1
NURS 5433 FNP II Final Exam - Version 2 Actual
Exam 2026/2027 | University of Texas at
Arlington | Complete Practice Test with Verified
Answers | Already Graded A+ (Brand New!!)
SECTION 1: CARDIOVASCULAR DISORDERS (15 Questions)
Case Study 1: Hypertension with Comorbidities
Scenario: A 58-year-old African American male with hypertension and stage 3 CKD (eGFR 45
mL/min/1.73m²) presents for follow-up. Current BP 148/92 mmHg on lisinopril 20 mg daily.
Labs: K⁺ 4.8 mEq/L, Cr 1.8 mg/dL, UACR 285 mg/g. No history of diabetes or CVD.
Q1. According to the 2017 ACC/AHA hypertension guidelines, what is the recommended BP
target for this patient?
A. <140/90 mmHg
B. <135/85 mmHg
C. <130/80 mmHg
D. <120/80 mmHg
Correct Answer: C. [CORRECT]
Rationale: The 2017 ACC/AHA guidelines recommend a BP target of <130/80 mmHg for all
adults, with particular emphasis on patients with CKD (stage 3 or higher) and/or albuminuria
(UACR ≥300 mg/g). This more aggressive target is supported by evidence from SPRINT and
other trials showing reduced progression of CKD and decreased cardiovascular events with
intensive BP control.
Q2. Which antihypertensive agent should be added to achieve target BP given his current
potassium of 4.8 mEq/L on lisinopril?
A. Spironolactone 25 mg daily
B. Amlodipine 5 mg daily
C. Losartan 50 mg daily
D. Chlorthalidone 12.5 mg daily
,2
Correct Answer: B. [CORRECT]
Rationale: With potassium at 4.8 mEq/L (upper normal) on an ACE inhibitor, adding an ARB or
aldosterone antagonist carries significant hyperkalemia risk. Amlodipine, a dihydropyridine
calcium channel blocker, is the preferred add-on agent in African American patients due to robust
BP-lowering efficacy, neutral effect on potassium and renal function, and complementary
mechanism to ACE inhibition. Thiazide diuretics may further reduce eGFR in CKD stage 3b+.
Q3. The patient achieves BP 128/78 mmHg on lisinopril 20 mg plus amlodipine 5 mg but
develops bilateral ankle edema. Which modification is most appropriate?
A. Discontinue amlodipine and switch to hydrochlorothiazide
B. Reduce amlodipine to 2.5 mg and add losartan
C. Continue current regimen; prescribe compression stockings
D. Switch amlodipine to lercanidipine
Correct Answer: D. [CORRECT]
Rationale: Amlodipine-induced peripheral edema results from preferential arteriolar dilation
without commensurate venous dilation, causing hydrostatic pressure in capillary beds.
Lercanidipine, a third-generation lipophilic CCB with higher vascular selectivity and longer half-
life, demonstrates significantly lower incidence of ankle edema (up to 50% reduction) while
maintaining equivalent antihypertensive efficacy. ACE inhibitor + CCB combinations remain
preferred in CKD with albuminuria.
Case Study 2: Dyslipidemia and ASCVD Risk
Scenario: A 55-year-old female with type 2 diabetes (HbA1c 6.8%), BP 132/84 mmHg on
lisinopril, and 10-year ASCVD risk of 8.2%. LDL-C 142 mg/dL, HDL-C 48 mg/dL, TG 186
mg/dL. Family history of premature CAD (father MI at age 52). She is a never-smoker.
Q4. According to the 2018 AHA/ACC/Multi-Society Cholesterol Guidelines, what is the
recommended intensity of statin therapy?
A. No statin indicated; lifestyle modification only
B. Moderate-intensity statin
C. High-intensity statin
D. High-intensity statin plus ezetimibe
Correct Answer: B. [CORRECT]
Rationale: The 2018 guidelines recommend moderate-intensity statin therapy for adults 40-75
years with diabetes and LDL-C 70-189 mg/dL regardless of calculated 10-year ASCVD risk.
While diabetes is a risk-enhancing factor, her 10-year risk <20% without established ASCVD or
,3
severe hyperlipidemia does not mandate high-intensity therapy. The family history of premature
ASCVD supports risk discussion but does not automatically escalate intensity.
Q5. Six months later on atorvastatin 20 mg, her LDL-C is 98 mg/dL. What is the most
appropriate management?
A. Continue current therapy; LDL-C goal achieved
B. Increase to atorvastatin 40 mg
C. Add ezetimibe 10 mg
D. Obtain coronary artery calcium score
Correct Answer: A. [CORRECT]
Rationale: For moderate-intensity statin candidates, the goal is ≥30% reduction in LDL-C rather
than a specific absolute target. A reduction from 142 to 98 mg/dL represents a 31% reduction,
meeting the threshold for therapeutic response. The "fire and forget" approach of the 2018
guidelines emphasizes adherence to appropriate-intensity statin rather than titrating to specific
LDL-C levels in primary prevention.
Case Study 3: Heart Failure Management
Scenario: A 68-year-old male with HFrEF (EF 35%) presents for follow-up. NYHA class II
symptoms. Current medications: lisinopril 20 mg, metoprolol succinate 100 mg, furosemide 40
mg daily. BP 108/68 mmHg, HR 72 bpm, creatinine 1.3 mg/dL, K⁺ 4.2 mEq/L.
Q6. According to current ACC/AHA/HFSA heart failure guidelines, which medication should be
added next to reduce mortality and hospitalization?
A. Digoxin 0.125 mg daily
B. Sacubitril/valsartan (Entresto®)
C. Spironolactone 25 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: C. [CORRECT]
Rationale: The 2022 AHA/ACC/HFSA guidelines recommend MRA therapy (spironolactone or
eplerenone) for all patients with HFrEF (EF ≤35%) to reduce mortality and hospitalization,
unless contraindicated (K⁺ >5.0 or eGFR <30). With K⁺ 4.2 and Cr 1.3, this patient is an ideal
candidate. MRAs should be initiated before ARNI in patients already tolerating ACE inhibitors,
as the benefit is well-established and cost-effective.
, 4
Q7. The patient tolerates spironolactone well with K⁺ 4.6 at 4 weeks. BP remains 106/66 mmHg.
What is the next step in GDMT optimization?
A. Increase lisinopril to 40 mg
B. Switch from lisinopril to sacubitril/valsartan
C. Add ivabradine
D. Add SGLT2 inhibitor (dapagliflozin)
Correct Answer: D. [CORRECT]
Rationale: The 2022 guidelines elevated SGLT2 inhibitors (dapagliflozin or empagliflozin) to
foundational therapy for HFrEF regardless of diabetes status (Class 1A recommendation).
DAPA-HF and EMPEROR-Reduced trials demonstrated 25-30% reduction in cardiovascular
death and worsening HF, independent of glucose-lowering effects. SGLT2 inhibitors should be
added to existing GDMT before considering ARNI substitution in hemodynamically stable
patients.
Case Study 4: Atrial Fibrillation
Scenario: A 72-year-old female with newly diagnosed nonvalvular atrial fibrillation (CHA₂DS₂-
VASc score 4, HAS-BLED 2). She is symptomatic with palpitations and mild dyspnea on
exertion. Echocardiogram shows normal LVEF, mild LA enlargement.
Q8. Which anticoagulation strategy is recommended for stroke prevention?
A. Aspirin 81 mg daily
B. Apixaban 5 mg twice daily
C. Warfarin with INR goal 2.0-3.0
D. Left atrial appendage occlusion device
Correct Answer: B. [CORRECT]
Rationale: Direct oral anticoagulants (DOACs) are preferred over warfarin for nonvalvular AF
in patients with CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) per 2023 ACC/AHA/ACCP/HRS
guidelines. Apixaban demonstrates superior safety (lower bleeding risk) and similar efficacy
compared to warfarin (ARISTOTLE trial), with no need for monitoring. Aspirin is insufficient
for stroke prevention in AF; LA appendage occlusion is reserved for patients with
contraindications to long-term anticoagulation.
Q9. For rate control with target resting HR <110 bpm, which medication is preferred given her
preserved EF?
A. Digoxin 0.125 mg daily
B. Diltiazem 240 mg daily
NURS 5433 FNP II Final Exam - Version 2 Actual
Exam 2026/2027 | University of Texas at
Arlington | Complete Practice Test with Verified
Answers | Already Graded A+ (Brand New!!)
SECTION 1: CARDIOVASCULAR DISORDERS (15 Questions)
Case Study 1: Hypertension with Comorbidities
Scenario: A 58-year-old African American male with hypertension and stage 3 CKD (eGFR 45
mL/min/1.73m²) presents for follow-up. Current BP 148/92 mmHg on lisinopril 20 mg daily.
Labs: K⁺ 4.8 mEq/L, Cr 1.8 mg/dL, UACR 285 mg/g. No history of diabetes or CVD.
Q1. According to the 2017 ACC/AHA hypertension guidelines, what is the recommended BP
target for this patient?
A. <140/90 mmHg
B. <135/85 mmHg
C. <130/80 mmHg
D. <120/80 mmHg
Correct Answer: C. [CORRECT]
Rationale: The 2017 ACC/AHA guidelines recommend a BP target of <130/80 mmHg for all
adults, with particular emphasis on patients with CKD (stage 3 or higher) and/or albuminuria
(UACR ≥300 mg/g). This more aggressive target is supported by evidence from SPRINT and
other trials showing reduced progression of CKD and decreased cardiovascular events with
intensive BP control.
Q2. Which antihypertensive agent should be added to achieve target BP given his current
potassium of 4.8 mEq/L on lisinopril?
A. Spironolactone 25 mg daily
B. Amlodipine 5 mg daily
C. Losartan 50 mg daily
D. Chlorthalidone 12.5 mg daily
,2
Correct Answer: B. [CORRECT]
Rationale: With potassium at 4.8 mEq/L (upper normal) on an ACE inhibitor, adding an ARB or
aldosterone antagonist carries significant hyperkalemia risk. Amlodipine, a dihydropyridine
calcium channel blocker, is the preferred add-on agent in African American patients due to robust
BP-lowering efficacy, neutral effect on potassium and renal function, and complementary
mechanism to ACE inhibition. Thiazide diuretics may further reduce eGFR in CKD stage 3b+.
Q3. The patient achieves BP 128/78 mmHg on lisinopril 20 mg plus amlodipine 5 mg but
develops bilateral ankle edema. Which modification is most appropriate?
A. Discontinue amlodipine and switch to hydrochlorothiazide
B. Reduce amlodipine to 2.5 mg and add losartan
C. Continue current regimen; prescribe compression stockings
D. Switch amlodipine to lercanidipine
Correct Answer: D. [CORRECT]
Rationale: Amlodipine-induced peripheral edema results from preferential arteriolar dilation
without commensurate venous dilation, causing hydrostatic pressure in capillary beds.
Lercanidipine, a third-generation lipophilic CCB with higher vascular selectivity and longer half-
life, demonstrates significantly lower incidence of ankle edema (up to 50% reduction) while
maintaining equivalent antihypertensive efficacy. ACE inhibitor + CCB combinations remain
preferred in CKD with albuminuria.
Case Study 2: Dyslipidemia and ASCVD Risk
Scenario: A 55-year-old female with type 2 diabetes (HbA1c 6.8%), BP 132/84 mmHg on
lisinopril, and 10-year ASCVD risk of 8.2%. LDL-C 142 mg/dL, HDL-C 48 mg/dL, TG 186
mg/dL. Family history of premature CAD (father MI at age 52). She is a never-smoker.
Q4. According to the 2018 AHA/ACC/Multi-Society Cholesterol Guidelines, what is the
recommended intensity of statin therapy?
A. No statin indicated; lifestyle modification only
B. Moderate-intensity statin
C. High-intensity statin
D. High-intensity statin plus ezetimibe
Correct Answer: B. [CORRECT]
Rationale: The 2018 guidelines recommend moderate-intensity statin therapy for adults 40-75
years with diabetes and LDL-C 70-189 mg/dL regardless of calculated 10-year ASCVD risk.
While diabetes is a risk-enhancing factor, her 10-year risk <20% without established ASCVD or
,3
severe hyperlipidemia does not mandate high-intensity therapy. The family history of premature
ASCVD supports risk discussion but does not automatically escalate intensity.
Q5. Six months later on atorvastatin 20 mg, her LDL-C is 98 mg/dL. What is the most
appropriate management?
A. Continue current therapy; LDL-C goal achieved
B. Increase to atorvastatin 40 mg
C. Add ezetimibe 10 mg
D. Obtain coronary artery calcium score
Correct Answer: A. [CORRECT]
Rationale: For moderate-intensity statin candidates, the goal is ≥30% reduction in LDL-C rather
than a specific absolute target. A reduction from 142 to 98 mg/dL represents a 31% reduction,
meeting the threshold for therapeutic response. The "fire and forget" approach of the 2018
guidelines emphasizes adherence to appropriate-intensity statin rather than titrating to specific
LDL-C levels in primary prevention.
Case Study 3: Heart Failure Management
Scenario: A 68-year-old male with HFrEF (EF 35%) presents for follow-up. NYHA class II
symptoms. Current medications: lisinopril 20 mg, metoprolol succinate 100 mg, furosemide 40
mg daily. BP 108/68 mmHg, HR 72 bpm, creatinine 1.3 mg/dL, K⁺ 4.2 mEq/L.
Q6. According to current ACC/AHA/HFSA heart failure guidelines, which medication should be
added next to reduce mortality and hospitalization?
A. Digoxin 0.125 mg daily
B. Sacubitril/valsartan (Entresto®)
C. Spironolactone 25 mg daily
D. Hydralazine/isosorbide dinitrate
Correct Answer: C. [CORRECT]
Rationale: The 2022 AHA/ACC/HFSA guidelines recommend MRA therapy (spironolactone or
eplerenone) for all patients with HFrEF (EF ≤35%) to reduce mortality and hospitalization,
unless contraindicated (K⁺ >5.0 or eGFR <30). With K⁺ 4.2 and Cr 1.3, this patient is an ideal
candidate. MRAs should be initiated before ARNI in patients already tolerating ACE inhibitors,
as the benefit is well-established and cost-effective.
, 4
Q7. The patient tolerates spironolactone well with K⁺ 4.6 at 4 weeks. BP remains 106/66 mmHg.
What is the next step in GDMT optimization?
A. Increase lisinopril to 40 mg
B. Switch from lisinopril to sacubitril/valsartan
C. Add ivabradine
D. Add SGLT2 inhibitor (dapagliflozin)
Correct Answer: D. [CORRECT]
Rationale: The 2022 guidelines elevated SGLT2 inhibitors (dapagliflozin or empagliflozin) to
foundational therapy for HFrEF regardless of diabetes status (Class 1A recommendation).
DAPA-HF and EMPEROR-Reduced trials demonstrated 25-30% reduction in cardiovascular
death and worsening HF, independent of glucose-lowering effects. SGLT2 inhibitors should be
added to existing GDMT before considering ARNI substitution in hemodynamically stable
patients.
Case Study 4: Atrial Fibrillation
Scenario: A 72-year-old female with newly diagnosed nonvalvular atrial fibrillation (CHA₂DS₂-
VASc score 4, HAS-BLED 2). She is symptomatic with palpitations and mild dyspnea on
exertion. Echocardiogram shows normal LVEF, mild LA enlargement.
Q8. Which anticoagulation strategy is recommended for stroke prevention?
A. Aspirin 81 mg daily
B. Apixaban 5 mg twice daily
C. Warfarin with INR goal 2.0-3.0
D. Left atrial appendage occlusion device
Correct Answer: B. [CORRECT]
Rationale: Direct oral anticoagulants (DOACs) are preferred over warfarin for nonvalvular AF
in patients with CHA₂DS₂-VASc ≥2 (men) or ≥3 (women) per 2023 ACC/AHA/ACCP/HRS
guidelines. Apixaban demonstrates superior safety (lower bleeding risk) and similar efficacy
compared to warfarin (ARISTOTLE trial), with no need for monitoring. Aspirin is insufficient
for stroke prevention in AF; LA appendage occlusion is reserved for patients with
contraindications to long-term anticoagulation.
Q9. For rate control with target resting HR <110 bpm, which medication is preferred given her
preserved EF?
A. Digoxin 0.125 mg daily
B. Diltiazem 240 mg daily
