Premium
PDF
PDF
Download Download
EXAMS
(2026) High-Yield Questions | FNP Study (PDF) | Questions & Answers
(Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Prep Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam Prep (2026) High-Yield Questions | FNP
Study (PDF) - 2026/2027 Update
Page 1
,Question 1
A 42-year-old presents with acute onset of severe, colicky right flank pain radiating to the groin,
associated with nausea and hematuria. Urinalysis shows pH 6.0, specific gravity 1.030, and
numerous red blood cells. CT scan reveals a 5 mm radiopaque stone at the ureterovesical junction.
Which metabolic abnormality is most likely contributing to stone formation in this individual?
A) Hypercalciuria due to primary hyperparathyroidism
B) Hyperuricosuria due to high purine intake
C) Hypocitraturia due to metabolic acidosis
D) Hyperoxaluria due to enteric hyperoxaluria
Answer: A) Hypercalciuria due to primary hyperparathyroidism
Explanation: Radiopaque stones are typically calcium oxalate or calcium phosphate. The most
common cause is hypercalciuria, often from primary hyperparathyroidism.
Hyperuricosuria produces radiolucent stones. Hypocitraturia and hyperoxaluria are less
common and not the leading cause.
Question 2
A patient with type 2 diabetes has an HbA1c of 8.5% despite metformin and lifestyle changes.
Estimated glomerular filtration rate (eGFR) is 55 mL/min/1.73m². Which of the following adds a
second agent that provides cardiovascular benefit and reduces progression of diabetic kidney
disease?
A) Glipizide
B) Sitagliptin
C) Empagliflozin
D) Insulin glargine
Answer: C) Empagliflozin
Explanation: SGLT2 inhibitors like empagliflozin have proven cardiovascular and renal protective
effects in patients with type 2 diabetes and CKD. Glipizide (sulfonylurea) and sitagliptin
(DPP-4 inhibitor) do not confer such benefits. Insulin is effective but not specifically
renal-protective.
Page 2
,Question 3
A 55-year-old with hypertension and chronic kidney disease (stage 3) is being treated with
lisinopril 20 mg daily. Three months later, serum creatinine rises from 1.2 to 1.6 mg/dL and
potassium is 5.6 mEq/L. Which of the following is the most appropriate next step?
A) Continue lisinopril and add a loop diuretic
B) Discontinue lisinopril and start amlodipine
C) Reduce lisinopril to 10 mg and add hydrochlorothiazide
D) Discontinue lisinopril and start an angiotensin receptor blocker
Answer: B) Discontinue lisinopril and start amlodipine
Explanation: Hyperkalemia (5.6 mEq/L) with rising creatinine indicates ACE inhibitor-induced renal
impairment. Discontinuation is warranted. Amlodipine is a safe alternative without
renin-angiotensin system effects. Reducing dose or switching to ARB may not resolve
hyperkalemia; thiazides are less effective in stage 3 CKD.
Question 4
A patient presents with acute onset of vertigo, nausea, and nystagmus lasting 6 hours. Audiometry
is normal. Dix-Hallpike maneuver reproduces vertigo with torsional nystagmus. Which of the
following best explains the pathophysiology?
A) Viral inflammation of the vestibular nerve
B) Ischemia of the posterior inferior cerebellar artery
C) Dislodged otoconia moving within a semicircular canal
D) Increased endolymph pressure due to endolymphatic hydrops
Answer: C) Dislodged otoconia moving within a semicircular canal
Explanation: The scenario describes benign paroxysmal positional vertigo (BPPV), where otoconia
migrate into a semicircular canal, causing inappropriate endolymph movement with
head position changes. Vestibular neuritis (A) causes prolonged vertigo without
positional triggers. Cerebellar stroke (B) would have other neurologic signs. Meniere's
(D) includes hearing loss and tinnitus.
Page 3
, Question 5
A 30-year-old presents with painful urination and purulent urethral discharge. Gram stain shows
intracellular gram-negative diplococci. The patient reports a single sexual partner in the past
month. Which of the following is the most appropriate empiric treatment?
A) Ceftriaxone 250 mg IM once plus azithromycin 1 g orally once
B) Ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 7 days
C) Cefixime 400 mg orally once plus azithromycin 1 g orally once
D) Azithromycin 2 g orally once alone
Answer: A) Ceftriaxone 250 mg IM once plus azithromycin 1 g orally once
Explanation: The presentation is classic for gonorrhea. Current CDC guidelines recommend
ceftriaxone 250 mg IM plus azithromycin 1 g orally for uncomplicated gonococcal
infection. Ceftriaxone 500 mg is for complicated or pharyngeal infections. Doxycycline
is not first-line for gonorrhea. Azithromycin monotherapy is not recommended due to
resistance.
Question 6
A 65-year-old with COPD (GOLD stage 3) has had increasing dyspnea and cough with purulent
sputum for 3 days. Temperature is 38.5°C, respiratory rate 24, oxygen saturation 89% on room air.
Chest X-ray shows no consolidation. Which of the following is the most appropriate initial
antibiotic?
A) Azithromycin
B) Amoxicillin-clavulanate
C) Levofloxacin
D) Trimethoprim-sulfamethoxazole
Answer: C) Levofloxacin
Explanation: This is an acute exacerbation of COPD (AECOPD) with purulent sputum and fever,
indicating a bacterial etiology. Guidelines recommend respiratory fluoroquinolones
(levofloxacin, moxifloxacin) for severe exacerbations or in patients with FEV1 < 50%
predicted (GOLD stage 3). Azithromycin is an alternative but less potent against
Pseudomonas. Amoxicillin-clavulanate is for moderate exacerbations. TMP-SMX has
poor respiratory coverage.
Page 4
Download Download
EXAMS
(2026) High-Yield Questions | FNP Study (PDF) | Questions & Answers
(Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Prep Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam Prep (2026) High-Yield Questions | FNP
Study (PDF) - 2026/2027 Update
Page 1
,Question 1
A 42-year-old presents with acute onset of severe, colicky right flank pain radiating to the groin,
associated with nausea and hematuria. Urinalysis shows pH 6.0, specific gravity 1.030, and
numerous red blood cells. CT scan reveals a 5 mm radiopaque stone at the ureterovesical junction.
Which metabolic abnormality is most likely contributing to stone formation in this individual?
A) Hypercalciuria due to primary hyperparathyroidism
B) Hyperuricosuria due to high purine intake
C) Hypocitraturia due to metabolic acidosis
D) Hyperoxaluria due to enteric hyperoxaluria
Answer: A) Hypercalciuria due to primary hyperparathyroidism
Explanation: Radiopaque stones are typically calcium oxalate or calcium phosphate. The most
common cause is hypercalciuria, often from primary hyperparathyroidism.
Hyperuricosuria produces radiolucent stones. Hypocitraturia and hyperoxaluria are less
common and not the leading cause.
Question 2
A patient with type 2 diabetes has an HbA1c of 8.5% despite metformin and lifestyle changes.
Estimated glomerular filtration rate (eGFR) is 55 mL/min/1.73m². Which of the following adds a
second agent that provides cardiovascular benefit and reduces progression of diabetic kidney
disease?
A) Glipizide
B) Sitagliptin
C) Empagliflozin
D) Insulin glargine
Answer: C) Empagliflozin
Explanation: SGLT2 inhibitors like empagliflozin have proven cardiovascular and renal protective
effects in patients with type 2 diabetes and CKD. Glipizide (sulfonylurea) and sitagliptin
(DPP-4 inhibitor) do not confer such benefits. Insulin is effective but not specifically
renal-protective.
Page 2
,Question 3
A 55-year-old with hypertension and chronic kidney disease (stage 3) is being treated with
lisinopril 20 mg daily. Three months later, serum creatinine rises from 1.2 to 1.6 mg/dL and
potassium is 5.6 mEq/L. Which of the following is the most appropriate next step?
A) Continue lisinopril and add a loop diuretic
B) Discontinue lisinopril and start amlodipine
C) Reduce lisinopril to 10 mg and add hydrochlorothiazide
D) Discontinue lisinopril and start an angiotensin receptor blocker
Answer: B) Discontinue lisinopril and start amlodipine
Explanation: Hyperkalemia (5.6 mEq/L) with rising creatinine indicates ACE inhibitor-induced renal
impairment. Discontinuation is warranted. Amlodipine is a safe alternative without
renin-angiotensin system effects. Reducing dose or switching to ARB may not resolve
hyperkalemia; thiazides are less effective in stage 3 CKD.
Question 4
A patient presents with acute onset of vertigo, nausea, and nystagmus lasting 6 hours. Audiometry
is normal. Dix-Hallpike maneuver reproduces vertigo with torsional nystagmus. Which of the
following best explains the pathophysiology?
A) Viral inflammation of the vestibular nerve
B) Ischemia of the posterior inferior cerebellar artery
C) Dislodged otoconia moving within a semicircular canal
D) Increased endolymph pressure due to endolymphatic hydrops
Answer: C) Dislodged otoconia moving within a semicircular canal
Explanation: The scenario describes benign paroxysmal positional vertigo (BPPV), where otoconia
migrate into a semicircular canal, causing inappropriate endolymph movement with
head position changes. Vestibular neuritis (A) causes prolonged vertigo without
positional triggers. Cerebellar stroke (B) would have other neurologic signs. Meniere's
(D) includes hearing loss and tinnitus.
Page 3
, Question 5
A 30-year-old presents with painful urination and purulent urethral discharge. Gram stain shows
intracellular gram-negative diplococci. The patient reports a single sexual partner in the past
month. Which of the following is the most appropriate empiric treatment?
A) Ceftriaxone 250 mg IM once plus azithromycin 1 g orally once
B) Ceftriaxone 500 mg IM once plus doxycycline 100 mg BID for 7 days
C) Cefixime 400 mg orally once plus azithromycin 1 g orally once
D) Azithromycin 2 g orally once alone
Answer: A) Ceftriaxone 250 mg IM once plus azithromycin 1 g orally once
Explanation: The presentation is classic for gonorrhea. Current CDC guidelines recommend
ceftriaxone 250 mg IM plus azithromycin 1 g orally for uncomplicated gonococcal
infection. Ceftriaxone 500 mg is for complicated or pharyngeal infections. Doxycycline
is not first-line for gonorrhea. Azithromycin monotherapy is not recommended due to
resistance.
Question 6
A 65-year-old with COPD (GOLD stage 3) has had increasing dyspnea and cough with purulent
sputum for 3 days. Temperature is 38.5°C, respiratory rate 24, oxygen saturation 89% on room air.
Chest X-ray shows no consolidation. Which of the following is the most appropriate initial
antibiotic?
A) Azithromycin
B) Amoxicillin-clavulanate
C) Levofloxacin
D) Trimethoprim-sulfamethoxazole
Answer: C) Levofloxacin
Explanation: This is an acute exacerbation of COPD (AECOPD) with purulent sputum and fever,
indicating a bacterial etiology. Guidelines recommend respiratory fluoroquinolones
(levofloxacin, moxifloxacin) for severe exacerbations or in patients with FEV1 < 50%
predicted (GOLD stage 3). Azithromycin is an alternative but less potent against
Pseudomonas. Amoxicillin-clavulanate is for moderate exacerbations. TMP-SMX has
poor respiratory coverage.
Page 4
