1
NURS 5433 / NURS5433 Midterm Exam Family
II FNP 2 Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Primary Care of Adults and Geriatrics | Q1 – Q15
Section 2 | Primary Care of Women and Reproductive Health | Q16 – Q30
Section 3 | Primary Care of Children and Adolescents | Q31 – Q45
Section 4 | Chronic Disease Management and Pharmacology | Q46 – Q60
Section 5 | Differential Diagnosis and Evidence-Based Practice | Q61 – Q75
SECTION 1: PRIMARY CARE OF ADULTS AND GERIATRICS
Question 1 of 75
A 68-year-old man presents to the clinic with a two-week history of progressive dyspnea on
exertion, orthopnea, and bilateral lower extremity edema. His past medical history includes type
2 diabetes mellitus, hypertension, and a myocardial infarction three years ago. On physical
examination, his blood pressure is 154/92 mmHg, heart rate is 88 beats per minute, respiratory
rate is 22 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals
bilateral crackles at the lung bases and an S3 gallop. A chest radiograph shows cardiomegaly and
pulmonary vascular congestion. His current medications include metformin, lisinopril, and
aspirin. Which medication class should be added to his regimen to reduce mortality in this
patient with HFrEF?
A. Initiate a loop diuretic such as furosemide to manage his volume overload
B. Start a beta-blocker such as metoprolol succinate to improve survival
C. Add a mineralocorticoid receptor antagonist such as spironolactone for mortality benefit
D. Prescribe a calcium channel blocker such as amlodipine for afterload reduction
Correct Answer: B
Rationale: Beta-blockers, specifically carvedilol, metoprolol succinate, and bisoprolol, are
cornerstone therapies in HFrEF that have demonstrated robust mortality reduction in landmark
clinical trials and are recommended as foundational therapy in current ACC/AHA/HFSA
,2
guidelines. While a loop diuretic is appropriate for symptomatic volume management, it does not
confer a mortality benefit and should not be selected as the primary addition for survival
improvement. The addition of guideline-directed medical therapy with a beta-blocker addresses
the neurohormonal activation that drives disease progression in heart failure with reduced
ejection fraction.
Question 2 of 75
A 72-year-old woman with a history of osteoporosis and chronic kidney disease stage 3b presents
for her annual wellness visit. She has been adherent to her alendronate 70 mg weekly for the past
five years. Her most recent dual-energy x-ray absorptiometry (DXA) scan reveals a T-score of -
2.1 at the lumbar spine and -1.8 at the femoral neck, representing improvement from her
baseline. She has no history of fragility fractures. Her serum creatinine is 1.6 mg/dL (eGFR 38
mL/min/1.73m²), and her 25-hydroxyvitamin D level is 28 ng/mL. What is the most appropriate
next step in her osteoporosis management?
A. Continue alendronate indefinitely given her chronic kidney disease and fracture risk
B. Discontinue alendronate and transition to denosumab 60 mg subcutaneously every six months
C. Implement a bisphosphonate holiday for two to three years with repeat DXA monitoring
D. Switch to zoledronic acid 5 mg IV annually to improve adherence and bone density
Correct Answer: C
Rationale: Current Endocrine Society and ACP guidelines recommend a bisphosphonate holiday
after approximately five years of therapy in patients with moderate fracture risk who have
demonstrated stable or improved bone density without incident fractures, as the antifracture
efficacy persists during the holiday period while reducing the risk of rare but serious adverse
effects such as atypical femur fractures and osteonecrosis of the jaw. Transitioning to denosumab
without a washout period poses a rebound fracture risk, and continuing bisphosphonates
indefinitely in this lower-risk profile contradicts evidence-based treatment duration
recommendations. A bisphosphonate holiday with periodic reassessment represents the standard
of care for this clinical scenario.
Question 3 of 75
A 55-year-old man with a 30 pack-year smoking history presents with a persistent cough,
hemoptysis, and unintentional weight loss of 15 pounds over three months. A chest CT reveals a
3.2 cm spiculated mass in the right upper lobe with mediastinal lymphadenopathy. His
performance status is excellent, and he has no significant comorbidities. What is the most
appropriate initial step in the diagnostic workup of this patient?
A. Obtain a positron emission tomography (PET) scan to evaluate for distant metastasis
,3
B. Perform a bronchoscopy with transbronchial needle aspiration of the mediastinal lymph nodes
C. Schedule a transthoracic needle biopsy of the pulmonary mass for tissue diagnosis
D. Initiate a staging workup with brain MRI and bone scan prior to tissue acquisition
Correct Answer: B
Rationale: In patients with suspected lung cancer and mediastinal lymphadenopathy,
endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the
preferred initial diagnostic and staging procedure as it simultaneously establishes a tissue
diagnosis and assesses mediastinal nodal involvement, which is critical for accurate staging and
treatment planning. A PET scan is valuable for staging but should not precede tissue diagnosis,
and transthoracic needle biopsy carries a higher pneumothorax risk without providing
mediastinal staging information. The current NCCN and ACCP guidelines emphasize that tissue
diagnosis and mediastinal staging should be obtained concurrently when feasible.
Question 4 of 75
A 64-year-old woman with type 2 diabetes presents for follow-up of her chronic low back pain.
She has been taking hydrocodone-acetaminophen 5/325 mg four times daily for the past eight
months with minimal functional improvement. Her pain is rated 6/10, and she reports no red flag
symptoms. She has tried physical therapy and NSAIDs without adequate relief. Her PHQ-9 score
is 8, indicating mild depression. What is the most appropriate next step in her pain management?
A. Increase the hydrocodone dose to 7.5/325 mg to achieve better analgesia
B. Initiate a structured opioid taper and transition to a multimodal non-opioid regimen
C. Add gabapentin 300 mg three times daily as adjunctive therapy
D. Refer for immediate lumbar spine MRI to evaluate for surgical pathology
Correct Answer: B
Rationale: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends that when
opioid therapy fails to provide meaningful improvement in pain and function, clinicians should
taper and discontinue opioids while transitioning to evidence-based non-opioid therapies, as the
risks of long-term opioid use—including dependence, overdose, and diminished efficacy—
outweigh benefits in this context. Increasing the opioid dose contradicts current guidelines and
escalates risk without evidence of improved outcomes, while adding gabapentin without
addressing the ineffective opioid foundation represents incomplete management. A lumbar MRI
is not indicated in the absence of red flag symptoms and would not change the immediate
management approach.
Question 5 of 75
, 4
A 78-year-old man residing in an assisted living facility is brought to the clinic by his daughter
due to confusion and increased somnolence over the past two days. His temperature is 38.2°C,
blood pressure is 142/78 mmHg, heart rate is 104 beats per minute, and respiratory rate is 24
breaths per minute. Physical examination reveals decreased breath sounds and dullness to
percussion over the right lower lung field. A chest radiograph confirms a right lower lobe
infiltrate. His most recent complete blood count shows a leukocyte count of 14,200/µL with a
left shift. What is the most appropriate initial empiric antibiotic regimen for this patient with
community-acquired pneumonia?
A. Azithromycin monotherapy to cover atypical pathogens
B. Ceftriaxone plus azithromycin to cover typical and atypical organisms
C. Vancomycin plus piperacillin-tazobactam for broad-spectrum coverage
D. Levofloxacin monotherapy for streamlined outpatient management
Correct Answer: B
Rationale: For older adults with community-acquired pneumonia requiring hospitalization, the
IDSA/ATS guidelines recommend combination therapy with a beta-lactam (ceftriaxone or
cefotaxime) plus a macrolide (azithromycin) or respiratory fluoroquinolone to ensure coverage
of both typical bacterial pathogens and atypical organisms such as Mycoplasma pneumoniae and
Legionella pneumophila. Azithromycin monotherapy lacks adequate coverage for Streptococcus
pneumoniae, while vancomycin and piperacillin-tazobactam are reserved for healthcare-
associated or severe pneumonia with risk factors for resistant organisms. Monotherapy with a
respiratory fluoroquinolone is an acceptable alternative but is not the preferred regimen when
combination therapy is feasible and fluoroquinolone adverse effects are a concern.
Question 6 of 75
A 62-year-old man with a history of benign prostatic hyperplasia presents with acute urinary
retention. He has been taking tamsulosin 0.4 mg daily for the past year with good symptomatic
control until two days ago when he developed complete inability to void, lower abdominal pain,
and bladder distension palpable above the pubic symphysis. A bladder scan reveals 850 mL of
urine. He recently started a new medication for seasonal allergies. What is the most likely
offending agent contributing to his acute urinary retention?
A. Loratadine, a second-generation antihistamine with minimal anticholinergic effects
B. Diphenhydramine, a first-generation antihistamine with potent anticholinergic properties
C. Fluticasone nasal spray, an intranasal corticosteroid with systemic absorption
D. Montelukast, a leukotriene receptor antagonist without anticholinergic activity
Correct Answer: B
NURS 5433 / NURS5433 Midterm Exam Family
II FNP 2 Actual Exam 2026/2027 | Complete
Exam-Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Primary Care of Adults and Geriatrics | Q1 – Q15
Section 2 | Primary Care of Women and Reproductive Health | Q16 – Q30
Section 3 | Primary Care of Children and Adolescents | Q31 – Q45
Section 4 | Chronic Disease Management and Pharmacology | Q46 – Q60
Section 5 | Differential Diagnosis and Evidence-Based Practice | Q61 – Q75
SECTION 1: PRIMARY CARE OF ADULTS AND GERIATRICS
Question 1 of 75
A 68-year-old man presents to the clinic with a two-week history of progressive dyspnea on
exertion, orthopnea, and bilateral lower extremity edema. His past medical history includes type
2 diabetes mellitus, hypertension, and a myocardial infarction three years ago. On physical
examination, his blood pressure is 154/92 mmHg, heart rate is 88 beats per minute, respiratory
rate is 22 breaths per minute, and oxygen saturation is 92% on room air. Auscultation reveals
bilateral crackles at the lung bases and an S3 gallop. A chest radiograph shows cardiomegaly and
pulmonary vascular congestion. His current medications include metformin, lisinopril, and
aspirin. Which medication class should be added to his regimen to reduce mortality in this
patient with HFrEF?
A. Initiate a loop diuretic such as furosemide to manage his volume overload
B. Start a beta-blocker such as metoprolol succinate to improve survival
C. Add a mineralocorticoid receptor antagonist such as spironolactone for mortality benefit
D. Prescribe a calcium channel blocker such as amlodipine for afterload reduction
Correct Answer: B
Rationale: Beta-blockers, specifically carvedilol, metoprolol succinate, and bisoprolol, are
cornerstone therapies in HFrEF that have demonstrated robust mortality reduction in landmark
clinical trials and are recommended as foundational therapy in current ACC/AHA/HFSA
,2
guidelines. While a loop diuretic is appropriate for symptomatic volume management, it does not
confer a mortality benefit and should not be selected as the primary addition for survival
improvement. The addition of guideline-directed medical therapy with a beta-blocker addresses
the neurohormonal activation that drives disease progression in heart failure with reduced
ejection fraction.
Question 2 of 75
A 72-year-old woman with a history of osteoporosis and chronic kidney disease stage 3b presents
for her annual wellness visit. She has been adherent to her alendronate 70 mg weekly for the past
five years. Her most recent dual-energy x-ray absorptiometry (DXA) scan reveals a T-score of -
2.1 at the lumbar spine and -1.8 at the femoral neck, representing improvement from her
baseline. She has no history of fragility fractures. Her serum creatinine is 1.6 mg/dL (eGFR 38
mL/min/1.73m²), and her 25-hydroxyvitamin D level is 28 ng/mL. What is the most appropriate
next step in her osteoporosis management?
A. Continue alendronate indefinitely given her chronic kidney disease and fracture risk
B. Discontinue alendronate and transition to denosumab 60 mg subcutaneously every six months
C. Implement a bisphosphonate holiday for two to three years with repeat DXA monitoring
D. Switch to zoledronic acid 5 mg IV annually to improve adherence and bone density
Correct Answer: C
Rationale: Current Endocrine Society and ACP guidelines recommend a bisphosphonate holiday
after approximately five years of therapy in patients with moderate fracture risk who have
demonstrated stable or improved bone density without incident fractures, as the antifracture
efficacy persists during the holiday period while reducing the risk of rare but serious adverse
effects such as atypical femur fractures and osteonecrosis of the jaw. Transitioning to denosumab
without a washout period poses a rebound fracture risk, and continuing bisphosphonates
indefinitely in this lower-risk profile contradicts evidence-based treatment duration
recommendations. A bisphosphonate holiday with periodic reassessment represents the standard
of care for this clinical scenario.
Question 3 of 75
A 55-year-old man with a 30 pack-year smoking history presents with a persistent cough,
hemoptysis, and unintentional weight loss of 15 pounds over three months. A chest CT reveals a
3.2 cm spiculated mass in the right upper lobe with mediastinal lymphadenopathy. His
performance status is excellent, and he has no significant comorbidities. What is the most
appropriate initial step in the diagnostic workup of this patient?
A. Obtain a positron emission tomography (PET) scan to evaluate for distant metastasis
,3
B. Perform a bronchoscopy with transbronchial needle aspiration of the mediastinal lymph nodes
C. Schedule a transthoracic needle biopsy of the pulmonary mass for tissue diagnosis
D. Initiate a staging workup with brain MRI and bone scan prior to tissue acquisition
Correct Answer: B
Rationale: In patients with suspected lung cancer and mediastinal lymphadenopathy,
endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the
preferred initial diagnostic and staging procedure as it simultaneously establishes a tissue
diagnosis and assesses mediastinal nodal involvement, which is critical for accurate staging and
treatment planning. A PET scan is valuable for staging but should not precede tissue diagnosis,
and transthoracic needle biopsy carries a higher pneumothorax risk without providing
mediastinal staging information. The current NCCN and ACCP guidelines emphasize that tissue
diagnosis and mediastinal staging should be obtained concurrently when feasible.
Question 4 of 75
A 64-year-old woman with type 2 diabetes presents for follow-up of her chronic low back pain.
She has been taking hydrocodone-acetaminophen 5/325 mg four times daily for the past eight
months with minimal functional improvement. Her pain is rated 6/10, and she reports no red flag
symptoms. She has tried physical therapy and NSAIDs without adequate relief. Her PHQ-9 score
is 8, indicating mild depression. What is the most appropriate next step in her pain management?
A. Increase the hydrocodone dose to 7.5/325 mg to achieve better analgesia
B. Initiate a structured opioid taper and transition to a multimodal non-opioid regimen
C. Add gabapentin 300 mg three times daily as adjunctive therapy
D. Refer for immediate lumbar spine MRI to evaluate for surgical pathology
Correct Answer: B
Rationale: The CDC Guideline for Prescribing Opioids for Chronic Pain recommends that when
opioid therapy fails to provide meaningful improvement in pain and function, clinicians should
taper and discontinue opioids while transitioning to evidence-based non-opioid therapies, as the
risks of long-term opioid use—including dependence, overdose, and diminished efficacy—
outweigh benefits in this context. Increasing the opioid dose contradicts current guidelines and
escalates risk without evidence of improved outcomes, while adding gabapentin without
addressing the ineffective opioid foundation represents incomplete management. A lumbar MRI
is not indicated in the absence of red flag symptoms and would not change the immediate
management approach.
Question 5 of 75
, 4
A 78-year-old man residing in an assisted living facility is brought to the clinic by his daughter
due to confusion and increased somnolence over the past two days. His temperature is 38.2°C,
blood pressure is 142/78 mmHg, heart rate is 104 beats per minute, and respiratory rate is 24
breaths per minute. Physical examination reveals decreased breath sounds and dullness to
percussion over the right lower lung field. A chest radiograph confirms a right lower lobe
infiltrate. His most recent complete blood count shows a leukocyte count of 14,200/µL with a
left shift. What is the most appropriate initial empiric antibiotic regimen for this patient with
community-acquired pneumonia?
A. Azithromycin monotherapy to cover atypical pathogens
B. Ceftriaxone plus azithromycin to cover typical and atypical organisms
C. Vancomycin plus piperacillin-tazobactam for broad-spectrum coverage
D. Levofloxacin monotherapy for streamlined outpatient management
Correct Answer: B
Rationale: For older adults with community-acquired pneumonia requiring hospitalization, the
IDSA/ATS guidelines recommend combination therapy with a beta-lactam (ceftriaxone or
cefotaxime) plus a macrolide (azithromycin) or respiratory fluoroquinolone to ensure coverage
of both typical bacterial pathogens and atypical organisms such as Mycoplasma pneumoniae and
Legionella pneumophila. Azithromycin monotherapy lacks adequate coverage for Streptococcus
pneumoniae, while vancomycin and piperacillin-tazobactam are reserved for healthcare-
associated or severe pneumonia with risk factors for resistant organisms. Monotherapy with a
respiratory fluoroquinolone is an acceptable alternative but is not the preferred regimen when
combination therapy is feasible and fluoroquinolone adverse effects are a concern.
Question 6 of 75
A 62-year-old man with a history of benign prostatic hyperplasia presents with acute urinary
retention. He has been taking tamsulosin 0.4 mg daily for the past year with good symptomatic
control until two days ago when he developed complete inability to void, lower abdominal pain,
and bladder distension palpable above the pubic symphysis. A bladder scan reveals 850 mL of
urine. He recently started a new medication for seasonal allergies. What is the most likely
offending agent contributing to his acute urinary retention?
A. Loratadine, a second-generation antihistamine with minimal anticholinergic effects
B. Diphenhydramine, a first-generation antihistamine with potent anticholinergic properties
C. Fluticasone nasal spray, an intranasal corticosteroid with systemic absorption
D. Montelukast, a leukotriene receptor antagonist without anticholinergic activity
Correct Answer: B
