NURS 5433 FNP II EXAM 300 TESTBANK QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
1. A 55-year-old male with a 30-pack-year smoking history presents with
progressive dyspnea on exertion and a dry cough for 2 months. Pulmonary function
tests show a reduced FEV1/FVC ratio of 0.65 with increased total lung capacity.
What is the most likely diagnosis?
A) Restrictive lung disease
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pulmonary fibrosis
Correct Answer: B) COPD
Rationale: A reduced FEV1/FVC ratio below 0.70 with increased total lung
capacity indicates air trapping, which is classic for COPD. Asthma typically shows
reversibility, and restrictive diseases present with reduced total lung capacity, not
increased .
2. A 45-year-old woman presents with a 3-month history of progressive proximal
muscle weakness, difficulty rising from a chair, and a heliotrope rash on her
eyelids with Gottron's papules on her knuckles. What is the most appropriate initial
diagnostic test?
A) Serum creatine kinase (CK)
B) Antinuclear antibody (ANA)
C) MRI of affected muscles
D) Electromyography (EMG)
Correct Answer: A) Serum creatine kinase (CK)
Rationale: The combination of heliotrope rash, Gottron's papules, and proximal
weakness is classic for dermatomyositis. CK is a sensitive initial test for muscle
inflammation. EMG and muscle biopsy are confirmatory tests, not initial .
3. A 68-year-old male with type 2 diabetes and hypertension presents with acute,
painless vision loss in the right eye described as a "curtain" coming down over the
past day. What is the most appropriate next step?
A) Urgent ophthalmology referral
,B) CT head without contrast
C) Aspirin 325 mg daily
D) Reassurance and follow-up in 1 week
Correct Answer: A) Urgent ophthalmology referral
Rationale: Painless monocular vision loss with a curtain-like description is
concerning for central retinal artery occlusion until proven otherwise. Time is
vision; urgent ophthalmology evaluation is critical .
4. A 32-year-old G2P1 at 34 weeks gestation presents with blood pressure of
165/110 mmHg and 3+ proteinuria. She reports a severe frontal headache and
visual blurring. What is the most appropriate immediate management?
A) Outpatient labetalol and bed rest
B) Immediate delivery by cesarean section
C) Magnesium sulfate IV and antihypertensive therapy
D) Oral nifedipine and close outpatient follow-up
Correct Answer: C) Magnesium sulfate IV and antihypertensive therapy
Rationale: This presentation with severe range blood pressure, proteinuria,
headache, and visual changes indicates preeclampsia with severe features.
Magnesium sulfate is indicated for seizure prophylaxis, and antihypertensives are
needed for blood pressure control. Delivery should be considered but not
necessarily by immediate cesarean .
5. A 28-year-old man presents with acute testicular pain, nausea, and vomiting. On
exam, the left testis is high-riding, horizontal, and tender. The cremasteric reflex is
absent. What is the most appropriate next step?
A) Scrotal ultrasound with Doppler
B) Immediate surgical exploration
C) Empiric antibiotics
D) Urinalysis
Correct Answer: B) Immediate surgical exploration
Rationale: Testicular torsion is a surgical emergency. The presence of a high-
riding, horizontally oriented testis with an absent cremasteric reflex strongly
suggests torsion. Immediate exploration without delay is indicated if clinical
suspicion is high .
6. A 65-year-old female with osteoporosis presents with acute severe low back
pain after sneezing. X-ray shows an L1 compression fracture with no neurologic
deficits. What is the most appropriate initial pain management?
A) Acetaminophen 1000 mg TID
B) Oxycodone as needed
,C) Ibuprofen 600 mg TID
D) Vertebroplasty
Correct Answer: B) Oxycodone as needed
Rationale: Acute vertebral fracture causes severe pain that often requires opioids
initially. NSAIDs should be used cautiously due to GI and renal risks.
Vertebroplasty is reserved for refractory pain, not initial management .
7. A 55-year-old female with a history of hypertension presents with a 2-day
history of severe, tearing chest pain radiating to the back. Blood pressure is
200/110 in the right arm and 130/70 in the left arm. What is the most appropriate
initial pharmacologic intervention?
A) Labetalol IV
B) Nitroglycerin IV
C) Sodium nitroprusside IV
D) Morphine IV
Correct Answer: A) Labetalol IV
Rationale: Tearing chest pain radiating to the back with unequal blood pressures in
the arms is concerning for aortic dissection. Beta-blockers (labetalol or esmolol)
should be given first to reduce shear force on the aortic wall before administering
afterload reducers like nitroprusside .
8. A 72-year-old male with benign prostatic hyperplasia presents with acute
urinary retention. A Foley catheter is placed, and 1200 mL of urine is drained. One
hour later, he becomes hypotensive (90/60) and tachycardic. What is the most
likely cause?
A) Hemorrhage
B) Post-obstructive diuresis
C) Myocardial infarction
D) Sepsis
Correct Answer: B) Post-obstructive diuresis
Rationale: Post-obstructive diuresis after relief of chronic urinary retention can
cause hypotension from salt and water loss. Urine output should be monitored, and
IV fluids should be administered as needed .
9. A 30-year-old woman presents with a 6-month history of heavy menstrual
bleeding, pelvic pain, and dyspareunia. Transvaginal ultrasound shows a diffusely
enlarged uterus with a heterogeneous myometrium and small cystic spaces. What
is the most likely diagnosis?
A) Adenomyosis
B) Uterine fibroids
, C) Endometrial polyp
D) Endometrial cancer
Correct Answer: A) Adenomyosis
Rationale: Adenomyosis involves ectopic endometrial tissue within the
myometrium, causing diffuse uterine enlargement, a heterogeneous myometrium,
and small cystic spaces. It commonly presents with heavy bleeding and
dysmenorrhea. Fibroids typically appear as well-demarcated masses .
10. A 68-year-old male with atrial fibrillation on warfarin presents with an INR of
8.0. He has minor gum bleeding but no other signs of hemorrhage. What is the
most appropriate management?
A) Hold warfarin and give vitamin K 2.5 mg orally
B) Hold warfarin and recheck INR in 24 hours
C) Give fresh frozen plasma
D) Continue warfarin at a reduced dose
Correct Answer: A) Hold warfarin and give vitamin K 2.5 mg orally
Rationale: An INR above 6.0 with minor bleeding requires holding warfarin and
administering low-dose oral vitamin K (1–2.5 mg). The INR should be rechecked
in 24 hours. Fresh frozen plasma is reserved for life-threatening hemorrhage .
11. A 40-year-old man presents with a 2-week history of watery diarrhea,
abdominal cramping, and bloating after a camping trip in the mountains. What is
the most appropriate initial diagnostic test?
A) Stool ova and parasite exam
B) Giardia stool antigen
C) C. difficile toxin
D) Colonoscopy
Correct Answer: B) Giardia stool antigen
Rationale: Subacute diarrhea after wilderness exposure is classic for Giardia
lamblia infection. Stool antigen testing is the most sensitive and specific initial test.
Ova and parasite examination is less sensitive .
12. A 55-year-old male with type 2 diabetes presents with a 3-month history of
progressive burning foot pain worse at night, reduced pinprick sensation distally,
and absent ankle reflexes. What is the first-line medication for his symptoms?
A) Gabapentin
B) Ibuprofen
C) Duloxetine
D) Amitriptyline
Correct Answer: A) Gabapentin
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+
1. A 55-year-old male with a 30-pack-year smoking history presents with
progressive dyspnea on exertion and a dry cough for 2 months. Pulmonary function
tests show a reduced FEV1/FVC ratio of 0.65 with increased total lung capacity.
What is the most likely diagnosis?
A) Restrictive lung disease
B) Chronic obstructive pulmonary disease (COPD)
C) Asthma
D) Pulmonary fibrosis
Correct Answer: B) COPD
Rationale: A reduced FEV1/FVC ratio below 0.70 with increased total lung
capacity indicates air trapping, which is classic for COPD. Asthma typically shows
reversibility, and restrictive diseases present with reduced total lung capacity, not
increased .
2. A 45-year-old woman presents with a 3-month history of progressive proximal
muscle weakness, difficulty rising from a chair, and a heliotrope rash on her
eyelids with Gottron's papules on her knuckles. What is the most appropriate initial
diagnostic test?
A) Serum creatine kinase (CK)
B) Antinuclear antibody (ANA)
C) MRI of affected muscles
D) Electromyography (EMG)
Correct Answer: A) Serum creatine kinase (CK)
Rationale: The combination of heliotrope rash, Gottron's papules, and proximal
weakness is classic for dermatomyositis. CK is a sensitive initial test for muscle
inflammation. EMG and muscle biopsy are confirmatory tests, not initial .
3. A 68-year-old male with type 2 diabetes and hypertension presents with acute,
painless vision loss in the right eye described as a "curtain" coming down over the
past day. What is the most appropriate next step?
A) Urgent ophthalmology referral
,B) CT head without contrast
C) Aspirin 325 mg daily
D) Reassurance and follow-up in 1 week
Correct Answer: A) Urgent ophthalmology referral
Rationale: Painless monocular vision loss with a curtain-like description is
concerning for central retinal artery occlusion until proven otherwise. Time is
vision; urgent ophthalmology evaluation is critical .
4. A 32-year-old G2P1 at 34 weeks gestation presents with blood pressure of
165/110 mmHg and 3+ proteinuria. She reports a severe frontal headache and
visual blurring. What is the most appropriate immediate management?
A) Outpatient labetalol and bed rest
B) Immediate delivery by cesarean section
C) Magnesium sulfate IV and antihypertensive therapy
D) Oral nifedipine and close outpatient follow-up
Correct Answer: C) Magnesium sulfate IV and antihypertensive therapy
Rationale: This presentation with severe range blood pressure, proteinuria,
headache, and visual changes indicates preeclampsia with severe features.
Magnesium sulfate is indicated for seizure prophylaxis, and antihypertensives are
needed for blood pressure control. Delivery should be considered but not
necessarily by immediate cesarean .
5. A 28-year-old man presents with acute testicular pain, nausea, and vomiting. On
exam, the left testis is high-riding, horizontal, and tender. The cremasteric reflex is
absent. What is the most appropriate next step?
A) Scrotal ultrasound with Doppler
B) Immediate surgical exploration
C) Empiric antibiotics
D) Urinalysis
Correct Answer: B) Immediate surgical exploration
Rationale: Testicular torsion is a surgical emergency. The presence of a high-
riding, horizontally oriented testis with an absent cremasteric reflex strongly
suggests torsion. Immediate exploration without delay is indicated if clinical
suspicion is high .
6. A 65-year-old female with osteoporosis presents with acute severe low back
pain after sneezing. X-ray shows an L1 compression fracture with no neurologic
deficits. What is the most appropriate initial pain management?
A) Acetaminophen 1000 mg TID
B) Oxycodone as needed
,C) Ibuprofen 600 mg TID
D) Vertebroplasty
Correct Answer: B) Oxycodone as needed
Rationale: Acute vertebral fracture causes severe pain that often requires opioids
initially. NSAIDs should be used cautiously due to GI and renal risks.
Vertebroplasty is reserved for refractory pain, not initial management .
7. A 55-year-old female with a history of hypertension presents with a 2-day
history of severe, tearing chest pain radiating to the back. Blood pressure is
200/110 in the right arm and 130/70 in the left arm. What is the most appropriate
initial pharmacologic intervention?
A) Labetalol IV
B) Nitroglycerin IV
C) Sodium nitroprusside IV
D) Morphine IV
Correct Answer: A) Labetalol IV
Rationale: Tearing chest pain radiating to the back with unequal blood pressures in
the arms is concerning for aortic dissection. Beta-blockers (labetalol or esmolol)
should be given first to reduce shear force on the aortic wall before administering
afterload reducers like nitroprusside .
8. A 72-year-old male with benign prostatic hyperplasia presents with acute
urinary retention. A Foley catheter is placed, and 1200 mL of urine is drained. One
hour later, he becomes hypotensive (90/60) and tachycardic. What is the most
likely cause?
A) Hemorrhage
B) Post-obstructive diuresis
C) Myocardial infarction
D) Sepsis
Correct Answer: B) Post-obstructive diuresis
Rationale: Post-obstructive diuresis after relief of chronic urinary retention can
cause hypotension from salt and water loss. Urine output should be monitored, and
IV fluids should be administered as needed .
9. A 30-year-old woman presents with a 6-month history of heavy menstrual
bleeding, pelvic pain, and dyspareunia. Transvaginal ultrasound shows a diffusely
enlarged uterus with a heterogeneous myometrium and small cystic spaces. What
is the most likely diagnosis?
A) Adenomyosis
B) Uterine fibroids
, C) Endometrial polyp
D) Endometrial cancer
Correct Answer: A) Adenomyosis
Rationale: Adenomyosis involves ectopic endometrial tissue within the
myometrium, causing diffuse uterine enlargement, a heterogeneous myometrium,
and small cystic spaces. It commonly presents with heavy bleeding and
dysmenorrhea. Fibroids typically appear as well-demarcated masses .
10. A 68-year-old male with atrial fibrillation on warfarin presents with an INR of
8.0. He has minor gum bleeding but no other signs of hemorrhage. What is the
most appropriate management?
A) Hold warfarin and give vitamin K 2.5 mg orally
B) Hold warfarin and recheck INR in 24 hours
C) Give fresh frozen plasma
D) Continue warfarin at a reduced dose
Correct Answer: A) Hold warfarin and give vitamin K 2.5 mg orally
Rationale: An INR above 6.0 with minor bleeding requires holding warfarin and
administering low-dose oral vitamin K (1–2.5 mg). The INR should be rechecked
in 24 hours. Fresh frozen plasma is reserved for life-threatening hemorrhage .
11. A 40-year-old man presents with a 2-week history of watery diarrhea,
abdominal cramping, and bloating after a camping trip in the mountains. What is
the most appropriate initial diagnostic test?
A) Stool ova and parasite exam
B) Giardia stool antigen
C) C. difficile toxin
D) Colonoscopy
Correct Answer: B) Giardia stool antigen
Rationale: Subacute diarrhea after wilderness exposure is classic for Giardia
lamblia infection. Stool antigen testing is the most sensitive and specific initial test.
Ova and parasite examination is less sensitive .
12. A 55-year-old male with type 2 diabetes presents with a 3-month history of
progressive burning foot pain worse at night, reduced pinprick sensation distally,
and absent ankle reflexes. What is the first-line medication for his symptoms?
A) Gabapentin
B) Ibuprofen
C) Duloxetine
D) Amitriptyline
Correct Answer: A) Gabapentin
