NURS 5433 Family Nurse Practitioner II: Comprehensive
Practice Final Exam Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Section 1: Acute and Chronic Adult/Geriatric Conditions (20
Questions)
Q1: A 68-year-old male with a 15-year history of hypertension presents for a follow-up
visit. His home blood pressure log shows readings averaging 148/92 mmHg over the
past month. He is currently taking lisinopril 20 mg daily. His serum creatinine is 1.2
mg/dL and potassium is 5.1 mEq/L. Which medication adjustment is most appropriate?
A. Increase lisinopril to 40 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add amlodipine 5 mg daily
D. Discontinue lisinopril and start losartan 50 mg daily
Correct Answer: C
Rationale: Correct because adding a calcium channel blocker such as amlodipine is the
preferred next step when ACE inhibitor monotherapy is inadequate and the patient has
borderline hyperkalemia, which would be exacerbated by increasing the ACE inhibitor or
adding a potassium-sparing approach. This matches JNC-8 and ACC/AHA guidelines
for stepwise hypertension management.
,Q2: A 72-year-old female with heart failure with reduced ejection fraction (HFrEF, EF
35%) reports increased dyspnea on exertion and 3-lb weight gain over one week. She is
adherent to lisinopril, metoprolol succinate, and furosemide. Her blood pressure is
108/68 mmHg, heart rate 72 bpm, and she has 1+ peripheral edema. Which intervention
is the priority?
A. Increase metoprolol succinate dose
B. Add spironolactone
C. Increase furosemide dose and reassess in 48–72 hours
D. Add digoxin
Correct Answer: C
Rationale: Correct because the patient demonstrates signs of volume overload with
mild weight gain and edema; optimizing loop diuretic therapy is the priority for acute
decompensation before initiating additional neurohormonal blockade. This matches the
standard approach to managing fluid status in HFrEF.
Q3: A 58-year-old male with type 2 diabetes mellitus has an HbA1c of 8.2% despite
metformin 2000 mg daily. His eGFR is 45 mL/min/1.73m². He has a history of
atherosclerotic cardiovascular disease (ASCVD). Which pharmacologic addition is most
appropriate?
A. Add glipizide 5 mg daily
B. Add empagliflozin 10 mg daily
C. Add pioglitazone 30 mg daily
D. Add sitagliptin 100 mg daily
,Correct Answer: B
Rationale: Correct because SGLT2 inhibitors such as empagliflozin provide
cardiovascular risk reduction and renal protective benefits in patients with ASCVD and
are appropriate even with eGFR in the 30–45 range, though glycemic efficacy may be
reduced. This matches ADA Standards of Care recommendations for patients with
ASCVD.
Q4: A 64-year-old female with COPD (GOLD Group D) reports increased sputum
production and dyspnea. She uses umeclidinium/vilanterol daily and has a PRN
albuterol. Her COPD Assessment Test (CAT) score is 18. Which modification best aligns
with GOLD guidelines?
A. Switch to tiotropium monotherapy
B. Add roflumilast
C. Add a daily inhaled corticosteroid to her LAMA/LABA combination
D. Initiate chronic oral corticosteroid therapy
Correct Answer: C
Rationale: Correct because patients with GOLD Group D and frequent exacerbations
benefit from triple therapy (ICS/LAMA/LABA); adding an inhaled corticosteroid to
existing LAMA/LABA therapy reduces exacerbation frequency. This matches the GOLD
2024 recommendation for triple therapy in high-risk COPD patients.
Q5: A 70-year-old male with stage 3b CKD (eGFR 38) presents with a serum potassium
of 5.8 mEq/L. He takes lisinopril, metoprolol, and spironolactone for heart failure. His
ECG shows peaked T waves. Which is the most appropriate immediate management?
, A. Administer oral kayexalate
B. Administer IV calcium gluconate and insulin/glucose
C. Discontinue metoprolol and recheck potassium in 1 week
D. Initiate hemodialysis
Correct Answer: B
Rationale: Correct because ECG changes in hyperkalemia indicate cardiac membrane
instability requiring immediate stabilization with IV calcium, followed by intracellular
shifting with insulin/glucose. This matches ACLS and nephrology guidelines for
symptomatic hyperkalemia management.
Q6: A 76-year-old female with osteoarthritis of the knees reports pain rated 6/10 despite
weight loss and physical therapy. She has a history of GI bleeding and chronic kidney
disease (eGFR 42). Which pharmacologic option is safest?
A. Ibuprofen 400 mg three times daily
B. Naproxen 250 mg twice daily with a PPI
C. Celecoxib 200 mg daily
D. Acetaminophen 1000 mg three times daily
Correct Answer: D
Rationale: Correct because acetaminophen is first-line for osteoarthritis pain and is the
safest option in a patient with both CKD and prior GI bleeding, whereas NSAIDs and
COX-2 inhibitors carry renal and cardiovascular risks. This matches ACR/AAOS
guidelines for OA management in high-risk older adults.
Practice Final Exam Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Section 1: Acute and Chronic Adult/Geriatric Conditions (20
Questions)
Q1: A 68-year-old male with a 15-year history of hypertension presents for a follow-up
visit. His home blood pressure log shows readings averaging 148/92 mmHg over the
past month. He is currently taking lisinopril 20 mg daily. His serum creatinine is 1.2
mg/dL and potassium is 5.1 mEq/L. Which medication adjustment is most appropriate?
A. Increase lisinopril to 40 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add amlodipine 5 mg daily
D. Discontinue lisinopril and start losartan 50 mg daily
Correct Answer: C
Rationale: Correct because adding a calcium channel blocker such as amlodipine is the
preferred next step when ACE inhibitor monotherapy is inadequate and the patient has
borderline hyperkalemia, which would be exacerbated by increasing the ACE inhibitor or
adding a potassium-sparing approach. This matches JNC-8 and ACC/AHA guidelines
for stepwise hypertension management.
,Q2: A 72-year-old female with heart failure with reduced ejection fraction (HFrEF, EF
35%) reports increased dyspnea on exertion and 3-lb weight gain over one week. She is
adherent to lisinopril, metoprolol succinate, and furosemide. Her blood pressure is
108/68 mmHg, heart rate 72 bpm, and she has 1+ peripheral edema. Which intervention
is the priority?
A. Increase metoprolol succinate dose
B. Add spironolactone
C. Increase furosemide dose and reassess in 48–72 hours
D. Add digoxin
Correct Answer: C
Rationale: Correct because the patient demonstrates signs of volume overload with
mild weight gain and edema; optimizing loop diuretic therapy is the priority for acute
decompensation before initiating additional neurohormonal blockade. This matches the
standard approach to managing fluid status in HFrEF.
Q3: A 58-year-old male with type 2 diabetes mellitus has an HbA1c of 8.2% despite
metformin 2000 mg daily. His eGFR is 45 mL/min/1.73m². He has a history of
atherosclerotic cardiovascular disease (ASCVD). Which pharmacologic addition is most
appropriate?
A. Add glipizide 5 mg daily
B. Add empagliflozin 10 mg daily
C. Add pioglitazone 30 mg daily
D. Add sitagliptin 100 mg daily
,Correct Answer: B
Rationale: Correct because SGLT2 inhibitors such as empagliflozin provide
cardiovascular risk reduction and renal protective benefits in patients with ASCVD and
are appropriate even with eGFR in the 30–45 range, though glycemic efficacy may be
reduced. This matches ADA Standards of Care recommendations for patients with
ASCVD.
Q4: A 64-year-old female with COPD (GOLD Group D) reports increased sputum
production and dyspnea. She uses umeclidinium/vilanterol daily and has a PRN
albuterol. Her COPD Assessment Test (CAT) score is 18. Which modification best aligns
with GOLD guidelines?
A. Switch to tiotropium monotherapy
B. Add roflumilast
C. Add a daily inhaled corticosteroid to her LAMA/LABA combination
D. Initiate chronic oral corticosteroid therapy
Correct Answer: C
Rationale: Correct because patients with GOLD Group D and frequent exacerbations
benefit from triple therapy (ICS/LAMA/LABA); adding an inhaled corticosteroid to
existing LAMA/LABA therapy reduces exacerbation frequency. This matches the GOLD
2024 recommendation for triple therapy in high-risk COPD patients.
Q5: A 70-year-old male with stage 3b CKD (eGFR 38) presents with a serum potassium
of 5.8 mEq/L. He takes lisinopril, metoprolol, and spironolactone for heart failure. His
ECG shows peaked T waves. Which is the most appropriate immediate management?
, A. Administer oral kayexalate
B. Administer IV calcium gluconate and insulin/glucose
C. Discontinue metoprolol and recheck potassium in 1 week
D. Initiate hemodialysis
Correct Answer: B
Rationale: Correct because ECG changes in hyperkalemia indicate cardiac membrane
instability requiring immediate stabilization with IV calcium, followed by intracellular
shifting with insulin/glucose. This matches ACLS and nephrology guidelines for
symptomatic hyperkalemia management.
Q6: A 76-year-old female with osteoarthritis of the knees reports pain rated 6/10 despite
weight loss and physical therapy. She has a history of GI bleeding and chronic kidney
disease (eGFR 42). Which pharmacologic option is safest?
A. Ibuprofen 400 mg three times daily
B. Naproxen 250 mg twice daily with a PPI
C. Celecoxib 200 mg daily
D. Acetaminophen 1000 mg three times daily
Correct Answer: D
Rationale: Correct because acetaminophen is first-line for osteoarthritis pain and is the
safest option in a patient with both CKD and prior GI bleeding, whereas NSAIDs and
COX-2 inhibitors carry renal and cardiovascular risks. This matches ACR/AAOS
guidelines for OA management in high-risk older adults.
