NURS 5433 FNP II Midterm (PDF) | (2026) Family
Nurse Practitioner Questions | FNP
Question 1
A 58-year-old male with hypertension and type 2
diabetes presents with sudden onset tearing chest pain
radiating to the interscapular region. BP is 160/100 in
the right arm and 90/60 in the left arm. What is the most
appropriate next step?
A) Administer thrombolytics
B) STAT chest CT angiography
C) Obtain serial troponins
D) Start heparin drip
Correct Answer: B
Rationale: The blood pressure differential (160/100 vs
90/60) and tearing pain suggest acute aortic dissection.
CT angiography is the definitive imaging study.
Thrombolytics (A) and heparin (D) are contraindicated as
1
,they worsen bleeding. Troponins (C) may be elevated but
delay life-saving diagnosis.
Question 2
A 72-year-old with heart failure with reduced ejection
fraction (HFrEF, EF 30%) presents with worsening dyspnea,
JVD, and +3 pitting edema. Creatinine is 1.9 mg/dL
(baseline 1.0). Which medication should be held?
A) Spironolactone
B) Furosemide
C) Carvedilol
D) Sacubitril/valsartan
Correct Answer: A
Rationale: Spironolactone (aldosterone antagonist) can
worsen acute kidney injury and cause life-threatening
hyperkalemia. Furosemide (B) is needed for volume
overload. Carvedilol (C) and sacubitril/valsartan (D) are
continued unless hypotensive or bradycardic.
2
,Question 3
Which ECG finding is most specific for acute pericarditis?
A) Diffuse ST elevation
B) ST depression in leads V2-V3
C) PR segment depression
D) Pathologic Q waves
Correct Answer: C
Rationale: PR segment depression is an early, highly
specific finding in acute pericarditis due to atrial
inflammation. Diffuse ST elevation (A) is classic but less
specific (can occur in early repolarization). ST depression
(B) suggests ischemia. Pathologic Q waves (D) indicate
prior myocardial infarction.
Question 4
A 45-year-old female has a BP of 152/96 mmHg on
three separate visits. She is not diabetic. According to the
3
, 2024 USPSTF guideline, what is the first-line screening
test for secondary hypertension?
A) Renal artery Doppler ultrasound
B) Plasma aldosterone/renin ratio
C) Serum creatinine and electrolytes
D) 24-hour urine cortisol
Correct Answer: C
Rationale: Basic metabolic panel (creatinine, electrolytes)
screens for renal disease and hypokalemia (suggesting
hyperaldosteronism). Aldosterone/renin ratio (B) is done
only if clinical clues exist (hypokalemia, resistant HTN).
Renal artery Doppler (A) if abdominal bruit or flash
pulmonary edema. Urine cortisol (D) for Cushing’s
syndrome (rare).
Question 5
A 68-year-old with symptomatic severe aortic stenosis
(valve area 0.8 cm², mean gradient 45 mmHg) is a
4
Nurse Practitioner Questions | FNP
Question 1
A 58-year-old male with hypertension and type 2
diabetes presents with sudden onset tearing chest pain
radiating to the interscapular region. BP is 160/100 in
the right arm and 90/60 in the left arm. What is the most
appropriate next step?
A) Administer thrombolytics
B) STAT chest CT angiography
C) Obtain serial troponins
D) Start heparin drip
Correct Answer: B
Rationale: The blood pressure differential (160/100 vs
90/60) and tearing pain suggest acute aortic dissection.
CT angiography is the definitive imaging study.
Thrombolytics (A) and heparin (D) are contraindicated as
1
,they worsen bleeding. Troponins (C) may be elevated but
delay life-saving diagnosis.
Question 2
A 72-year-old with heart failure with reduced ejection
fraction (HFrEF, EF 30%) presents with worsening dyspnea,
JVD, and +3 pitting edema. Creatinine is 1.9 mg/dL
(baseline 1.0). Which medication should be held?
A) Spironolactone
B) Furosemide
C) Carvedilol
D) Sacubitril/valsartan
Correct Answer: A
Rationale: Spironolactone (aldosterone antagonist) can
worsen acute kidney injury and cause life-threatening
hyperkalemia. Furosemide (B) is needed for volume
overload. Carvedilol (C) and sacubitril/valsartan (D) are
continued unless hypotensive or bradycardic.
2
,Question 3
Which ECG finding is most specific for acute pericarditis?
A) Diffuse ST elevation
B) ST depression in leads V2-V3
C) PR segment depression
D) Pathologic Q waves
Correct Answer: C
Rationale: PR segment depression is an early, highly
specific finding in acute pericarditis due to atrial
inflammation. Diffuse ST elevation (A) is classic but less
specific (can occur in early repolarization). ST depression
(B) suggests ischemia. Pathologic Q waves (D) indicate
prior myocardial infarction.
Question 4
A 45-year-old female has a BP of 152/96 mmHg on
three separate visits. She is not diabetic. According to the
3
, 2024 USPSTF guideline, what is the first-line screening
test for secondary hypertension?
A) Renal artery Doppler ultrasound
B) Plasma aldosterone/renin ratio
C) Serum creatinine and electrolytes
D) 24-hour urine cortisol
Correct Answer: C
Rationale: Basic metabolic panel (creatinine, electrolytes)
screens for renal disease and hypokalemia (suggesting
hyperaldosteronism). Aldosterone/renin ratio (B) is done
only if clinical clues exist (hypokalemia, resistant HTN).
Renal artery Doppler (A) if abdominal bruit or flash
pulmonary edema. Urine cortisol (D) for Cushing’s
syndrome (rare).
Question 5
A 68-year-old with symptomatic severe aortic stenosis
(valve area 0.8 cm², mean gradient 45 mmHg) is a
4
