NURS 5433 | FNP II
OBJECTIVE ASSESSMENT -- EXAM
NURS 5433 MIDTERM FNP II Midterm Exam
Bank (2026/2027), Questions & Answers
(Verified Answers) With Detailed Rationales
|| Complete A+ Guide - UTA
Family Nurse Practitioner Primary Care II
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disease Management in Gastrointestinal, Hepatic, and Renal
Primary Care Disease
Endocrine and Metabolic Disorder Musculoskeletal and Integumentary
Management Conditions
Pulmonary and HEENT Clinical Differential Diagnosis and
Reasoning Evidence-Based Practice
COVER PAGE - 1
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 1
, SECTION 1 | Cardiovascular and Hematologic Disorders | Q1-Q20 | NURS 5433 MIDTERM FNP II Midterm Exam Bank (2026/2027),
Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA 2026/2027
Q1 Question 1 of 100
A 62-year-old man with a history of hypertension and hyperlipidemia presents with substernal chest
pressure that occurs predictably when he climbs two flights of stairs and resolves within five minutes of
rest. His vital signs are BP 148/92 mmHg, HR 78 bpm, and SpO2 98%. Resting ECG is normal. Which
next step is most appropriate?
A. Schedule an exercise stress test
B. Prescribe sublingual nitroglycerin and re-evaluate in four weeks
C. Refer immediately for coronary angiography
D. Start a calcium channel blocker and reassess in three months
Correct Answer: A
Rationale:
Predictable, exertional chest discomfort relieved by rest is classic stable angina. In a patient with intermediate pretest
probability of coronary artery disease and a normal resting ECG, an exercise stress test is the appropriate noninvasive
next step to identify inducible ischemia. Immediate angiography is reserved for high-risk features, and empirical
medication without diagnostic confirmation delays correct therapy.
Q2 Question 2 of 100
A 71-year-old woman presents with palpitations and intermittent lightheadedness for two weeks. ECG
shows an irregularly irregular rhythm with no discrete P waves and a ventricular rate of 132 bpm. She
has no history of heart failure, valvular disease, or thyroid disease. Her CHA2DS2-VASc score is 4.
What is the most appropriate initial management?
A. Begin apixaban and schedule cardioversion in four weeks
B. Order a transesophageal echocardiogram before any therapy decision
C. Begin amiodarone loading and discharge with cardiology follow-up in six weeks
D. Begin rate control with a beta blocker and start oral anticoagulation
Correct Answer: D
Rationale:
New atrial fibrillation with rapid ventricular response in a hemodynamically stable patient is managed with rate control
and stroke prevention. With a CHA2DS2-VASc of 4, anticoagulation is clearly indicated, and a beta blocker is a first-line
rate control agent in the absence of heart failure or severe asthma. Cardioversion is not first-line for asymptomatic new
AFib of uncertain duration without TEE confirmation, and amiodarone is not appropriate initial therapy.
Q3 Question 3 of 100
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 2
, A 68-year-old man with an ejection fraction of 28% presents with increasing dyspnea on exertion,
two-pillow orthopnea, and 5 lb weight gain over the past week. Lungs show bibasilar crackles, JVP is
elevated, and there is 2+ pitting edema to the mid-calf. Which medication regimen, in addition to a
low-sodium diet, has the strongest evidence for reducing mortality in his condition?
A. Loop diuretic plus a calcium channel blocker
B. ACE inhibitor, beta blocker, and mineralocorticoid receptor antagonist
C. Hydralazine plus isosorbide dinitrate as initial triple therapy
D. Digoxin plus an ARB for symptom-driven decongestion
Correct Answer: B
Rationale:
Guideline-directed medical therapy for HFrEF with an EF under 40% includes an ACE inhibitor (or ARB/ARNI), an
evidence-based beta blocker (carvedilol, metoprolol succinate, bisoprolol), and a mineralocorticoid receptor antagonist,
all of which reduce mortality. Loop diuretics improve congestion but do not reduce mortality. Hydralazine-isosorbide
dinitrate is added later, especially in Black patients already on optimal therapy. Calcium channel blockers and digoxin do
not improve mortality.
Q4 Question 4 of 100
A 58-year-old woman with hypertension on lisinopril 40 mg and amlodipine 10 mg has an average home
BP of 158/96 mmHg confirmed on multiple readings. She denies symptoms. Labs including creatinine
and potassium are normal, and her medication adherence is confirmed. What is the most appropriate
next adjustment?
A. Add a thiazide-like diuretic such as chlorthalidone
B. Switch lisinopril to losartan for better nighttime coverage
C. Add a beta blocker as the third agent
D. Increase amlodipine to 15 mg, which is the maximum dose
Correct Answer: A
Rationale:
Resistant hypertension on an ACE inhibitor and a dihydropyridine calcium channel blocker should be addressed by
adding a thiazide-like diuretic, most commonly chlorthalidone or indapamide, which improves BP control and has
cardiovascular outcome data. Switching ACE inhibitors within the same class is not effective. Beta blockers are not
first-line for uncomplicated resistant hypertension, and amlodipine is FDA-approved only up to 10 mg daily.
Q5 Question 5 of 100
Amplitude (mV, schematic)
Simplified ECG tracing (lead V3)
Time (seconds)
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 3
, A 64-year-old man develops severe substernal chest pressure with diaphoresis while shoveling snow.
In the emergency department, ECG shows 3 mm ST-segment elevation in leads V1 through V4.
Troponin is markedly elevated. He is hemodynamically stable. What is the most appropriate immediate
management?
A. Administer thrombolytics within 30 minutes if PCI is not available within 120 minutes
B. Schedule outpatient stress testing after troponin trends
C. Start high-dose statins only after a cardiac MRI confirms infarct size
D. Admit for observation and serial troponins over 24 hours
Correct Answer: A
Rationale:
ST-elevation myocardial infarction (STEMI) involving the anterior wall requires reperfusion as quickly as possible:
primary percutaneous coronary intervention is preferred when achievable within 90 minutes of first medical contact, and
fibrinolytic therapy is indicated when PCI cannot be performed within 120 minutes. Delaying reperfusion for stress
testing, MRI, or extended observation worsens myocardial salvage and outcomes.
Q6 Question 6 of 100
A 55-year-old woman with a long history of mitral valve prolapse presents with progressive dyspnea on
exertion and a holosystolic murmur at the apex radiating to the axilla. Echocardiogram shows severe
mitral regurgitation with a left ventricular ejection fraction of 58%. She is symptomatic despite optimal
medical therapy. What is the most appropriate next step?
A. Continue medical therapy and reassess in six months
B. Refer for mitral valve surgery evaluation
C. Begin sildenafil for afterload reduction
D. Order annual stress echocardiography and defer intervention
Correct Answer: B
Rationale:
Symptomatic severe primary mitral regurgitation with preserved left ventricular function is a Class I indication for mitral
valve surgery (repair preferred over replacement when feasible). Continued medical therapy without addressing the
mechanical lesion leads to progressive LV remodeling and heart failure. Sildenafil has no role in chronic primary MR
management.
Q7 Question 7 of 100
A 47-year-old woman with no known cardiovascular disease has a 10-year ASCVD risk of 7.8%. Her
LDL cholesterol is 142 mg/dL. She has no family history of premature CAD, no diabetes, and her BP is
well controlled. She is a non-smoker. What is the most appropriate recommendation?
A. Start a high-intensity statin because her 10-year risk is borderline
B. Focus on lifestyle modifications and reassess lipid panel in three to twelve months
C. Start a fibrate based on elevated LDL alone
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 4
OBJECTIVE ASSESSMENT -- EXAM
NURS 5433 MIDTERM FNP II Midterm Exam
Bank (2026/2027), Questions & Answers
(Verified Answers) With Detailed Rationales
|| Complete A+ Guide - UTA
Family Nurse Practitioner Primary Care II
100 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disease Management in Gastrointestinal, Hepatic, and Renal
Primary Care Disease
Endocrine and Metabolic Disorder Musculoskeletal and Integumentary
Management Conditions
Pulmonary and HEENT Clinical Differential Diagnosis and
Reasoning Evidence-Based Practice
COVER PAGE - 1
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 1
, SECTION 1 | Cardiovascular and Hematologic Disorders | Q1-Q20 | NURS 5433 MIDTERM FNP II Midterm Exam Bank (2026/2027),
Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA 2026/2027
Q1 Question 1 of 100
A 62-year-old man with a history of hypertension and hyperlipidemia presents with substernal chest
pressure that occurs predictably when he climbs two flights of stairs and resolves within five minutes of
rest. His vital signs are BP 148/92 mmHg, HR 78 bpm, and SpO2 98%. Resting ECG is normal. Which
next step is most appropriate?
A. Schedule an exercise stress test
B. Prescribe sublingual nitroglycerin and re-evaluate in four weeks
C. Refer immediately for coronary angiography
D. Start a calcium channel blocker and reassess in three months
Correct Answer: A
Rationale:
Predictable, exertional chest discomfort relieved by rest is classic stable angina. In a patient with intermediate pretest
probability of coronary artery disease and a normal resting ECG, an exercise stress test is the appropriate noninvasive
next step to identify inducible ischemia. Immediate angiography is reserved for high-risk features, and empirical
medication without diagnostic confirmation delays correct therapy.
Q2 Question 2 of 100
A 71-year-old woman presents with palpitations and intermittent lightheadedness for two weeks. ECG
shows an irregularly irregular rhythm with no discrete P waves and a ventricular rate of 132 bpm. She
has no history of heart failure, valvular disease, or thyroid disease. Her CHA2DS2-VASc score is 4.
What is the most appropriate initial management?
A. Begin apixaban and schedule cardioversion in four weeks
B. Order a transesophageal echocardiogram before any therapy decision
C. Begin amiodarone loading and discharge with cardiology follow-up in six weeks
D. Begin rate control with a beta blocker and start oral anticoagulation
Correct Answer: D
Rationale:
New atrial fibrillation with rapid ventricular response in a hemodynamically stable patient is managed with rate control
and stroke prevention. With a CHA2DS2-VASc of 4, anticoagulation is clearly indicated, and a beta blocker is a first-line
rate control agent in the absence of heart failure or severe asthma. Cardioversion is not first-line for asymptomatic new
AFib of uncertain duration without TEE confirmation, and amiodarone is not appropriate initial therapy.
Q3 Question 3 of 100
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 2
, A 68-year-old man with an ejection fraction of 28% presents with increasing dyspnea on exertion,
two-pillow orthopnea, and 5 lb weight gain over the past week. Lungs show bibasilar crackles, JVP is
elevated, and there is 2+ pitting edema to the mid-calf. Which medication regimen, in addition to a
low-sodium diet, has the strongest evidence for reducing mortality in his condition?
A. Loop diuretic plus a calcium channel blocker
B. ACE inhibitor, beta blocker, and mineralocorticoid receptor antagonist
C. Hydralazine plus isosorbide dinitrate as initial triple therapy
D. Digoxin plus an ARB for symptom-driven decongestion
Correct Answer: B
Rationale:
Guideline-directed medical therapy for HFrEF with an EF under 40% includes an ACE inhibitor (or ARB/ARNI), an
evidence-based beta blocker (carvedilol, metoprolol succinate, bisoprolol), and a mineralocorticoid receptor antagonist,
all of which reduce mortality. Loop diuretics improve congestion but do not reduce mortality. Hydralazine-isosorbide
dinitrate is added later, especially in Black patients already on optimal therapy. Calcium channel blockers and digoxin do
not improve mortality.
Q4 Question 4 of 100
A 58-year-old woman with hypertension on lisinopril 40 mg and amlodipine 10 mg has an average home
BP of 158/96 mmHg confirmed on multiple readings. She denies symptoms. Labs including creatinine
and potassium are normal, and her medication adherence is confirmed. What is the most appropriate
next adjustment?
A. Add a thiazide-like diuretic such as chlorthalidone
B. Switch lisinopril to losartan for better nighttime coverage
C. Add a beta blocker as the third agent
D. Increase amlodipine to 15 mg, which is the maximum dose
Correct Answer: A
Rationale:
Resistant hypertension on an ACE inhibitor and a dihydropyridine calcium channel blocker should be addressed by
adding a thiazide-like diuretic, most commonly chlorthalidone or indapamide, which improves BP control and has
cardiovascular outcome data. Switching ACE inhibitors within the same class is not effective. Beta blockers are not
first-line for uncomplicated resistant hypertension, and amlodipine is FDA-approved only up to 10 mg daily.
Q5 Question 5 of 100
Amplitude (mV, schematic)
Simplified ECG tracing (lead V3)
Time (seconds)
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 3
, A 64-year-old man develops severe substernal chest pressure with diaphoresis while shoveling snow.
In the emergency department, ECG shows 3 mm ST-segment elevation in leads V1 through V4.
Troponin is markedly elevated. He is hemodynamically stable. What is the most appropriate immediate
management?
A. Administer thrombolytics within 30 minutes if PCI is not available within 120 minutes
B. Schedule outpatient stress testing after troponin trends
C. Start high-dose statins only after a cardiac MRI confirms infarct size
D. Admit for observation and serial troponins over 24 hours
Correct Answer: A
Rationale:
ST-elevation myocardial infarction (STEMI) involving the anterior wall requires reperfusion as quickly as possible:
primary percutaneous coronary intervention is preferred when achievable within 90 minutes of first medical contact, and
fibrinolytic therapy is indicated when PCI cannot be performed within 120 minutes. Delaying reperfusion for stress
testing, MRI, or extended observation worsens myocardial salvage and outcomes.
Q6 Question 6 of 100
A 55-year-old woman with a long history of mitral valve prolapse presents with progressive dyspnea on
exertion and a holosystolic murmur at the apex radiating to the axilla. Echocardiogram shows severe
mitral regurgitation with a left ventricular ejection fraction of 58%. She is symptomatic despite optimal
medical therapy. What is the most appropriate next step?
A. Continue medical therapy and reassess in six months
B. Refer for mitral valve surgery evaluation
C. Begin sildenafil for afterload reduction
D. Order annual stress echocardiography and defer intervention
Correct Answer: B
Rationale:
Symptomatic severe primary mitral regurgitation with preserved left ventricular function is a Class I indication for mitral
valve surgery (repair preferred over replacement when feasible). Continued medical therapy without addressing the
mechanical lesion leads to progressive LV remodeling and heart failure. Sildenafil has no role in chronic primary MR
management.
Q7 Question 7 of 100
A 47-year-old woman with no known cardiovascular disease has a 10-year ASCVD risk of 7.8%. Her
LDL cholesterol is 142 mg/dL. She has no family history of premature CAD, no diabetes, and her BP is
well controlled. She is a non-smoker. What is the most appropriate recommendation?
A. Start a high-intensity statin because her 10-year risk is borderline
B. Focus on lifestyle modifications and reassess lipid panel in three to twelve months
C. Start a fibrate based on elevated LDL alone
5433 MIDTERM FNP II Midterm Exam Bank (2026/2027), Questions & Answers (Verified Answers) With Detailed Rationales || Complete A+ Guide - UTA -- 2026/2027 | Passing Score: 80% | Page 4
