NUR 509 - FNP Adults Final Exam |St.
Thomas University Exam with Verified
Rationales Practice Questions and Answers
2026 with complete solution
1. A 55-year-old man with hypertension and diabetes has a blood pressure of
148/92 mmHg on lisinopril 20 mg daily. According to current guidelines, what is
the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add a thiazide diuretic
C. Add a calcium channel blocker or thiazide diuretic
D. Recheck blood pressure in 3 months
Answer: C
Rationale: For non-Black adults on an ACE inhibitor or ARB who are not at goal,
adding a thiazide diuretic or calcium channel blocker is recommended before
maximizing the dose. Increasing to 40 mg is also an option, but adding a second
agent often achieves target more effectively and with fewer side effects.
Rechecking without change delays control.
2. A 68-year-old woman with osteoporosis has a DEXA T-score of -3.0 at the
lumbar spine and a history of a hip fracture 2 years ago. She cannot tolerate
oral bisphosphonates due to severe GERD. Which is the most appropriate
alternative therapy?
A. Denosumab
B. Raloxifene
,C. Calcitonin nasal spray
D. Teriparatide
Answer: D
Rationale: Teriparatide is an anabolic agent that stimulates bone formation and is
indicated for high-risk patients with severe osteoporosis and fractures. Denosumab
is an antiresorptive and also appropriate, but in a patient with very high risk and
inability to take bisphosphonates, anabolic therapy is often preferred. Teriparatide
is typically reserved for high-risk individuals. However, guidelines recommend
anabolic therapy (teriparatide, abaloparatide, romosozumab) for those with very
high fracture risk. Denosumab is also a strong antiresorptive. Both are correct, but
given "most appropriate" and her high risk (T -3.0 + hip fracture), teriparatide is the
anabolic choice.
3. A 72-year-old man with benign prostatic hyperplasia and hypertension
reports dizziness upon standing. He is on tamsulosin and hydrochlorothiazide.
What is the most likely cause?
A. Hypoglycemia
B. Orthostatic hypotension from tamsulosin
C. Hypertensive urgency
D. Dehydration from hydrochlorothiazide alone
Answer: B
Rationale: Tamsulosin is an alpha-1 blocker that can cause orthostatic
hypotension, especially when combined with a diuretic. The patient should be
counseled to rise slowly and take the medication at bedtime. The diuretic may
contribute but tamsulosin is the primary culprit.
,4. A 30-year-old woman with polycystic ovary syndrome (PCOS) and a BMI of
32 is trying to conceive. What is the first-line intervention to improve fertility?
A. Clomiphene citrate
B. Metformin
C. Lifestyle modifications: weight loss through diet and exercise
D. Letrozole
Answer: C
Rationale: Weight loss of 5-10% can restore ovulation in many women with PCOS
and obesity. Lifestyle modification is the initial recommended step before ovulation
induction agents. Letrozole or clomiphene may follow if needed.
5. A 60-year-old female with type 2 diabetes on metformin has an A1C of 7.8%.
She has stable chronic kidney disease with eGFR 40 mL/min. Which second-
line agent is preferred for cardiovascular and renal protection?
A. Glipizide
B. Pioglitazone
C. SGLT2 inhibitor (e.g., dapagliflozin)
D. Sitagliptin
Answer: C
Rationale: SGLT2 inhibitors have proven cardiovascular and renal benefits in
patients with CKD and diabetes. They are recommended as add-on therapy
regardless of A1C if eGFR allows (dapagliflozin down to eGFR 25). Sulfonylureas do
not offer this protection. Pioglitazone may cause fluid retention.
, 6. A 45-year-old woman with asthma uses albuterol twice weekly for
symptoms. She wakes at night once per week with cough. What is the next step
according to GINA guidelines?
A. Continue albuterol alone
B. Add a low-dose inhaled corticosteroid (ICS)
C. Add a long-acting beta-agonist (LABA) alone
D. Refer to pulmonology
Answer: B
Rationale: GINA Step 2 recommends low-dose ICS for patients with symptoms >2
times per month and risk factors like nighttime awakenings. LABA alone without
ICS is not recommended. Albuterol alone is insufficient control.
7. A 52-year-old postmenopausal woman with breast cancer (ER-positive) on
anastrozole reports severe joint pain. What is the best management?
A. Discontinue anastrozole immediately
B. Switch to tamoxifen after discussing options if pain is intolerable
C. Add ibuprofen 800 mg TID
D. No change; arthralgia is unrelated to anastrozole
Answer: B
Rationale: Aromatase inhibitor-induced arthralgia is common. Initial management
includes analgesics and exercise. If severe and affecting quality of life, switching to
tamoxifen (a SERM) is an option after risk-benefit discussion. Discontinuation alone
increases recurrence risk. Ibuprofen may be used but does not address the
underlying cause.
Thomas University Exam with Verified
Rationales Practice Questions and Answers
2026 with complete solution
1. A 55-year-old man with hypertension and diabetes has a blood pressure of
148/92 mmHg on lisinopril 20 mg daily. According to current guidelines, what is
the most appropriate next step?
A. Increase lisinopril to 40 mg daily
B. Add a thiazide diuretic
C. Add a calcium channel blocker or thiazide diuretic
D. Recheck blood pressure in 3 months
Answer: C
Rationale: For non-Black adults on an ACE inhibitor or ARB who are not at goal,
adding a thiazide diuretic or calcium channel blocker is recommended before
maximizing the dose. Increasing to 40 mg is also an option, but adding a second
agent often achieves target more effectively and with fewer side effects.
Rechecking without change delays control.
2. A 68-year-old woman with osteoporosis has a DEXA T-score of -3.0 at the
lumbar spine and a history of a hip fracture 2 years ago. She cannot tolerate
oral bisphosphonates due to severe GERD. Which is the most appropriate
alternative therapy?
A. Denosumab
B. Raloxifene
,C. Calcitonin nasal spray
D. Teriparatide
Answer: D
Rationale: Teriparatide is an anabolic agent that stimulates bone formation and is
indicated for high-risk patients with severe osteoporosis and fractures. Denosumab
is an antiresorptive and also appropriate, but in a patient with very high risk and
inability to take bisphosphonates, anabolic therapy is often preferred. Teriparatide
is typically reserved for high-risk individuals. However, guidelines recommend
anabolic therapy (teriparatide, abaloparatide, romosozumab) for those with very
high fracture risk. Denosumab is also a strong antiresorptive. Both are correct, but
given "most appropriate" and her high risk (T -3.0 + hip fracture), teriparatide is the
anabolic choice.
3. A 72-year-old man with benign prostatic hyperplasia and hypertension
reports dizziness upon standing. He is on tamsulosin and hydrochlorothiazide.
What is the most likely cause?
A. Hypoglycemia
B. Orthostatic hypotension from tamsulosin
C. Hypertensive urgency
D. Dehydration from hydrochlorothiazide alone
Answer: B
Rationale: Tamsulosin is an alpha-1 blocker that can cause orthostatic
hypotension, especially when combined with a diuretic. The patient should be
counseled to rise slowly and take the medication at bedtime. The diuretic may
contribute but tamsulosin is the primary culprit.
,4. A 30-year-old woman with polycystic ovary syndrome (PCOS) and a BMI of
32 is trying to conceive. What is the first-line intervention to improve fertility?
A. Clomiphene citrate
B. Metformin
C. Lifestyle modifications: weight loss through diet and exercise
D. Letrozole
Answer: C
Rationale: Weight loss of 5-10% can restore ovulation in many women with PCOS
and obesity. Lifestyle modification is the initial recommended step before ovulation
induction agents. Letrozole or clomiphene may follow if needed.
5. A 60-year-old female with type 2 diabetes on metformin has an A1C of 7.8%.
She has stable chronic kidney disease with eGFR 40 mL/min. Which second-
line agent is preferred for cardiovascular and renal protection?
A. Glipizide
B. Pioglitazone
C. SGLT2 inhibitor (e.g., dapagliflozin)
D. Sitagliptin
Answer: C
Rationale: SGLT2 inhibitors have proven cardiovascular and renal benefits in
patients with CKD and diabetes. They are recommended as add-on therapy
regardless of A1C if eGFR allows (dapagliflozin down to eGFR 25). Sulfonylureas do
not offer this protection. Pioglitazone may cause fluid retention.
, 6. A 45-year-old woman with asthma uses albuterol twice weekly for
symptoms. She wakes at night once per week with cough. What is the next step
according to GINA guidelines?
A. Continue albuterol alone
B. Add a low-dose inhaled corticosteroid (ICS)
C. Add a long-acting beta-agonist (LABA) alone
D. Refer to pulmonology
Answer: B
Rationale: GINA Step 2 recommends low-dose ICS for patients with symptoms >2
times per month and risk factors like nighttime awakenings. LABA alone without
ICS is not recommended. Albuterol alone is insufficient control.
7. A 52-year-old postmenopausal woman with breast cancer (ER-positive) on
anastrozole reports severe joint pain. What is the best management?
A. Discontinue anastrozole immediately
B. Switch to tamoxifen after discussing options if pain is intolerable
C. Add ibuprofen 800 mg TID
D. No change; arthralgia is unrelated to anastrozole
Answer: B
Rationale: Aromatase inhibitor-induced arthralgia is common. Initial management
includes analgesics and exercise. If severe and affecting quality of life, switching to
tamoxifen (a SERM) is an option after risk-benefit discussion. Discontinuation alone
increases recurrence risk. Ibuprofen may be used but does not address the
underlying cause.
