NURS 5434 FNP III Final Exam – Family Nurse Practitioner: 2026 Practice Exam with 200+
Questions, Correct Answers, and Detailed Rationales – Complete Test Prep for FNP
Certification, Clinical Management, and Advanced Practice Nursing – Digital Download
NURS 5434 FNP III Final Exam – 200 Practice Questions
with Answers & Rationales (2026 Edition)
Question 1
A 55-year-old male with hypertension presents with sudden, severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 130/70 in the left
arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe tearing chest pain, often
radiating to the back, with pulse or blood pressure differential between arms. This is a
medical emergency requiring immediate imaging (CT angiography).
Question 2
A 28-year-old woman reports three episodes of pelvic pain, fever, and dyspareunia over
the past 6 months. She has a history of chlamydia. Bimanual exam reveals cervical
motion tenderness and adnexal tenderness. What is the most appropriate next step?
A. Oral doxycycline alone
B. Intramuscular ceftriaxone plus oral doxycycline
,C. Outpatient observation
D. Referral for laparoscopy
Correct Answer: B
Rationale: This is pelvic inflammatory disease (PID). CDC guidelines recommend IM
ceftriaxone 500 mg plus oral doxycycline 100 mg BID for 14 days. Metronidazole is often
added. Hospitalization is indicated for pregnancy, severe illness, or failure of outpatient
therapy.
Question 3
A 72-year-old male with type 2 diabetes and CKD stage 3 presents with a foot ulcer on
the plantar surface. The wound is 2 cm, deep to fascia, with purulent drainage. There is
erythema extending 3 cm proximally. The patient is afebrile. What is the most
appropriate management?
A. Oral amoxicillin-clavulanate and outpatient wound care
B. Surgical debridement and IV antibiotics
C. Topical silver dressing and close follow-up
D. Offloading with a total contact cast
Correct Answer: B
Rationale: This is a deep foot ulcer with cellulitis, in a diabetic patient. Presence of
purulence, depth to fascia, and diabetes with CKD warrants hospitalization for IV
antibiotics and surgical debridement to prevent osteomyelitis and amputation.
Question 4
A 45-year-old woman has a blood pressure of 148/92 mmHg on three separate
occasions. She has no other medical issues. What is the first-line medication for
,hypertension in a non-Black patient without compelling indications?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Correct Answer: B
Rationale: For non-Black patients with hypertension, first-line agents include ACE
inhibitors (lisinopril), ARBs, CCBs, or thiazides. ACE inhibitors are often preferred due to
cardiovascular and renal protective effects, especially in younger patients.
Question 5
A 65-year-old male with a 40-pack-year smoking history reports a chronic cough with
hemoptysis and weight loss. Chest X-ray shows a right hilar mass. What is the most
appropriate next step?
A. Sputum cytology
B. CT chest with contrast
C. PET scan
D. Bronchoscopy with biopsy
Correct Answer: B
Rationale: After an abnormal chest X-ray suggesting lung cancer, the next step is
contrast-enhanced CT chest to better characterize the mass and guide biopsy.
Bronchoscopy or biopsy follows based on CT findings.
Question 6
A 30-year-old woman presents with painful menstrual periods that began 2 years ago
, and have progressively worsened. She also reports dyspareunia and chronic pelvic pain.
What is the most likely diagnosis?
A. Primary dysmenorrhea
B. Endometriosis
C. Pelvic adhesions
D. Ovarian cyst
Correct Answer: B
Rationale: Progressive dysmenorrhea, dyspareunia, and chronic pelvic pain are classic for
endometriosis. Diagnosis is often clinical; laparoscopy is gold standard. Primary
dysmenorrhea begins soon after menarche and is not progressive.
Question 7
A 68-year-old woman with osteoporosis presents with acute onset of severe low back
pain after bending to pick up a grocery bag. She is unable to stand. What is the most
appropriate initial imaging?
A. Plain X-ray of lumbosacral spine
B. MRI spine without contrast
C. CT myelogram
D. Bone scan
Correct Answer: A
Rationale: Suspected vertebral compression fracture in an osteoporotic patient. Plain X-
ray is first-line to confirm fracture. MRI is indicated if neurologic deficits or suspicion of
malignancy.
Questions, Correct Answers, and Detailed Rationales – Complete Test Prep for FNP
Certification, Clinical Management, and Advanced Practice Nursing – Digital Download
NURS 5434 FNP III Final Exam – 200 Practice Questions
with Answers & Rationales (2026 Edition)
Question 1
A 55-year-old male with hypertension presents with sudden, severe, tearing chest pain
radiating to the back. Blood pressure is 160/90 in the right arm and 130/70 in the left
arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection presents with sudden, severe tearing chest pain, often
radiating to the back, with pulse or blood pressure differential between arms. This is a
medical emergency requiring immediate imaging (CT angiography).
Question 2
A 28-year-old woman reports three episodes of pelvic pain, fever, and dyspareunia over
the past 6 months. She has a history of chlamydia. Bimanual exam reveals cervical
motion tenderness and adnexal tenderness. What is the most appropriate next step?
A. Oral doxycycline alone
B. Intramuscular ceftriaxone plus oral doxycycline
,C. Outpatient observation
D. Referral for laparoscopy
Correct Answer: B
Rationale: This is pelvic inflammatory disease (PID). CDC guidelines recommend IM
ceftriaxone 500 mg plus oral doxycycline 100 mg BID for 14 days. Metronidazole is often
added. Hospitalization is indicated for pregnancy, severe illness, or failure of outpatient
therapy.
Question 3
A 72-year-old male with type 2 diabetes and CKD stage 3 presents with a foot ulcer on
the plantar surface. The wound is 2 cm, deep to fascia, with purulent drainage. There is
erythema extending 3 cm proximally. The patient is afebrile. What is the most
appropriate management?
A. Oral amoxicillin-clavulanate and outpatient wound care
B. Surgical debridement and IV antibiotics
C. Topical silver dressing and close follow-up
D. Offloading with a total contact cast
Correct Answer: B
Rationale: This is a deep foot ulcer with cellulitis, in a diabetic patient. Presence of
purulence, depth to fascia, and diabetes with CKD warrants hospitalization for IV
antibiotics and surgical debridement to prevent osteomyelitis and amputation.
Question 4
A 45-year-old woman has a blood pressure of 148/92 mmHg on three separate
occasions. She has no other medical issues. What is the first-line medication for
,hypertension in a non-Black patient without compelling indications?
A. Hydrochlorothiazide
B. Lisinopril
C. Amlodipine
D. Metoprolol
Correct Answer: B
Rationale: For non-Black patients with hypertension, first-line agents include ACE
inhibitors (lisinopril), ARBs, CCBs, or thiazides. ACE inhibitors are often preferred due to
cardiovascular and renal protective effects, especially in younger patients.
Question 5
A 65-year-old male with a 40-pack-year smoking history reports a chronic cough with
hemoptysis and weight loss. Chest X-ray shows a right hilar mass. What is the most
appropriate next step?
A. Sputum cytology
B. CT chest with contrast
C. PET scan
D. Bronchoscopy with biopsy
Correct Answer: B
Rationale: After an abnormal chest X-ray suggesting lung cancer, the next step is
contrast-enhanced CT chest to better characterize the mass and guide biopsy.
Bronchoscopy or biopsy follows based on CT findings.
Question 6
A 30-year-old woman presents with painful menstrual periods that began 2 years ago
, and have progressively worsened. She also reports dyspareunia and chronic pelvic pain.
What is the most likely diagnosis?
A. Primary dysmenorrhea
B. Endometriosis
C. Pelvic adhesions
D. Ovarian cyst
Correct Answer: B
Rationale: Progressive dysmenorrhea, dyspareunia, and chronic pelvic pain are classic for
endometriosis. Diagnosis is often clinical; laparoscopy is gold standard. Primary
dysmenorrhea begins soon after menarche and is not progressive.
Question 7
A 68-year-old woman with osteoporosis presents with acute onset of severe low back
pain after bending to pick up a grocery bag. She is unable to stand. What is the most
appropriate initial imaging?
A. Plain X-ray of lumbosacral spine
B. MRI spine without contrast
C. CT myelogram
D. Bone scan
Correct Answer: A
Rationale: Suspected vertebral compression fracture in an osteoporotic patient. Plain X-
ray is first-line to confirm fracture. MRI is indicated if neurologic deficits or suspicion of
malignancy.
