NURS 5338 Family Clinical Practice II
Final Actual Exam 2026/2027 | Verified
Questions
Graduate-Level Advanced Practice Nursing Curriculum |
Verified Q&A | Family Nurse Practitioner Students
Comprehensive 75-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 75-question actual exam set provides original Graduate-Level advanced practice
nursing questions covering Endocrine and Metabolic Disorders, Cardiovascular Disorders, Musculoskeletal
Disorders, EENT, Dermatologic, and Pediatric Cardiology, and Neurologic, Psychiatric, and Urgent/Emergent
Care. The content is designed to reinforce official NURS 5338 course objectives for actual exam readiness and
clinical proficiency by strengthening primary care diagnosis, laboratory interpretation, guideline-based
pharmacologic and nonpharmacologic management, red flag recognition, referral decisions, and lifespan-focused
family clinical reasoning. Each item includes Verified Questions with concise rationales grounded in advanced
practice nursing guidance, evidence-based primary care standards, and current clinical practice guidelines.
Domain: Endocrine and Metabolic Disorders
1. A 52-year-old adult has polyuria, polydipsia, fasting glucose 158 mg/dL, and A1c 7.2 percent.
Which diagnosis is most consistent?
A. Type 2 diabetes mellitus
B. Central diabetes insipidus
C. Primary hypothyroidism
D. Adrenal insufficiency
Correct Answer: A
Rationale: A1c at or above 6.5 percent with hyperglycemic symptoms supports diabetes, and adult onset
with metabolic features most often fits type 2 disease.
2. A lean adolescent has weight loss, abdominal pain, glucose 420 mg/dL, ketonuria, and
Kussmaul respirations. Which action is most urgent?
A. Start lifestyle counseling only
B. Send for emergency management of diabetic ketoacidosis
C. Schedule routine A1c in three months
D. Begin metformin without ketone management
Correct Answer: B
Rationale: Ketonuria, acidosis-pattern breathing, and marked hyperglycemia suggest diabetic ketoacidosis
requiring emergency fluid, insulin, and electrolyte care.
3. Which medication is commonly first-line for type 2 diabetes when renal function allows and no
contraindication exists?
A. Levothyroxine
B. Prednisone
C. Metformin
D. Hydrochlorothiazide
Correct Answer: C
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
, Rationale: Metformin is a standard initial pharmacologic option for type 2 diabetes because it lowers
hepatic glucose output and improves insulin sensitivity.
4. Which diabetes medication class is associated with genital mycotic infection risk due to
increased urinary glucose?
A. DPP-4 inhibitor
B. Sulfonylurea
C. Basal insulin
D. SGLT2 inhibitor
Correct Answer: D
Rationale: SGLT2 inhibitors increase urinary glucose excretion, which can promote genital fungal
infections.
5. A patient with type 2 diabetes and albuminuria needs kidney-protective blood pressure therapy.
Which class is often preferred?
A. ACE inhibitor or angiotensin receptor blocker
B. Short-acting benzodiazepine
C. Loop antibiotic
D. First-generation antihistamine
Correct Answer: A
Rationale: Renin-angiotensin system blockade can reduce albuminuria and slow diabetic kidney disease
progression when clinically appropriate.
6. A patient has TSH 12 mIU/L and low free T4 with fatigue and cold intolerance. Which
interpretation is most likely?
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Subclinical hyperthyroidism
D. Pheochromocytoma
Correct Answer: B
Rationale: High TSH with low free T4 indicates thyroid gland underproduction with pituitary
compensation.
7. A patient has suppressed TSH, elevated free T4, tremor, and weight loss. Which condition is
most likely?
A. Hashimoto hypothyroidism
B. Addison disease
C. Hyperthyroidism
D. Syndrome of inappropriate antidiuretic hormone
Correct Answer: C
Rationale: Low TSH with high thyroid hormone and adrenergic symptoms supports hyperthyroidism.
8. Which counseling is most important for levothyroxine administration?
A. Take only when symptoms occur
B. Crush into grapefruit juice nightly
C. Double doses after missed weeks
D. Take consistently on an empty stomach apart from calcium or iron
Correct Answer: D
Rationale: Levothyroxine absorption is affected by food, calcium, and iron, so consistent empty-stomach
dosing supports stable levels.
9. A patient has episodic headache, sweating, palpitations, and severe hypertension. Which
endocrine diagnosis should be considered?
A. Pheochromocytoma
B. Type 1 diabetes
C. Hypoparathyroidism
D. Graves ophthalmopathy
Correct Answer: A
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
, Rationale: Paroxysmal adrenergic symptoms with severe hypertension suggest catecholamine excess from
pheochromocytoma.
10. A patient has hypercalcemia, kidney stones, constipation, and elevated parathyroid hormone.
Which diagnosis is likely?
A. Hypoparathyroidism
B. Primary hyperparathyroidism
C. Secondary adrenal insufficiency
D. Diabetes insipidus
Correct Answer: B
Rationale: Elevated parathyroid hormone with hypercalcemia and stones is consistent with primary
hyperparathyroidism.
11. Which finding is most consistent with adrenal crisis?
A. Hypertension with moon facies
B. Mild seasonal fatigue only
C. Severe hypotension, vomiting, weakness, and hyponatremia
D. Isolated elevated LDL
Correct Answer: C
Rationale: Acute cortisol deficiency can cause shock, gastrointestinal symptoms, weakness, and electrolyte
disturbances.
12. Which feature supports Cushing syndrome?
A. Weight loss with low blood pressure only
B. Cold intolerance and bradycardia
C. Polyuria with very dilute urine only
D. Proximal muscle weakness, wide purple striae, and hyperglycemia
Correct Answer: D
Rationale: Glucocorticoid excess causes catabolism, central adiposity, skin changes, and glucose elevation.
13. Which lab pattern is consistent with syndrome of inappropriate antidiuretic hormone?
A. Low serum sodium with inappropriately concentrated urine
B. High sodium with very dilute urine
C. High glucose with ketones
D. Low calcium with high phosphate only
Correct Answer: A
Rationale: SIADH causes water retention, hyponatremia, and urine that remains concentrated despite low
serum sodium.
14. A patient has high urine volume, intense thirst, high serum sodium, and dilute urine after
pituitary surgery. Which condition is likely?
A. SIADH
B. Central diabetes insipidus
C. Hypothyroidism
D. Primary aldosteronism
Correct Answer: B
Rationale: ADH deficiency after pituitary injury causes water diuresis, hypernatremia, and dilute urine.
15. Which lipid result is an indication for high-intensity statin consideration in many adults
regardless of calculated risk?
A. HDL cholesterol above 70 mg/dL
B. Triglycerides 90 mg/dL
C. LDL cholesterol 190 mg/dL or higher
D. Total cholesterol 130 mg/dL
Correct Answer: C
Rationale: Very high LDL is treated aggressively because lifetime atherosclerotic risk is high.
16. Which feature best supports metabolic syndrome?
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
Final Actual Exam 2026/2027 | Verified
Questions
Graduate-Level Advanced Practice Nursing Curriculum |
Verified Q&A | Family Nurse Practitioner Students
Comprehensive 75-Question Original Actual Exam Set | 2026/2027
Introduction
This 2026/2027 comprehensive 75-question actual exam set provides original Graduate-Level advanced practice
nursing questions covering Endocrine and Metabolic Disorders, Cardiovascular Disorders, Musculoskeletal
Disorders, EENT, Dermatologic, and Pediatric Cardiology, and Neurologic, Psychiatric, and Urgent/Emergent
Care. The content is designed to reinforce official NURS 5338 course objectives for actual exam readiness and
clinical proficiency by strengthening primary care diagnosis, laboratory interpretation, guideline-based
pharmacologic and nonpharmacologic management, red flag recognition, referral decisions, and lifespan-focused
family clinical reasoning. Each item includes Verified Questions with concise rationales grounded in advanced
practice nursing guidance, evidence-based primary care standards, and current clinical practice guidelines.
Domain: Endocrine and Metabolic Disorders
1. A 52-year-old adult has polyuria, polydipsia, fasting glucose 158 mg/dL, and A1c 7.2 percent.
Which diagnosis is most consistent?
A. Type 2 diabetes mellitus
B. Central diabetes insipidus
C. Primary hypothyroidism
D. Adrenal insufficiency
Correct Answer: A
Rationale: A1c at or above 6.5 percent with hyperglycemic symptoms supports diabetes, and adult onset
with metabolic features most often fits type 2 disease.
2. A lean adolescent has weight loss, abdominal pain, glucose 420 mg/dL, ketonuria, and
Kussmaul respirations. Which action is most urgent?
A. Start lifestyle counseling only
B. Send for emergency management of diabetic ketoacidosis
C. Schedule routine A1c in three months
D. Begin metformin without ketone management
Correct Answer: B
Rationale: Ketonuria, acidosis-pattern breathing, and marked hyperglycemia suggest diabetic ketoacidosis
requiring emergency fluid, insulin, and electrolyte care.
3. Which medication is commonly first-line for type 2 diabetes when renal function allows and no
contraindication exists?
A. Levothyroxine
B. Prednisone
C. Metformin
D. Hydrochlorothiazide
Correct Answer: C
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
, Rationale: Metformin is a standard initial pharmacologic option for type 2 diabetes because it lowers
hepatic glucose output and improves insulin sensitivity.
4. Which diabetes medication class is associated with genital mycotic infection risk due to
increased urinary glucose?
A. DPP-4 inhibitor
B. Sulfonylurea
C. Basal insulin
D. SGLT2 inhibitor
Correct Answer: D
Rationale: SGLT2 inhibitors increase urinary glucose excretion, which can promote genital fungal
infections.
5. A patient with type 2 diabetes and albuminuria needs kidney-protective blood pressure therapy.
Which class is often preferred?
A. ACE inhibitor or angiotensin receptor blocker
B. Short-acting benzodiazepine
C. Loop antibiotic
D. First-generation antihistamine
Correct Answer: A
Rationale: Renin-angiotensin system blockade can reduce albuminuria and slow diabetic kidney disease
progression when clinically appropriate.
6. A patient has TSH 12 mIU/L and low free T4 with fatigue and cold intolerance. Which
interpretation is most likely?
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Subclinical hyperthyroidism
D. Pheochromocytoma
Correct Answer: B
Rationale: High TSH with low free T4 indicates thyroid gland underproduction with pituitary
compensation.
7. A patient has suppressed TSH, elevated free T4, tremor, and weight loss. Which condition is
most likely?
A. Hashimoto hypothyroidism
B. Addison disease
C. Hyperthyroidism
D. Syndrome of inappropriate antidiuretic hormone
Correct Answer: C
Rationale: Low TSH with high thyroid hormone and adrenergic symptoms supports hyperthyroidism.
8. Which counseling is most important for levothyroxine administration?
A. Take only when symptoms occur
B. Crush into grapefruit juice nightly
C. Double doses after missed weeks
D. Take consistently on an empty stomach apart from calcium or iron
Correct Answer: D
Rationale: Levothyroxine absorption is affected by food, calcium, and iron, so consistent empty-stomach
dosing supports stable levels.
9. A patient has episodic headache, sweating, palpitations, and severe hypertension. Which
endocrine diagnosis should be considered?
A. Pheochromocytoma
B. Type 1 diabetes
C. Hypoparathyroidism
D. Graves ophthalmopathy
Correct Answer: A
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
, Rationale: Paroxysmal adrenergic symptoms with severe hypertension suggest catecholamine excess from
pheochromocytoma.
10. A patient has hypercalcemia, kidney stones, constipation, and elevated parathyroid hormone.
Which diagnosis is likely?
A. Hypoparathyroidism
B. Primary hyperparathyroidism
C. Secondary adrenal insufficiency
D. Diabetes insipidus
Correct Answer: B
Rationale: Elevated parathyroid hormone with hypercalcemia and stones is consistent with primary
hyperparathyroidism.
11. Which finding is most consistent with adrenal crisis?
A. Hypertension with moon facies
B. Mild seasonal fatigue only
C. Severe hypotension, vomiting, weakness, and hyponatremia
D. Isolated elevated LDL
Correct Answer: C
Rationale: Acute cortisol deficiency can cause shock, gastrointestinal symptoms, weakness, and electrolyte
disturbances.
12. Which feature supports Cushing syndrome?
A. Weight loss with low blood pressure only
B. Cold intolerance and bradycardia
C. Polyuria with very dilute urine only
D. Proximal muscle weakness, wide purple striae, and hyperglycemia
Correct Answer: D
Rationale: Glucocorticoid excess causes catabolism, central adiposity, skin changes, and glucose elevation.
13. Which lab pattern is consistent with syndrome of inappropriate antidiuretic hormone?
A. Low serum sodium with inappropriately concentrated urine
B. High sodium with very dilute urine
C. High glucose with ketones
D. Low calcium with high phosphate only
Correct Answer: A
Rationale: SIADH causes water retention, hyponatremia, and urine that remains concentrated despite low
serum sodium.
14. A patient has high urine volume, intense thirst, high serum sodium, and dilute urine after
pituitary surgery. Which condition is likely?
A. SIADH
B. Central diabetes insipidus
C. Hypothyroidism
D. Primary aldosteronism
Correct Answer: B
Rationale: ADH deficiency after pituitary injury causes water diuresis, hypernatremia, and dilute urine.
15. Which lipid result is an indication for high-intensity statin consideration in many adults
regardless of calculated risk?
A. HDL cholesterol above 70 mg/dL
B. Triglycerides 90 mg/dL
C. LDL cholesterol 190 mg/dL or higher
D. Total cholesterol 130 mg/dL
Correct Answer: C
Rationale: Very high LDL is treated aggressively because lifetime atherosclerotic risk is high.
16. Which feature best supports metabolic syndrome?
NURS 5338 Family Clinical Practice II Final Actual Exam 2026/2027 | Verified Questions
