NURS 5433 FNP II FINAL EXAM REVIEW 2026 FAMILY NURSING AND
PRACTICE QUESTIONS ACCURATE EXAM COMPLETE ACTUAL QUESTIONS
WITH WELL ELABORATED ANSWERS WITH DETAILED RATIONALES
1. A 58-year-old patient presents to the family practice clinic for follow-up of
hypertension and reports intermittent headaches, fatigue, and difficulty
adhering to the prescribed medication regimen. The blood pressure today is
168/96 mmHg, and the patient states that home readings are usually lower.
Which action should the FNP take first to obtain the most clinically useful
information?
A. Increase the current antihypertensive dose immediately
B. Obtain a detailed medication, adherence, home-monitoring, and blood-
pressure measurement history
C. Order an extensive endocrine evaluation for secondary hypertension
D. Tell the patient that the home readings are probably inaccurate
Answer: B
2. A 67-year-old woman with type 2 diabetes reports increasing thirst,
nocturia, and fatigue despite taking metformin as prescribed. Her BMI is 34
kg/m², and her most recent A1C increased from 7.1% to 9.2%. Which
approach best reflects comprehensive primary-care management?
A. Focus exclusively on increasing the metformin dose
B. Discontinue all medications and begin insulin immediately
C. Assess adherence, lifestyle factors, complications, cardiovascular risk, and
the need for additional glucose-lowering therapy
D. Reassure her that an A1C of 9.2% is acceptable for most older adults
Answer: C
3. A 45-year-old man presents with persistent cough, fever, night sweats, and
unintentional weight loss. He recently immigrated from an area with a high
prevalence of tuberculosis. Which diagnostic approach is most appropriate?
A. Evaluate for tuberculosis with appropriate testing and respiratory
precautions while considering alternative causes
B. Treat empirically for uncomplicated community-acquired pneumonia
pg. 1
, without further assessment
C. Diagnose asthma because the cough has persisted for several weeks
D. Prescribe an antihistamine and reassess in six months
Answer: A
4. A 72-year-old patient reports progressive difficulty remembering recent
conversations but remains independent with finances, medications,
transportation, and household responsibilities. The FNP wants to distinguish
normal aging from a possible neurocognitive disorder. Which finding is most
concerning for a pathologic process?
A. Occasionally forgetting a person's name but remembering it later
B. Taking longer to learn unfamiliar technology
C. Misplacing an object and subsequently locating it
D. Progressive impairment that interferes with previously independent daily
activities
Answer: D
5. A 32-year-old woman presents with dysuria, urinary frequency, and urgency
for two days. She has no fever, flank pain, vaginal discharge, or pregnancy
risk. Which diagnosis is most consistent with this presentation?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Pelvic inflammatory disease
D. Nephrolithiasis
Answer: A
6. A 29-year-old woman presents with lower abdominal pain, fever,
dyspareunia, and purulent cervical discharge. Pelvic examination
demonstrates cervical motion tenderness. Which condition should the FNP
strongly consider?
A. Vulvovaginal candidiasis
B. Pelvic inflammatory disease
C. Uncomplicated cystitis
pg. 2
, D. Atrophic vaginitis
Answer: B
7. A 51-year-old woman reports hot flashes, night sweats, irregular menstrual
cycles, sleep disruption, and vaginal dryness. She has no history of breast
cancer, thromboembolic disease, or unexplained vaginal bleeding. Which
initial management discussion is most appropriate?
A. Explain that symptoms should always be ignored because menopause is
physiologic
B. Begin testosterone therapy as first-line treatment
C. Discuss individualized treatment options based on symptom severity,
risks, benefits, and patient preferences
D. Prescribe long-term antibiotics to prevent menopausal complications
Answer: C
8. A 64-year-old man presents with progressive urinary hesitancy, weak
stream, intermittency, and nocturia. Digital rectal examination reveals a
symmetrically enlarged prostate without nodules. Which diagnosis is most
likely?
A. Acute bacterial prostatitis
B. Prostate cancer
C. Urethral carcinoma
D. Benign prostatic hyperplasia
Answer: D
9. A 76-year-old patient takes eight prescription medications and several over-
the-counter supplements. During medication reconciliation, the FNP
discovers that two medications from different clinicians have similar
therapeutic effects. Which intervention best reduces medication-related
harm?
A. Ask the patient to stop all medications for one week
B. Compare every medication, dose, indication, effectiveness, adverse
effects, and interaction risk before making changes
C. Continue every medication because each was prescribed by a clinician
pg. 3
, D. Remove all over-the-counter products without further discussion
Answer: B
10. A 42-year-old patient presents with episodic palpitations, tremor, heat
intolerance, weight loss despite increased appetite, and anxiety.
Examination reveals a fine tremor and tachycardia. Which endocrine
disorder should be considered most strongly?
A. Hypothyroidism
B. Primary adrenal insufficiency
C. Hyperthyroidism
D. Hypoparathyroidism
Answer: C
11. A 61-year-old man with hypertension develops sudden severe substernal
chest pressure while walking. The pain radiates to his left arm and is
associated with diaphoresis and nausea. Which action should take priority
in the primary-care setting?
A. Treat the presentation as potentially acute coronary syndrome and
activate emergency evaluation
B. Schedule an outpatient stress test for the following month
C. Recommend an antacid and reassess after one hour
D. Attribute the symptoms to anxiety because he has a history of stress
Answer: A
12. A 55-year-old woman has exertional chest discomfort that resolves after
several minutes of rest. Her risk factors include diabetes, hypertension,
hyperlipidemia, and tobacco exposure. Which clinical feature is most
characteristic of stable angina?
A. Pain that consistently occurs only after eating
B. Chest discomfort that predictably occurs with exertion and improves with
rest
C. Chest pain that lasts continuously for several days
D. Sharp pain that worsens exclusively with inspiration
Answer: B
pg. 4
PRACTICE QUESTIONS ACCURATE EXAM COMPLETE ACTUAL QUESTIONS
WITH WELL ELABORATED ANSWERS WITH DETAILED RATIONALES
1. A 58-year-old patient presents to the family practice clinic for follow-up of
hypertension and reports intermittent headaches, fatigue, and difficulty
adhering to the prescribed medication regimen. The blood pressure today is
168/96 mmHg, and the patient states that home readings are usually lower.
Which action should the FNP take first to obtain the most clinically useful
information?
A. Increase the current antihypertensive dose immediately
B. Obtain a detailed medication, adherence, home-monitoring, and blood-
pressure measurement history
C. Order an extensive endocrine evaluation for secondary hypertension
D. Tell the patient that the home readings are probably inaccurate
Answer: B
2. A 67-year-old woman with type 2 diabetes reports increasing thirst,
nocturia, and fatigue despite taking metformin as prescribed. Her BMI is 34
kg/m², and her most recent A1C increased from 7.1% to 9.2%. Which
approach best reflects comprehensive primary-care management?
A. Focus exclusively on increasing the metformin dose
B. Discontinue all medications and begin insulin immediately
C. Assess adherence, lifestyle factors, complications, cardiovascular risk, and
the need for additional glucose-lowering therapy
D. Reassure her that an A1C of 9.2% is acceptable for most older adults
Answer: C
3. A 45-year-old man presents with persistent cough, fever, night sweats, and
unintentional weight loss. He recently immigrated from an area with a high
prevalence of tuberculosis. Which diagnostic approach is most appropriate?
A. Evaluate for tuberculosis with appropriate testing and respiratory
precautions while considering alternative causes
B. Treat empirically for uncomplicated community-acquired pneumonia
pg. 1
, without further assessment
C. Diagnose asthma because the cough has persisted for several weeks
D. Prescribe an antihistamine and reassess in six months
Answer: A
4. A 72-year-old patient reports progressive difficulty remembering recent
conversations but remains independent with finances, medications,
transportation, and household responsibilities. The FNP wants to distinguish
normal aging from a possible neurocognitive disorder. Which finding is most
concerning for a pathologic process?
A. Occasionally forgetting a person's name but remembering it later
B. Taking longer to learn unfamiliar technology
C. Misplacing an object and subsequently locating it
D. Progressive impairment that interferes with previously independent daily
activities
Answer: D
5. A 32-year-old woman presents with dysuria, urinary frequency, and urgency
for two days. She has no fever, flank pain, vaginal discharge, or pregnancy
risk. Which diagnosis is most consistent with this presentation?
A. Acute uncomplicated cystitis
B. Acute pyelonephritis
C. Pelvic inflammatory disease
D. Nephrolithiasis
Answer: A
6. A 29-year-old woman presents with lower abdominal pain, fever,
dyspareunia, and purulent cervical discharge. Pelvic examination
demonstrates cervical motion tenderness. Which condition should the FNP
strongly consider?
A. Vulvovaginal candidiasis
B. Pelvic inflammatory disease
C. Uncomplicated cystitis
pg. 2
, D. Atrophic vaginitis
Answer: B
7. A 51-year-old woman reports hot flashes, night sweats, irregular menstrual
cycles, sleep disruption, and vaginal dryness. She has no history of breast
cancer, thromboembolic disease, or unexplained vaginal bleeding. Which
initial management discussion is most appropriate?
A. Explain that symptoms should always be ignored because menopause is
physiologic
B. Begin testosterone therapy as first-line treatment
C. Discuss individualized treatment options based on symptom severity,
risks, benefits, and patient preferences
D. Prescribe long-term antibiotics to prevent menopausal complications
Answer: C
8. A 64-year-old man presents with progressive urinary hesitancy, weak
stream, intermittency, and nocturia. Digital rectal examination reveals a
symmetrically enlarged prostate without nodules. Which diagnosis is most
likely?
A. Acute bacterial prostatitis
B. Prostate cancer
C. Urethral carcinoma
D. Benign prostatic hyperplasia
Answer: D
9. A 76-year-old patient takes eight prescription medications and several over-
the-counter supplements. During medication reconciliation, the FNP
discovers that two medications from different clinicians have similar
therapeutic effects. Which intervention best reduces medication-related
harm?
A. Ask the patient to stop all medications for one week
B. Compare every medication, dose, indication, effectiveness, adverse
effects, and interaction risk before making changes
C. Continue every medication because each was prescribed by a clinician
pg. 3
, D. Remove all over-the-counter products without further discussion
Answer: B
10. A 42-year-old patient presents with episodic palpitations, tremor, heat
intolerance, weight loss despite increased appetite, and anxiety.
Examination reveals a fine tremor and tachycardia. Which endocrine
disorder should be considered most strongly?
A. Hypothyroidism
B. Primary adrenal insufficiency
C. Hyperthyroidism
D. Hypoparathyroidism
Answer: C
11. A 61-year-old man with hypertension develops sudden severe substernal
chest pressure while walking. The pain radiates to his left arm and is
associated with diaphoresis and nausea. Which action should take priority
in the primary-care setting?
A. Treat the presentation as potentially acute coronary syndrome and
activate emergency evaluation
B. Schedule an outpatient stress test for the following month
C. Recommend an antacid and reassess after one hour
D. Attribute the symptoms to anxiety because he has a history of stress
Answer: A
12. A 55-year-old woman has exertional chest discomfort that resolves after
several minutes of rest. Her risk factors include diabetes, hypertension,
hyperlipidemia, and tobacco exposure. Which clinical feature is most
characteristic of stable angina?
A. Pain that consistently occurs only after eating
B. Chest discomfort that predictably occurs with exertion and improves with
rest
C. Chest pain that lasts continuously for several days
D. Sharp pain that worsens exclusively with inspiration
Answer: B
pg. 4
