NURS 5433
FNP II FINAL EXAM
FAMILY NURSING 2026 EXAM
CONTAINS:
• Comprehensive advanced health assessment review
• System-based physical examinations (all body systems)
• Interpretation of normal and abnormal findings
• Clinical reasoning and diagnostic decision-making
• Differential diagnosis development
• Pathophysiology correlation to clinical presentations
• Diagnostic test and imaging interpretation
• Acute and chronic disease management principles
• Evidence-based treatment selection
• Pharmacologic and non-pharmacologic interventions AMONG
OTHERS!!!
,A 58-year-old male patient presents with a blood pressure of 158/92 mmHg on two separate
occasions. He has no history of diabetes, CKD, or CAD. His BMI is 28, and he is a current smoker.
According to the ACC/AHA guidelines, which of the following is the most appropriate initial course of
action?
A) Initiate pharmacological therapy immediately with an ACE inhibitor and a thiazide diuretic.
B) Initiate pharmacological therapy immediately with a calcium channel blocker.
C) Recommend lifestyle modifications alone and reassess blood pressure in 3 to 6 months.
D) Recommend lifestyle modifications and initiate pharmacological therapy with a thiazide diuretic.
Correct Answer: D) Recommend lifestyle modifications and initiate pharmacological therapy
with a thiazide diuretic.
Explanation / Rationale:
According to the ACC/AHA 2017 guidelines, this patient presents with Stage 2 Hypertension (≥140/90
mmHg). For patients with Stage 2 HTN and no established ASCVD (atherosclerotic cardiovascular
disease), the recommendation is to initiate two first-line agents from different classes (usually an ACE
inhibitor/ARB or CCB combined with a thiazide diuretic), or initiate monotherapy if the patient is
already on medication. However, option D suggests one agent plus lifestyle changes, which is a
simplified exam view of Stage 1 vs Stage 2 nuances, but often exams look for the "best" initial step
among provided choices. Actually, for Stage 2 (BP ≥140/90), guidelines suggest starting with two
drugs or one drug if not on meds. Let's refine the options logic.
Refinement Logic: In a patient with Stage 2 HTN (158/92) and no high-risk comorbidities like DM or
CKD, guidelines suggest starting with 2 agents OR 1 agent. However, looking at the options provided
in a typical exam context:
Option A (ACE + Thiazide) is actually the most accurate guideline recommendation for Stage 2 to bring
BP down quickly.
Option D (Lifestyle + 1 drug) is usually reserved for Stage 1 (130-139/80-89) or low-risk Stage 2, but
guidelines emphasize two drugs for Stage 2.
Wait, let's re-evaluate the question intent. If the question implies Stage 1 (130-139), then D is correct.
But 158/92 is Stage 2. Therefore, the best answer should reflect aggressive management.
However, looking at standard board review styles (like ANCC/AANP), if a patient has Stage 2 HTN, you
generally start meds. If the options make you choose between "Start 2 meds" vs "Lifestyle only," you
choose meds.
Let's assume the correct answer logic intended here is that Stage 2 requires meds. Option A is the most
aggressive and correct for Stage 2.
,Correction for the final output: I will generate the question where Option A is the correct answer for
Stage 2, or adjust the BP to Stage 1 if I want to test lifestyle vs meds. Let's stick to the generated
scenario: 158/92 is Stage 2. Therefore, lifestyle only (C) is wrong. Monotherapy (D) is less effective
than dual therapy (A). Therefore A is the best answer. I will adjust the output to reflect A as correct.
Revised Output for Question 1:
Correct Answer: A) Initiate pharmacological therapy immediately with an ACE inhibitor and a
thiazide diuretic.
Explanation / Rationale: The patient has Stage 2 hypertension (≥140/90 mmHg). Current
guidelines recommend initiating pharmacological therapy with two first-line agents of different
classes for patients with Stage 2 hypertension and an average BP more than 20/10 mmHg above
target. While lifestyle modifications are essential for all patients, they are not sufficient as the sole
treatment for Stage 2 hypertension. Using two drugs (e.g., ACE inhibitor and thiazide diuretic)
increases the likelihood of achieving BP control compared to monotherapy.
A 65-year-old female with a history of osteoarthritis and hypertension presents with complaints of
"heartburn" and "burning pain" in the epigastric region that worsens when lying down. She has been
taking ibuprofen 600mg TID for knee pain for the past three weeks. What is the most appropriate
diagnostic test to confirm the suspected diagnosis of peptic ulcer disease (PUD)?
A) Upper gastrointestinal (GI) series with barium swallow.
B) Esophagogastroduodenoscopy (EGD).
C) H. pylori stool antigen test.
D) Abdominal ultrasound.
Correct Answer: B) Esophagogastroduodenoscopy (EGD).
Explanation / Rationale:
EGD is the gold standard for diagnosing PUD. It allows for direct visualization of the mucosa to
identify ulcers, assess for severity, and obtain biopsies if necessary (to rule out malignancy or confirm
H. pylori infection). This patient is "alarm symptom" positive due to her age (>60) and NSAID use,
making EGD the mandatory choice to rule out gastric cancer.
Option A (Upper GI series) can detect larger ulcers but lacks the sensitivity and specificity of EGD and
cannot perform biopsies.
, Option C (H. pylori stool antigen) is useful for identifying the bacteria but does not visualize the ulcer
or rule out other pathology.
Option D (Abdominal ultrasound) is used for solid organ and gallbladder assessment, not mucosal
evaluation of the stomach.
A 42-year-old male presents with acute onset of severe, unilateral, sharp flank pain radiating to the
groin, accompanied by nausea and vomiting. He is writhing in exam room, unable to find a
comfortable position. His urinalysis reveals hematuria. Which of the following is the first-line imaging
modality of choice for this patient?
A) Abdominal X-ray (KUB).
B) Non-contrast Computed Tomography (CT) of the abdomen and pelvis.
C) Ultrasound of the kidneys.
D) Magnetic Resonance Imaging (MRI) of the abdomen.
Correct Answer: B) Non-contrast Computed Tomography (CT) of the abdomen and pelvis.
Explanation / Rationale:
The clinical presentation is classic for nephrolithiasis (kidney stone). Non-contrast CT is the diagnostic
modality of choice because it is highly sensitive (95-99%) and specific for detecting stones of all sizes
and densities. It can also identify other causes of abdominal pain.
Option A (KUB) has low sensitivity because many stones are radiolucent (invisible on X-ray) and bowel
gas can obscure findings.
Option C (Ultrasound) is the preferred choice for pregnant patients and children to avoid radiation, but
in the general adult population, CT is superior.
Option D (MRI) is not typically used for stone diagnosis due to cost, availability, and lower sensitivity
for calcifications compared to CT.
A 28-year-old female presents with a complaint of vaginal discharge, itching, and dysuria. A wet
mount microscopy reveals pseudohyphae and budding yeast. She reports she is currently 12 weeks
pregnant. Which of the following is the most appropriate treatment option?
A) Oral Fluconazole (Diflucan) 150 mg single dose.
B) Intravaginal Clotrimazole cream.
C) Oral Metronidazole 500 mg BID for 7 days.
FNP II FINAL EXAM
FAMILY NURSING 2026 EXAM
CONTAINS:
• Comprehensive advanced health assessment review
• System-based physical examinations (all body systems)
• Interpretation of normal and abnormal findings
• Clinical reasoning and diagnostic decision-making
• Differential diagnosis development
• Pathophysiology correlation to clinical presentations
• Diagnostic test and imaging interpretation
• Acute and chronic disease management principles
• Evidence-based treatment selection
• Pharmacologic and non-pharmacologic interventions AMONG
OTHERS!!!
,A 58-year-old male patient presents with a blood pressure of 158/92 mmHg on two separate
occasions. He has no history of diabetes, CKD, or CAD. His BMI is 28, and he is a current smoker.
According to the ACC/AHA guidelines, which of the following is the most appropriate initial course of
action?
A) Initiate pharmacological therapy immediately with an ACE inhibitor and a thiazide diuretic.
B) Initiate pharmacological therapy immediately with a calcium channel blocker.
C) Recommend lifestyle modifications alone and reassess blood pressure in 3 to 6 months.
D) Recommend lifestyle modifications and initiate pharmacological therapy with a thiazide diuretic.
Correct Answer: D) Recommend lifestyle modifications and initiate pharmacological therapy
with a thiazide diuretic.
Explanation / Rationale:
According to the ACC/AHA 2017 guidelines, this patient presents with Stage 2 Hypertension (≥140/90
mmHg). For patients with Stage 2 HTN and no established ASCVD (atherosclerotic cardiovascular
disease), the recommendation is to initiate two first-line agents from different classes (usually an ACE
inhibitor/ARB or CCB combined with a thiazide diuretic), or initiate monotherapy if the patient is
already on medication. However, option D suggests one agent plus lifestyle changes, which is a
simplified exam view of Stage 1 vs Stage 2 nuances, but often exams look for the "best" initial step
among provided choices. Actually, for Stage 2 (BP ≥140/90), guidelines suggest starting with two
drugs or one drug if not on meds. Let's refine the options logic.
Refinement Logic: In a patient with Stage 2 HTN (158/92) and no high-risk comorbidities like DM or
CKD, guidelines suggest starting with 2 agents OR 1 agent. However, looking at the options provided
in a typical exam context:
Option A (ACE + Thiazide) is actually the most accurate guideline recommendation for Stage 2 to bring
BP down quickly.
Option D (Lifestyle + 1 drug) is usually reserved for Stage 1 (130-139/80-89) or low-risk Stage 2, but
guidelines emphasize two drugs for Stage 2.
Wait, let's re-evaluate the question intent. If the question implies Stage 1 (130-139), then D is correct.
But 158/92 is Stage 2. Therefore, the best answer should reflect aggressive management.
However, looking at standard board review styles (like ANCC/AANP), if a patient has Stage 2 HTN, you
generally start meds. If the options make you choose between "Start 2 meds" vs "Lifestyle only," you
choose meds.
Let's assume the correct answer logic intended here is that Stage 2 requires meds. Option A is the most
aggressive and correct for Stage 2.
,Correction for the final output: I will generate the question where Option A is the correct answer for
Stage 2, or adjust the BP to Stage 1 if I want to test lifestyle vs meds. Let's stick to the generated
scenario: 158/92 is Stage 2. Therefore, lifestyle only (C) is wrong. Monotherapy (D) is less effective
than dual therapy (A). Therefore A is the best answer. I will adjust the output to reflect A as correct.
Revised Output for Question 1:
Correct Answer: A) Initiate pharmacological therapy immediately with an ACE inhibitor and a
thiazide diuretic.
Explanation / Rationale: The patient has Stage 2 hypertension (≥140/90 mmHg). Current
guidelines recommend initiating pharmacological therapy with two first-line agents of different
classes for patients with Stage 2 hypertension and an average BP more than 20/10 mmHg above
target. While lifestyle modifications are essential for all patients, they are not sufficient as the sole
treatment for Stage 2 hypertension. Using two drugs (e.g., ACE inhibitor and thiazide diuretic)
increases the likelihood of achieving BP control compared to monotherapy.
A 65-year-old female with a history of osteoarthritis and hypertension presents with complaints of
"heartburn" and "burning pain" in the epigastric region that worsens when lying down. She has been
taking ibuprofen 600mg TID for knee pain for the past three weeks. What is the most appropriate
diagnostic test to confirm the suspected diagnosis of peptic ulcer disease (PUD)?
A) Upper gastrointestinal (GI) series with barium swallow.
B) Esophagogastroduodenoscopy (EGD).
C) H. pylori stool antigen test.
D) Abdominal ultrasound.
Correct Answer: B) Esophagogastroduodenoscopy (EGD).
Explanation / Rationale:
EGD is the gold standard for diagnosing PUD. It allows for direct visualization of the mucosa to
identify ulcers, assess for severity, and obtain biopsies if necessary (to rule out malignancy or confirm
H. pylori infection). This patient is "alarm symptom" positive due to her age (>60) and NSAID use,
making EGD the mandatory choice to rule out gastric cancer.
Option A (Upper GI series) can detect larger ulcers but lacks the sensitivity and specificity of EGD and
cannot perform biopsies.
, Option C (H. pylori stool antigen) is useful for identifying the bacteria but does not visualize the ulcer
or rule out other pathology.
Option D (Abdominal ultrasound) is used for solid organ and gallbladder assessment, not mucosal
evaluation of the stomach.
A 42-year-old male presents with acute onset of severe, unilateral, sharp flank pain radiating to the
groin, accompanied by nausea and vomiting. He is writhing in exam room, unable to find a
comfortable position. His urinalysis reveals hematuria. Which of the following is the first-line imaging
modality of choice for this patient?
A) Abdominal X-ray (KUB).
B) Non-contrast Computed Tomography (CT) of the abdomen and pelvis.
C) Ultrasound of the kidneys.
D) Magnetic Resonance Imaging (MRI) of the abdomen.
Correct Answer: B) Non-contrast Computed Tomography (CT) of the abdomen and pelvis.
Explanation / Rationale:
The clinical presentation is classic for nephrolithiasis (kidney stone). Non-contrast CT is the diagnostic
modality of choice because it is highly sensitive (95-99%) and specific for detecting stones of all sizes
and densities. It can also identify other causes of abdominal pain.
Option A (KUB) has low sensitivity because many stones are radiolucent (invisible on X-ray) and bowel
gas can obscure findings.
Option C (Ultrasound) is the preferred choice for pregnant patients and children to avoid radiation, but
in the general adult population, CT is superior.
Option D (MRI) is not typically used for stone diagnosis due to cost, availability, and lower sensitivity
for calcifications compared to CT.
A 28-year-old female presents with a complaint of vaginal discharge, itching, and dysuria. A wet
mount microscopy reveals pseudohyphae and budding yeast. She reports she is currently 12 weeks
pregnant. Which of the following is the most appropriate treatment option?
A) Oral Fluconazole (Diflucan) 150 mg single dose.
B) Intravaginal Clotrimazole cream.
C) Oral Metronidazole 500 mg BID for 7 days.
