NURS 5433 FNP II MIDTERM EXAM PREPARATION GUIDE
UNIVERSITY OF TEXAS AT ARLINGTON ADVANCED PRACTICE NURSING
2026 CLINICAL GUIDELINE ALIGNMENT
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 58 year old male patient presents to the clinic for a follow up of heart failure with
reduced ejection fraction. His current ejection fraction is 32 percent. He is currently
taking Lisinopril, Carvedilol, and Furosemide. His blood pressure today is 110 over 70
and his heart rate is 68. He has no signs of fluid overload. According to the current
ACC/AHA guidelines for heart failure, what is the most appropriate next step in his
pharmacological management?
A. Add Digoxin to improve his ejection fraction.
B. Add an Aldosterone Antagonist like Spironolactone.
C. Add a Sodium Glucose Cotransporter 2 Inhibitor like Dapagliflozin.
D. Discontinue the Carvedilol because his blood pressure is too low.
Answer: C
Rationale: Current guideline-directed medical therapy for heart failure with reduced
ejection fraction, often referred to as the four pillars of therapy, includes an ACE
inhibitor or ARB or ARNI, a beta blocker, an aldosterone antagonist, and a Sodium
Glucose Cotransporter 2 inhibitor. Because this patient is already on an ACE inhibitor
, and a beta blocker and is tolerating them well without hypotension, the addition of an
SGLT2 inhibitor is strongly recommended to reduce heart failure hospitalization and
cardiovascular mortality, regardless of whether the patient has diabetes mellitus.
While an aldosterone antagonist is also indicated, SGLT2 inhibitors are preferred early
in the disease trajectory due to their robust clinical trial data and tolerability. Digoxin is
only used for symptom control in patients who remain symptomatic despite optimal
guideline-directed medical therapy. Discontinuing the beta blocker is contraindicated
as beta blockers reduce mortality in this population.
Question 2
A 72 year old female with a history of hypertension and atrial fibrillation presents for
her annual wellness exam. Her CHA2DS2-VASc score is 4. She is currently taking
Aspirin 81 mg daily for stroke prevention. She denies any bleeding episodes. What is
the standard of care regarding her stroke prevention strategy?
A. Continue Aspirin 81 mg daily as it is sufficient for her stroke risk.
B. Discontinue Aspirin and initiate a Direct Oral Anticoagulant such as Apixaban.
C. Add Clopidogrel 75 mg to her current Aspirin regimen for dual antiplatelet therapy.
D. Initiate Warfarin with a target INR of 2.0 to 2.5.
Answer: B
Rationale: The CHA2DS2-VASc score is used to assess stroke risk in patients with non-
valvular atrial fibrillation. A score of 4 indicates a high risk for stroke. Current
guidelines strongly recommend oral anticoagulation over antiplatelet therapy for
stroke prevention in patients with a score of 2 or greater in men and 3 or greater in
women. Direct Oral Anticoagulants, such as Apixaban, are preferred over Warfarin due
to their predictable pharmacokinetics, lack of routine INR monitoring, and lower risk of
intracranial hemorrhage. Dual antiplatelet therapy with Aspirin and Clopidogrel is not
indicated for stroke prevention in atrial fibrillation and significantly increases bleeding
risk without providing adequate stroke protection compared to anticoagulants.
SECTION 2: ENDOCRINE DISORDERS
UNIVERSITY OF TEXAS AT ARLINGTON ADVANCED PRACTICE NURSING
2026 CLINICAL GUIDELINE ALIGNMENT
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 58 year old male patient presents to the clinic for a follow up of heart failure with
reduced ejection fraction. His current ejection fraction is 32 percent. He is currently
taking Lisinopril, Carvedilol, and Furosemide. His blood pressure today is 110 over 70
and his heart rate is 68. He has no signs of fluid overload. According to the current
ACC/AHA guidelines for heart failure, what is the most appropriate next step in his
pharmacological management?
A. Add Digoxin to improve his ejection fraction.
B. Add an Aldosterone Antagonist like Spironolactone.
C. Add a Sodium Glucose Cotransporter 2 Inhibitor like Dapagliflozin.
D. Discontinue the Carvedilol because his blood pressure is too low.
Answer: C
Rationale: Current guideline-directed medical therapy for heart failure with reduced
ejection fraction, often referred to as the four pillars of therapy, includes an ACE
inhibitor or ARB or ARNI, a beta blocker, an aldosterone antagonist, and a Sodium
Glucose Cotransporter 2 inhibitor. Because this patient is already on an ACE inhibitor
, and a beta blocker and is tolerating them well without hypotension, the addition of an
SGLT2 inhibitor is strongly recommended to reduce heart failure hospitalization and
cardiovascular mortality, regardless of whether the patient has diabetes mellitus.
While an aldosterone antagonist is also indicated, SGLT2 inhibitors are preferred early
in the disease trajectory due to their robust clinical trial data and tolerability. Digoxin is
only used for symptom control in patients who remain symptomatic despite optimal
guideline-directed medical therapy. Discontinuing the beta blocker is contraindicated
as beta blockers reduce mortality in this population.
Question 2
A 72 year old female with a history of hypertension and atrial fibrillation presents for
her annual wellness exam. Her CHA2DS2-VASc score is 4. She is currently taking
Aspirin 81 mg daily for stroke prevention. She denies any bleeding episodes. What is
the standard of care regarding her stroke prevention strategy?
A. Continue Aspirin 81 mg daily as it is sufficient for her stroke risk.
B. Discontinue Aspirin and initiate a Direct Oral Anticoagulant such as Apixaban.
C. Add Clopidogrel 75 mg to her current Aspirin regimen for dual antiplatelet therapy.
D. Initiate Warfarin with a target INR of 2.0 to 2.5.
Answer: B
Rationale: The CHA2DS2-VASc score is used to assess stroke risk in patients with non-
valvular atrial fibrillation. A score of 4 indicates a high risk for stroke. Current
guidelines strongly recommend oral anticoagulation over antiplatelet therapy for
stroke prevention in patients with a score of 2 or greater in men and 3 or greater in
women. Direct Oral Anticoagulants, such as Apixaban, are preferred over Warfarin due
to their predictable pharmacokinetics, lack of routine INR monitoring, and lower risk of
intracranial hemorrhage. Dual antiplatelet therapy with Aspirin and Clopidogrel is not
indicated for stroke prevention in atrial fibrillation and significantly increases bleeding
risk without providing adequate stroke protection compared to anticoagulants.
SECTION 2: ENDOCRINE DISORDERS
