NURS 5433 FNP II MIDTERM EXAM 2026/2027 PREP QUESTIONS
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE
TEST EXAM ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALES (LATEST UPDATED VERSION
2026 EDITION) |GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED EXAM
1. A 45-year-old male with hypertension and type 2 diabetes presents with a non-
healing ulcer on his right great toe. The ulcer is 2 cm in diameter, has a pale base
with minimal granulation tissue, and surrounding skin is cool to touch. Dorsalis
pads and posterior tibia pulses are absent.
What is the MOST appropriate initial diagnostic test?
A) Arterial duplex ultrasound
B) Ankle-brachial index (ABI) with toe pressures
C) Magnetic resonance angiography (MRA)
D) Transcutaneous oximetry
**B) Ankle-brachial index (ABI) with toe pressures (CORRECT ANSWER) **
RATIONALE: ABI is noninvasive, inexpensive, and the recommended initial test
for peripheral artery disease (PAD). Toe pressures are useful if vessels are no
compressible (common in diabetes). Duplex ultrasound is more detailed but not
first-line; MRA is advanced imaging.
2. A 28-year-old G2P1 at 34 weeks’ gestation presents with painless, bright red
vaginal bleeding. She denies trauma or contractions. Fetal heart rate is 140 bpm
with good variability. What is the NEXT step in management?
A) Digital cervical examination to assess dilation
B) Immediate cesarean section
C) Transabdominal ultrasound to rule out placenta Previa
, D) Administration of betamethasone for fetal lung maturity
**C) Transabdominal ultrasound to rule out placenta Previa (CORRECT ANSWER)
**
RATIONALE: Painless third-trimester bleeding suggests placenta Previa until
proven otherwise. Digital exam is contraindicated due to risk of catastrophic
hemorrhage. Ultrasound is first-line. Cesarean is indicated only if Previa
confirmed with active bleeding.
3. A 60-year-old woman with osteoarthritis reports bilateral knee pain that is
worse with activity and improves with rest. She has taken acetaminophen 1000
mg q8h for 3 months with partial relief. She has history of hypertension
(controlled on Lisinopril) and chronic kidney disease stage 3 (eGFI 45). What is the
MOST appropriate next pharmacologic therapy?
A) Naproxen 500 mg BID
B) Diclofenac topical gel 1% applied to knees QID
C) Celecoxib 200 mg daily
D) Tramadol 50 mg QID
**B) Diclofenac topical gel 1% applied to knees QID (CORRECT ANSWER) **
RATIONALE: Topical NSAIDs have minimal systemic absorption and are safe in
CKD stage 3. Oral NSAIDs (naproxen, celecoxib) are relatively contraindicated due
to renal risk. Tramadol is an option but not first-line for osteoarthritis due to side
effect profile.
4. A 5-year-old boy is brought in with a 3-day history of fever (102°F),
nonproductive cough, and conjunctival injection without exudate. On exam, he
has a strawberry tongue, cervical lymphadenopathy, and a polymorphous truncal
rash. What is the MOST likely diagnosis?
A) Scarlet fever
B) Measles (rubella)
, C) Kawasaki disease
D) Stevens-Johnson syndrome
**C) Kawasaki disease (CORRECT ANSWER) **
RATIONALE: Kawasaki disease is an acute vasculitis in children with fever >5
days, bilateral conjunctival injection, oral mucosal changes (strawberry tongue),
rash, and cervical lymphadenopathy. Scarlet fever typically has pharyngitis and
sandpaper rash; measles has Kopplin spots.
5. A 72-year-old male with atrial fibrillation on warfarin (INR 2.5) presents with
acute onset of severe abdominal pain, nausea, and hematochezia. His abdomen is
tender with mild distension. CT angiogram reveals superior mesenteric artery
thrombus. Which of the following is the MOST appropriate immediate
intervention?
A) Intravenous heparin drip
B) Surgical embolectomy
C) Percutaneous thrombectomy with intra-arterial thrombolytic
D) Bowel resection with primary anastomosis
**C) Percutaneous thrombectomy with intra-arterial thrombolytic (CORRECT
ANSWER) **
RATIONALE: Acute mesenteric ischemia from arterial embolus is a surgical
emergency; however, endovascular techniques (thrombectomy/thrombolysis) are
increasingly first-line if available and no peritonitis. Heparin alone insufficient.
Surgical embolectomy is alternative but more invasive.
6. A 35-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Labs: TSH 12.5 maul/L (0.4-4.0), free T4 0.6 ng/ld.
(0.8-1.8). Anti-thyroid peroxidase antibodies are strongly positive.
She is not pregnant. What is the appropriate initial levothyroxine dose?
, A) 12.5 mcg daily
B) 25 mcg daily
C) 50 mcg daily
D) 100 mcg daily
**C) 50 mcg daily (CORRECT ANSWER) **
RATIONALE: For young healthy adults with hypothyroidism, starting dose
is 1.6 mcg/kg/day (~100 mcg for 70 kg), but lower starting dose (50 mcg)
is often used for those with mild disease or to avoid overtreatment in
those with possible ischemic heart disease. Since no cardiac history,
50-75 mcg is reasonable. 12.5-25 mcg too low.
7. A 55-year-old man with history of alcohol use disorder presents with
jaundice, ascites, and asterisks. Labs: AST 120 U/L, ALT 65 U/L,
total bilirubin 4.5 mg/ld., INR 1.8, creatinine 1.4 mg/ld. Madre’s
discriminant function (DF) is calculated as 45. What is the BEST
treatment?
A) Abstinence from alcohol and high-protein diet
B) Pentoxifylline 400 mg TID
C) Prednisolone 40 mg daily for 4 weeks followed by taper
D) N-acetyl cysteine 150 mg/kg IV
**C) Prednisolone 40 mg daily for 4 weeks followed by taper (CORRECT
ANSWER) **
RATIONALE: Madre DF >32 indicates severe alcoholic hepatitis.
Corticosteroids (prednisolone) reduce mortality. Pentoxifylline is
alternative but less effective. N-acetyl cysteine may be adjunct but not
AND A NEW UPDATED STUDY GUIDE COMPLETE ACCURATE
TEST EXAM ACTUAL QUESTIONS AND CORRECT VERIFIED
ANSWERS WITH RATIONALES (LATEST UPDATED VERSION
2026 EDITION) |GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED EXAM
1. A 45-year-old male with hypertension and type 2 diabetes presents with a non-
healing ulcer on his right great toe. The ulcer is 2 cm in diameter, has a pale base
with minimal granulation tissue, and surrounding skin is cool to touch. Dorsalis
pads and posterior tibia pulses are absent.
What is the MOST appropriate initial diagnostic test?
A) Arterial duplex ultrasound
B) Ankle-brachial index (ABI) with toe pressures
C) Magnetic resonance angiography (MRA)
D) Transcutaneous oximetry
**B) Ankle-brachial index (ABI) with toe pressures (CORRECT ANSWER) **
RATIONALE: ABI is noninvasive, inexpensive, and the recommended initial test
for peripheral artery disease (PAD). Toe pressures are useful if vessels are no
compressible (common in diabetes). Duplex ultrasound is more detailed but not
first-line; MRA is advanced imaging.
2. A 28-year-old G2P1 at 34 weeks’ gestation presents with painless, bright red
vaginal bleeding. She denies trauma or contractions. Fetal heart rate is 140 bpm
with good variability. What is the NEXT step in management?
A) Digital cervical examination to assess dilation
B) Immediate cesarean section
C) Transabdominal ultrasound to rule out placenta Previa
, D) Administration of betamethasone for fetal lung maturity
**C) Transabdominal ultrasound to rule out placenta Previa (CORRECT ANSWER)
**
RATIONALE: Painless third-trimester bleeding suggests placenta Previa until
proven otherwise. Digital exam is contraindicated due to risk of catastrophic
hemorrhage. Ultrasound is first-line. Cesarean is indicated only if Previa
confirmed with active bleeding.
3. A 60-year-old woman with osteoarthritis reports bilateral knee pain that is
worse with activity and improves with rest. She has taken acetaminophen 1000
mg q8h for 3 months with partial relief. She has history of hypertension
(controlled on Lisinopril) and chronic kidney disease stage 3 (eGFI 45). What is the
MOST appropriate next pharmacologic therapy?
A) Naproxen 500 mg BID
B) Diclofenac topical gel 1% applied to knees QID
C) Celecoxib 200 mg daily
D) Tramadol 50 mg QID
**B) Diclofenac topical gel 1% applied to knees QID (CORRECT ANSWER) **
RATIONALE: Topical NSAIDs have minimal systemic absorption and are safe in
CKD stage 3. Oral NSAIDs (naproxen, celecoxib) are relatively contraindicated due
to renal risk. Tramadol is an option but not first-line for osteoarthritis due to side
effect profile.
4. A 5-year-old boy is brought in with a 3-day history of fever (102°F),
nonproductive cough, and conjunctival injection without exudate. On exam, he
has a strawberry tongue, cervical lymphadenopathy, and a polymorphous truncal
rash. What is the MOST likely diagnosis?
A) Scarlet fever
B) Measles (rubella)
, C) Kawasaki disease
D) Stevens-Johnson syndrome
**C) Kawasaki disease (CORRECT ANSWER) **
RATIONALE: Kawasaki disease is an acute vasculitis in children with fever >5
days, bilateral conjunctival injection, oral mucosal changes (strawberry tongue),
rash, and cervical lymphadenopathy. Scarlet fever typically has pharyngitis and
sandpaper rash; measles has Kopplin spots.
5. A 72-year-old male with atrial fibrillation on warfarin (INR 2.5) presents with
acute onset of severe abdominal pain, nausea, and hematochezia. His abdomen is
tender with mild distension. CT angiogram reveals superior mesenteric artery
thrombus. Which of the following is the MOST appropriate immediate
intervention?
A) Intravenous heparin drip
B) Surgical embolectomy
C) Percutaneous thrombectomy with intra-arterial thrombolytic
D) Bowel resection with primary anastomosis
**C) Percutaneous thrombectomy with intra-arterial thrombolytic (CORRECT
ANSWER) **
RATIONALE: Acute mesenteric ischemia from arterial embolus is a surgical
emergency; however, endovascular techniques (thrombectomy/thrombolysis) are
increasingly first-line if available and no peritonitis. Heparin alone insufficient.
Surgical embolectomy is alternative but more invasive.
6. A 35-year-old female presents with fatigue, weight gain, cold intolerance,
and constipation. Labs: TSH 12.5 maul/L (0.4-4.0), free T4 0.6 ng/ld.
(0.8-1.8). Anti-thyroid peroxidase antibodies are strongly positive.
She is not pregnant. What is the appropriate initial levothyroxine dose?
, A) 12.5 mcg daily
B) 25 mcg daily
C) 50 mcg daily
D) 100 mcg daily
**C) 50 mcg daily (CORRECT ANSWER) **
RATIONALE: For young healthy adults with hypothyroidism, starting dose
is 1.6 mcg/kg/day (~100 mcg for 70 kg), but lower starting dose (50 mcg)
is often used for those with mild disease or to avoid overtreatment in
those with possible ischemic heart disease. Since no cardiac history,
50-75 mcg is reasonable. 12.5-25 mcg too low.
7. A 55-year-old man with history of alcohol use disorder presents with
jaundice, ascites, and asterisks. Labs: AST 120 U/L, ALT 65 U/L,
total bilirubin 4.5 mg/ld., INR 1.8, creatinine 1.4 mg/ld. Madre’s
discriminant function (DF) is calculated as 45. What is the BEST
treatment?
A) Abstinence from alcohol and high-protein diet
B) Pentoxifylline 400 mg TID
C) Prednisolone 40 mg daily for 4 weeks followed by taper
D) N-acetyl cysteine 150 mg/kg IV
**C) Prednisolone 40 mg daily for 4 weeks followed by taper (CORRECT
ANSWER) **
RATIONALE: Madre DF >32 indicates severe alcoholic hepatitis.
Corticosteroids (prednisolone) reduce mortality. Pentoxifylline is
alternative but less effective. N-acetyl cysteine may be adjunct but not
