
Answer: C. <0.70
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence of
persistent airflow limitation.
, 2026 UPDATED QUESTIONS DOWNLOAD
4. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) has an EF of 30%.
Which medication is proven to provide a mortality benefit?
A. Furosemide
B. Lisinopril (ACE Inhibitor)
C. Amlodipine
D. Digoxin
Answer: B. Lisinopril (ACE Inhibitor)
Rationale: ACE inhibitors, ARBs, and Beta-blockers are the foundation of HFrEF therapy
because they reduce mortality and morbidity.
5. What is the "Gold Standard" for diagnosing "Giant Cell Arteritis" (Temporal Arteritis)?
A. Elevated ESR/CRP
B. Temporal Artery Biopsy
C. Ultrasound of the Temporal Artery
D. Head CT
Answer: B. Temporal Artery Biopsy
Rationale: While elevated inflammatory markers suggest the diagnosis, a biopsy is required for
definitive confirmation to prevent blindness.
6. Which medication is first-line for a geriatric patient with Depression and insomnia?
A. Amitriptyline (TCA)
B. Mirtazapine (Remeron)
C. Sertraline (SSRI)
D. Alprazolam
Answer: B. Mirtazapine (Remeron)
Rationale: Mirtazapine is often used in seniors because its side effects—sedation and weight
gain—can be beneficial for patients with insomnia and weight loss.
7. A 60-year-old male presents with sudden "flashes of light" and a "curtain" over his
vision. Diagnosis?
A. Acute Glaucoma
B. Cataracts
C. Retinal Detachment
D. Macular Degeneration
Answer: C. Retinal Detachment
Rationale: Sudden flashes (photopsia) and a curtain-like shadow over the field of vision are
hallmarks of retinal detachment.
8. Which lab is most specific for diagnosing Rheumatoid Arthritis (RA)?
A. Rheumatoid Factor (RF)
B. Anti-CCP (Anti-cyclic citrullinated peptide)
C. ESR
, 2026 UPDATED QUESTIONS DOWNLOAD
D. CRP
Answer: B. Anti-CCP
Rationale: Anti-CCP is highly specific (~95%) for RA and can be detected very early in the
disease process.
9. What is the first-line treatment for a 70-year-old with Herpes Zoster (Shingles)?
A. Topical Hydrocortisone
B. Oral Valacyclovir (within 72 hours)
C. Oral Amoxicillin
D. Topical Nystatin
Answer: B. Oral Valacyclovir
Rationale: Antivirals should be started within 72 hours of rash onset to reduce the duration of
symptoms and risk of post-herpetic neuralgia.
10. "Heberden’s Nodes" (DIP joints) are classic physical findings in:
A. Rheumatoid Arthritis
B. Osteoarthritis (OA)
C. Systemic Lupus Erythematosus
D. Gout
Answer: B. Osteoarthritis (OA)
Rationale: These bony enlargements at the distal interphalangeal joints are characteristic of the
degeneration seen in OA.
11. A "Positive Phalen’s Test" (paresthesia after 60s of wrist flexion) indicates:
A. Cubital Tunnel Syndrome
B. Carpal Tunnel Syndrome
C. Wrist Fracture
D. Radial Nerve Palsy
Answer: B. Carpal Tunnel Syndrome
Rationale: This maneuver increases pressure on the median nerve within the carpal tunnel.
12. Which antibiotic class carries a "Black Box Warning" for tendon rupture?
A. Macrolides
B. Penicillins
C. Fluoroquinolones (e.g., Ciprofloxacin)
D. Tetracyclines
Answer: C. Fluoroquinolones
Rationale: Quinolones are associated with an increased risk of Achilles tendonitis and rupture,
especially in older adults.
13. A "Positive Murphy’s Sign" (inspiratory arrest during RUQ palpation) suggests:
A. Appendicitis
B. Acute Cholecystitis
, 2026 UPDATED QUESTIONS DOWNLOAD
C. Pancreatitis
D. Diverticulitis
Answer: B. Acute Cholecystitis
Rationale: This indicates inflammation of the gallbladder when it contacts the examiner's hand
during deep inspiration.
14. What is the first-line treatment for an adult with an "uncomplicated UTI" (Cystitis)?
A. Ciprofloxacin
B. Nitrofurantoin (Macrobid)
C. Amoxicillin
D. Doxycycline
Answer: B. Nitrofurantoin (Macrobid)
Rationale: Per current guidelines, Nitrofurantoin, TMP-SMX, or Fosfomycin are first-line for
uncomplicated cystitis.
15. A "Positive McBurney’s Point" tenderness (RLQ) is highly suggestive of:
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Kidney Stones
Answer: B. Appendicitis
Rationale: McBurney's point (one-third the distance from the iliac spine to the umbilicus) is the
classic location for appendicitis pain.
16. Which cranial nerve is affected in "Bell’s Palsy"?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN III (Oculomotor)
D. CN X (Vagus)
Answer: B. CN VII (Facial)
Rationale: Bell's Palsy is an idiopathic, acute unilateral paralysis of the facial nerve.
17. "Cotton Wool Spots" on a funduscopic exam are indicative of:
A. Glaucoma
B. Diabetic or Hypertensive Retinopathy (Ischemia)
C. Cataracts
D. Macular Degeneration
Answer: B. Diabetic or Hypertensive Retinopathy
Rationale: These fluffy white patches represent micro-infarctions of the retinal nerve fiber layer.
18. A patient with "Target" lesions (Erythema Migrans) after a tick bite should be treated
for:
A. Rocky Mountain Spotted Fever
NURS 5433 Family II Midterm Prep: 450+ High-Yield Practice Questions & Detailed
Rationales | FNP Board-Style (2024-2026 Edition)
Prepare for your NURS 5433 Family II Midterm with 450+ high-yield practice questions
covering chronic disease management in adults and geriatrics. This guide includes
detailed rationales in italics and verified answers in bold based on current clinical
guidelines for cardiology, pulmonology, and chronic acute care. Perfect for FNP students
seeking a comprehensive study resource for complex primary care diagnostics.
1. A 65-year-old male with a 40-pack-year smoking history presents with "painless"
gross hematuria. What is the priority differential?
A. Acute Prostatitis
B. Nephrolithiasis (Kidney Stones)
C. Bladder Cancer
D. Interstitial Cystitis
Answer: C. Bladder Cancer
Rationale: Painless gross hematuria in an older adult, especially a smoker, is malignancy of the
urinary tract until proven otherwise.
2. Which heart murmur is described as a harsh, crescendo-decrescendo systolic
murmur heard best at the 2nd right intercostal space?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B. Aortic Stenosis
Rationale: Aortic Stenosis is a systolic murmur that often radiates to the carotid arteries and is
best heard at the base of the heart (right 2nd ICS).
3. According to GOLD guidelines, which FEV1/FVC ratio is diagnostic for COPD?
A. <0.80
B. <0.75
C. <0.70
D. <0.65
Answer: C. <0.70
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the presence of
persistent airflow limitation.
, 2026 UPDATED QUESTIONS DOWNLOAD
4. A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) has an EF of 30%.
Which medication is proven to provide a mortality benefit?
A. Furosemide
B. Lisinopril (ACE Inhibitor)
C. Amlodipine
D. Digoxin
Answer: B. Lisinopril (ACE Inhibitor)
Rationale: ACE inhibitors, ARBs, and Beta-blockers are the foundation of HFrEF therapy
because they reduce mortality and morbidity.
5. What is the "Gold Standard" for diagnosing "Giant Cell Arteritis" (Temporal Arteritis)?
A. Elevated ESR/CRP
B. Temporal Artery Biopsy
C. Ultrasound of the Temporal Artery
D. Head CT
Answer: B. Temporal Artery Biopsy
Rationale: While elevated inflammatory markers suggest the diagnosis, a biopsy is required for
definitive confirmation to prevent blindness.
6. Which medication is first-line for a geriatric patient with Depression and insomnia?
A. Amitriptyline (TCA)
B. Mirtazapine (Remeron)
C. Sertraline (SSRI)
D. Alprazolam
Answer: B. Mirtazapine (Remeron)
Rationale: Mirtazapine is often used in seniors because its side effects—sedation and weight
gain—can be beneficial for patients with insomnia and weight loss.
7. A 60-year-old male presents with sudden "flashes of light" and a "curtain" over his
vision. Diagnosis?
A. Acute Glaucoma
B. Cataracts
C. Retinal Detachment
D. Macular Degeneration
Answer: C. Retinal Detachment
Rationale: Sudden flashes (photopsia) and a curtain-like shadow over the field of vision are
hallmarks of retinal detachment.
8. Which lab is most specific for diagnosing Rheumatoid Arthritis (RA)?
A. Rheumatoid Factor (RF)
B. Anti-CCP (Anti-cyclic citrullinated peptide)
C. ESR
, 2026 UPDATED QUESTIONS DOWNLOAD
D. CRP
Answer: B. Anti-CCP
Rationale: Anti-CCP is highly specific (~95%) for RA and can be detected very early in the
disease process.
9. What is the first-line treatment for a 70-year-old with Herpes Zoster (Shingles)?
A. Topical Hydrocortisone
B. Oral Valacyclovir (within 72 hours)
C. Oral Amoxicillin
D. Topical Nystatin
Answer: B. Oral Valacyclovir
Rationale: Antivirals should be started within 72 hours of rash onset to reduce the duration of
symptoms and risk of post-herpetic neuralgia.
10. "Heberden’s Nodes" (DIP joints) are classic physical findings in:
A. Rheumatoid Arthritis
B. Osteoarthritis (OA)
C. Systemic Lupus Erythematosus
D. Gout
Answer: B. Osteoarthritis (OA)
Rationale: These bony enlargements at the distal interphalangeal joints are characteristic of the
degeneration seen in OA.
11. A "Positive Phalen’s Test" (paresthesia after 60s of wrist flexion) indicates:
A. Cubital Tunnel Syndrome
B. Carpal Tunnel Syndrome
C. Wrist Fracture
D. Radial Nerve Palsy
Answer: B. Carpal Tunnel Syndrome
Rationale: This maneuver increases pressure on the median nerve within the carpal tunnel.
12. Which antibiotic class carries a "Black Box Warning" for tendon rupture?
A. Macrolides
B. Penicillins
C. Fluoroquinolones (e.g., Ciprofloxacin)
D. Tetracyclines
Answer: C. Fluoroquinolones
Rationale: Quinolones are associated with an increased risk of Achilles tendonitis and rupture,
especially in older adults.
13. A "Positive Murphy’s Sign" (inspiratory arrest during RUQ palpation) suggests:
A. Appendicitis
B. Acute Cholecystitis
, 2026 UPDATED QUESTIONS DOWNLOAD
C. Pancreatitis
D. Diverticulitis
Answer: B. Acute Cholecystitis
Rationale: This indicates inflammation of the gallbladder when it contacts the examiner's hand
during deep inspiration.
14. What is the first-line treatment for an adult with an "uncomplicated UTI" (Cystitis)?
A. Ciprofloxacin
B. Nitrofurantoin (Macrobid)
C. Amoxicillin
D. Doxycycline
Answer: B. Nitrofurantoin (Macrobid)
Rationale: Per current guidelines, Nitrofurantoin, TMP-SMX, or Fosfomycin are first-line for
uncomplicated cystitis.
15. A "Positive McBurney’s Point" tenderness (RLQ) is highly suggestive of:
A. Cholecystitis
B. Appendicitis
C. Diverticulitis
D. Kidney Stones
Answer: B. Appendicitis
Rationale: McBurney's point (one-third the distance from the iliac spine to the umbilicus) is the
classic location for appendicitis pain.
16. Which cranial nerve is affected in "Bell’s Palsy"?
A. CN V (Trigeminal)
B. CN VII (Facial)
C. CN III (Oculomotor)
D. CN X (Vagus)
Answer: B. CN VII (Facial)
Rationale: Bell's Palsy is an idiopathic, acute unilateral paralysis of the facial nerve.
17. "Cotton Wool Spots" on a funduscopic exam are indicative of:
A. Glaucoma
B. Diabetic or Hypertensive Retinopathy (Ischemia)
C. Cataracts
D. Macular Degeneration
Answer: B. Diabetic or Hypertensive Retinopathy
Rationale: These fluffy white patches represent micro-infarctions of the retinal nerve fiber layer.
18. A patient with "Target" lesions (Erythema Migrans) after a tick bite should be treated
for:
A. Rocky Mountain Spotted Fever
