NRNP 6568 FINAL EXAM NEWEST 2025 TEST BANK|
SYNTHESIS IN ADVANCED NURSING PRACTICE OF
PATIENT IN FAMILY CARE FINAL EXAM REVIEW WITH
300 ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ GRADED A+ (BRAND NEW!!)
1. A family nurse practitioner (FNP) is caring for a 58-year-old
male with hypertension, type 2 diabetes, and stage 3 chronic
kidney disease. Which medication class should be used with
caution due to risk of further renal decline?
A) ACE inhibitors
B) Metformin
C) NSAIDs
D) GLP-1 agonists
Answer: C) NSAIDs
Rationale: NSAIDs reduce renal prostaglandin-mediated
vasodilation, decreasing glomerular filtration rate (GFR). They
are contraindicated in advanced CKD. ACE inhibitors/ARBs are
renoprotective. Metformin is renally cleared but not directly
nephrotoxic; GLP-1 agonists are generally safe.
1
,2. A 72-year-old female with heart failure with preserved
ejection fraction (HFpEF) presents with worsening dyspnea, JVD,
and bilateral pitting edema. Which diuretic regimen is most
appropriate initially?
A) Hydrochlorothiazide 25 mg daily
B) Furosemide 40 mg IV
C) Spironolactone 25 mg daily
D) Metolazone 5 mg daily
Answer: B) Furosemide 40 mg IV
Rationale: IV loop diuretics (furosemide, bumetanide, torsemide)
are first-line for acute decompensated HFpEF with volume
overload. Thiazides (HCTZ) are for mild hypertension;
spironolactone is adjunctive; metolazone is added for diuretic
resistance.
3. According to USPSTF guidelines, which screening test is
recommended for cervical cancer in a 28-year-old woman with
no prior abnormal Pap tests?
2
, A) HPV testing alone every 5 years
B) Pap smear alone every 3 years
C) Co-testing (Pap + HPV) every 5 years
D) No screening needed until age 30
Answer: B) Pap smear alone every 3 years
Rationale: USPSTF (2018) recommends cervical cancer screening
with Pap test alone every 3 years for women aged 21–29. HPV
testing is too sensitive in this age group (high transient infection
rate). Co-testing starts at age 30 every 5 years.
4. A 45-year-old male with depression has been on sertraline
150 mg daily for 8 weeks with minimal improvement. He denies
suicidal ideation. What is the next best step?
A) Increase sertraline to 200 mg
B) Switch to bupropion
C) Augment with aripiprazole
D) Add thyroid hormone (T3)
Answer: C) Augment with aripiprazole
Rationale: For inadequate response to an SSRI at therapeutic
3
, dose, augmentation with aripiprazole (lowest dose 2–5 mg) is
FDA-approved for treatment-resistant depression. Increasing
beyond 150 mg is unlikely to help. Bupropion is an alternative
switch, not first-line augmentation. T3 augmentation is less
evidence-based.
5. An FNP is managing a 67-year-old with COPD (GOLD group
E). Which maintenance therapy is recommended to reduce
exacerbations?
A) Albuterol PRN only
B) LAMA monotherapy
C) LABA + ICS + LAMA triple therapy
D) Theophylline
Answer: C) LABA + ICS + LAMA triple therapy
Rationale: GOLD 2025 guidelines recommend triple therapy
(LABA/LAMA/ICS) for patients with frequent exacerbations
(≥2/year) or blood eosinophils ≥300. Albuterol PRN is
insufficient; LAMA alone is for less severe disease; theophylline is
third-line.
4
SYNTHESIS IN ADVANCED NURSING PRACTICE OF
PATIENT IN FAMILY CARE FINAL EXAM REVIEW WITH
300 ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ GRADED A+ (BRAND NEW!!)
1. A family nurse practitioner (FNP) is caring for a 58-year-old
male with hypertension, type 2 diabetes, and stage 3 chronic
kidney disease. Which medication class should be used with
caution due to risk of further renal decline?
A) ACE inhibitors
B) Metformin
C) NSAIDs
D) GLP-1 agonists
Answer: C) NSAIDs
Rationale: NSAIDs reduce renal prostaglandin-mediated
vasodilation, decreasing glomerular filtration rate (GFR). They
are contraindicated in advanced CKD. ACE inhibitors/ARBs are
renoprotective. Metformin is renally cleared but not directly
nephrotoxic; GLP-1 agonists are generally safe.
1
,2. A 72-year-old female with heart failure with preserved
ejection fraction (HFpEF) presents with worsening dyspnea, JVD,
and bilateral pitting edema. Which diuretic regimen is most
appropriate initially?
A) Hydrochlorothiazide 25 mg daily
B) Furosemide 40 mg IV
C) Spironolactone 25 mg daily
D) Metolazone 5 mg daily
Answer: B) Furosemide 40 mg IV
Rationale: IV loop diuretics (furosemide, bumetanide, torsemide)
are first-line for acute decompensated HFpEF with volume
overload. Thiazides (HCTZ) are for mild hypertension;
spironolactone is adjunctive; metolazone is added for diuretic
resistance.
3. According to USPSTF guidelines, which screening test is
recommended for cervical cancer in a 28-year-old woman with
no prior abnormal Pap tests?
2
, A) HPV testing alone every 5 years
B) Pap smear alone every 3 years
C) Co-testing (Pap + HPV) every 5 years
D) No screening needed until age 30
Answer: B) Pap smear alone every 3 years
Rationale: USPSTF (2018) recommends cervical cancer screening
with Pap test alone every 3 years for women aged 21–29. HPV
testing is too sensitive in this age group (high transient infection
rate). Co-testing starts at age 30 every 5 years.
4. A 45-year-old male with depression has been on sertraline
150 mg daily for 8 weeks with minimal improvement. He denies
suicidal ideation. What is the next best step?
A) Increase sertraline to 200 mg
B) Switch to bupropion
C) Augment with aripiprazole
D) Add thyroid hormone (T3)
Answer: C) Augment with aripiprazole
Rationale: For inadequate response to an SSRI at therapeutic
3
, dose, augmentation with aripiprazole (lowest dose 2–5 mg) is
FDA-approved for treatment-resistant depression. Increasing
beyond 150 mg is unlikely to help. Bupropion is an alternative
switch, not first-line augmentation. T3 augmentation is less
evidence-based.
5. An FNP is managing a 67-year-old with COPD (GOLD group
E). Which maintenance therapy is recommended to reduce
exacerbations?
A) Albuterol PRN only
B) LAMA monotherapy
C) LABA + ICS + LAMA triple therapy
D) Theophylline
Answer: C) LABA + ICS + LAMA triple therapy
Rationale: GOLD 2025 guidelines recommend triple therapy
(LABA/LAMA/ICS) for patients with frequent exacerbations
(≥2/year) or blood eosinophils ≥300. Albuterol PRN is
insufficient; LAMA alone is for less severe disease; theophylline is
third-line.
4
