NURS 5433 / NURS5433 Family II (FNP 2) Midterm
Exam Actual 2026 with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY CONDITIONS (15
Questions)
Q1: A 58-year-old male with a history of hypertension presents for a follow-up visit.
His blood pressure readings over the past month have averaged 148/92 mmHg on
his current regimen of lisinopril 10 mg daily. According to the 2017 ACC/AHA
hypertension guidelines, what is the most appropriate next step in management?
A. Continue current lisinopril dose and recheck in 6 months
B. Add a thiazide diuretic to the current ACE inhibitor regimen [CORRECT]
C. Switch from lisinopril to an ARB monotherapy
D. Discontinue lisinopril and start a calcium channel blocker alone
Correct Answer: B
Rationale: The patient's BP of 148/92 mmHg places him in Stage 2 hypertension
(>=140/90); current guidelines recommend initiating two first-line agents from
different classes when BP is >20/10 mmHg above goal, making the addition of a
thiazide diuretic to the ACE inhibitor the most appropriate step.
Q2: A 62-year-old female with hyperlipidemia has a fasting lipid panel showing: Total
cholesterol 245 mg/dL, LDL 168 mg/dL, HDL 48 mg/dL, Triglycerides 180 mg/dL.
She has type 2 diabetes but no history of ASCVD. What is her 10-year ASCVD risk
category and recommended LDL target?
A. Low risk; LDL target <130 mg/dL
B. Intermediate risk; LDL target <100 mg/dL
C. High risk (diabetes age 40-75); LDL target <100 mg/dL or >=50% reduction
[CORRECT]
D. Very high risk; LDL target <70 mg/dL
Correct Answer: C
Rationale: Patients with diabetes aged 40-75 years are classified as high risk for
ASCVD; the ACC/AHA guidelines recommend either an LDL target <100 mg/dL or a
reduction of >=50% using moderate-intensity statin therapy, with consideration of
high-intensity statin if multiple risk factors exist.
,Q3: A 70-year-old male with heart failure with reduced ejection fraction (HFrEF, EF
35%) presents with worsening dyspnea and peripheral edema. He is currently on
lisinopril, metoprolol succinate, and furosemide. Which medication should be added
to his regimen to reduce mortality and hospitalization based on current
evidence-based guidelines?
A. Digoxin for symptom control and mortality benefit
B. Sacubitril/valsartan (Entresto) to replace the ACE inhibitor [CORRECT]
C. Amlodipine for afterload reduction
D. Hydralazine/isosorbide dinitrate as first-line therapy
Correct Answer: B
Rationale: The PARADIGM-HF trial demonstrated that sacubitril/valsartan (an ARNI)
significantly reduced cardiovascular death and heart failure hospitalization
compared to enalapril in HFrEF patients, and current ACC/AHA/HFSA guidelines
recommend replacing ACE inhibitors with ARNIs in eligible NYHA Class II-III patients.
Q4: A 45-year-old male presents with acute chest pain radiating to his left arm,
diaphoresis, and nausea. His ECG shows ST-segment elevation in leads V1-V4.
Which is the most appropriate immediate management strategy?
A. Administer aspirin, clopidogrel, and schedule cardiac catheterization within 72
hours
B. Administer aspirin, load with P2Y12 inhibitor, and activate the cath lab for primary
PCI within 90 minutes [CORRECT]
C. Administer thrombolytics and transfer to a PCI-capable center
D. Start heparin drip and obtain a stress test once pain resolves
Correct Answer: B
Rationale: STEMI (ST-elevation myocardial infarction) requires immediate
reperfusion therapy; primary percutaneous coronary intervention (PCI) is the
preferred strategy when available within 90 minutes of first medical contact, along
with dual antiplatelet therapy (aspirin + P2Y12 inhibitor) and anticoagulation.
Q5: A 55-year-old female with a history of atrial fibrillation is started on warfarin
therapy. Which dietary counseling is most important to provide regarding vitamin K
intake?
A. Completely avoid all green leafy vegetables
B. Maintain consistent vitamin K intake rather than avoiding it entirely [CORRECT]
C. Double vitamin K intake to counteract warfarin effects
D. Take vitamin K supplements daily to prevent bleeding
Correct Answer: B
,Rationale: The key to successful warfarin management is maintaining consistent
daily vitamin K intake (typically 90-120 mcg/day) rather than avoiding it completely,
as sudden increases or decreases in vitamin K consumption can destabilize INR
levels and increase bleeding or clotting risk.
Q6: A 68-year-old male with peripheral artery disease (PAD) complains of
intermittent claudication in his calves after walking two blocks. His ABI is 0.72. What
is the first-line pharmacologic therapy to improve walking distance and symptoms?
A. Aspirin 325 mg daily for antiplatelet effect
B. Cilostazol 100 mg twice daily [CORRECT]
C. Clopidogrel 75 mg daily instead of aspirin
D. Warfarin anticoagulation to prevent thrombosis
Correct Answer: B
Rationale: Cilostazol is a phosphodiesterase III inhibitor that is FDA-approved and
recommended as first-line pharmacologic therapy for intermittent claudication in
PAD; it improves walking distance by 40-50% through vasodilation and inhibition of
platelet aggregation, though it is contraindicated in heart failure.
Q7: A 35-year-old female with asthma presents with increased wheezing and
shortness of breath. She uses her albuterol inhaler more than twice daily. According
to the NHLBI asthma guidelines (EPR-4), what is the most appropriate step-up in
therapy?
A. Continue albuterol PRN and add oral prednisone daily
B. Add a low-dose inhaled corticosteroid (ICS) to her regimen [CORRECT]
C. Switch to a leukotriene receptor antagonist monotherapy
D. Start high-dose ICS and long-acting beta-agonist (LABA) combination
Correct Answer: B
Rationale: According to NHLBI EPR-4 guidelines, patients with asthma using
short-acting beta-agonists (SABA) more than twice weekly or with any nighttime
awakenings should step up to Step 2 therapy, which involves adding a low-dose
inhaled corticosteroid (ICS) to control underlying airway inflammation.
Q8: A 68-year-old male with a 40 pack-year smoking history presents with chronic
cough and dyspnea. Spirometry shows FEV1/FVC ratio of 0.62 and FEV1 55%
predicted. What is his GOLD classification and recommended initial
pharmacotherapy?
A. GOLD Stage 1; short-acting bronchodilator PRN
B. GOLD Stage 2 (Moderate); long-acting bronchodilator [CORRECT]
, C. GOLD Stage 3; dual long-acting bronchodilator therapy
D. GOLD Stage 4; triple therapy with ICS/LABA/LAMA
Correct Answer: B
Rationale: With FEV1 50-80% predicted (55%) and FEV1/FVC <0.70, this patient has
GOLD Stage 2 (Moderate) COPD; the GOLD 2024 guidelines recommend initiating a
long-acting bronchodilator (either LAMA or LABA) as first-line maintenance therapy
for Group B patients to improve symptoms and reduce exacerbations.
Q9: A 42-year-old female presents with acute onset of pleuritic chest pain, dyspnea,
and tachycardia. D-dimer is elevated, and CT pulmonary angiography confirms a
pulmonary embolism. She has no contraindications to anticoagulation. What is the
preferred initial treatment?
A. Start unfractionated heparin IV and transition to warfarin
B. Start a direct oral anticoagulant (DOAC) such as apixaban or rivaroxaban
[CORRECT]
C. Administer thrombolytics immediately for all PE patients
D. Place an inferior vena cava (IVC) filter and defer anticoagulation
Correct Answer: B
Rationale: For hemodynamically stable patients with acute PE and no
contraindications, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban,
dabigatran, or edoxaban are preferred over warfarin-based regimens due to
equivalent efficacy, lower bleeding risk, and no need for INR monitoring, as supported
by multiple randomized trials.
Q10: A 50-year-old male presents with severe community-acquired pneumonia
(CURB-65 score 3). He is hemodynamically stable but requires hospital admission.
What is the recommended empiric antibiotic regimen according to IDSA/ATS
guidelines?
A. Azithromycin monotherapy
B. Ceftriaxone plus azithromycin OR ceftriaxone plus doxycycline [CORRECT]
C. Vancomycin plus piperacillin-tazobactam
D. Levofloxacin monotherapy for all hospitalized patients
Correct Answer: B
Rationale: For hospitalized patients with non-severe community-acquired
pneumonia, IDSA/ATS guidelines recommend empiric therapy with a beta-lactam
(ceftriaxone or ampicillin) plus a macrolide (azithromycin) OR a beta-lactam plus
Exam Actual 2026 with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
SECTION 1: CARDIOVASCULAR & RESPIRATORY CONDITIONS (15
Questions)
Q1: A 58-year-old male with a history of hypertension presents for a follow-up visit.
His blood pressure readings over the past month have averaged 148/92 mmHg on
his current regimen of lisinopril 10 mg daily. According to the 2017 ACC/AHA
hypertension guidelines, what is the most appropriate next step in management?
A. Continue current lisinopril dose and recheck in 6 months
B. Add a thiazide diuretic to the current ACE inhibitor regimen [CORRECT]
C. Switch from lisinopril to an ARB monotherapy
D. Discontinue lisinopril and start a calcium channel blocker alone
Correct Answer: B
Rationale: The patient's BP of 148/92 mmHg places him in Stage 2 hypertension
(>=140/90); current guidelines recommend initiating two first-line agents from
different classes when BP is >20/10 mmHg above goal, making the addition of a
thiazide diuretic to the ACE inhibitor the most appropriate step.
Q2: A 62-year-old female with hyperlipidemia has a fasting lipid panel showing: Total
cholesterol 245 mg/dL, LDL 168 mg/dL, HDL 48 mg/dL, Triglycerides 180 mg/dL.
She has type 2 diabetes but no history of ASCVD. What is her 10-year ASCVD risk
category and recommended LDL target?
A. Low risk; LDL target <130 mg/dL
B. Intermediate risk; LDL target <100 mg/dL
C. High risk (diabetes age 40-75); LDL target <100 mg/dL or >=50% reduction
[CORRECT]
D. Very high risk; LDL target <70 mg/dL
Correct Answer: C
Rationale: Patients with diabetes aged 40-75 years are classified as high risk for
ASCVD; the ACC/AHA guidelines recommend either an LDL target <100 mg/dL or a
reduction of >=50% using moderate-intensity statin therapy, with consideration of
high-intensity statin if multiple risk factors exist.
,Q3: A 70-year-old male with heart failure with reduced ejection fraction (HFrEF, EF
35%) presents with worsening dyspnea and peripheral edema. He is currently on
lisinopril, metoprolol succinate, and furosemide. Which medication should be added
to his regimen to reduce mortality and hospitalization based on current
evidence-based guidelines?
A. Digoxin for symptom control and mortality benefit
B. Sacubitril/valsartan (Entresto) to replace the ACE inhibitor [CORRECT]
C. Amlodipine for afterload reduction
D. Hydralazine/isosorbide dinitrate as first-line therapy
Correct Answer: B
Rationale: The PARADIGM-HF trial demonstrated that sacubitril/valsartan (an ARNI)
significantly reduced cardiovascular death and heart failure hospitalization
compared to enalapril in HFrEF patients, and current ACC/AHA/HFSA guidelines
recommend replacing ACE inhibitors with ARNIs in eligible NYHA Class II-III patients.
Q4: A 45-year-old male presents with acute chest pain radiating to his left arm,
diaphoresis, and nausea. His ECG shows ST-segment elevation in leads V1-V4.
Which is the most appropriate immediate management strategy?
A. Administer aspirin, clopidogrel, and schedule cardiac catheterization within 72
hours
B. Administer aspirin, load with P2Y12 inhibitor, and activate the cath lab for primary
PCI within 90 minutes [CORRECT]
C. Administer thrombolytics and transfer to a PCI-capable center
D. Start heparin drip and obtain a stress test once pain resolves
Correct Answer: B
Rationale: STEMI (ST-elevation myocardial infarction) requires immediate
reperfusion therapy; primary percutaneous coronary intervention (PCI) is the
preferred strategy when available within 90 minutes of first medical contact, along
with dual antiplatelet therapy (aspirin + P2Y12 inhibitor) and anticoagulation.
Q5: A 55-year-old female with a history of atrial fibrillation is started on warfarin
therapy. Which dietary counseling is most important to provide regarding vitamin K
intake?
A. Completely avoid all green leafy vegetables
B. Maintain consistent vitamin K intake rather than avoiding it entirely [CORRECT]
C. Double vitamin K intake to counteract warfarin effects
D. Take vitamin K supplements daily to prevent bleeding
Correct Answer: B
,Rationale: The key to successful warfarin management is maintaining consistent
daily vitamin K intake (typically 90-120 mcg/day) rather than avoiding it completely,
as sudden increases or decreases in vitamin K consumption can destabilize INR
levels and increase bleeding or clotting risk.
Q6: A 68-year-old male with peripheral artery disease (PAD) complains of
intermittent claudication in his calves after walking two blocks. His ABI is 0.72. What
is the first-line pharmacologic therapy to improve walking distance and symptoms?
A. Aspirin 325 mg daily for antiplatelet effect
B. Cilostazol 100 mg twice daily [CORRECT]
C. Clopidogrel 75 mg daily instead of aspirin
D. Warfarin anticoagulation to prevent thrombosis
Correct Answer: B
Rationale: Cilostazol is a phosphodiesterase III inhibitor that is FDA-approved and
recommended as first-line pharmacologic therapy for intermittent claudication in
PAD; it improves walking distance by 40-50% through vasodilation and inhibition of
platelet aggregation, though it is contraindicated in heart failure.
Q7: A 35-year-old female with asthma presents with increased wheezing and
shortness of breath. She uses her albuterol inhaler more than twice daily. According
to the NHLBI asthma guidelines (EPR-4), what is the most appropriate step-up in
therapy?
A. Continue albuterol PRN and add oral prednisone daily
B. Add a low-dose inhaled corticosteroid (ICS) to her regimen [CORRECT]
C. Switch to a leukotriene receptor antagonist monotherapy
D. Start high-dose ICS and long-acting beta-agonist (LABA) combination
Correct Answer: B
Rationale: According to NHLBI EPR-4 guidelines, patients with asthma using
short-acting beta-agonists (SABA) more than twice weekly or with any nighttime
awakenings should step up to Step 2 therapy, which involves adding a low-dose
inhaled corticosteroid (ICS) to control underlying airway inflammation.
Q8: A 68-year-old male with a 40 pack-year smoking history presents with chronic
cough and dyspnea. Spirometry shows FEV1/FVC ratio of 0.62 and FEV1 55%
predicted. What is his GOLD classification and recommended initial
pharmacotherapy?
A. GOLD Stage 1; short-acting bronchodilator PRN
B. GOLD Stage 2 (Moderate); long-acting bronchodilator [CORRECT]
, C. GOLD Stage 3; dual long-acting bronchodilator therapy
D. GOLD Stage 4; triple therapy with ICS/LABA/LAMA
Correct Answer: B
Rationale: With FEV1 50-80% predicted (55%) and FEV1/FVC <0.70, this patient has
GOLD Stage 2 (Moderate) COPD; the GOLD 2024 guidelines recommend initiating a
long-acting bronchodilator (either LAMA or LABA) as first-line maintenance therapy
for Group B patients to improve symptoms and reduce exacerbations.
Q9: A 42-year-old female presents with acute onset of pleuritic chest pain, dyspnea,
and tachycardia. D-dimer is elevated, and CT pulmonary angiography confirms a
pulmonary embolism. She has no contraindications to anticoagulation. What is the
preferred initial treatment?
A. Start unfractionated heparin IV and transition to warfarin
B. Start a direct oral anticoagulant (DOAC) such as apixaban or rivaroxaban
[CORRECT]
C. Administer thrombolytics immediately for all PE patients
D. Place an inferior vena cava (IVC) filter and defer anticoagulation
Correct Answer: B
Rationale: For hemodynamically stable patients with acute PE and no
contraindications, direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban,
dabigatran, or edoxaban are preferred over warfarin-based regimens due to
equivalent efficacy, lower bleeding risk, and no need for INR monitoring, as supported
by multiple randomized trials.
Q10: A 50-year-old male presents with severe community-acquired pneumonia
(CURB-65 score 3). He is hemodynamically stable but requires hospital admission.
What is the recommended empiric antibiotic regimen according to IDSA/ATS
guidelines?
A. Azithromycin monotherapy
B. Ceftriaxone plus azithromycin OR ceftriaxone plus doxycycline [CORRECT]
C. Vancomycin plus piperacillin-tazobactam
D. Levofloxacin monotherapy for all hospitalized patients
Correct Answer: B
Rationale: For hospitalized patients with non-severe community-acquired
pneumonia, IDSA/ATS guidelines recommend empiric therapy with a beta-lactam
(ceftriaxone or ampicillin) plus a macrolide (azithromycin) OR a beta-lactam plus
