NURS 5433 FNP II Final Exam – DIRECT
CONTENT Original Practice Questions (Family
Nurse Practitioner Curriculum) LATEST UPDATE
2026 /2027
INTRO:
*This original practice exam is designed for students preparing for the NURS 5433 Family
Nurse Practitioner (FNP) II Final Exam at the University of Texas at Arlington (UTA) or
similar FNP programs. Topics include advanced acute and chronic management across the
lifespan, complex pharmacotherapy, differential diagnosis, evidence-based guidelines, and
clinical decision-making. Answers are in bold italic * with italicized rationales.
1. A 65-year-old male with a 40-pack-year smoking history presents with hemoptysis,
weight loss, and a persistent cough. Chest x-ray shows a right hilar mass. What is
the most appropriate next step?
A) PET scan
B) CT chest with contrast
C) Sputum cytology
D) Bronchoscopy with biopsy
Answer: D
Suspected lung cancer requires tissue diagnosis. Bronchoscopy with biopsy is the
next step for central/hilar lesions. CT and PET are staging studies after diagnosis.
2. A 58-year-old female with hypertension and diabetes presents with new-onset atrial
fibrillation. Her CHA2DS2-VASc score is 4. What is the most appropriate
anticoagulation?
A) Aspirin 325 mg daily
B) Aspirin and clopidogrel
C) Apixaban
D) Warfarin without bridging
,Answer: C
*DOACs (apixaban, rivaroxaban, dabigatran) are preferred over warfarin for non-
valvular AF. CHA2DS2-VASc ≥2 in men or ≥3 in women requires anticoagulation.*
3. A 72-year-old male with heart failure with reduced ejection fraction (HFrEF)
presents with dyspnea, fatigue, and an EF of 30%. He is on lisinopril, metoprolol
succinate, and furosemide. What medication should be added to reduce mortality?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Amlodipine
Answer: B
*Mineralocorticoid receptor antagonists (spironolactone, eplerenone) reduce
mortality in HFrEF (NYHA II-IV, EF ≤35%). Added to ACE inhibitor/ARB and beta-
blocker.*
4. A 45-year-old female presents with fatigue, joint pain, and a rash on her face. ANA
is positive 1:640. Anti-dsDNA is positive. Urinalysis shows proteinuria. What is the
most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus with lupus nephritis
C) Mixed connective tissue disease
D) Sjögren's syndrome
Answer: B
Positive ANA + anti-dsDNA + proteinuria = SLE with lupus nephritis. Requires
nephrology referral and immunosuppression (mycophenolate or cyclophosphamide).
5. A 55-year-old male with type 2 diabetes has an A1c of 9.2% on metformin 2000 mg
daily and glipizide 10 mg BID. He has CKD stage 3b (eGFR 35). What is the best next
add-on therapy?
A) Sitagliptin
B) Pioglitazone
C) Empagliflozin
D) Insulin glargine
Answer: C
SGLT2 inhibitors (empagliflozin, canagliflozin) provide cardiorenal benefits and are
, preferred in diabetics with CKD or heart failure. Insulin if A1c remains >9% on triple
therapy.
6. A 28-year-old pregnant patient at 34 weeks presents with a blood pressure of
160/105 mmHg, headache, and visual changes. Urine protein is 5 g/24 hours. What is
the most appropriate management?
A) Outpatient labetalol and bed rest
B) Magnesium sulfate and delivery
C) Nifedipine and discharge
D) Methyldopa and follow up in 1 week
Answer: B
Severe preeclampsia at ≥34 weeks requires delivery. Magnesium sulfate for seizure
prophylaxis. Antihypertensives (labetalol, hydralazine, nifedipine) for BP control.
7. A 62-year-old female presents with acute shortness of breath, pleuritic chest pain,
and tachycardia after a long flight. She has a history of breast cancer. What is the
most appropriate next step?
A) D-dimer
B) CT pulmonary angiography
C) Lower extremity ultrasound
D) Chest x-ray
Answer: B
High clinical probability for PE (cancer + recent travel + symptoms) requires CTPA for
definitive diagnosis. D-dimer has low specificity in cancer patients.
8. A 50-year-old male with cirrhosis presents with confusion, asterixis, and elevated
ammonia. What is first-line treatment?
A) Lactulose
B) Rifaximin
C) IV albumin
D) Paracentesis
Answer: A
Lactulose is first-line for hepatic encephalopathy. Rifaximin added if inadequate
response. Lactulose acidifies colon, traps ammonia as ammonium.
9. A 35-year-old female presents with palpitations, heat intolerance, and weight loss.
TSH is <0.01, free T4 is elevated. Thyroid ultrasound shows diffuse increased
vascularity. What is the most likely diagnosis?
CONTENT Original Practice Questions (Family
Nurse Practitioner Curriculum) LATEST UPDATE
2026 /2027
INTRO:
*This original practice exam is designed for students preparing for the NURS 5433 Family
Nurse Practitioner (FNP) II Final Exam at the University of Texas at Arlington (UTA) or
similar FNP programs. Topics include advanced acute and chronic management across the
lifespan, complex pharmacotherapy, differential diagnosis, evidence-based guidelines, and
clinical decision-making. Answers are in bold italic * with italicized rationales.
1. A 65-year-old male with a 40-pack-year smoking history presents with hemoptysis,
weight loss, and a persistent cough. Chest x-ray shows a right hilar mass. What is
the most appropriate next step?
A) PET scan
B) CT chest with contrast
C) Sputum cytology
D) Bronchoscopy with biopsy
Answer: D
Suspected lung cancer requires tissue diagnosis. Bronchoscopy with biopsy is the
next step for central/hilar lesions. CT and PET are staging studies after diagnosis.
2. A 58-year-old female with hypertension and diabetes presents with new-onset atrial
fibrillation. Her CHA2DS2-VASc score is 4. What is the most appropriate
anticoagulation?
A) Aspirin 325 mg daily
B) Aspirin and clopidogrel
C) Apixaban
D) Warfarin without bridging
,Answer: C
*DOACs (apixaban, rivaroxaban, dabigatran) are preferred over warfarin for non-
valvular AF. CHA2DS2-VASc ≥2 in men or ≥3 in women requires anticoagulation.*
3. A 72-year-old male with heart failure with reduced ejection fraction (HFrEF)
presents with dyspnea, fatigue, and an EF of 30%. He is on lisinopril, metoprolol
succinate, and furosemide. What medication should be added to reduce mortality?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Amlodipine
Answer: B
*Mineralocorticoid receptor antagonists (spironolactone, eplerenone) reduce
mortality in HFrEF (NYHA II-IV, EF ≤35%). Added to ACE inhibitor/ARB and beta-
blocker.*
4. A 45-year-old female presents with fatigue, joint pain, and a rash on her face. ANA
is positive 1:640. Anti-dsDNA is positive. Urinalysis shows proteinuria. What is the
most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus with lupus nephritis
C) Mixed connective tissue disease
D) Sjögren's syndrome
Answer: B
Positive ANA + anti-dsDNA + proteinuria = SLE with lupus nephritis. Requires
nephrology referral and immunosuppression (mycophenolate or cyclophosphamide).
5. A 55-year-old male with type 2 diabetes has an A1c of 9.2% on metformin 2000 mg
daily and glipizide 10 mg BID. He has CKD stage 3b (eGFR 35). What is the best next
add-on therapy?
A) Sitagliptin
B) Pioglitazone
C) Empagliflozin
D) Insulin glargine
Answer: C
SGLT2 inhibitors (empagliflozin, canagliflozin) provide cardiorenal benefits and are
, preferred in diabetics with CKD or heart failure. Insulin if A1c remains >9% on triple
therapy.
6. A 28-year-old pregnant patient at 34 weeks presents with a blood pressure of
160/105 mmHg, headache, and visual changes. Urine protein is 5 g/24 hours. What is
the most appropriate management?
A) Outpatient labetalol and bed rest
B) Magnesium sulfate and delivery
C) Nifedipine and discharge
D) Methyldopa and follow up in 1 week
Answer: B
Severe preeclampsia at ≥34 weeks requires delivery. Magnesium sulfate for seizure
prophylaxis. Antihypertensives (labetalol, hydralazine, nifedipine) for BP control.
7. A 62-year-old female presents with acute shortness of breath, pleuritic chest pain,
and tachycardia after a long flight. She has a history of breast cancer. What is the
most appropriate next step?
A) D-dimer
B) CT pulmonary angiography
C) Lower extremity ultrasound
D) Chest x-ray
Answer: B
High clinical probability for PE (cancer + recent travel + symptoms) requires CTPA for
definitive diagnosis. D-dimer has low specificity in cancer patients.
8. A 50-year-old male with cirrhosis presents with confusion, asterixis, and elevated
ammonia. What is first-line treatment?
A) Lactulose
B) Rifaximin
C) IV albumin
D) Paracentesis
Answer: A
Lactulose is first-line for hepatic encephalopathy. Rifaximin added if inadequate
response. Lactulose acidifies colon, traps ammonia as ammonium.
9. A 35-year-old female presents with palpitations, heat intolerance, and weight loss.
TSH is <0.01, free T4 is elevated. Thyroid ultrasound shows diffuse increased
vascularity. What is the most likely diagnosis?
