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 male with a 15-year history of type 2 diabetes mellitus presents for his quarterly
follow-up. He reports increasing nocturia over the past three months and mild dyspnea on
exertion when climbing stairs. His current medications include metformin 1000 mg BID,
lisinopril 20 mg daily, and atorvastatin 40 mg nightly. Physical examination reveals 2+ bilateral
lower extremity edema, clear lung fields, and a regular heart rate of 84 bpm. Laboratory studies
show HbA1c 8.2%, eGFR 42 mL/min/1.73m² (down from 58 six months ago), urine albumin-to-
creatinine ratio 285 mg/g, and potassium 5.1 mEq/L. His blood pressure today is 148/92 mmHg.
He lives alone and manages his own medications.
A. Increase lisinopril to 40 mg daily and add furosemide 20 mg daily
B. Discontinue metformin, initiate insulin therapy, and add an SGLT2 inhibitor
C. Add an SGLT2 inhibitor and switch lisinopril to losartan while monitoring potassium ✓
CORRECT
D. Refer to nephrology immediately and initiate hemodialysis preparation
Correct Answer: C
,2
Rationale: An SGLT2 inhibitor is indicated for this patient with diabetic kidney disease (eGFR
>30 and albuminuria >30 mg/g) as it reduces progression of CKD and cardiovascular events per
ADA guidelines. Switching from lisinopril to losartan addresses his hyperkalemia while
maintaining renoprotective benefits, as ARBs have a more favorable potassium profile in this
context. The most tempting distractor A is incorrect because doubling the ACE inhibitor with
existing hyperkalemia and worsening renal function risks dangerous electrolyte disturbances and
acute kidney injury.
Question 2 of 75
A 54-year-old female office worker presents with six weeks of progressive right shoulder pain
that worsens when reaching overhead or behind her back. She denies trauma but notes the pain
began after painting her ceiling. On examination, active abduction is limited to 110 degrees with
a painful arc between 60-120 degrees. Passive range of motion exceeds active range. There is
tenderness over the lateral aspect of the greater tuberosity, and the drop arm test is negative.
Jobe's empty can test reproduces her pain. She has no cervical spine tenderness or neurologic
deficits. She takes ibuprofen 400 mg PRN with minimal relief.
A. Order an MRI of the right shoulder to evaluate for a full-thickness rotator cuff tear
B. Prescribe a subacromial corticosteroid injection and initiate structured physical therapy
C. Immobilize the shoulder in a sling for three weeks to promote tendon healing
D. Refer urgently to orthopedics for arthroscopic surgical evaluation ✓ CORRECT
Correct Answer: B
Rationale: This presentation is classic for subacromial impingement syndrome with likely
supraspinatus tendinopathy, indicated by the painful arc, positive Jobe's test, and preserved
passive range of motion. A subacromial corticosteroid injection combined with physical therapy
focusing on rotator cuff strengthening and scapular stabilization is first-line conservative
management. The most tempting distractor A is incorrect because MRI is not indicated without
red flags for full-thickness tear, which are absent given the negative drop arm test and
maintained passive range of motion; imaging would add unnecessary cost and delay appropriate
treatment.
Question 3 of 75
A 72-year-old female with hypertension and osteoarthritis presents for her annual wellness visit.
Her daughter, who accompanied her, reports that her mother has had two minor fender-benders in
the past year and seems increasingly confused about medication timing. The patient scores 24/30
on the Montreal Cognitive Assessment (MoCA), losing points on delayed recall, clock drawing,
and executive function tasks. She lives independently but her daughter is concerned about safety.
Her medication list includes amlodipine 5 mg daily, hydrochlorothiazide 25 mg daily, tramadol
,3
50 mg BID PRN, and diphenhydramine 25 mg nightly for sleep. Her blood pressure is 138/82
mmHg.
A. Discontinue tramadol and diphenhydramine, reassess in six weeks, and initiate a driving
safety evaluation ✓ CORRECT
B. Immediately revoke her driver's license and recommend assisted living placement
C. Start memantine 10 mg daily for presumed Alzheimer's disease
D. Order a brain MRI and refer to neurology for comprehensive dementia workup
Correct Answer: A
Rationale: This patient's cognitive decline is likely multifactorial and potentially reversible, with
tramadol (an opioid with serotonergic activity causing confusion in elders) and diphenhydramine
(a potent anticholinergic explicitly contraindicated in older adults per Beers criteria) as major
contributors. Deprescribing these agents while implementing a formal driving safety evaluation
addresses both immediate safety and reversible causes before labeling her with dementia. The
most tempting distractor D is incorrect because jumping to neuroimaging and neurology referral
without first removing offending medications violates the geriatric principle of "diagnose before
you treat" and misses an opportunity for meaningful functional improvement.
Question 4 of 75
A 45-year-old male construction worker presents with a two-week history of low back pain after
lifting a heavy beam. He describes the pain as aching and localized to the right lumbosacral
region without radiation. Physical examination reveals paravertebral muscle spasm, pain with
lumbar extension, and a negative straight leg raise test bilaterally. He has no saddle anesthesia,
no bowel or bladder dysfunction, and no fever. He smokes one pack of cigarettes daily and
reports the pain is worse at the end of his work shift. He has been taking naproxen 220 mg twice
daily with partial relief.
A. Order lumbar spine MRI to evaluate for herniated nucleus pulposus
B. Prescribe cyclobenzaprine 10 mg TID and oxycodone 5 mg Q4H PRN for breakthrough pain
C. Continue naproxen, add a muscle relaxant for short-term use, and provide activity
modification counseling with a return-to-work plan ✓ CORRECT
D. Place on strict bed rest for 72 hours followed by gradual mobilization
Correct Answer: C
Rationale: This patient has uncomplicated acute mechanical low back pain without red flags for
serious pathology, making conservative management with NSAIDs, short-term muscle relaxants,
and early mobilization the evidence-based approach per ACP guidelines. Activity modification
, 4
with a structured return-to-work plan prevents chronic disability and addresses his occupational
demands. The most tempting distractor A is incorrect because MRI is contraindicated within the
first six weeks of uncomplicated back pain without red flags, as it leads to unnecessary
interventions, increased costs, and no improvement in outcomes compared to conservative
management.
Question 5 of 75
A 79-year-old male with atrial fibrillation on warfarin therapy presents after a fall from standing
height. He struck his head on a countertop and has a small frontal hematoma. He denies loss of
consciousness, nausea, vomiting, or headache. His INR today is 3.4 (therapeutic range 2.0-3.0).
His GCS is 15, and neurologic examination is entirely normal. He takes warfarin for a
CHA₂DS₂-VASc score of 5. His last dose was this morning. He lives with his wife and is
otherwise independent.
A. Administer IV vitamin K 10 mg and four-factor prothrombin complex concentrate
immediately
B. Obtain a non-contrast head CT and observe for 24 hours before resuming anticoagulation
C. Obtain an urgent non-contrast head CT, and if negative, hold warfarin for 48-72 hours with
serial neurologic checks ✓ CORRECT
D. Resume warfarin tonight at the usual dose since he has no neurologic deficits
Correct Answer: C
Rationale: In an anticoagulated patient with head trauma, even minor trauma carries significant
risk for delayed intracranial hemorrhage; guidelines mandate urgent head CT and a period of
observation with held anticoagulation. The CHA₂DS₂-VASc of 5 indicates high stroke risk, so
anticoagulation must be resumed promptly after a negative CT and brief hold, balancing
thromboembolic and bleeding risks. The most tempting distractor A is incorrect because
immediate reversal with PCC and vitamin K is reserved for life-threatening bleeding or
confirmed intracranial hemorrhage, not for a minor head trauma with normal examination where
the risks of reversal exceed benefits.
Question 6 of 75
A 62-year-old female presents with fatigue, constipation, and cold intolerance over the past four
months. She has gained 8 pounds despite no dietary changes. Her past medical history is
significant for hypertension and she takes lisinopril 10 mg daily. Physical examination reveals
dry, coarse skin, periorbital puffiness, and delayed relaxation phase of deep tendon reflexes.
Laboratory studies show TSH 12.4 mIU/L (reference 0.4-4.0), free T4 0.8 ng/dL (reference 0.8-
1.8), and positive thyroid peroxidase antibodies. Her total cholesterol is 218 mg/dL.
A. Start levothyroxine 125 mcg daily and recheck TSH in six weeks
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 male with a 15-year history of type 2 diabetes mellitus presents for his quarterly
follow-up. He reports increasing nocturia over the past three months and mild dyspnea on
exertion when climbing stairs. His current medications include metformin 1000 mg BID,
lisinopril 20 mg daily, and atorvastatin 40 mg nightly. Physical examination reveals 2+ bilateral
lower extremity edema, clear lung fields, and a regular heart rate of 84 bpm. Laboratory studies
show HbA1c 8.2%, eGFR 42 mL/min/1.73m² (down from 58 six months ago), urine albumin-to-
creatinine ratio 285 mg/g, and potassium 5.1 mEq/L. His blood pressure today is 148/92 mmHg.
He lives alone and manages his own medications.
A. Increase lisinopril to 40 mg daily and add furosemide 20 mg daily
B. Discontinue metformin, initiate insulin therapy, and add an SGLT2 inhibitor
C. Add an SGLT2 inhibitor and switch lisinopril to losartan while monitoring potassium ✓
CORRECT
D. Refer to nephrology immediately and initiate hemodialysis preparation
Correct Answer: C
,2
Rationale: An SGLT2 inhibitor is indicated for this patient with diabetic kidney disease (eGFR
>30 and albuminuria >30 mg/g) as it reduces progression of CKD and cardiovascular events per
ADA guidelines. Switching from lisinopril to losartan addresses his hyperkalemia while
maintaining renoprotective benefits, as ARBs have a more favorable potassium profile in this
context. The most tempting distractor A is incorrect because doubling the ACE inhibitor with
existing hyperkalemia and worsening renal function risks dangerous electrolyte disturbances and
acute kidney injury.
Question 2 of 75
A 54-year-old female office worker presents with six weeks of progressive right shoulder pain
that worsens when reaching overhead or behind her back. She denies trauma but notes the pain
began after painting her ceiling. On examination, active abduction is limited to 110 degrees with
a painful arc between 60-120 degrees. Passive range of motion exceeds active range. There is
tenderness over the lateral aspect of the greater tuberosity, and the drop arm test is negative.
Jobe's empty can test reproduces her pain. She has no cervical spine tenderness or neurologic
deficits. She takes ibuprofen 400 mg PRN with minimal relief.
A. Order an MRI of the right shoulder to evaluate for a full-thickness rotator cuff tear
B. Prescribe a subacromial corticosteroid injection and initiate structured physical therapy
C. Immobilize the shoulder in a sling for three weeks to promote tendon healing
D. Refer urgently to orthopedics for arthroscopic surgical evaluation ✓ CORRECT
Correct Answer: B
Rationale: This presentation is classic for subacromial impingement syndrome with likely
supraspinatus tendinopathy, indicated by the painful arc, positive Jobe's test, and preserved
passive range of motion. A subacromial corticosteroid injection combined with physical therapy
focusing on rotator cuff strengthening and scapular stabilization is first-line conservative
management. The most tempting distractor A is incorrect because MRI is not indicated without
red flags for full-thickness tear, which are absent given the negative drop arm test and
maintained passive range of motion; imaging would add unnecessary cost and delay appropriate
treatment.
Question 3 of 75
A 72-year-old female with hypertension and osteoarthritis presents for her annual wellness visit.
Her daughter, who accompanied her, reports that her mother has had two minor fender-benders in
the past year and seems increasingly confused about medication timing. The patient scores 24/30
on the Montreal Cognitive Assessment (MoCA), losing points on delayed recall, clock drawing,
and executive function tasks. She lives independently but her daughter is concerned about safety.
Her medication list includes amlodipine 5 mg daily, hydrochlorothiazide 25 mg daily, tramadol
,3
50 mg BID PRN, and diphenhydramine 25 mg nightly for sleep. Her blood pressure is 138/82
mmHg.
A. Discontinue tramadol and diphenhydramine, reassess in six weeks, and initiate a driving
safety evaluation ✓ CORRECT
B. Immediately revoke her driver's license and recommend assisted living placement
C. Start memantine 10 mg daily for presumed Alzheimer's disease
D. Order a brain MRI and refer to neurology for comprehensive dementia workup
Correct Answer: A
Rationale: This patient's cognitive decline is likely multifactorial and potentially reversible, with
tramadol (an opioid with serotonergic activity causing confusion in elders) and diphenhydramine
(a potent anticholinergic explicitly contraindicated in older adults per Beers criteria) as major
contributors. Deprescribing these agents while implementing a formal driving safety evaluation
addresses both immediate safety and reversible causes before labeling her with dementia. The
most tempting distractor D is incorrect because jumping to neuroimaging and neurology referral
without first removing offending medications violates the geriatric principle of "diagnose before
you treat" and misses an opportunity for meaningful functional improvement.
Question 4 of 75
A 45-year-old male construction worker presents with a two-week history of low back pain after
lifting a heavy beam. He describes the pain as aching and localized to the right lumbosacral
region without radiation. Physical examination reveals paravertebral muscle spasm, pain with
lumbar extension, and a negative straight leg raise test bilaterally. He has no saddle anesthesia,
no bowel or bladder dysfunction, and no fever. He smokes one pack of cigarettes daily and
reports the pain is worse at the end of his work shift. He has been taking naproxen 220 mg twice
daily with partial relief.
A. Order lumbar spine MRI to evaluate for herniated nucleus pulposus
B. Prescribe cyclobenzaprine 10 mg TID and oxycodone 5 mg Q4H PRN for breakthrough pain
C. Continue naproxen, add a muscle relaxant for short-term use, and provide activity
modification counseling with a return-to-work plan ✓ CORRECT
D. Place on strict bed rest for 72 hours followed by gradual mobilization
Correct Answer: C
Rationale: This patient has uncomplicated acute mechanical low back pain without red flags for
serious pathology, making conservative management with NSAIDs, short-term muscle relaxants,
and early mobilization the evidence-based approach per ACP guidelines. Activity modification
, 4
with a structured return-to-work plan prevents chronic disability and addresses his occupational
demands. The most tempting distractor A is incorrect because MRI is contraindicated within the
first six weeks of uncomplicated back pain without red flags, as it leads to unnecessary
interventions, increased costs, and no improvement in outcomes compared to conservative
management.
Question 5 of 75
A 79-year-old male with atrial fibrillation on warfarin therapy presents after a fall from standing
height. He struck his head on a countertop and has a small frontal hematoma. He denies loss of
consciousness, nausea, vomiting, or headache. His INR today is 3.4 (therapeutic range 2.0-3.0).
His GCS is 15, and neurologic examination is entirely normal. He takes warfarin for a
CHA₂DS₂-VASc score of 5. His last dose was this morning. He lives with his wife and is
otherwise independent.
A. Administer IV vitamin K 10 mg and four-factor prothrombin complex concentrate
immediately
B. Obtain a non-contrast head CT and observe for 24 hours before resuming anticoagulation
C. Obtain an urgent non-contrast head CT, and if negative, hold warfarin for 48-72 hours with
serial neurologic checks ✓ CORRECT
D. Resume warfarin tonight at the usual dose since he has no neurologic deficits
Correct Answer: C
Rationale: In an anticoagulated patient with head trauma, even minor trauma carries significant
risk for delayed intracranial hemorrhage; guidelines mandate urgent head CT and a period of
observation with held anticoagulation. The CHA₂DS₂-VASc of 5 indicates high stroke risk, so
anticoagulation must be resumed promptly after a negative CT and brief hold, balancing
thromboembolic and bleeding risks. The most tempting distractor A is incorrect because
immediate reversal with PCC and vitamin K is reserved for life-threatening bleeding or
confirmed intracranial hemorrhage, not for a minor head trauma with normal examination where
the risks of reversal exceed benefits.
Question 6 of 75
A 62-year-old female presents with fatigue, constipation, and cold intolerance over the past four
months. She has gained 8 pounds despite no dietary changes. Her past medical history is
significant for hypertension and she takes lisinopril 10 mg daily. Physical examination reveals
dry, coarse skin, periorbital puffiness, and delayed relaxation phase of deep tendon reflexes.
Laboratory studies show TSH 12.4 mIU/L (reference 0.4-4.0), free T4 0.8 ng/dL (reference 0.8-
1.8), and positive thyroid peroxidase antibodies. Her total cholesterol is 218 mg/dL.
A. Start levothyroxine 125 mcg daily and recheck TSH in six weeks
