1|Page
NURS 5434 FNP III FINAL EXAM – 300
QUESTIONS & ANSWERS UNIVERSITY OF
TEXAS AT ARLINGTON | 2026–2027 EDITION |
FNP CERTIFICATION PREP
SECTION 1 – CARDIOVASCULAR DISORDERS (35 Questions)
**Question 1.**
A 68-year-old patient with heart failure with reduced ejection fraction
(HFrEF, EF 30%) is taking lisinopril, carvedilol, and spironolactone. BP
105/65, HR 62. She denies dizziness but reports ongoing dyspnea on
exertion. According to updated ACC/AHA guidelines, what is the most
appropriate next pharmacologic addition?
A) Add amlodipine
B) Add digoxin
C) **Add an SGLT2 inhibitor (dapagliflozin or empagliflozin)**
D) Add hydralazine/isosorbide dinitrate only if African American
**Answer: C**
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**Rationale:** The four pillars of HFrEF GDMT are: ACEi/ARNi, beta-
blocker, aldosterone antagonist, and SGLT2 inhibitor. SGLT2 inhibitors
reduce HF hospitalizations and CV mortality regardless of diabetes
status.
---
**Question 2.**
A 72-year-old man has 3 months of progressive dyspnea on exertion,
orthopnea, and leg edema. Echocardiogram: LVEF 60%, left atrial
enlargement, concentric LV hypertrophy. What is the primary
pathophysiologic defect, and which medication class should be avoided?
A) Systolic dysfunction; avoid beta-blockers
B) **Diastolic dysfunction (HFpEF); avoid non-dihydropyridine CCBs
(diltiazem, verapamil)**
C) Right heart failure; avoid ACE inhibitors
D) Restrictive cardiomyopathy; avoid loop diuretics
**Answer: B**
**Rationale:** HFpEF is caused by stiff, noncompliant ventricles. Non-
dihydropyridine CCBs have negative inotropic effects and can worsen
diastolic dysfunction.
,3|Page
---
**Question 3.**
A patient with atrial fibrillation and CHA₂DS₂‑VASc score 4 is on
apixaban. He falls and has a large forehead hematoma. Vital signs stable,
head CT negative. What is the most appropriate management?
A) **Hold apixaban 24–48 hours, then resume**
B) Reverse with andexanet alfa immediately
C) Discontinue apixaban permanently
D) Switch to warfarin
**Answer: A**
**Rationale:** With non‑life‑threatening bleeding and no intracranial
hemorrhage, temporary interruption (24–48 hours) is safe. Andexanet is
reserved for life‑threatening or intracranial bleeding.
---
**Question 4.**
A 55-year-old man with hypertension presents with sudden, severe
tearing chest pain radiating to the back. BP 160/90 in right arm, 130/70
in left arm. Most likely diagnosis?
, 4|Page
A) Acute MI
B) Pulmonary embolism
C) **Aortic dissection**
D) Pericarditis
**Answer: C**
**Rationale:** Aortic dissection presents with tearing pain and
pulse/blood pressure differential between arms. It is a medical
emergency requiring immediate CT angiography.
---
**Question 5.**
A 45-year-old non‑Black patient has BP 148/92 mm Hg on three
occasions with no other medical issues. First‑line antihypertensive?
A) Hydrochlorothiazide
B) **Lisinopril (ACE inhibitor)**
C) Amlodipine
D) Metoprolol
**Answer: B**
NURS 5434 FNP III FINAL EXAM – 300
QUESTIONS & ANSWERS UNIVERSITY OF
TEXAS AT ARLINGTON | 2026–2027 EDITION |
FNP CERTIFICATION PREP
SECTION 1 – CARDIOVASCULAR DISORDERS (35 Questions)
**Question 1.**
A 68-year-old patient with heart failure with reduced ejection fraction
(HFrEF, EF 30%) is taking lisinopril, carvedilol, and spironolactone. BP
105/65, HR 62. She denies dizziness but reports ongoing dyspnea on
exertion. According to updated ACC/AHA guidelines, what is the most
appropriate next pharmacologic addition?
A) Add amlodipine
B) Add digoxin
C) **Add an SGLT2 inhibitor (dapagliflozin or empagliflozin)**
D) Add hydralazine/isosorbide dinitrate only if African American
**Answer: C**
,2|Page
**Rationale:** The four pillars of HFrEF GDMT are: ACEi/ARNi, beta-
blocker, aldosterone antagonist, and SGLT2 inhibitor. SGLT2 inhibitors
reduce HF hospitalizations and CV mortality regardless of diabetes
status.
---
**Question 2.**
A 72-year-old man has 3 months of progressive dyspnea on exertion,
orthopnea, and leg edema. Echocardiogram: LVEF 60%, left atrial
enlargement, concentric LV hypertrophy. What is the primary
pathophysiologic defect, and which medication class should be avoided?
A) Systolic dysfunction; avoid beta-blockers
B) **Diastolic dysfunction (HFpEF); avoid non-dihydropyridine CCBs
(diltiazem, verapamil)**
C) Right heart failure; avoid ACE inhibitors
D) Restrictive cardiomyopathy; avoid loop diuretics
**Answer: B**
**Rationale:** HFpEF is caused by stiff, noncompliant ventricles. Non-
dihydropyridine CCBs have negative inotropic effects and can worsen
diastolic dysfunction.
,3|Page
---
**Question 3.**
A patient with atrial fibrillation and CHA₂DS₂‑VASc score 4 is on
apixaban. He falls and has a large forehead hematoma. Vital signs stable,
head CT negative. What is the most appropriate management?
A) **Hold apixaban 24–48 hours, then resume**
B) Reverse with andexanet alfa immediately
C) Discontinue apixaban permanently
D) Switch to warfarin
**Answer: A**
**Rationale:** With non‑life‑threatening bleeding and no intracranial
hemorrhage, temporary interruption (24–48 hours) is safe. Andexanet is
reserved for life‑threatening or intracranial bleeding.
---
**Question 4.**
A 55-year-old man with hypertension presents with sudden, severe
tearing chest pain radiating to the back. BP 160/90 in right arm, 130/70
in left arm. Most likely diagnosis?
, 4|Page
A) Acute MI
B) Pulmonary embolism
C) **Aortic dissection**
D) Pericarditis
**Answer: C**
**Rationale:** Aortic dissection presents with tearing pain and
pulse/blood pressure differential between arms. It is a medical
emergency requiring immediate CT angiography.
---
**Question 5.**
A 45-year-old non‑Black patient has BP 148/92 mm Hg on three
occasions with no other medical issues. First‑line antihypertensive?
A) Hydrochlorothiazide
B) **Lisinopril (ACE inhibitor)**
C) Amlodipine
D) Metoprolol
**Answer: B**
