NURS 5433 FAMILY II FINAL EXAM LATEST 2026
UPDATE 100+ QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 45-year-old male with hypertension presents with sudden-onset severe chest
pain radiating to the back. Aortic dissection is suspected. Which initial imaging
study is most definitive?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography
D) Transesophageal echocardiogram
Correct Answer: C. CT angiography has high sensitivity and specificity for aortic
dissection, is widely available, and provides detailed vascular anatomy. Chest X-ray
is often normal. TTE has lower sensitivity for thoracic aortic dissection. TEE is
useful but more invasive and operator-dependent.
Question 2
A 60-year-old female with chronic heart failure presents with worsening dyspnea,
jugular venous distension, and lower extremity edema. Which medication is most
likely to reduce mortality in this setting?
A) Furosemide
B) Digoxin
C) Carvedilol
D) Hydralazine
Correct Answer: C. Carvedilol, a beta-blocker, reduces mortality in chronic heart
failure with reduced ejection fraction by blocking sympathetic overactivity.
Furosemide manages symptoms but does not improve survival. Digoxin reduces
hospitalizations without mortality benefit. Hydralazine is second-line.
,Question 3
A 30-year-old pregnant woman at 28 weeks gestation presents with epigastric
pain, nausea, and blood pressure of 160/100 mmHg. Labs show platelets
80,000/μL and AST 120 U/L. What is the most appropriate next step?
A) Administer labetalol and discharge
B) Immediate delivery
C) Outpatient monitoring with antihypertensives
D) Administer magnesium sulfate and plan for delivery
Correct Answer: D. This patient has HELLP syndrome (hemolysis, elevated liver
enzymes, low platelets). Magnesium sulfate prevents seizures, and delivery is
indicated regardless of gestational age due to maternal risk. Labetalol alone is
insufficient. Outpatient monitoring is unsafe.
Question 4
A 55-year-old male with type 2 diabetes and a non-healing ulcer on his right great
toe has absent dorsalis pedis pulses. Ankle-brachial index (ABI) is 0.5. What is the
most appropriate initial management?
A) Aspirin and statin therapy
B) Surgical bypass consultation
C) Wound debridement only
D) Hyperbaric oxygen therapy
Correct Answer: A. Initial management of peripheral artery disease includes
antiplatelet therapy (aspirin) and statins to reduce cardiovascular risk. Surgical
bypass is considered after medical therapy. Debridement alone does not address
ischemia. Hyperbaric oxygen is not first-line.
Question 5
A 70-year-old male with COPD presents with worsening dyspnea, cough with
purulent sputum, and fever. Chest X-ray shows no infiltrate. Which antibiotic is
,most appropriate?
A) Azithromycin
B) Levofloxacin
C) Amoxicillin-clavulanate
D) Cephalexin
Correct Answer: B. Levofloxacin (a respiratory fluoroquinolone) covers typical and
atypical pathogens in acute exacerbation of COPD with purulent sputum.
Azithromycin is also used but has higher resistance. Amoxicillin-clavulanate is less
effective for atypicals. Cephalexin is not respiratory-spectrum.
Question 6
A 25-year-old female with systemic lupus erythematosus presents with acute flank
pain, hematuria, and hypertension. Urinalysis shows dysmorphic RBCs and RBC
casts. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Nephrolithiasis
C) Lupus nephritis
D) Renal vein thrombosis
Correct Answer: C. RBC casts indicate glomerulonephritis, and in a lupus patient,
active lupus nephritis is most likely. Pyelonephritis would have WBC casts.
Nephrolithiasis does not cause casts. Renal vein thrombosis presents with flank
pain but not RBC casts.
Question 7
A 50-year-old male presents with right upper quadrant pain, fever, and jaundice.
Ultrasound shows dilated intrahepatic ducts and a stone in the common bile duct.
What is the definitive treatment?
A) Ursodeoxycholic acid
B) ERCP with sphincterotomy
, C) Laparoscopic cholecystectomy
D) Observation
Correct Answer: B. ERCP with sphincterotomy is definitive for common bile duct
stones causing cholangitis (Charcot’s triad). Ursodeoxycholic acid is for dissolution,
not acute obstruction. Cholecystectomy treats gallbladder, not ductal stones.
Observation risks sepsis.
Question 8
A 65-year-old female with atrial fibrillation on warfarin presents with sudden
severe headache, vomiting, and left-sided weakness. INR is 4.5. Head CT shows
right parietal intracerebral hemorrhage. Which intervention is most urgent?
A) Administer fresh frozen plasma
B) Administer vitamin K intravenously
C) Reverse warfarin with prothrombin complex concentrate
D) Administer platelets
Correct Answer: C. Prothrombin complex concentrate (PCC) rapidly reverses
warfarin in intracerebral hemorrhage. FFP is slower. Vitamin K takes hours.
Platelets are not indicated unless on antiplatelet agents.
Question 9
A 32-year-old male presents with episodic palpitations, sweating, and severe
headaches lasting 15 minutes. Blood pressure is 210/120 mmHg during episode.
Which test is most diagnostic?
A) Plasma metanephrines
B) Renal artery doppler
C) Serum aldosterone-to-renin ratio
D) 24-hour urinary cortisol
Correct Answer: A. Episodic hypertension with palpitations and headache suggests
pheochromocytoma; plasma-free metanephrines are most sensitive. Renal artery
UPDATE 100+ QUESTIONS AND DETAILED VERIFIED
ANSWERS FROM ACTUAL EXAMS TEST GRADE A+
Question 1
A 45-year-old male with hypertension presents with sudden-onset severe chest
pain radiating to the back. Aortic dissection is suspected. Which initial imaging
study is most definitive?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography
D) Transesophageal echocardiogram
Correct Answer: C. CT angiography has high sensitivity and specificity for aortic
dissection, is widely available, and provides detailed vascular anatomy. Chest X-ray
is often normal. TTE has lower sensitivity for thoracic aortic dissection. TEE is
useful but more invasive and operator-dependent.
Question 2
A 60-year-old female with chronic heart failure presents with worsening dyspnea,
jugular venous distension, and lower extremity edema. Which medication is most
likely to reduce mortality in this setting?
A) Furosemide
B) Digoxin
C) Carvedilol
D) Hydralazine
Correct Answer: C. Carvedilol, a beta-blocker, reduces mortality in chronic heart
failure with reduced ejection fraction by blocking sympathetic overactivity.
Furosemide manages symptoms but does not improve survival. Digoxin reduces
hospitalizations without mortality benefit. Hydralazine is second-line.
,Question 3
A 30-year-old pregnant woman at 28 weeks gestation presents with epigastric
pain, nausea, and blood pressure of 160/100 mmHg. Labs show platelets
80,000/μL and AST 120 U/L. What is the most appropriate next step?
A) Administer labetalol and discharge
B) Immediate delivery
C) Outpatient monitoring with antihypertensives
D) Administer magnesium sulfate and plan for delivery
Correct Answer: D. This patient has HELLP syndrome (hemolysis, elevated liver
enzymes, low platelets). Magnesium sulfate prevents seizures, and delivery is
indicated regardless of gestational age due to maternal risk. Labetalol alone is
insufficient. Outpatient monitoring is unsafe.
Question 4
A 55-year-old male with type 2 diabetes and a non-healing ulcer on his right great
toe has absent dorsalis pedis pulses. Ankle-brachial index (ABI) is 0.5. What is the
most appropriate initial management?
A) Aspirin and statin therapy
B) Surgical bypass consultation
C) Wound debridement only
D) Hyperbaric oxygen therapy
Correct Answer: A. Initial management of peripheral artery disease includes
antiplatelet therapy (aspirin) and statins to reduce cardiovascular risk. Surgical
bypass is considered after medical therapy. Debridement alone does not address
ischemia. Hyperbaric oxygen is not first-line.
Question 5
A 70-year-old male with COPD presents with worsening dyspnea, cough with
purulent sputum, and fever. Chest X-ray shows no infiltrate. Which antibiotic is
,most appropriate?
A) Azithromycin
B) Levofloxacin
C) Amoxicillin-clavulanate
D) Cephalexin
Correct Answer: B. Levofloxacin (a respiratory fluoroquinolone) covers typical and
atypical pathogens in acute exacerbation of COPD with purulent sputum.
Azithromycin is also used but has higher resistance. Amoxicillin-clavulanate is less
effective for atypicals. Cephalexin is not respiratory-spectrum.
Question 6
A 25-year-old female with systemic lupus erythematosus presents with acute flank
pain, hematuria, and hypertension. Urinalysis shows dysmorphic RBCs and RBC
casts. What is the most likely diagnosis?
A) Acute pyelonephritis
B) Nephrolithiasis
C) Lupus nephritis
D) Renal vein thrombosis
Correct Answer: C. RBC casts indicate glomerulonephritis, and in a lupus patient,
active lupus nephritis is most likely. Pyelonephritis would have WBC casts.
Nephrolithiasis does not cause casts. Renal vein thrombosis presents with flank
pain but not RBC casts.
Question 7
A 50-year-old male presents with right upper quadrant pain, fever, and jaundice.
Ultrasound shows dilated intrahepatic ducts and a stone in the common bile duct.
What is the definitive treatment?
A) Ursodeoxycholic acid
B) ERCP with sphincterotomy
, C) Laparoscopic cholecystectomy
D) Observation
Correct Answer: B. ERCP with sphincterotomy is definitive for common bile duct
stones causing cholangitis (Charcot’s triad). Ursodeoxycholic acid is for dissolution,
not acute obstruction. Cholecystectomy treats gallbladder, not ductal stones.
Observation risks sepsis.
Question 8
A 65-year-old female with atrial fibrillation on warfarin presents with sudden
severe headache, vomiting, and left-sided weakness. INR is 4.5. Head CT shows
right parietal intracerebral hemorrhage. Which intervention is most urgent?
A) Administer fresh frozen plasma
B) Administer vitamin K intravenously
C) Reverse warfarin with prothrombin complex concentrate
D) Administer platelets
Correct Answer: C. Prothrombin complex concentrate (PCC) rapidly reverses
warfarin in intracerebral hemorrhage. FFP is slower. Vitamin K takes hours.
Platelets are not indicated unless on antiplatelet agents.
Question 9
A 32-year-old male presents with episodic palpitations, sweating, and severe
headaches lasting 15 minutes. Blood pressure is 210/120 mmHg during episode.
Which test is most diagnostic?
A) Plasma metanephrines
B) Renal artery doppler
C) Serum aldosterone-to-renin ratio
D) 24-hour urinary cortisol
Correct Answer: A. Episodic hypertension with palpitations and headache suggests
pheochromocytoma; plasma-free metanephrines are most sensitive. Renal artery
