1
NURS 5433 FNP II Midterm Exam Review
Family Nursing UTA Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Primary Care of Adults — Questions 1-25]
Q1: According to the ACC/AHA 2017 guidelines, what is the blood pressure goal for a non-
pregnant adult with hypertension and no other comorbidities?
A. <140/90 mmHg
B. <130/80 mmHg
C. <120/70 mmHg
D. <150/90 mmHg
B. <130/80 mmHg [CORRECT]
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines define hypertension as a BP of ≥130/80 mmHg and
establish a treatment goal of <130/80 mmHg for most adults to reduce the risk of cardiovascular
events. Previous guidelines (JNC 8) targeted <140/90 mmHg, but current evidence supports
stricter control for primary prevention. Goal <120/70 is for secondary prevention or high-risk
groups (like SPRINT trial) but the general primary prevention goal is <130/80.
Q2: A 55-year-old male with a history of hypertension presents with a blood pressure of 145/92
mmHg. He has no history of CKD or diabetes. According to ACC/AHA guidelines, which
medication class is considered an appropriate first-line therapy?
A. Beta-blocker
B. ACE Inhibitor
C. Thiazide diuretic
D. Alpha-blocker
C. Thiazide diuretic [CORRECT]
,2
Correct Answer: C
Rationale: First-line agents for uncomplicated hypertension include thiazide diuretics, calcium
channel blockers (CCBs), ACE inhibitors, or ARBs. However, in the general Black population or
non-Black patients without compelling comorbidities (like CKD or diabetes), thiazides and
CCBs are often preferred initial choices. Beta-blockers and alpha-blockers are not recommended
as first-line monotherapy for uncomplicated HTN.
Q3: A 45-year-old female is diagnosed with Type 2 Diabetes Mellitus with an HbA1c of 7.8%.
She has no contraindications. According to ADA standards, what is the first-line oral
pharmacologic agent?
A. Insulin
B. Sulfonylurea
C. Metformin
D. DPP-4 inhibitor
C. Metformin [CORRECT]
Correct Answer: C
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of Type 2
Diabetes Mellitus, provided it is not contraindicated (e.g., advanced CKD) and is tolerated. It is
effective, low-cost, weight-neutral, and has a strong cardiovascular safety profile. Insulin is
reserved for severe hyperglycemia or when HbA1c is >10%, while sulfonylureas carry a risk of
hypoglycemia and weight gain.
Q4: Which laboratory value is the primary screening test used to diagnose diabetes mellitus?
A. Random Blood Glucose ≥ 200 mg/dL
B. Hemoglobin A1c ≥ 6.5%
C. Fasting Plasma Glucose ≥ 126 mg/dL
D. All of the above are diagnostic criteria
D. All of the above are diagnostic criteria [CORRECT]
,3
Correct Answer: D
Rationale: The ADA accepts four criteria for the diagnosis of diabetes: Hemoglobin A1c ≥ 6.5%,
Fasting Plasma Glucose ≥ 126 mg/dL, 2-hour plasma glucose during OGTT ≥ 200 mg/dL, or
Random Plasma Glucose ≥ 200 mg/dL in a patient with classic symptoms. In the absence of
unequivocal hyperglycemia with classic symptoms, the test should be repeated to confirm the
diagnosis.
Q5: A patient with Type 2 Diabetes and established ASCVD is currently on Metformin. What
medication class should be added second-line to reduce cardiovascular mortality?
A. Sulfonylurea
B. GLP-1 Receptor Agonist or SGLT2 Inhibitor
C. Basal Insulin
D. Meglitinide
B. GLP-1 Receptor Agonist or SGLT2 Inhibitor [CORRECT]
Correct Answer: B
Rationale: For patients with Type 2 Diabetes and established ASCVD (or high risk for it), ADA
guidelines recommend adding a GLP-1 Receptor Agonist or SGLT2 Inhibitor with proven
cardiovascular benefit, regardless of HbA1c levels. These agents have been shown to reduce
major adverse cardiovascular events (MACE) and heart failure hospitalizations. Sulfonylureas
and meglitinides do not offer cardiovascular benefit and increase hypoglycemia risk.
Q6: A 40-year-old male presents for a routine exam. His lipid panel shows LDL 170 mg/dL,
HDL 40 mg/dL, and Triglycerides 150 mg/dL. His 10-year ASCVD risk score is calculated at
8%. What is the most appropriate intervention?
A. No medication, repeat lipid panel in 5 years.
B. Initiate moderate-intensity statin therapy.
C. Initiate high-intensity statin therapy.
D. Recommend niacin supplements.
B. Initiate moderate-intensity statin therapy. [CORRECT]
, 4
Correct Answer: B
Rationale: According to ACC/AHA guidelines, adults aged 40–75 with LDL 70–189 mg/dL and
a 10-year ASCVD risk of ≥7.5% should be started on a moderate-intensity statin. The patient's
risk of 8% places him in the category for statin therapy for primary prevention. High-intensity
statins are generally reserved for risk ≥20% or clinical ASCVD, while niacin is no longer
recommended due to lack of benefit and adverse effects.
Q7: What is the recommended LDL cholesterol goal for a patient with established clinical
ASCVD (secondary prevention)?
A. <100 mg/dL
B. <70 mg/dL
C. <130 mg/dL
D. <50 mg/dL
B. <70 mg/dL [CORRECT]
Correct Answer: B
Rationale: For patients with established ASCVD (Secondary Prevention), the 2018 ACC/AHA
cholesterol guidelines recommend a reduction in LDL-C of ≥50% and a goal of <70 mg/dL. In
very high-risk patients (multiple major events), the threshold may be lowered further to <55
mg/dL. The goal of <100 is outdated for modern aggressive management.
Q8: A 60-year-old patient presents with dyspnea on exertion and lower extremity edema. An
echocardiogram reveals an LVEF of 35%. What is the term for this condition?
A. Heart Failure with Preserved Ejection Fraction (HFpEF)
B. Heart Failure with Reduced Ejection Fraction (HFrEF)
C. Right-sided Heart Failure
D. Diastolic Dysfunction
B. Heart Failure with Reduced Ejection Fraction (HFrEF) [CORRECT]
NURS 5433 FNP II Midterm Exam Review
Family Nursing UTA Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Primary Care of Adults — Questions 1-25]
Q1: According to the ACC/AHA 2017 guidelines, what is the blood pressure goal for a non-
pregnant adult with hypertension and no other comorbidities?
A. <140/90 mmHg
B. <130/80 mmHg
C. <120/70 mmHg
D. <150/90 mmHg
B. <130/80 mmHg [CORRECT]
Correct Answer: B
Rationale: The 2017 ACC/AHA guidelines define hypertension as a BP of ≥130/80 mmHg and
establish a treatment goal of <130/80 mmHg for most adults to reduce the risk of cardiovascular
events. Previous guidelines (JNC 8) targeted <140/90 mmHg, but current evidence supports
stricter control for primary prevention. Goal <120/70 is for secondary prevention or high-risk
groups (like SPRINT trial) but the general primary prevention goal is <130/80.
Q2: A 55-year-old male with a history of hypertension presents with a blood pressure of 145/92
mmHg. He has no history of CKD or diabetes. According to ACC/AHA guidelines, which
medication class is considered an appropriate first-line therapy?
A. Beta-blocker
B. ACE Inhibitor
C. Thiazide diuretic
D. Alpha-blocker
C. Thiazide diuretic [CORRECT]
,2
Correct Answer: C
Rationale: First-line agents for uncomplicated hypertension include thiazide diuretics, calcium
channel blockers (CCBs), ACE inhibitors, or ARBs. However, in the general Black population or
non-Black patients without compelling comorbidities (like CKD or diabetes), thiazides and
CCBs are often preferred initial choices. Beta-blockers and alpha-blockers are not recommended
as first-line monotherapy for uncomplicated HTN.
Q3: A 45-year-old female is diagnosed with Type 2 Diabetes Mellitus with an HbA1c of 7.8%.
She has no contraindications. According to ADA standards, what is the first-line oral
pharmacologic agent?
A. Insulin
B. Sulfonylurea
C. Metformin
D. DPP-4 inhibitor
C. Metformin [CORRECT]
Correct Answer: C
Rationale: Metformin is the preferred initial pharmacologic agent for the treatment of Type 2
Diabetes Mellitus, provided it is not contraindicated (e.g., advanced CKD) and is tolerated. It is
effective, low-cost, weight-neutral, and has a strong cardiovascular safety profile. Insulin is
reserved for severe hyperglycemia or when HbA1c is >10%, while sulfonylureas carry a risk of
hypoglycemia and weight gain.
Q4: Which laboratory value is the primary screening test used to diagnose diabetes mellitus?
A. Random Blood Glucose ≥ 200 mg/dL
B. Hemoglobin A1c ≥ 6.5%
C. Fasting Plasma Glucose ≥ 126 mg/dL
D. All of the above are diagnostic criteria
D. All of the above are diagnostic criteria [CORRECT]
,3
Correct Answer: D
Rationale: The ADA accepts four criteria for the diagnosis of diabetes: Hemoglobin A1c ≥ 6.5%,
Fasting Plasma Glucose ≥ 126 mg/dL, 2-hour plasma glucose during OGTT ≥ 200 mg/dL, or
Random Plasma Glucose ≥ 200 mg/dL in a patient with classic symptoms. In the absence of
unequivocal hyperglycemia with classic symptoms, the test should be repeated to confirm the
diagnosis.
Q5: A patient with Type 2 Diabetes and established ASCVD is currently on Metformin. What
medication class should be added second-line to reduce cardiovascular mortality?
A. Sulfonylurea
B. GLP-1 Receptor Agonist or SGLT2 Inhibitor
C. Basal Insulin
D. Meglitinide
B. GLP-1 Receptor Agonist or SGLT2 Inhibitor [CORRECT]
Correct Answer: B
Rationale: For patients with Type 2 Diabetes and established ASCVD (or high risk for it), ADA
guidelines recommend adding a GLP-1 Receptor Agonist or SGLT2 Inhibitor with proven
cardiovascular benefit, regardless of HbA1c levels. These agents have been shown to reduce
major adverse cardiovascular events (MACE) and heart failure hospitalizations. Sulfonylureas
and meglitinides do not offer cardiovascular benefit and increase hypoglycemia risk.
Q6: A 40-year-old male presents for a routine exam. His lipid panel shows LDL 170 mg/dL,
HDL 40 mg/dL, and Triglycerides 150 mg/dL. His 10-year ASCVD risk score is calculated at
8%. What is the most appropriate intervention?
A. No medication, repeat lipid panel in 5 years.
B. Initiate moderate-intensity statin therapy.
C. Initiate high-intensity statin therapy.
D. Recommend niacin supplements.
B. Initiate moderate-intensity statin therapy. [CORRECT]
, 4
Correct Answer: B
Rationale: According to ACC/AHA guidelines, adults aged 40–75 with LDL 70–189 mg/dL and
a 10-year ASCVD risk of ≥7.5% should be started on a moderate-intensity statin. The patient's
risk of 8% places him in the category for statin therapy for primary prevention. High-intensity
statins are generally reserved for risk ≥20% or clinical ASCVD, while niacin is no longer
recommended due to lack of benefit and adverse effects.
Q7: What is the recommended LDL cholesterol goal for a patient with established clinical
ASCVD (secondary prevention)?
A. <100 mg/dL
B. <70 mg/dL
C. <130 mg/dL
D. <50 mg/dL
B. <70 mg/dL [CORRECT]
Correct Answer: B
Rationale: For patients with established ASCVD (Secondary Prevention), the 2018 ACC/AHA
cholesterol guidelines recommend a reduction in LDL-C of ≥50% and a goal of <70 mg/dL. In
very high-risk patients (multiple major events), the threshold may be lowered further to <55
mg/dL. The goal of <100 is outdated for modern aggressive management.
Q8: A 60-year-old patient presents with dyspnea on exertion and lower extremity edema. An
echocardiogram reveals an LVEF of 35%. What is the term for this condition?
A. Heart Failure with Preserved Ejection Fraction (HFpEF)
B. Heart Failure with Reduced Ejection Fraction (HFrEF)
C. Right-sided Heart Failure
D. Diastolic Dysfunction
B. Heart Failure with Reduced Ejection Fraction (HFrEF) [CORRECT]
