NURS 5433 FNP II Final Exam Questions & Verified
Answers 2 VERSIONS
This specialized graduate nursing resource delivers a comprehensive collection of
past exam questions, verified answers, and detailed clinical rationales explicitly
built for the NURS 5433 Family Nurse Practitioner (FNP) II Final Examination. It focuses
on the advanced practice evaluation, differential diagnosis, and evidence-based primary
care management of complex acute and chronic illnesses across the lifespan. Preparing
with these targeted testing materials will refine your clinical decision-making, optimize
your pharmaceutical management plans, and guarantee an A grade on your
proctored terminal assessment.
1. A 68-year-old male with type 2 diabetes and a history of myocardial infarction is
on metformin, lisinopril, and atorvastatin. His most recent HbA1c is 7.8%.
According to the ADA guidelines, which medication class should be added to
reduce his risk of cardiovascular events?
A) Sulfonylurea
B) SGLT2 inhibitor
C) DPP-4 inhibitor
D) Insulin
Answer: B
Rationale: In patients with type 2 diabetes and established ASCVD, SGLT2 inhibitors or
GLP-1 receptor agonists with proven cardiovascular benefit are recommended to reduce
major adverse cardiovascular events, independent of glycemic control. Sulfonylureas and
DPP-4 inhibitors do not have this benefit.
2. A 32-year-old woman presents with a 3-day history of unilateral facial pain,
nasal congestion, and purulent nasal discharge. She has a temperature of 38.2°C.
Which finding would most strongly support a diagnosis of acute bacterial
rhinosinusitis?
A) Symptoms lasting less than 10 days
B) Double worsening of symptoms after initial improvement
C) Clear nasal discharge
D) Itchy, watery eyes
,Answer: B
Rationale: Acute bacterial rhinosinusitis is suggested by symptoms lasting >10 days
without improvement, severe symptoms (fever >39°C, purulent discharge, facial pain) for
3–4 days, or double worsening (initial improvement followed by worsening). Clear
discharge and itchy eyes suggest viral or allergic etiology.
3. A 55-year-old man presents with a 2-month history of intermittent claudication.
His ankle-brachial index (ABI) is 0.75. What is the most appropriate initial
management?
A) Immediate referral for revascularization
B) Supervised exercise therapy and smoking cessation
C) Initiation of warfarin
D) Bed rest and elevation
Answer: B
Rationale: For symptomatic peripheral artery disease with claudication, supervised exercise
therapy and smoking cessation are first-line. Revascularization is reserved for disabling
symptoms or critical limb ischemia. Anticoagulation is not indicated unless there is
another indication.
4. A 28-year-old woman presents with a 2-week history of palpitations, heat
intolerance, and weight loss. Her TSH is undetectable, and free T4 is elevated.
Which medication is most appropriate for initial management?
A) Levothyroxine
B) Methimazole
C) Radioactive iodine
D) Propranolol alone
Answer: B
Rationale: Methimazole is first-line for Graves' disease. Beta-blockers like propranolol can
control symptoms but do not treat the underlying hyperthyroidism. Radioactive iodine is
definitive but not initial. Levothyroxine would worsen the condition.
5. A 62-year-old woman presents with a 3-month history of fatigue, weight gain,
and cold intolerance. Her TSH is elevated, and free T4 is low. Which laboratory test
should be ordered to confirm the most common cause?
,A) Thyroid peroxidase antibodies
B) Thyroglobulin
C) Thyroid-stimulating immunoglobulin
D) Calcitonin
Answer: A
Rationale: Hashimoto's thyroiditis is the most common cause of primary hypothyroidism
in the US, confirmed by elevated TPO antibodies. TSH receptor antibodies are seen in
Graves'. Thyroglobulin is used for cancer monitoring. Calcitonin is for medullary thyroid
cancer.
6. A 45-year-old man with a BMI of 32 kg/m² and a fasting glucose of 118 mg/dL
is diagnosed with prediabetes. Which intervention has the strongest evidence for
preventing progression to diabetes?
A) Metformin 500 mg twice daily
B) Intensive lifestyle intervention with 7% weight loss and 150 min/week of exercise
C) Pioglitazone 15 mg daily
D) Annual HbA1c screening only
Answer: B
Rationale: The Diabetes Prevention Program showed that intensive lifestyle intervention is
more effective than metformin for preventing diabetes in prediabetes. Metformin is an
option, especially in those <60 years or BMI ≥35, but lifestyle is first-line.
7. A 72-year-old woman with osteoporosis is started on alendronate. Which
instruction is essential to prevent esophageal irritation?
A) Take with food
B) Take at bedtime
C) Take with a full glass of water and remain upright for 30 minutes
D) Take with calcium supplements
Answer: C
Rationale: Bisphosphonates like alendronate must be taken on an empty stomach with 6–
8 oz of plain water, and the patient must remain upright for at least 30 minutes to prevent
esophagitis. Taking with food or other medications reduces absorption.
, 8. A 35-year-old woman presents with a 6-month history of generalized anxiety
disorder. She is started on buspirone. Which statement indicates she understands
the teaching?
A) "I will feel the full effect within a few days."
B) "I can take this as needed for panic attacks."
C) "It may take 2–4 weeks to work."
D) "I should avoid grapefruit juice."
Answer: C
Rationale: Buspirone takes 2–4 weeks to achieve therapeutic effect and is not effective for
acute anxiety or panic attacks. It is generally well-tolerated and does not require dietary
restrictions like grapefruit.
9. A 4-year-old child presents with a 2-day history of fever, sore throat, and
tonsillar exudates. A rapid strep test is positive. Which antibiotic is first-line?
A) Amoxicillin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
Answer: A
Rationale: Penicillin or amoxicillin is first-line for group A streptococcal pharyngitis.
Azithromycin is for penicillin-allergic patients. Ciprofloxacin and doxycycline are not first-
line and have broader coverage.
10. A 58-year-old man presents with a 3-month history of nocturia, hesitancy, and
weak urinary stream. His DRE is normal, and PSA is 1.2 ng/mL. Which medication
is most appropriate for symptom relief?
A) Tamsulosin
B) Finasteride
C) Oxybutynin
D) Sildenafil
Answer: A
Rationale: Alpha-blockers like tamsulosin provide rapid symptom relief for BPH by
relaxing smooth muscle. Finasteride takes months and is for larger prostates. Oxybutynin
is for overactive bladder. Sildenafil is for ED.
Answers 2 VERSIONS
This specialized graduate nursing resource delivers a comprehensive collection of
past exam questions, verified answers, and detailed clinical rationales explicitly
built for the NURS 5433 Family Nurse Practitioner (FNP) II Final Examination. It focuses
on the advanced practice evaluation, differential diagnosis, and evidence-based primary
care management of complex acute and chronic illnesses across the lifespan. Preparing
with these targeted testing materials will refine your clinical decision-making, optimize
your pharmaceutical management plans, and guarantee an A grade on your
proctored terminal assessment.
1. A 68-year-old male with type 2 diabetes and a history of myocardial infarction is
on metformin, lisinopril, and atorvastatin. His most recent HbA1c is 7.8%.
According to the ADA guidelines, which medication class should be added to
reduce his risk of cardiovascular events?
A) Sulfonylurea
B) SGLT2 inhibitor
C) DPP-4 inhibitor
D) Insulin
Answer: B
Rationale: In patients with type 2 diabetes and established ASCVD, SGLT2 inhibitors or
GLP-1 receptor agonists with proven cardiovascular benefit are recommended to reduce
major adverse cardiovascular events, independent of glycemic control. Sulfonylureas and
DPP-4 inhibitors do not have this benefit.
2. A 32-year-old woman presents with a 3-day history of unilateral facial pain,
nasal congestion, and purulent nasal discharge. She has a temperature of 38.2°C.
Which finding would most strongly support a diagnosis of acute bacterial
rhinosinusitis?
A) Symptoms lasting less than 10 days
B) Double worsening of symptoms after initial improvement
C) Clear nasal discharge
D) Itchy, watery eyes
,Answer: B
Rationale: Acute bacterial rhinosinusitis is suggested by symptoms lasting >10 days
without improvement, severe symptoms (fever >39°C, purulent discharge, facial pain) for
3–4 days, or double worsening (initial improvement followed by worsening). Clear
discharge and itchy eyes suggest viral or allergic etiology.
3. A 55-year-old man presents with a 2-month history of intermittent claudication.
His ankle-brachial index (ABI) is 0.75. What is the most appropriate initial
management?
A) Immediate referral for revascularization
B) Supervised exercise therapy and smoking cessation
C) Initiation of warfarin
D) Bed rest and elevation
Answer: B
Rationale: For symptomatic peripheral artery disease with claudication, supervised exercise
therapy and smoking cessation are first-line. Revascularization is reserved for disabling
symptoms or critical limb ischemia. Anticoagulation is not indicated unless there is
another indication.
4. A 28-year-old woman presents with a 2-week history of palpitations, heat
intolerance, and weight loss. Her TSH is undetectable, and free T4 is elevated.
Which medication is most appropriate for initial management?
A) Levothyroxine
B) Methimazole
C) Radioactive iodine
D) Propranolol alone
Answer: B
Rationale: Methimazole is first-line for Graves' disease. Beta-blockers like propranolol can
control symptoms but do not treat the underlying hyperthyroidism. Radioactive iodine is
definitive but not initial. Levothyroxine would worsen the condition.
5. A 62-year-old woman presents with a 3-month history of fatigue, weight gain,
and cold intolerance. Her TSH is elevated, and free T4 is low. Which laboratory test
should be ordered to confirm the most common cause?
,A) Thyroid peroxidase antibodies
B) Thyroglobulin
C) Thyroid-stimulating immunoglobulin
D) Calcitonin
Answer: A
Rationale: Hashimoto's thyroiditis is the most common cause of primary hypothyroidism
in the US, confirmed by elevated TPO antibodies. TSH receptor antibodies are seen in
Graves'. Thyroglobulin is used for cancer monitoring. Calcitonin is for medullary thyroid
cancer.
6. A 45-year-old man with a BMI of 32 kg/m² and a fasting glucose of 118 mg/dL
is diagnosed with prediabetes. Which intervention has the strongest evidence for
preventing progression to diabetes?
A) Metformin 500 mg twice daily
B) Intensive lifestyle intervention with 7% weight loss and 150 min/week of exercise
C) Pioglitazone 15 mg daily
D) Annual HbA1c screening only
Answer: B
Rationale: The Diabetes Prevention Program showed that intensive lifestyle intervention is
more effective than metformin for preventing diabetes in prediabetes. Metformin is an
option, especially in those <60 years or BMI ≥35, but lifestyle is first-line.
7. A 72-year-old woman with osteoporosis is started on alendronate. Which
instruction is essential to prevent esophageal irritation?
A) Take with food
B) Take at bedtime
C) Take with a full glass of water and remain upright for 30 minutes
D) Take with calcium supplements
Answer: C
Rationale: Bisphosphonates like alendronate must be taken on an empty stomach with 6–
8 oz of plain water, and the patient must remain upright for at least 30 minutes to prevent
esophagitis. Taking with food or other medications reduces absorption.
, 8. A 35-year-old woman presents with a 6-month history of generalized anxiety
disorder. She is started on buspirone. Which statement indicates she understands
the teaching?
A) "I will feel the full effect within a few days."
B) "I can take this as needed for panic attacks."
C) "It may take 2–4 weeks to work."
D) "I should avoid grapefruit juice."
Answer: C
Rationale: Buspirone takes 2–4 weeks to achieve therapeutic effect and is not effective for
acute anxiety or panic attacks. It is generally well-tolerated and does not require dietary
restrictions like grapefruit.
9. A 4-year-old child presents with a 2-day history of fever, sore throat, and
tonsillar exudates. A rapid strep test is positive. Which antibiotic is first-line?
A) Amoxicillin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
Answer: A
Rationale: Penicillin or amoxicillin is first-line for group A streptococcal pharyngitis.
Azithromycin is for penicillin-allergic patients. Ciprofloxacin and doxycycline are not first-
line and have broader coverage.
10. A 58-year-old man presents with a 3-month history of nocturia, hesitancy, and
weak urinary stream. His DRE is normal, and PSA is 1.2 ng/mL. Which medication
is most appropriate for symptom relief?
A) Tamsulosin
B) Finasteride
C) Oxybutynin
D) Sildenafil
Answer: A
Rationale: Alpha-blockers like tamsulosin provide rapid symptom relief for BPH by
relaxing smooth muscle. Finasteride takes months and is for larger prostates. Oxybutynin
is for overactive bladder. Sildenafil is for ED.
