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NURS 5433 FNP II MIDTERM EXAM
REVIEW Actual Exam 2026/2027 Complete
Questions and Verified Answers Family
Nursing UTA Pass Guaranteed - A+ Graded
SECTION I: CARDIOVASCULAR CONDITIONS IN PRIMARY CARE (Questions 1-15)
Hypertension
Question 1 A 58-year-old African American male presents for follow-up. His home BP log
shows readings of 138/86, 142/88, and 136/84 mmHg over the past two weeks. In clinic today,
his BP is 146/92 mmHg. He has no comorbidities. According to current ACC/AHA guidelines,
what is the most appropriate classification and next step?
A. Stage 1 hypertension; continue lifestyle modifications and recheck in 3 months
B. Stage 2 hypertension; initiate pharmacologic therapy with thiazide diuretic or CCB
C. Stage 1 hypertension; initiate single antihypertensive agent
D. Elevated BP; intensive lifestyle modifications and recheck in 3-6 months
Correct Answer: B
Rationale: According to the 2017 ACC/AHA guidelines, Stage 2 hypertension is defined as BP
≥140/90 mmHg. This patient's average BP (including both home and office readings) meets
Stage 2 criteria. For Stage 2 hypertension without comorbidities, pharmacologic therapy should
be initiated with either a thiazide diuretic, ACE inhibitor, ARB, or CCB. In African American
patients, thiazide diuretics or CCBs are particularly effective as initial therapy. The key features
supporting this answer are: (1) sustained BP ≥140/90 mmHg across multiple readings, (2)
average home BP readings also elevated, and (3) Stage 2 hypertension requires immediate
pharmacologic intervention regardless of race or comorbidities. Option A is incorrect because
lifestyle modifications alone are insufficient for Stage 2 hypertension. Option C is incorrect
because single agent therapy is appropriate, but the classification is Stage 2, not Stage 1. Option
D is incorrect because the BP exceeds 140/90 mmHg, ruling out "elevated" category.
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Question 2 A 45-year-old female with resistant hypertension (BP 158/96 mmHg on lisinopril 40
mg daily and amlodipine 10 mg daily) undergoes evaluation for secondary causes. Laboratory
studies reveal: K+ 3.2 mEq/L (normal 3.5-5.0), Na+ 142 mEq/L, creatinine 1.0 mg/dL. Plasma
aldosterone concentration is 25 ng/dL (elevated) and plasma renin activity is 0.5 ng/mL/hour
(suppressed). What is the most likely diagnosis and appropriate confirmatory test?
A. Renal artery stenosis; CT angiography of renal arteries
B. Primary aldosteronism; saline suppression test or aldosterone-renin ratio
C. Pheochromocytoma; 24-hour urine metanephrines and catecholamines
D. Cushing's syndrome; 1 mg overnight dexamethasone suppression test
Correct Answer: B
Rationale: This presentation is classic for primary aldosteronism (Conn's syndrome), the most
common cause of secondary hypertension. Key diagnostic clues include: (1) resistant
hypertension despite two maximally dosed agents, (2) spontaneous hypokalemia (K+ 3.2)
without diuretic use, (3) elevated aldosterone with suppressed renin activity, and (4) the
aldosterone-renin ratio (ARR) is markedly elevated at 50 (>20 suggests primary aldosteronism).
The saline suppression test or ARR >20 with aldosterone >15 ng/dL confirms the diagnosis.
Option A is incorrect because renal artery stenosis typically presents with elevated renin activity,
not suppressed renin. Option C is incorrect because pheochromocytoma presents with episodic
hypertension, headaches, sweating, and palpitations, not hypokalemia. Option D is incorrect
because Cushing's syndrome presents with central obesity, striae, and glucose intolerance, not
specifically with hypokalemia and suppressed renin.
Question 3 A 32-year-old female presents at 16 weeks gestation with BP 156/104 mmHg. She
reports headaches and visual changes. Urine protein is 2+. Which antihypertensive regimen is
most appropriate for this patient?
A. Lisinopril 10 mg daily with plan to increase to 20 mg
B. Labetalol 200 mg twice daily with methyldopa 250 mg twice daily as add-on if needed
C. Amlodipine 5 mg daily with chlorthalidone 12.5 mg daily
D. Losartan 50 mg daily with hydrochlorothiazide 25 mg daily
Correct Answer: B
Rationale: In pregnancy, ACE inhibitors (Option A), ARBs (Option D), and direct renin
inhibitors are absolutely contraindicated due to teratogenic effects on fetal renal development
and skull ossification. First-line antihypertensives in pregnancy include labetalol, nifedipine, and
methyldopa. This patient has severe-range BP (≥160/110) with symptoms and proteinuria,
concerning for preeclampsia. Labetalol is preferred for acute and chronic management in
pregnancy due to its established safety profile. Methyldopa is the only antihypertensive with
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long-term safety data for children exposed in utero. Option C includes chlorthalidone, which is
generally avoided in pregnancy due to potential volume depletion and electrolyte disturbances.
The clinical presentation requires prompt BP control with pregnancy-safe agents and close
monitoring for preeclampsia progression.
Question 4 A 72-year-old female with CKD Stage 3b (eGFR 38 mL/min/1.73m²), diabetes, and
hypertension presents with BP 148/88 mmHg on amlodipine 5 mg daily. Her home BP average is
152/86 mmHg. According to KDIGO and ADA guidelines, what is the target BP and optimal
pharmacologic strategy?
A. Target <140/90; add hydrochlorothiazide 25 mg daily
B. Target <130/80; add lisinopril and titrate to maximum tolerated dose
C. Target <150/90; add losartan 50 mg daily
D. Target <120/80; add metoprolol succinate 50 mg daily
Correct Answer: B
Rationale: For patients with diabetes and CKD, both KDIGO and ADA recommend a target BP
of <130/80 mmHg if tolerated. ACE inhibitors or ARBs are first-line agents in CKD with
albuminuria due to their renal protective effects (reduce proteinuria and slow CKD progression).
This patient's eGFR of 38 mL/min/1.73m² indicates significant renal impairment where ACE
inhibitors/ARBs are indicated. Lisinopril is preferred over losartan in this case because ACE
inhibitors have more robust data for cardiovascular protection in diabetes. The dose should be
titrated while monitoring potassium and creatinine (expect up to 30% increase in creatinine,
which is acceptable if <30% and stabilizes). Option A is incorrect because thiazides are less
effective when eGFR <30 (though effective at eGFR 38), and the target is too lenient. Option C
has an inappropriate target for this high-risk population. Option D's target of <120/80 is
associated with increased risk of hypotension and AKI in elderly patients with CKD (per
SPRINT trial subgroup analyses).
Question 5 A 55-year-old male with newly diagnosed hypertension (BP 146/94 mmHg,
confirmed on ambulatory monitoring) asks about lifestyle modifications. Which counseling
statement reflects current evidence-based recommendations?
A. "Adopt the DASH diet, aiming for 2400 mg sodium daily initially, with goal of 1500 mg if
possible; this can lower SBP by 8-14 mmHg"
B. "Aerobic exercise of 90 minutes per week at moderate intensity is sufficient to reduce
cardiovascular risk"
C. "Limit alcohol to no more than 3 drinks per day for men, which can reduce SBP by 2-4
mmHg"
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D. "Weight loss is only beneficial if you lose more than 20 pounds; smaller amounts don't affect
BP significantly"
Correct Answer: A
Rationale: The DASH (Dietary Approaches to Stop Hypertension) eating plan is one of the most
effective lifestyle interventions for hypertension. Key components include: (1) emphasizing
fruits, vegetables, whole grains, low-fat dairy; (2) reducing saturated and total fat; (3) sodium
restriction to 2400 mg/day initially, with optimal goal of 1500 mg/day; (4) expected SBP
reduction of 8-14 mmHg. Option B is incorrect because current guidelines recommend at least
150 minutes per week of moderate-intensity aerobic activity, not 90 minutes. Option C is
incorrect because alcohol should be limited to ≤2 drinks per day for men and ≤1 drink per day
for women (standard drinks: 12 oz beer, 5 oz wine, 1.5 oz spirits). Option D is incorrect because
weight loss of even 5-10 pounds (1 kg weight loss ≈ 1 mmHg SBP reduction) provides
meaningful BP benefits; the threshold is not 20 pounds.
Hyperlipidemia
Question 6 A 50-year-old male with Type 2 diabetes, BP 138/84 mmHg on medication, and LDL
118 mg/dL presents for cardiovascular risk assessment. He does not smoke. His 10-year ASCVD
risk is calculated at 8.2%. According to 2018 ACC/AHA Cholesterol Guidelines, what is the
most appropriate management?
A. High-intensity statin therapy because diabetes is a risk-enhancing factor
B. Moderate-intensity statin because 10-year risk is <10% and no other risk enhancers present
C. Statin therapy not indicated; recalculate risk with coronary artery calcium score
D. Ezetimibe add-on therapy to moderate-intensity statin for additional LDL reduction
Correct Answer: A
Rationale: According to the 2018 ACC/AHA cholesterol guidelines, patients with diabetes aged
40-75 years should be started on at least moderate-intensity statin therapy. However, this patient
has diabetes PLUS a 10-year ASCVD risk >7.5%, which qualifies him for high-intensity statin
therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg). Diabetes is considered a major risk
factor, and when combined with elevated 10-year risk, high-intensity therapy is indicated to
achieve ≥50% LDL reduction. The goal LDL for high-risk patients is <100 mg/dL or ≥50%
reduction. Option B underestimates the risk because diabetes in this age group with elevated
calculated risk warrants aggressive therapy. Option C is incorrect because CAC scoring is used
for risk stratification in intermediate-risk patients without diabetes (5-7.5% risk with risk
enhancers, or 7.5-20% without). Option D is incorrect because ezetimibe is reserved for patients
not at goal on maximally tolerated statin therapy or with statin intolerance.
NURS 5433 FNP II MIDTERM EXAM
REVIEW Actual Exam 2026/2027 Complete
Questions and Verified Answers Family
Nursing UTA Pass Guaranteed - A+ Graded
SECTION I: CARDIOVASCULAR CONDITIONS IN PRIMARY CARE (Questions 1-15)
Hypertension
Question 1 A 58-year-old African American male presents for follow-up. His home BP log
shows readings of 138/86, 142/88, and 136/84 mmHg over the past two weeks. In clinic today,
his BP is 146/92 mmHg. He has no comorbidities. According to current ACC/AHA guidelines,
what is the most appropriate classification and next step?
A. Stage 1 hypertension; continue lifestyle modifications and recheck in 3 months
B. Stage 2 hypertension; initiate pharmacologic therapy with thiazide diuretic or CCB
C. Stage 1 hypertension; initiate single antihypertensive agent
D. Elevated BP; intensive lifestyle modifications and recheck in 3-6 months
Correct Answer: B
Rationale: According to the 2017 ACC/AHA guidelines, Stage 2 hypertension is defined as BP
≥140/90 mmHg. This patient's average BP (including both home and office readings) meets
Stage 2 criteria. For Stage 2 hypertension without comorbidities, pharmacologic therapy should
be initiated with either a thiazide diuretic, ACE inhibitor, ARB, or CCB. In African American
patients, thiazide diuretics or CCBs are particularly effective as initial therapy. The key features
supporting this answer are: (1) sustained BP ≥140/90 mmHg across multiple readings, (2)
average home BP readings also elevated, and (3) Stage 2 hypertension requires immediate
pharmacologic intervention regardless of race or comorbidities. Option A is incorrect because
lifestyle modifications alone are insufficient for Stage 2 hypertension. Option C is incorrect
because single agent therapy is appropriate, but the classification is Stage 2, not Stage 1. Option
D is incorrect because the BP exceeds 140/90 mmHg, ruling out "elevated" category.
,2
Question 2 A 45-year-old female with resistant hypertension (BP 158/96 mmHg on lisinopril 40
mg daily and amlodipine 10 mg daily) undergoes evaluation for secondary causes. Laboratory
studies reveal: K+ 3.2 mEq/L (normal 3.5-5.0), Na+ 142 mEq/L, creatinine 1.0 mg/dL. Plasma
aldosterone concentration is 25 ng/dL (elevated) and plasma renin activity is 0.5 ng/mL/hour
(suppressed). What is the most likely diagnosis and appropriate confirmatory test?
A. Renal artery stenosis; CT angiography of renal arteries
B. Primary aldosteronism; saline suppression test or aldosterone-renin ratio
C. Pheochromocytoma; 24-hour urine metanephrines and catecholamines
D. Cushing's syndrome; 1 mg overnight dexamethasone suppression test
Correct Answer: B
Rationale: This presentation is classic for primary aldosteronism (Conn's syndrome), the most
common cause of secondary hypertension. Key diagnostic clues include: (1) resistant
hypertension despite two maximally dosed agents, (2) spontaneous hypokalemia (K+ 3.2)
without diuretic use, (3) elevated aldosterone with suppressed renin activity, and (4) the
aldosterone-renin ratio (ARR) is markedly elevated at 50 (>20 suggests primary aldosteronism).
The saline suppression test or ARR >20 with aldosterone >15 ng/dL confirms the diagnosis.
Option A is incorrect because renal artery stenosis typically presents with elevated renin activity,
not suppressed renin. Option C is incorrect because pheochromocytoma presents with episodic
hypertension, headaches, sweating, and palpitations, not hypokalemia. Option D is incorrect
because Cushing's syndrome presents with central obesity, striae, and glucose intolerance, not
specifically with hypokalemia and suppressed renin.
Question 3 A 32-year-old female presents at 16 weeks gestation with BP 156/104 mmHg. She
reports headaches and visual changes. Urine protein is 2+. Which antihypertensive regimen is
most appropriate for this patient?
A. Lisinopril 10 mg daily with plan to increase to 20 mg
B. Labetalol 200 mg twice daily with methyldopa 250 mg twice daily as add-on if needed
C. Amlodipine 5 mg daily with chlorthalidone 12.5 mg daily
D. Losartan 50 mg daily with hydrochlorothiazide 25 mg daily
Correct Answer: B
Rationale: In pregnancy, ACE inhibitors (Option A), ARBs (Option D), and direct renin
inhibitors are absolutely contraindicated due to teratogenic effects on fetal renal development
and skull ossification. First-line antihypertensives in pregnancy include labetalol, nifedipine, and
methyldopa. This patient has severe-range BP (≥160/110) with symptoms and proteinuria,
concerning for preeclampsia. Labetalol is preferred for acute and chronic management in
pregnancy due to its established safety profile. Methyldopa is the only antihypertensive with
,3
long-term safety data for children exposed in utero. Option C includes chlorthalidone, which is
generally avoided in pregnancy due to potential volume depletion and electrolyte disturbances.
The clinical presentation requires prompt BP control with pregnancy-safe agents and close
monitoring for preeclampsia progression.
Question 4 A 72-year-old female with CKD Stage 3b (eGFR 38 mL/min/1.73m²), diabetes, and
hypertension presents with BP 148/88 mmHg on amlodipine 5 mg daily. Her home BP average is
152/86 mmHg. According to KDIGO and ADA guidelines, what is the target BP and optimal
pharmacologic strategy?
A. Target <140/90; add hydrochlorothiazide 25 mg daily
B. Target <130/80; add lisinopril and titrate to maximum tolerated dose
C. Target <150/90; add losartan 50 mg daily
D. Target <120/80; add metoprolol succinate 50 mg daily
Correct Answer: B
Rationale: For patients with diabetes and CKD, both KDIGO and ADA recommend a target BP
of <130/80 mmHg if tolerated. ACE inhibitors or ARBs are first-line agents in CKD with
albuminuria due to their renal protective effects (reduce proteinuria and slow CKD progression).
This patient's eGFR of 38 mL/min/1.73m² indicates significant renal impairment where ACE
inhibitors/ARBs are indicated. Lisinopril is preferred over losartan in this case because ACE
inhibitors have more robust data for cardiovascular protection in diabetes. The dose should be
titrated while monitoring potassium and creatinine (expect up to 30% increase in creatinine,
which is acceptable if <30% and stabilizes). Option A is incorrect because thiazides are less
effective when eGFR <30 (though effective at eGFR 38), and the target is too lenient. Option C
has an inappropriate target for this high-risk population. Option D's target of <120/80 is
associated with increased risk of hypotension and AKI in elderly patients with CKD (per
SPRINT trial subgroup analyses).
Question 5 A 55-year-old male with newly diagnosed hypertension (BP 146/94 mmHg,
confirmed on ambulatory monitoring) asks about lifestyle modifications. Which counseling
statement reflects current evidence-based recommendations?
A. "Adopt the DASH diet, aiming for 2400 mg sodium daily initially, with goal of 1500 mg if
possible; this can lower SBP by 8-14 mmHg"
B. "Aerobic exercise of 90 minutes per week at moderate intensity is sufficient to reduce
cardiovascular risk"
C. "Limit alcohol to no more than 3 drinks per day for men, which can reduce SBP by 2-4
mmHg"
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D. "Weight loss is only beneficial if you lose more than 20 pounds; smaller amounts don't affect
BP significantly"
Correct Answer: A
Rationale: The DASH (Dietary Approaches to Stop Hypertension) eating plan is one of the most
effective lifestyle interventions for hypertension. Key components include: (1) emphasizing
fruits, vegetables, whole grains, low-fat dairy; (2) reducing saturated and total fat; (3) sodium
restriction to 2400 mg/day initially, with optimal goal of 1500 mg/day; (4) expected SBP
reduction of 8-14 mmHg. Option B is incorrect because current guidelines recommend at least
150 minutes per week of moderate-intensity aerobic activity, not 90 minutes. Option C is
incorrect because alcohol should be limited to ≤2 drinks per day for men and ≤1 drink per day
for women (standard drinks: 12 oz beer, 5 oz wine, 1.5 oz spirits). Option D is incorrect because
weight loss of even 5-10 pounds (1 kg weight loss ≈ 1 mmHg SBP reduction) provides
meaningful BP benefits; the threshold is not 20 pounds.
Hyperlipidemia
Question 6 A 50-year-old male with Type 2 diabetes, BP 138/84 mmHg on medication, and LDL
118 mg/dL presents for cardiovascular risk assessment. He does not smoke. His 10-year ASCVD
risk is calculated at 8.2%. According to 2018 ACC/AHA Cholesterol Guidelines, what is the
most appropriate management?
A. High-intensity statin therapy because diabetes is a risk-enhancing factor
B. Moderate-intensity statin because 10-year risk is <10% and no other risk enhancers present
C. Statin therapy not indicated; recalculate risk with coronary artery calcium score
D. Ezetimibe add-on therapy to moderate-intensity statin for additional LDL reduction
Correct Answer: A
Rationale: According to the 2018 ACC/AHA cholesterol guidelines, patients with diabetes aged
40-75 years should be started on at least moderate-intensity statin therapy. However, this patient
has diabetes PLUS a 10-year ASCVD risk >7.5%, which qualifies him for high-intensity statin
therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg). Diabetes is considered a major risk
factor, and when combined with elevated 10-year risk, high-intensity therapy is indicated to
achieve ≥50% LDL reduction. The goal LDL for high-risk patients is <100 mg/dL or ≥50%
reduction. Option B underestimates the risk because diabetes in this age group with elevated
calculated risk warrants aggressive therapy. Option C is incorrect because CAC scoring is used
for risk stratification in intermediate-risk patients without diabetes (5-7.5% risk with risk
enhancers, or 7.5-20% without). Option D is incorrect because ezetimibe is reserved for patients
not at goal on maximally tolerated statin therapy or with statin intolerance.
