NURS 5433 FNP II Final Exam Questions & Verified
Answers 3 VERSIONS
This specialized graduate nursing resource delivers a comprehensive collection of
past exam questions, verified answers, and detailed clinical rationales explicitly
built for the NURS 5433 Family Nurse Practitioner (FNP) II Final Examination. It focuses
on the advanced practice evaluation, differential diagnosis, and evidence-based primary
care management of complex acute and chronic illnesses across the lifespan. Preparing
with these targeted testing materials will refine your clinical decision-making, optimize
your pharmaceutical management plans, and guarantee an A grade on your
proctored terminal assessment.
1. A 62-year-old man with atrial fibrillation is on warfarin. His INR is 5.8 and he
has no bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Transfuse fresh frozen plasma
D) Continue warfarin and monitor
Answer: B
Rationale: For INR 4.5–10 without bleeding, guidelines recommend holding warfarin and
rechecking INR, without routine vitamin K. IV vitamin K is for serious bleeding or INR >10.
FFP is for active bleeding.
2. A 28-year-old woman presents with a 3-day history of severe vulvar pain and a
"kissing" lesion pattern. Which organism is most likely?
A) Candida albicans
B) Herpes simplex virus
C) Treponema pallidum
D) Gardnerella vaginalis
Answer: B
Rationale: Primary HSV presents with painful vesicles and ulcers that may coalesce
("kissing" lesions). Candida causes thick white discharge and itching. Syphilis is painless.
Gardnerella causes bacterial vaginosis with fishy odor.
,3. A 45-year-old man presents with sudden onset of severe unilateral scrotal pain
and nausea. The testis is high-riding and the cremasteric reflex is absent. What is
the priority action?
A) Order scrotal ultrasound
B) Attempt manual detorsion
C) Immediate urology referral for surgical exploration
D) Administer antibiotics
Answer: C
Rationale: Testicular torsion is a surgical emergency. If suspicion is high and ultrasound
would delay care, immediate urology referral for exploration is indicated. Manual
detorsion can be attempted but should not delay surgery.
4. A 72-year-old woman presents with a 2-month history of fatigue and bone pain.
Labs show hypercalcemia, elevated PTH, and low phosphorus. What is the most
likely diagnosis?
A) Primary hyperparathyroidism
B) Malignancy-associated hypercalcemia
C) Vitamin D toxicity
D) Sarcoidosis
Answer: A
Rationale: Primary hyperparathyroidism causes high PTH, high calcium, and low
phosphorus. Malignancy typically has low PTH. Vitamin D toxicity has high calcium and
low PTH. Sarcoidosis has high calcium but low PTH.
5. A 4-year-old child presents with a 2-day history of fever, rash, and strawberry
tongue. Which diagnosis is most likely?
A) Scarlet fever
B) Kawasaki disease
C) Measles
D) Rubella
Answer: A
Rationale: Scarlet fever presents with fever, sandpaper-like rash, strawberry tongue, and
pharyngitis. Kawasaki has fever >5 days, conjunctivitis, rash, and extremity changes.
Measles has Koplik spots. Rubella has a milder rash and lymphadenopathy.
,6. A 55-year-old woman with type 2 diabetes is on metformin. Her HbA1c is 8.5%.
She has no cardiovascular disease. What is the next best step?
A) Add a sulfonylurea
B) Add an SGLT2 inhibitor
C) Add a GLP-1 receptor agonist
D) Add insulin
Answer: B
Rationale: For patients with type 2 diabetes without ASCVD, SGLT2 inhibitors or GLP-1
RAs are preferred add-on therapies due to weight loss and low hypoglycemia risk.
Sulfonylureas cause hypoglycemia and weight gain. Insulin is later.
7. A 30-year-old man presents with a 4-day history of penile discharge and
dysuria. He reports unprotected sex. Which test is most appropriate initially?
A) Urinalysis
B) NAAT for Chlamydia and Gonorrhea
C) Culture of discharge
D) Blood cultures
Answer: B
Rationale: Nucleic acid amplification testing (NAAT) is the preferred method for detecting
Chlamydia and Gonorrhea from urine or urethral swab. Urinalysis is nonspecific. Culture is
less sensitive. Blood cultures are not indicated.
8. A 6-month-old infant presents with a 2-day history of fever, irritability, and a
bulging fontanel. What is the priority action?
A) Administer acetaminophen and observe
B) Obtain blood cultures and start antibiotics
C) Perform lumbar puncture
D) Order a CT scan
Answer: B
Rationale: Suspected bacterial meningitis requires immediate blood cultures and empiric
antibiotics. Lumbar puncture may be delayed if the infant is unstable but should be done
as soon as safe. CT is not first-line.
, 9. A 40-year-old woman presents with a 2-week history of palpitations and weight
loss. Her TSH is low and free T4 is high. Which medication is first-line for long-
term management of Graves' disease?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine
D) Propranolol
Answer: A
Rationale: Methimazole is first-line for Graves' disease. Radioactive iodine is definitive but
not initial. Propranolol controls symptoms but does not treat the disease. Levothyroxine
would worsen hyperthyroidism.
10. A 65-year-old man presents with a 3-month history of nocturia, hesitancy, and
weak stream. His PSA is 4.5 ng/mL. What is the next step?
A) Start tamsulosin
B) Refer for prostate biopsy
C) Repeat PSA in 6 months
D) Start finasteride
Answer: B
Rationale: PSA >4.0 ng/mL warrants further evaluation, typically prostate biopsy, to rule
out prostate cancer. Tamsulosin and finasteride treat BPH but do not address cancer risk.
11. A 2-year-old child presents with a 1-day history of drooling, stridor, and high
fever. The child is sitting forward and refuses to lie down. What is the priority
action?
A) Examine the throat with a tongue depressor
B) Administer nebulized epinephrine
C) Keep the child calm and prepare for intubation
D) Start antibiotics
Answer: C
Rationale: This presentation suggests epiglottitis, a medical emergency. Do not examine
the throat as it may precipitate airway obstruction. Keep the child calm, prepare for
intubation, and administer antibiotics after airway is secured.
Answers 3 VERSIONS
This specialized graduate nursing resource delivers a comprehensive collection of
past exam questions, verified answers, and detailed clinical rationales explicitly
built for the NURS 5433 Family Nurse Practitioner (FNP) II Final Examination. It focuses
on the advanced practice evaluation, differential diagnosis, and evidence-based primary
care management of complex acute and chronic illnesses across the lifespan. Preparing
with these targeted testing materials will refine your clinical decision-making, optimize
your pharmaceutical management plans, and guarantee an A grade on your
proctored terminal assessment.
1. A 62-year-old man with atrial fibrillation is on warfarin. His INR is 5.8 and he
has no bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 24 hours
C) Transfuse fresh frozen plasma
D) Continue warfarin and monitor
Answer: B
Rationale: For INR 4.5–10 without bleeding, guidelines recommend holding warfarin and
rechecking INR, without routine vitamin K. IV vitamin K is for serious bleeding or INR >10.
FFP is for active bleeding.
2. A 28-year-old woman presents with a 3-day history of severe vulvar pain and a
"kissing" lesion pattern. Which organism is most likely?
A) Candida albicans
B) Herpes simplex virus
C) Treponema pallidum
D) Gardnerella vaginalis
Answer: B
Rationale: Primary HSV presents with painful vesicles and ulcers that may coalesce
("kissing" lesions). Candida causes thick white discharge and itching. Syphilis is painless.
Gardnerella causes bacterial vaginosis with fishy odor.
,3. A 45-year-old man presents with sudden onset of severe unilateral scrotal pain
and nausea. The testis is high-riding and the cremasteric reflex is absent. What is
the priority action?
A) Order scrotal ultrasound
B) Attempt manual detorsion
C) Immediate urology referral for surgical exploration
D) Administer antibiotics
Answer: C
Rationale: Testicular torsion is a surgical emergency. If suspicion is high and ultrasound
would delay care, immediate urology referral for exploration is indicated. Manual
detorsion can be attempted but should not delay surgery.
4. A 72-year-old woman presents with a 2-month history of fatigue and bone pain.
Labs show hypercalcemia, elevated PTH, and low phosphorus. What is the most
likely diagnosis?
A) Primary hyperparathyroidism
B) Malignancy-associated hypercalcemia
C) Vitamin D toxicity
D) Sarcoidosis
Answer: A
Rationale: Primary hyperparathyroidism causes high PTH, high calcium, and low
phosphorus. Malignancy typically has low PTH. Vitamin D toxicity has high calcium and
low PTH. Sarcoidosis has high calcium but low PTH.
5. A 4-year-old child presents with a 2-day history of fever, rash, and strawberry
tongue. Which diagnosis is most likely?
A) Scarlet fever
B) Kawasaki disease
C) Measles
D) Rubella
Answer: A
Rationale: Scarlet fever presents with fever, sandpaper-like rash, strawberry tongue, and
pharyngitis. Kawasaki has fever >5 days, conjunctivitis, rash, and extremity changes.
Measles has Koplik spots. Rubella has a milder rash and lymphadenopathy.
,6. A 55-year-old woman with type 2 diabetes is on metformin. Her HbA1c is 8.5%.
She has no cardiovascular disease. What is the next best step?
A) Add a sulfonylurea
B) Add an SGLT2 inhibitor
C) Add a GLP-1 receptor agonist
D) Add insulin
Answer: B
Rationale: For patients with type 2 diabetes without ASCVD, SGLT2 inhibitors or GLP-1
RAs are preferred add-on therapies due to weight loss and low hypoglycemia risk.
Sulfonylureas cause hypoglycemia and weight gain. Insulin is later.
7. A 30-year-old man presents with a 4-day history of penile discharge and
dysuria. He reports unprotected sex. Which test is most appropriate initially?
A) Urinalysis
B) NAAT for Chlamydia and Gonorrhea
C) Culture of discharge
D) Blood cultures
Answer: B
Rationale: Nucleic acid amplification testing (NAAT) is the preferred method for detecting
Chlamydia and Gonorrhea from urine or urethral swab. Urinalysis is nonspecific. Culture is
less sensitive. Blood cultures are not indicated.
8. A 6-month-old infant presents with a 2-day history of fever, irritability, and a
bulging fontanel. What is the priority action?
A) Administer acetaminophen and observe
B) Obtain blood cultures and start antibiotics
C) Perform lumbar puncture
D) Order a CT scan
Answer: B
Rationale: Suspected bacterial meningitis requires immediate blood cultures and empiric
antibiotics. Lumbar puncture may be delayed if the infant is unstable but should be done
as soon as safe. CT is not first-line.
, 9. A 40-year-old woman presents with a 2-week history of palpitations and weight
loss. Her TSH is low and free T4 is high. Which medication is first-line for long-
term management of Graves' disease?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine
D) Propranolol
Answer: A
Rationale: Methimazole is first-line for Graves' disease. Radioactive iodine is definitive but
not initial. Propranolol controls symptoms but does not treat the disease. Levothyroxine
would worsen hyperthyroidism.
10. A 65-year-old man presents with a 3-month history of nocturia, hesitancy, and
weak stream. His PSA is 4.5 ng/mL. What is the next step?
A) Start tamsulosin
B) Refer for prostate biopsy
C) Repeat PSA in 6 months
D) Start finasteride
Answer: B
Rationale: PSA >4.0 ng/mL warrants further evaluation, typically prostate biopsy, to rule
out prostate cancer. Tamsulosin and finasteride treat BPH but do not address cancer risk.
11. A 2-year-old child presents with a 1-day history of drooling, stridor, and high
fever. The child is sitting forward and refuses to lie down. What is the priority
action?
A) Examine the throat with a tongue depressor
B) Administer nebulized epinephrine
C) Keep the child calm and prepare for intubation
D) Start antibiotics
Answer: C
Rationale: This presentation suggests epiglottitis, a medical emergency. Do not examine
the throat as it may precipitate airway obstruction. Keep the child calm, prepare for
intubation, and administer antibiotics after airway is secured.
