NURS 5434 FNP III Final Exam 2026 | Family Nurse Practitioner Comprehensive Final
Exam Study Guide | Verified Questions & Detailed Answers | Advanced Primary Care &
Clinical Management Review for FNP Students | Complete Preparation Bundle for Exam
Success | 2026
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with hypertension presents with sudden onset of tearing chest
pain radiating to the back. BP is 160/90 in right arm, 100/60 in left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with tearing chest pain, pulse or BP
differential between arms, and radiation to the back.
2. Which medication reduces mortality and hospitalizations in chronic systolic heart
failure (HFrEF) but is contraindicated in pregnancy?
A. Lisinopril
B. Furosemide
C. Digoxin
D. Metoprolol
,Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril) reduce mortality in HFrEF but are teratogenic;
contraindicated in pregnancy.
3. First-line therapy for stable angina with no contraindications is:
A. Nitroglycerin PRN
B. Aspirin + beta-blocker
C. Calcium channel blocker
D. Ranolazine
Correct Answer: B
Rationale: Aspirin reduces thrombotic events; beta-blockers reduce myocardial oxygen
demand and improve survival.
4. A 72-year-old with atrial fibrillation (CHA₂DS₂-VASc score of 4) is on warfarin. INR is
4.8 with minor gum bleeding. Next step?
A. Hold warfarin and give vitamin K 10 mg IV
B. Hold warfarin and recheck INR tomorrow
C. Give fresh frozen plasma
D. Continue warfarin at same dose
Correct Answer: B
Rationale: INR 4.5–5.0 with minor bleeding → hold 1–2 doses, recheck INR. Vitamin K IV
is for serious bleeding.
5. What ECG finding is most specific for acute pericarditis?
A. Widespread ST elevation
B. ST depression in V1–V3
,C. PR segment depression
D. Pathologic Q waves
Correct Answer: C
Rationale: PR depression is highly specific for acute pericarditis; diffuse ST elevation is
common but less specific.
6. Which statin is considered high-intensity and indicated post-ACS?
A. Simvastatin 10 mg
B. Pravastatin 20 mg
C. Atorvastatin 80 mg
D. Lovastatin 40 mg
Correct Answer: C
Rationale: Atorvastatin 80 mg (or rosuvastatin 20–40 mg) is high-intensity, reducing LDL
by >50%.
7. A 45-year-old with hypertension and diabetes has BP 148/90. Initial medication of
choice is:
A. HCTZ
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: C
Rationale: ACE inhibitors (or ARBs) are first-line in diabetics with hypertension due to
renoprotective effects.
8. Most common cause of valvular stenosis in an elderly patient is:
A. Rheumatic fever
, B. Infective endocarditis
C. Calcific aortic stenosis
D. Mitral valve prolapse
Correct Answer: C
Rationale: Calcific degeneration of trileaflet or bicuspid aortic valve is most common in
elderly.
9. Ankle-brachial index (ABI) <0.90 indicates:
A. Venous insufficiency
B. Peripheral artery disease
C. Normal finding
D. Neuropathy
Correct Answer: B
Rationale: ABI <0.90 is diagnostic for PAD; ABI 1.0–1.4 is normal.
10. Digoxin toxicity is associated with which electrolyte abnormality?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Hypokalemia increases digoxin binding to Na-K-ATPase, increasing toxicity
risk.
Section 2: Pulmonology (11–20)
Exam Study Guide | Verified Questions & Detailed Answers | Advanced Primary Care &
Clinical Management Review for FNP Students | Complete Preparation Bundle for Exam
Success | 2026
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with hypertension presents with sudden onset of tearing chest
pain radiating to the back. BP is 160/90 in right arm, 100/60 in left arm. What is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with tearing chest pain, pulse or BP
differential between arms, and radiation to the back.
2. Which medication reduces mortality and hospitalizations in chronic systolic heart
failure (HFrEF) but is contraindicated in pregnancy?
A. Lisinopril
B. Furosemide
C. Digoxin
D. Metoprolol
,Correct Answer: A
Rationale: ACE inhibitors (e.g., lisinopril) reduce mortality in HFrEF but are teratogenic;
contraindicated in pregnancy.
3. First-line therapy for stable angina with no contraindications is:
A. Nitroglycerin PRN
B. Aspirin + beta-blocker
C. Calcium channel blocker
D. Ranolazine
Correct Answer: B
Rationale: Aspirin reduces thrombotic events; beta-blockers reduce myocardial oxygen
demand and improve survival.
4. A 72-year-old with atrial fibrillation (CHA₂DS₂-VASc score of 4) is on warfarin. INR is
4.8 with minor gum bleeding. Next step?
A. Hold warfarin and give vitamin K 10 mg IV
B. Hold warfarin and recheck INR tomorrow
C. Give fresh frozen plasma
D. Continue warfarin at same dose
Correct Answer: B
Rationale: INR 4.5–5.0 with minor bleeding → hold 1–2 doses, recheck INR. Vitamin K IV
is for serious bleeding.
5. What ECG finding is most specific for acute pericarditis?
A. Widespread ST elevation
B. ST depression in V1–V3
,C. PR segment depression
D. Pathologic Q waves
Correct Answer: C
Rationale: PR depression is highly specific for acute pericarditis; diffuse ST elevation is
common but less specific.
6. Which statin is considered high-intensity and indicated post-ACS?
A. Simvastatin 10 mg
B. Pravastatin 20 mg
C. Atorvastatin 80 mg
D. Lovastatin 40 mg
Correct Answer: C
Rationale: Atorvastatin 80 mg (or rosuvastatin 20–40 mg) is high-intensity, reducing LDL
by >50%.
7. A 45-year-old with hypertension and diabetes has BP 148/90. Initial medication of
choice is:
A. HCTZ
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: C
Rationale: ACE inhibitors (or ARBs) are first-line in diabetics with hypertension due to
renoprotective effects.
8. Most common cause of valvular stenosis in an elderly patient is:
A. Rheumatic fever
, B. Infective endocarditis
C. Calcific aortic stenosis
D. Mitral valve prolapse
Correct Answer: C
Rationale: Calcific degeneration of trileaflet or bicuspid aortic valve is most common in
elderly.
9. Ankle-brachial index (ABI) <0.90 indicates:
A. Venous insufficiency
B. Peripheral artery disease
C. Normal finding
D. Neuropathy
Correct Answer: B
Rationale: ABI <0.90 is diagnostic for PAD; ABI 1.0–1.4 is normal.
10. Digoxin toxicity is associated with which electrolyte abnormality?
A. Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Hypokalemia increases digoxin binding to Na-K-ATPase, increasing toxicity
risk.
Section 2: Pulmonology (11–20)
