1
NURS 5433 / NURS5433 Final Exam Family II
FNP 2 Actual Exam 2026/2027 | Complete Exam-
Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Primary Care of Adults and Geriatrics | Q1 – Q20
Section 2 | Primary Care of Women and Reproductive Health | Q21 – Q40
Section 3 | Primary Care of Children and Adolescents | Q41 – Q60
Section 4 | Chronic Disease Management and Pharmacology | Q61 – Q80
Section 5 | Professional Role, Ethics, and Evidence-Based Practice | Q81 – Q100
SECTION 1: PRIMARY CARE OF ADULTS AND GERIATRICS
Question 1 of 100
A 55-year-old male presents for a routine physical examination. He has a blood pressure reading
of 148/92 mm Hg in the right arm and 146/90 mm Hg in the left arm, confirmed on two separate
visits. He has no known history of cardiovascular disease, diabetes, or chronic kidney disease.
His BMI is 28 kg/m², and he currently smokes a pack of cigarettes daily. According to the
ACC/AHA guidelines, what is the most appropriate initial pharmacologic treatment for this
patient?
A. Hydrochlorothiazide 12.5 mg daily
B. Amlodipine 5 mg daily
C. Lisinopril 10 mg daily ✓ CORRECT
D. Metoprolol succinate 25 mg daily
Correct Answer: C
Rationale: The patient has stage 2 hypertension and is a smoker with no compelling indications
like CKD or diabetes, but ACE inhibitors are often preferred as first-line therapy due to their
,2
cardiovascular protective effects and renal benefits, particularly given his elevated cardiovascular
risk profile. Hydrochlorothiazide is a reasonable alternative but is generally less effective for
cardiovascular event prevention compared to ACE inhibitors in high-risk patients. Amlodipine is
also appropriate but often reserved for patients who cannot tolerate ACE inhibitors or require
additional vasodilation.
Question 2 of 100
A 72-year-old female presents with progressive memory loss, difficulty managing her finances,
and getting lost in familiar neighborhoods over the past six months. Her daughter reports that the
patient has become more apathetic and irritable. A Mini-Mental State Exam (MMSE) score is
22/30. Physical examination is unremarkable except for mild cognitive deficits. Which
diagnostic test is most critical to perform first to rule out reversible causes of her cognitive
decline?
A. Brain MRI
B. Vitamin B12 and TSH levels ✓ CORRECT
C. Rapid Plasma Reagin (RPR)
D. Lumbar puncture for cerebrospinal fluid analysis
Correct Answer: B
Rationale: Laboratory tests for vitamin B12 deficiency and hypothyroidism are essential first
steps because they represent common, reversible causes of dementia that are easily treated.
While a brain MRI is important to visualize structural changes like tumors or hydrocephalus, it is
more costly and invasive than blood work and should follow after excluding metabolic causes.
Lumbar puncture is reserved for atypical presentations or when specific neurodegenerative
diseases are suspected.
Question 3 of 100
A 68-year-old male with a 40-pack-year smoking history presents with a persistent cough,
hemoptysis, and 15-pound weight loss over the last two months. A chest X-ray reveals a 3 cm
,3
spiculated mass in the right upper lobe. A CT-guided biopsy confirms non-small cell lung cancer.
Laboratory results show a serum sodium level of 128 mEq/L. What is the most appropriate
management for his hyponatremia in this context?
A. Normal saline infusion
B. Fluid restriction ✓ CORRECT
C. Hypertonic saline infusion
D. Demeclocycline therapy
Correct Answer: B
Rationale: This patient likely has the syndrome of inappropriate antidiuretic hormone (SIADH)
secretion secondary to his malignancy, and the primary management for euvolemic hyponatremia
caused by SIADH is fluid restriction. Hypertonic saline is reserved for severe, symptomatic
hyponatremia with neurological changes, which this patient does not currently exhibit.
Demeclocycline is a second-line treatment for chronic SIADH if fluid restriction fails, not the
initial management step.
Question 4 of 100
A 60-year-old female presents with complaints of vaginal dryness, dyspareunia, and occasional
urinary urgency. She entered menopause three years ago and has not taken any hormone
replacement therapy. She has no history of breast cancer or thromboembolic disease. What is the
most appropriate first-line treatment for her genitourinary syndrome of menopause (GSM)?
A. Oral estrogen-progestin therapy
B. Vaginal estrogen cream ✓ CORRECT
C. Selective estrogen receptor modulators (SERMs)
D. Oral ospemifene
Correct Answer: B
, 4
Rationale: Vaginal estrogen is the first-line treatment for genitourinary syndrome of menopause
because it delivers estrogen directly to the affected tissues with minimal systemic absorption,
relieving symptoms effectively while lowering the risk of systemic side effects. Oral estrogen-
progestin therapy carries higher risks such as venous thromboembolism and breast cancer and is
generally reserved for moderate-to-severe vasomotor symptoms rather than isolated vaginal
symptoms. Ospemifene is an oral alternative for dyspareunia but is typically considered if topical
therapies are ineffective.
Question 5 of 100
A 50-year-old male presents with acute onset of severe pain, swelling, and redness in his left first
metatarsophalangeal joint. He reports a previous similar episode two years ago. He consumes
alcohol frequently and has a diet high in red meat. Aspiration of the joint reveals negatively
birefringent needle-shaped crystals under polarized microscopy. What is the most appropriate
pharmacologic intervention for an acute flare during this visit?
A. Allopurinol 100 mg daily
B. Indomethacin 50 mg three times daily ✓ CORRECT
C. Probenecid 500 mg twice daily
D. Prednisone 10 mg daily
Correct Answer: B
Question 6 of 100
An 80-year-old female is brought to the clinic by her son due to increasing confusion and
agitation over the last 24 hours. She has a history of urinary incontinence and had a recent
urinary catheter placed during a hospitalization two weeks ago. Her temperature is 100.8°F
(38.2°C), heart rate is 102 bpm, and blood pressure is 110/70 mm Hg. Physical examination
reveals suprapubic tenderness. What is the most appropriate next step in management?
A. Initiate antipsychotic medication for agitation
NURS 5433 / NURS5433 Final Exam Family II
FNP 2 Actual Exam 2026/2027 | Complete Exam-
Style Questions | 100% Verified – Detailed
Rationales – Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Primary Care of Adults and Geriatrics | Q1 – Q20
Section 2 | Primary Care of Women and Reproductive Health | Q21 – Q40
Section 3 | Primary Care of Children and Adolescents | Q41 – Q60
Section 4 | Chronic Disease Management and Pharmacology | Q61 – Q80
Section 5 | Professional Role, Ethics, and Evidence-Based Practice | Q81 – Q100
SECTION 1: PRIMARY CARE OF ADULTS AND GERIATRICS
Question 1 of 100
A 55-year-old male presents for a routine physical examination. He has a blood pressure reading
of 148/92 mm Hg in the right arm and 146/90 mm Hg in the left arm, confirmed on two separate
visits. He has no known history of cardiovascular disease, diabetes, or chronic kidney disease.
His BMI is 28 kg/m², and he currently smokes a pack of cigarettes daily. According to the
ACC/AHA guidelines, what is the most appropriate initial pharmacologic treatment for this
patient?
A. Hydrochlorothiazide 12.5 mg daily
B. Amlodipine 5 mg daily
C. Lisinopril 10 mg daily ✓ CORRECT
D. Metoprolol succinate 25 mg daily
Correct Answer: C
Rationale: The patient has stage 2 hypertension and is a smoker with no compelling indications
like CKD or diabetes, but ACE inhibitors are often preferred as first-line therapy due to their
,2
cardiovascular protective effects and renal benefits, particularly given his elevated cardiovascular
risk profile. Hydrochlorothiazide is a reasonable alternative but is generally less effective for
cardiovascular event prevention compared to ACE inhibitors in high-risk patients. Amlodipine is
also appropriate but often reserved for patients who cannot tolerate ACE inhibitors or require
additional vasodilation.
Question 2 of 100
A 72-year-old female presents with progressive memory loss, difficulty managing her finances,
and getting lost in familiar neighborhoods over the past six months. Her daughter reports that the
patient has become more apathetic and irritable. A Mini-Mental State Exam (MMSE) score is
22/30. Physical examination is unremarkable except for mild cognitive deficits. Which
diagnostic test is most critical to perform first to rule out reversible causes of her cognitive
decline?
A. Brain MRI
B. Vitamin B12 and TSH levels ✓ CORRECT
C. Rapid Plasma Reagin (RPR)
D. Lumbar puncture for cerebrospinal fluid analysis
Correct Answer: B
Rationale: Laboratory tests for vitamin B12 deficiency and hypothyroidism are essential first
steps because they represent common, reversible causes of dementia that are easily treated.
While a brain MRI is important to visualize structural changes like tumors or hydrocephalus, it is
more costly and invasive than blood work and should follow after excluding metabolic causes.
Lumbar puncture is reserved for atypical presentations or when specific neurodegenerative
diseases are suspected.
Question 3 of 100
A 68-year-old male with a 40-pack-year smoking history presents with a persistent cough,
hemoptysis, and 15-pound weight loss over the last two months. A chest X-ray reveals a 3 cm
,3
spiculated mass in the right upper lobe. A CT-guided biopsy confirms non-small cell lung cancer.
Laboratory results show a serum sodium level of 128 mEq/L. What is the most appropriate
management for his hyponatremia in this context?
A. Normal saline infusion
B. Fluid restriction ✓ CORRECT
C. Hypertonic saline infusion
D. Demeclocycline therapy
Correct Answer: B
Rationale: This patient likely has the syndrome of inappropriate antidiuretic hormone (SIADH)
secretion secondary to his malignancy, and the primary management for euvolemic hyponatremia
caused by SIADH is fluid restriction. Hypertonic saline is reserved for severe, symptomatic
hyponatremia with neurological changes, which this patient does not currently exhibit.
Demeclocycline is a second-line treatment for chronic SIADH if fluid restriction fails, not the
initial management step.
Question 4 of 100
A 60-year-old female presents with complaints of vaginal dryness, dyspareunia, and occasional
urinary urgency. She entered menopause three years ago and has not taken any hormone
replacement therapy. She has no history of breast cancer or thromboembolic disease. What is the
most appropriate first-line treatment for her genitourinary syndrome of menopause (GSM)?
A. Oral estrogen-progestin therapy
B. Vaginal estrogen cream ✓ CORRECT
C. Selective estrogen receptor modulators (SERMs)
D. Oral ospemifene
Correct Answer: B
, 4
Rationale: Vaginal estrogen is the first-line treatment for genitourinary syndrome of menopause
because it delivers estrogen directly to the affected tissues with minimal systemic absorption,
relieving symptoms effectively while lowering the risk of systemic side effects. Oral estrogen-
progestin therapy carries higher risks such as venous thromboembolism and breast cancer and is
generally reserved for moderate-to-severe vasomotor symptoms rather than isolated vaginal
symptoms. Ospemifene is an oral alternative for dyspareunia but is typically considered if topical
therapies are ineffective.
Question 5 of 100
A 50-year-old male presents with acute onset of severe pain, swelling, and redness in his left first
metatarsophalangeal joint. He reports a previous similar episode two years ago. He consumes
alcohol frequently and has a diet high in red meat. Aspiration of the joint reveals negatively
birefringent needle-shaped crystals under polarized microscopy. What is the most appropriate
pharmacologic intervention for an acute flare during this visit?
A. Allopurinol 100 mg daily
B. Indomethacin 50 mg three times daily ✓ CORRECT
C. Probenecid 500 mg twice daily
D. Prednisone 10 mg daily
Correct Answer: B
Question 6 of 100
An 80-year-old female is brought to the clinic by her son due to increasing confusion and
agitation over the last 24 hours. She has a history of urinary incontinence and had a recent
urinary catheter placed during a hospitalization two weeks ago. Her temperature is 100.8°F
(38.2°C), heart rate is 102 bpm, and blood pressure is 110/70 mm Hg. Physical examination
reveals suprapubic tenderness. What is the most appropriate next step in management?
A. Initiate antipsychotic medication for agitation
