NURS 5434 FNP III Final Exam (PDF) | (2026)
Family Nurse Practitioner Questions | FNP
1. A 58-year-old man with hypertension presents with
sudden onset tearing chest pain radiating to the back. BP
is 180/110 in the right arm and 100/60 in the left arm.
What is the most appropriate next step?
A) ECG and troponin
B) Chest x-ray
C) CT angiography
D) Emergent surgery consult
Answer: C
Rationale: Discrepant blood pressures and tearing pain
suggest aortic dissection. CT angiography is the definitive
imaging study. Surgery consult is urgent but after
diagnosis.
2. Which medication class reduces mortality in chronic
heart failure with reduced ejection fraction (HFrEF) and
should be started early?
1
,A) Thiazide diuretics
B) Beta-blockers (carvedilol, metoprolol succinate)
C) Calcium channel blockers
D) Nitrates
Answer: B
Rationale: Beta-blockers improve survival in HFrEF by
reducing sympathetic overactivity and decreasing sudden
cardiac death.
3. A patient with atrial fibrillation (AF) has a
CHA₂ DS₂ -VASc score of 3 and a HAS-BLED score of 2.
What is the next step?
A) Aspirin 81 mg daily
B) No anticoagulation
C) Warfarin or DOAC
D) Left atrial appendage closure device
Answer: C
Rationale: CHA₂ DS₂ -VASc ≥2 in men or ≥3 in women
2
,warrants oral anticoagulation regardless of HAS-BLED
score.
4. An asymptomatic 72-year-old has a systolic ejection
murmur at the right upper sternal border radiating to the
carotids, with delayed carotid upstroke. Most likely
diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Hypertrophic cardiomyopathy
D) Aortic sclerosis
Answer: B
Rationale: Classic findings of aortic stenosis: crescendo-
decrescendo murmur, radiation to carotids, pulsus parvus
et tardus (delayed upstroke).
5. First-line antihypertensive for a 45-year-old Black
patient with diabetes and microalbuminuria?
A) Metoprolol
B) HCTZ
3
, C) Amlodipine
D) Lisinopril
Answer: D
Rationale: ACE inhibitors (or ARBs) are preferred for
diabetes with microalbuminuria due to renoprotection.
Guidelines recommend ACEi/ARB plus CCB or thiazide for
Black patients.
6. A patient with known CAD reports worsening dyspnea
on exertion and orthopnea. Exam shows JVD, S3 gallop,
and bilateral crackles. Next best step?
A) Increase beta-blocker
B) Oral furosemide
C) IV furosemide in ED
D) Echocardiogram
Answer: C
Rationale: Acute decompensated heart failure with
volume overload requires IV loop diuretic, typically
administered in the emergency department or hospital.
4
Family Nurse Practitioner Questions | FNP
1. A 58-year-old man with hypertension presents with
sudden onset tearing chest pain radiating to the back. BP
is 180/110 in the right arm and 100/60 in the left arm.
What is the most appropriate next step?
A) ECG and troponin
B) Chest x-ray
C) CT angiography
D) Emergent surgery consult
Answer: C
Rationale: Discrepant blood pressures and tearing pain
suggest aortic dissection. CT angiography is the definitive
imaging study. Surgery consult is urgent but after
diagnosis.
2. Which medication class reduces mortality in chronic
heart failure with reduced ejection fraction (HFrEF) and
should be started early?
1
,A) Thiazide diuretics
B) Beta-blockers (carvedilol, metoprolol succinate)
C) Calcium channel blockers
D) Nitrates
Answer: B
Rationale: Beta-blockers improve survival in HFrEF by
reducing sympathetic overactivity and decreasing sudden
cardiac death.
3. A patient with atrial fibrillation (AF) has a
CHA₂ DS₂ -VASc score of 3 and a HAS-BLED score of 2.
What is the next step?
A) Aspirin 81 mg daily
B) No anticoagulation
C) Warfarin or DOAC
D) Left atrial appendage closure device
Answer: C
Rationale: CHA₂ DS₂ -VASc ≥2 in men or ≥3 in women
2
,warrants oral anticoagulation regardless of HAS-BLED
score.
4. An asymptomatic 72-year-old has a systolic ejection
murmur at the right upper sternal border radiating to the
carotids, with delayed carotid upstroke. Most likely
diagnosis?
A) Mitral regurgitation
B) Aortic stenosis
C) Hypertrophic cardiomyopathy
D) Aortic sclerosis
Answer: B
Rationale: Classic findings of aortic stenosis: crescendo-
decrescendo murmur, radiation to carotids, pulsus parvus
et tardus (delayed upstroke).
5. First-line antihypertensive for a 45-year-old Black
patient with diabetes and microalbuminuria?
A) Metoprolol
B) HCTZ
3
, C) Amlodipine
D) Lisinopril
Answer: D
Rationale: ACE inhibitors (or ARBs) are preferred for
diabetes with microalbuminuria due to renoprotection.
Guidelines recommend ACEi/ARB plus CCB or thiazide for
Black patients.
6. A patient with known CAD reports worsening dyspnea
on exertion and orthopnea. Exam shows JVD, S3 gallop,
and bilateral crackles. Next best step?
A) Increase beta-blocker
B) Oral furosemide
C) IV furosemide in ED
D) Echocardiogram
Answer: C
Rationale: Acute decompensated heart failure with
volume overload requires IV loop diuretic, typically
administered in the emergency department or hospital.
4
