NURS 5433 FNP II Midterm Exam Review
(2026/2027) (PDF) | Family Nursing |
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,───────────────────────────────────────────────────────
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1. A 55-year-old male with hypertension and type 2 diabetes presents for a
routine follow-up. His blood pressure is 142/88 mm Hg on lisinopril 20 mg
daily. His most recent LDL cholesterol is 130 mg/dL. What is the most
appropriate next step in management?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Start atorvastatin 40 mg daily
d) Start aspirin 81 mg daily
Correct answer c) Start atorvastatin 40 mg daily
.Expert-Explanation For a diabetic patient with LDL >70 mg/dL and a 10-year
ASCVD risk >7.5% (which this patient has due to age, hypertension, diabetes),
moderate-to-high intensity statin is indicated. Atorvastatin 40 mg is high
intensity. Adding a second antihypertensive is reasonable but statin has greater
mortality benefit. Aspirin is for secondary prevention only..
2. A 32-year-old G2P1 woman at 28 weeks gestation presents with a 3-day
history of headache, blurred vision, and right upper quadrant pain. Her blood
pressure is 168/102 mm Hg. Urinalysis shows 3+ protein. What is the most
appropriate next step?
a) Admit to labor and delivery for magnesium sulfate and antihypertensives
b) Prescribe labetalol 200 mg twice daily as outpatient
c) Schedule induction of labor at 37 weeks
d) Recommend bed rest at home with daily blood pressure monitoring
Correct answer a) Admit to labor and delivery for magnesium sulfate and
antihypertensives
.Expert-Explanation This patient has severe preeclampsia (BP ≥160/110 with
symptoms or significant proteinuria). Immediate hospitalization is required for
fetal monitoring, magnesium sulfate for seizure prophylaxis, and
antihypertensives (labetalol or hydralazine). Outpatient management is unsafe.
Delivery is indicated at 34 weeks for severe features, but at 28 weeks,
expectant management with inpatient monitoring may be attempted if mother
and fetus are stable..
,3. A 68-year-old woman with osteoarthritis reports increasing knee pain despite
taking ibuprofen 400 mg three times daily. She has a history of a gastric ulcer 2
years ago. Which medication would be the safest addition to her regimen?
a) Naproxen 500 mg twice daily
b) Celecoxib 200 mg daily
c) Acetaminophen 1000 mg three times daily
d) Prednisone 5 mg daily
Correct answer c) Acetaminophen 1000 mg three times daily
.Expert-Explanation Acetaminophen is first-line for osteoarthritis due to its
favorable safety profile, especially in patients with prior GI bleeding. It has no GI
or renal toxicity. Celecoxib (COX-2 inhibitor) has lower GI risk than non-
selective NSAIDs but still increases risk of cardiovascular events and can affect
renal function. Prednisone is not indicated for chronic OA pain..
4. A 45-year-old man presents with acute onset of severe, tearing chest pain
that radiates to his back. His blood pressure is 180/100 mm Hg in the right
arm and 130/80 mm Hg in the left arm. What is the most likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Correct answer c) Aortic dissection
Expert-Explanation The classic presentation of aortic dissection is sudden,
severe tearing chest or back pain with a difference in blood pressure between
arms. This is a surgical emergency requiring immediate CT angiography.
Myocardial infarction presents with pressure-like pain, not tearing. Pulmonary
embolism causes dyspnea and pleuritic pain. Pericarditis pain is positional and
relieved by leaning forward.
5. A 2-year-old child is brought to the clinic with a barking cough, inspiratory
stridor, and low-grade fever that worsens at night. The child is fully vaccinated.
What is the most appropriate initial management?
a) Oral dexamethasone 0.6 mg/kg and observation
b) Nebulized racemic epinephrine and admission
c) Intramuscular ceftriaxone for suspected epiglottitis
d) Chest x-ray to rule out foreign body
Correct answer a) Oral dexamethasone 0.6 mg/kg and observation
.Expert-Explanation This is mild-to-moderate croup (laryngotracheobronchitis).
Dexamethasone (0.6 mg/kg orally once) reduces inflammation and prevents
progression. Nebulized epinephrine is for moderate-to-severe stridor at rest or
, impending respiratory failure. Epiglottitis (now rare due to Hib vaccine) presents
with drooling, tripod positioning, and toxic appearance, not barking cough..
6. A 28-year-old woman presents with 3 days of dysuria, frequency, and
suprapubic pain. She has no vaginal discharge or fever. Urinalysis shows
positive nitrites and leukocyte esterase. She has no drug allergies. What is the
first-line antibiotic?
a) Ciprofloxacin 500 mg twice daily for 3 days
b) Nitrofurantoin 100 mg twice daily for 5 days
c) Trimethoprim-sulfamethoxazole twice daily for 3 days
d) Fosfomycin 3 g one-time dose
Correct answer b) Nitrofurantoin 100 mg twice daily for 5 days
.Expert-Explanation For uncomplicated cystitis in a healthy woman,
nitrofurantoin is first-line due to low resistance rates and minimal systemic side
effects. Fluoroquinolones (ciprofloxacin) are reserved for complicated UTIs or
pyelonephritis due to resistance and side effects. TMP-SMX has high resistance
in many regions (>20%). Fosfomycin is an alternative but requires a single dose
and is less effective for E. coli..
7. A 72-year-old man with heart failure with reduced ejection fraction (HFrEF) on
carvedilol, lisinopril, and furosemide presents with increasing dyspnea, jugular
venous distention, and 3+ pitting edema. His weight is up 8 lbs since last visit 2
weeks ago. What is the most appropriate adjustment?
a) Increase carvedilol to target dose
b) Increase lisinopril to target dose
c) Increase furosemide and consider adding metolazone
d) Add digoxin 0.125 mg daily
Correct answer c) Increase furosemide and consider adding metolazone
Expert-Explanation This patient has acute-on-chronic decompensated heart
failure with volume overload. The priority is diuresis. Increasing the loop
diuretic (furosemide) is first-line; if resistance occurs, adding a thiazide diuretic
like metolazone provides sequential nephron blockade. Increasing GDMT
(carvedilol, lisinopril) is important but not for acute decompensation. Digoxin is
not first-line for volume overload.
8. A 55-year-old woman with a 30-pack-year smoking history presents with a
chronic cough producing small amounts of white sputum for the past 2 years.
She has no hemoptysis or weight loss. Spirometry shows FEV1/FVC of 0.65 and
FEV1 65% of predicted. What is the most appropriate next step?
a) Chest x-ray and CT chest
(2026/2027) (PDF) | Family Nursing |
UTA Questions and Ansẉers with
Expert-Verified Explanation
This Exam contains:
Guarantee passing score
Questions and Ansẉers
Expert-Verified Explanation
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
1. A 55-year-old male with hypertension and type 2 diabetes presents for a
routine follow-up. His blood pressure is 142/88 mm Hg on lisinopril 20 mg
daily. His most recent LDL cholesterol is 130 mg/dL. What is the most
appropriate next step in management?
a) Add amlodipine 5 mg daily
b) Increase lisinopril to 40 mg daily
c) Start atorvastatin 40 mg daily
d) Start aspirin 81 mg daily
Correct answer c) Start atorvastatin 40 mg daily
.Expert-Explanation For a diabetic patient with LDL >70 mg/dL and a 10-year
ASCVD risk >7.5% (which this patient has due to age, hypertension, diabetes),
moderate-to-high intensity statin is indicated. Atorvastatin 40 mg is high
intensity. Adding a second antihypertensive is reasonable but statin has greater
mortality benefit. Aspirin is for secondary prevention only..
2. A 32-year-old G2P1 woman at 28 weeks gestation presents with a 3-day
history of headache, blurred vision, and right upper quadrant pain. Her blood
pressure is 168/102 mm Hg. Urinalysis shows 3+ protein. What is the most
appropriate next step?
a) Admit to labor and delivery for magnesium sulfate and antihypertensives
b) Prescribe labetalol 200 mg twice daily as outpatient
c) Schedule induction of labor at 37 weeks
d) Recommend bed rest at home with daily blood pressure monitoring
Correct answer a) Admit to labor and delivery for magnesium sulfate and
antihypertensives
.Expert-Explanation This patient has severe preeclampsia (BP ≥160/110 with
symptoms or significant proteinuria). Immediate hospitalization is required for
fetal monitoring, magnesium sulfate for seizure prophylaxis, and
antihypertensives (labetalol or hydralazine). Outpatient management is unsafe.
Delivery is indicated at 34 weeks for severe features, but at 28 weeks,
expectant management with inpatient monitoring may be attempted if mother
and fetus are stable..
,3. A 68-year-old woman with osteoarthritis reports increasing knee pain despite
taking ibuprofen 400 mg three times daily. She has a history of a gastric ulcer 2
years ago. Which medication would be the safest addition to her regimen?
a) Naproxen 500 mg twice daily
b) Celecoxib 200 mg daily
c) Acetaminophen 1000 mg three times daily
d) Prednisone 5 mg daily
Correct answer c) Acetaminophen 1000 mg three times daily
.Expert-Explanation Acetaminophen is first-line for osteoarthritis due to its
favorable safety profile, especially in patients with prior GI bleeding. It has no GI
or renal toxicity. Celecoxib (COX-2 inhibitor) has lower GI risk than non-
selective NSAIDs but still increases risk of cardiovascular events and can affect
renal function. Prednisone is not indicated for chronic OA pain..
4. A 45-year-old man presents with acute onset of severe, tearing chest pain
that radiates to his back. His blood pressure is 180/100 mm Hg in the right
arm and 130/80 mm Hg in the left arm. What is the most likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Correct answer c) Aortic dissection
Expert-Explanation The classic presentation of aortic dissection is sudden,
severe tearing chest or back pain with a difference in blood pressure between
arms. This is a surgical emergency requiring immediate CT angiography.
Myocardial infarction presents with pressure-like pain, not tearing. Pulmonary
embolism causes dyspnea and pleuritic pain. Pericarditis pain is positional and
relieved by leaning forward.
5. A 2-year-old child is brought to the clinic with a barking cough, inspiratory
stridor, and low-grade fever that worsens at night. The child is fully vaccinated.
What is the most appropriate initial management?
a) Oral dexamethasone 0.6 mg/kg and observation
b) Nebulized racemic epinephrine and admission
c) Intramuscular ceftriaxone for suspected epiglottitis
d) Chest x-ray to rule out foreign body
Correct answer a) Oral dexamethasone 0.6 mg/kg and observation
.Expert-Explanation This is mild-to-moderate croup (laryngotracheobronchitis).
Dexamethasone (0.6 mg/kg orally once) reduces inflammation and prevents
progression. Nebulized epinephrine is for moderate-to-severe stridor at rest or
, impending respiratory failure. Epiglottitis (now rare due to Hib vaccine) presents
with drooling, tripod positioning, and toxic appearance, not barking cough..
6. A 28-year-old woman presents with 3 days of dysuria, frequency, and
suprapubic pain. She has no vaginal discharge or fever. Urinalysis shows
positive nitrites and leukocyte esterase. She has no drug allergies. What is the
first-line antibiotic?
a) Ciprofloxacin 500 mg twice daily for 3 days
b) Nitrofurantoin 100 mg twice daily for 5 days
c) Trimethoprim-sulfamethoxazole twice daily for 3 days
d) Fosfomycin 3 g one-time dose
Correct answer b) Nitrofurantoin 100 mg twice daily for 5 days
.Expert-Explanation For uncomplicated cystitis in a healthy woman,
nitrofurantoin is first-line due to low resistance rates and minimal systemic side
effects. Fluoroquinolones (ciprofloxacin) are reserved for complicated UTIs or
pyelonephritis due to resistance and side effects. TMP-SMX has high resistance
in many regions (>20%). Fosfomycin is an alternative but requires a single dose
and is less effective for E. coli..
7. A 72-year-old man with heart failure with reduced ejection fraction (HFrEF) on
carvedilol, lisinopril, and furosemide presents with increasing dyspnea, jugular
venous distention, and 3+ pitting edema. His weight is up 8 lbs since last visit 2
weeks ago. What is the most appropriate adjustment?
a) Increase carvedilol to target dose
b) Increase lisinopril to target dose
c) Increase furosemide and consider adding metolazone
d) Add digoxin 0.125 mg daily
Correct answer c) Increase furosemide and consider adding metolazone
Expert-Explanation This patient has acute-on-chronic decompensated heart
failure with volume overload. The priority is diuresis. Increasing the loop
diuretic (furosemide) is first-line; if resistance occurs, adding a thiazide diuretic
like metolazone provides sequential nephron blockade. Increasing GDMT
(carvedilol, lisinopril) is important but not for acute decompensation. Digoxin is
not first-line for volume overload.
8. A 55-year-old woman with a 30-pack-year smoking history presents with a
chronic cough producing small amounts of white sputum for the past 2 years.
She has no hemoptysis or weight loss. Spirometry shows FEV1/FVC of 0.65 and
FEV1 65% of predicted. What is the most appropriate next step?
a) Chest x-ray and CT chest
