NUR 509 FNP ADULTS FINAL EXAM
NEWEST 2026 | ACTUAL TEST BANK WITH 200 Q&A|MCQS|
& RATIONALES FAMILY NURSE PRACTITIONER –
ADULT PRIMARY CARE
TABLE OF CONTENTS
1. Cardiovascular Disorders (Q1-20)
2. Respiratory Disorders (Q21-35)
3. Endocrine & Metabolic Disorders (Q36-55)
4. Neurological Disorders (Q56-70)
5. Gastrointestinal & Hepatic Disorders (Q71-85)
6. Renal & Genitourinary Disorders (Q86-95)
7. Musculoskeletal & Rheumatologic Disorders (Q96-110)
8. Dermatologic Disorders (Q111-120)
9. Infectious Diseases & Immunology (Q121-135)
10. Hematologic Disorders (Q136-145)
11. Psychiatric & Behavioral Health (Q146-155)
12. Geriatrics & Polypharmacy (Q156-165)
13. Women’s & Men’s Health (Adult) (Q166-175)
14. Preventive Care & Health Screening (Q176-185)
15. Pain Management & Palliative Care (Q186-195)
16. Emergencies & Urgent Care in FNP Practice (Q196-200)
CARDIOVASCULAR DISORDERS
Question 1: A 58-year-old male with hypertension presents for a follow-up. His
blood pressure today is 148/92 mm Hg. He takes lisinopril 20 mg daily. Which is
the most appropriate next step?
A) Increase lisinopril to 40 mg daily
B) Add hydrochlorothiazide 12.5 mg daily
C) Recheck blood pressure in 3 months
D) Order a renal artery ultrasound
1
,Answer: B) Add hydrochlorothiazide 12.5 mg daily
Rationale: The patient’s BP remains above goal (<130/80 per ACC/AHA guidelines)
on monotherapy. Adding a thiazide diuretic is a recommended second agent for
hypertension management. Increasing lisinopril further (A) may be considered but
adding a different class is often more effective. Waiting 3 months (C) is not
appropriate as BP is uncontrolled. Renal artery ultrasound (D) is not indicated
without suspicion of renovascular hypertension (e.g., resistant hypertension, flash
pulmonary edema, abdominal bruit).
Question 2: A 72-year-old woman with heart failure with preserved ejection
fraction (HFpEF) complains of dyspnea on exertion and lower extremity edema.
Her BP is 145/88 mm Hg. Which medication is most beneficial for symptom
management and reducing hospitalizations in HFpEF?
A) Digoxin
B) Spironolactone
C) Metoprolol succinate
D) Ivabradine
Answer: B) Spironolactone
Rationale: Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
have been shown to reduce hospitalizations in HFpEF (TOPCAT trial). Loop
diuretics are used for volume overload. Digoxin (A) may help in HFrEF but not
proven in HFpEF. Beta-blockers (C) are not specifically beneficial in HFpEF unless
for comorbid conditions. Ivabradine (D) is for HFrEF with elevated heart rate.
Question 3: A 65-year-old man with known coronary artery disease reports
substernal chest pressure when walking up stairs. Symptoms resolve within 5
minutes of rest. His ECG shows no acute changes. The most appropriate initial
treatment to reduce mortality in this patient is:
A) Aspirin 81 mg daily
B) Sublingual nitroglycerin as needed
C) Ranolazine twice daily
D) Percutaneous coronary intervention
2
,Answer: A) Aspirin 81 mg daily
Rationale: Aspirin reduces cardiovascular events and mortality in patients with
stable ischemic heart disease and should be initiated in all patients unless
contraindicated. Sublingual nitroglycerin (B) treats acute symptoms but does not
reduce mortality. Ranolazine (C) is an antianginal but not first-line for mortality
reduction. PCI (D) may be indicated for symptom management but does not
reduce mortality in stable angina.
Question 4: A 55-year-old woman presents with palpitations. Her ECG shows
atrial fibrillation with a ventricular rate of 140 bpm. She is hemodynamically
stable. What is the most appropriate initial pharmacologic management?
A) Digoxin 0.25 mg IV push
B) Amiodarone 150 mg IV over 10 minutes
C) Metoprolol 5 mg IV push
D) Aspirin 325 mg orally
Answer: C) Metoprolol 5 mg IV push
Rationale: In hemodynamically stable atrial fibrillation, rate control is first-line.
Beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers
(diltiazem) are preferred. Digoxin (A) is second-line. IV amiodarone (B) is for
rhythm control in unstable patients or when rate control fails. Aspirin (D) is for
stroke prevention, not acute rate control.
Question 5: A 68-year-old with chronic heart failure (HFrEF, LVEF 35%) is taking
lisinopril, carvedilol, and furosemide. Which additional medication has been
shown to reduce mortality and should be considered?
A) Hydralazine and isosorbide dinitrate
B) Spironolactone
C) Dapagliflozin
D) All of the above
Answer: D) All of the above
Rationale: Spironolactone (RALES trial), hydralazine/isosorbide dinitrate (A-HeFT
3
, in African Americans and those with persistent symptoms), and SGLT2 inhibitors
(dapagliflozin – DAPA-HF trial) all reduce mortality and hospitalizations in HFrEF
when added to guideline-directed therapy.
Question 6: A 62-year-old man with a 30-pack-year smoking history reports a 1-
week history of left calf pain with walking that resolves with rest. His dorsalis
pedis pulse is 1+ on the left, 2+ on the right. Ankle-brachial index (ABI) is 0.65 on
the left. The most appropriate initial management is:
A) Referral for angiography and possible stenting
B) Aspirin, statin, smoking cessation counseling, and supervised exercise therapy
C) Warfarin for 3 months
D) Below-knee amputation consultation
Answer: B) Aspirin, statin, smoking cessation counseling, and supervised
exercise therapy
Rationale: This patient has intermittent claudication from peripheral artery
disease (PAD). Initial management includes cardiovascular risk reduction:
antiplatelet therapy, statin, smoking cessation, and supervised exercise (which
improves walking distance). Revascularization (A) is reserved for disabling
claudication or critical limb ischemia. Warfarin (C) is not indicated for PAD alone.
Amputation (D) is not appropriate at this stage.
Question 7: A 70-year-old woman reports palpitations. ECG shows a regular
narrow-complex tachycardia at 180 bpm. She is alert, BP 110/70, no chest pain.
Vagal maneuvers fail. Next best step:
A) Synchronized cardioversion at 100 J
B) IV adenosine 6 mg rapid push
C) IV metoprolol 5 mg
D) Oral amiodarone loading
Answer: B) IV adenosine 6 mg rapid push
Rationale: This is likely supraventricular tachycardia (SVT). In a hemodynamically
stable patient, IV adenosine is first-line for diagnosis and treatment. Synchronized
4
NEWEST 2026 | ACTUAL TEST BANK WITH 200 Q&A|MCQS|
& RATIONALES FAMILY NURSE PRACTITIONER –
ADULT PRIMARY CARE
TABLE OF CONTENTS
1. Cardiovascular Disorders (Q1-20)
2. Respiratory Disorders (Q21-35)
3. Endocrine & Metabolic Disorders (Q36-55)
4. Neurological Disorders (Q56-70)
5. Gastrointestinal & Hepatic Disorders (Q71-85)
6. Renal & Genitourinary Disorders (Q86-95)
7. Musculoskeletal & Rheumatologic Disorders (Q96-110)
8. Dermatologic Disorders (Q111-120)
9. Infectious Diseases & Immunology (Q121-135)
10. Hematologic Disorders (Q136-145)
11. Psychiatric & Behavioral Health (Q146-155)
12. Geriatrics & Polypharmacy (Q156-165)
13. Women’s & Men’s Health (Adult) (Q166-175)
14. Preventive Care & Health Screening (Q176-185)
15. Pain Management & Palliative Care (Q186-195)
16. Emergencies & Urgent Care in FNP Practice (Q196-200)
CARDIOVASCULAR DISORDERS
Question 1: A 58-year-old male with hypertension presents for a follow-up. His
blood pressure today is 148/92 mm Hg. He takes lisinopril 20 mg daily. Which is
the most appropriate next step?
A) Increase lisinopril to 40 mg daily
B) Add hydrochlorothiazide 12.5 mg daily
C) Recheck blood pressure in 3 months
D) Order a renal artery ultrasound
1
,Answer: B) Add hydrochlorothiazide 12.5 mg daily
Rationale: The patient’s BP remains above goal (<130/80 per ACC/AHA guidelines)
on monotherapy. Adding a thiazide diuretic is a recommended second agent for
hypertension management. Increasing lisinopril further (A) may be considered but
adding a different class is often more effective. Waiting 3 months (C) is not
appropriate as BP is uncontrolled. Renal artery ultrasound (D) is not indicated
without suspicion of renovascular hypertension (e.g., resistant hypertension, flash
pulmonary edema, abdominal bruit).
Question 2: A 72-year-old woman with heart failure with preserved ejection
fraction (HFpEF) complains of dyspnea on exertion and lower extremity edema.
Her BP is 145/88 mm Hg. Which medication is most beneficial for symptom
management and reducing hospitalizations in HFpEF?
A) Digoxin
B) Spironolactone
C) Metoprolol succinate
D) Ivabradine
Answer: B) Spironolactone
Rationale: Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
have been shown to reduce hospitalizations in HFpEF (TOPCAT trial). Loop
diuretics are used for volume overload. Digoxin (A) may help in HFrEF but not
proven in HFpEF. Beta-blockers (C) are not specifically beneficial in HFpEF unless
for comorbid conditions. Ivabradine (D) is for HFrEF with elevated heart rate.
Question 3: A 65-year-old man with known coronary artery disease reports
substernal chest pressure when walking up stairs. Symptoms resolve within 5
minutes of rest. His ECG shows no acute changes. The most appropriate initial
treatment to reduce mortality in this patient is:
A) Aspirin 81 mg daily
B) Sublingual nitroglycerin as needed
C) Ranolazine twice daily
D) Percutaneous coronary intervention
2
,Answer: A) Aspirin 81 mg daily
Rationale: Aspirin reduces cardiovascular events and mortality in patients with
stable ischemic heart disease and should be initiated in all patients unless
contraindicated. Sublingual nitroglycerin (B) treats acute symptoms but does not
reduce mortality. Ranolazine (C) is an antianginal but not first-line for mortality
reduction. PCI (D) may be indicated for symptom management but does not
reduce mortality in stable angina.
Question 4: A 55-year-old woman presents with palpitations. Her ECG shows
atrial fibrillation with a ventricular rate of 140 bpm. She is hemodynamically
stable. What is the most appropriate initial pharmacologic management?
A) Digoxin 0.25 mg IV push
B) Amiodarone 150 mg IV over 10 minutes
C) Metoprolol 5 mg IV push
D) Aspirin 325 mg orally
Answer: C) Metoprolol 5 mg IV push
Rationale: In hemodynamically stable atrial fibrillation, rate control is first-line.
Beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers
(diltiazem) are preferred. Digoxin (A) is second-line. IV amiodarone (B) is for
rhythm control in unstable patients or when rate control fails. Aspirin (D) is for
stroke prevention, not acute rate control.
Question 5: A 68-year-old with chronic heart failure (HFrEF, LVEF 35%) is taking
lisinopril, carvedilol, and furosemide. Which additional medication has been
shown to reduce mortality and should be considered?
A) Hydralazine and isosorbide dinitrate
B) Spironolactone
C) Dapagliflozin
D) All of the above
Answer: D) All of the above
Rationale: Spironolactone (RALES trial), hydralazine/isosorbide dinitrate (A-HeFT
3
, in African Americans and those with persistent symptoms), and SGLT2 inhibitors
(dapagliflozin – DAPA-HF trial) all reduce mortality and hospitalizations in HFrEF
when added to guideline-directed therapy.
Question 6: A 62-year-old man with a 30-pack-year smoking history reports a 1-
week history of left calf pain with walking that resolves with rest. His dorsalis
pedis pulse is 1+ on the left, 2+ on the right. Ankle-brachial index (ABI) is 0.65 on
the left. The most appropriate initial management is:
A) Referral for angiography and possible stenting
B) Aspirin, statin, smoking cessation counseling, and supervised exercise therapy
C) Warfarin for 3 months
D) Below-knee amputation consultation
Answer: B) Aspirin, statin, smoking cessation counseling, and supervised
exercise therapy
Rationale: This patient has intermittent claudication from peripheral artery
disease (PAD). Initial management includes cardiovascular risk reduction:
antiplatelet therapy, statin, smoking cessation, and supervised exercise (which
improves walking distance). Revascularization (A) is reserved for disabling
claudication or critical limb ischemia. Warfarin (C) is not indicated for PAD alone.
Amputation (D) is not appropriate at this stage.
Question 7: A 70-year-old woman reports palpitations. ECG shows a regular
narrow-complex tachycardia at 180 bpm. She is alert, BP 110/70, no chest pain.
Vagal maneuvers fail. Next best step:
A) Synchronized cardioversion at 100 J
B) IV adenosine 6 mg rapid push
C) IV metoprolol 5 mg
D) Oral amiodarone loading
Answer: B) IV adenosine 6 mg rapid push
Rationale: This is likely supraventricular tachycardia (SVT). In a hemodynamically
stable patient, IV adenosine is first-line for diagnosis and treatment. Synchronized
4
