NURS 5433 Family Nurse Practitioner II Midterm Exam
Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass Guaranteed –
A+ Graded
SECTION 1: PRIMARY CARE OF ADULTS (Acute/Chronic Conditions) – 18 Questions
Q1: A 48-year-old male with newly diagnosed hypertension (BP 146/92 mmHg) has no
comorbidities. According to JNC8 guidelines, which medication is appropriate first-line
therapy?
A. Atenolol 50 mg daily
B. Hydrochlorothiazide 12.5 mg daily [CORRECT]
C. Clonidine 0.1 mg BID
D. Hydralazine 25 mg BID
Correct Answer: B
Rationale: Correct because thiazide-type diuretics are one of the four first-line
antihypertensive classes recommended by JNC8 for non-Black adults without diabetes
or CKD; beta-blockers are not first-line unless a compelling indication exists.
Q2: A 62-year-old male with type 2 diabetes mellitus (A1c 8.4%), hypertension (BP
152/88 mmHg), and chronic kidney disease (eGFR 42 mL/min/1.73m², UACR 280 mg/g)
takes metformin 1000 mg BID and lisinopril 20 mg daily. Which medication modification
is most appropriate at this visit?
A. Increase metformin to 2000 mg BID
B. Add glipizide 5 mg daily
C. Add dapagliflozin 10 mg daily [CORRECT]
D. Discontinue lisinopril and start losartan
Correct Answer: C
Rationale: Correct because dapagliflozin is an SGLT2 inhibitor proven to slow CKD
progression in patients with eGFR ≥20 mL/min/1.73m² and albuminuria, and guidelines
,recommend SGLT2 inhibitors for T2DM patients with CKD regardless of glycemic
control.
Q3: A 52-year-old female is newly diagnosed with type 2 diabetes mellitus (A1c 8.5%,
fasting glucose 168 mg/dL). Her BMI is 32 and eGFR is 68 mL/min/1.73m². Which is
the most appropriate initial management?
A. Insulin glargine 10 units daily
B. Metformin 500 mg daily plus lifestyle modification [CORRECT]
C. Sitagliptin 100 mg daily
D. Glyburide 5 mg daily
Correct Answer: B
Rationale: Correct because metformin remains first-line pharmacotherapy for type 2
diabetes unless contraindicated, combined with lifestyle modification; it is
weight-neutral, does not cause hypoglycemia, and is effective for A1c reduction in newly
diagnosed patients.
Q4: A 60-year-old male with ASCVD (prior MI 2 years ago) is taking atorvastatin 20 mg
daily. His LDL cholesterol is 92 mg/dL. Which is the most appropriate management?
A. Continue atorvastatin 20 mg
B. Increase to atorvastatin 40-80 mg [CORRECT]
C. Add fenofibrate 145 mg daily
D. Switch to pravastatin 40 mg
Correct Answer: B
Rationale: Correct because secondary prevention in ASCVD requires high-intensity
statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg); moderate-intensity
dosing is insufficient for this very high-risk population.
Q5: A 68-year-old male with COPD has an FEV1 of 52% predicted, mMRC dyspnea score
of 2, and 2 exacerbations in the past year. His blood eosinophil count is 350/µL. Which
initial therapy is most appropriate?
A. SABA PRN only
B. LAMA monotherapy
C. LABA/LAMA combination [CORRECT]
D. LABA/ICS combination
Correct Answer: C
, Rationale: Correct because this patient has GOLD Group D COPD with frequent
exacerbations, and initial therapy with LABA/LAMA is recommended; ICS may be
considered but LABA/LAMA is first-line for frequent exacerbators.
Q6: A 26-year-old female with persistent asthma uses low-dose inhaled corticosteroids
daily with albuterol as needed. She reports nighttime awakenings twice weekly and
decreased exercise tolerance. Which adjustment is most appropriate?
A. Switch to albuterol-only therapy
B. Increase to medium-dose ICS alone
C. Add LABA to low-dose ICS [CORRECT]
D. Start oral prednisone 10 mg daily
Correct Answer: C
Rationale: Correct because according to NAEPP stepwise guidelines for adults, adding a
long-acting beta-agonist to low-dose inhaled corticosteroids (Step 3) is preferred over
increasing ICS alone for patients with persistent symptoms on low-dose ICS.
Q7: A 64-year-old male with HFrEF (EF 32%), NYHA Class II, is already on lisinopril 20
mg and metoprolol succinate 100 mg. His BP is 108/68 mmHg, potassium 4.2 mEq/L,
and eGFR 48 mL/min/1.73m². Which addition is most appropriate?
A. Add hydralazine/isosorbide dinitrate
B. Add spironolactone 25 mg daily [CORRECT]
C. Add digoxin 0.125 mg daily
D. Increase lisinopril to 40 mg daily
Correct Answer: B
Rationale: Correct because mineralocorticoid receptor antagonists reduce mortality in
HFrEF when added to ACE inhibitors and beta-blockers, provided potassium and renal
function are monitored.
Q8: A 58-year-old obese female (BMI 34) has knee osteoarthritis with pain rated 6/10.
She has failed acetaminophen 3 g daily and topical diclofenac. She has controlled
hypertension. Which is the most appropriate next step?
A. Oral ibuprofen 600 mg TID
B. Intra-articular corticosteroid injection [CORRECT]
C. Intra-articular hyaluronic acid
D. Refer for total knee arthroplasty
Correct Answer: B
Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass Guaranteed –
A+ Graded
SECTION 1: PRIMARY CARE OF ADULTS (Acute/Chronic Conditions) – 18 Questions
Q1: A 48-year-old male with newly diagnosed hypertension (BP 146/92 mmHg) has no
comorbidities. According to JNC8 guidelines, which medication is appropriate first-line
therapy?
A. Atenolol 50 mg daily
B. Hydrochlorothiazide 12.5 mg daily [CORRECT]
C. Clonidine 0.1 mg BID
D. Hydralazine 25 mg BID
Correct Answer: B
Rationale: Correct because thiazide-type diuretics are one of the four first-line
antihypertensive classes recommended by JNC8 for non-Black adults without diabetes
or CKD; beta-blockers are not first-line unless a compelling indication exists.
Q2: A 62-year-old male with type 2 diabetes mellitus (A1c 8.4%), hypertension (BP
152/88 mmHg), and chronic kidney disease (eGFR 42 mL/min/1.73m², UACR 280 mg/g)
takes metformin 1000 mg BID and lisinopril 20 mg daily. Which medication modification
is most appropriate at this visit?
A. Increase metformin to 2000 mg BID
B. Add glipizide 5 mg daily
C. Add dapagliflozin 10 mg daily [CORRECT]
D. Discontinue lisinopril and start losartan
Correct Answer: C
Rationale: Correct because dapagliflozin is an SGLT2 inhibitor proven to slow CKD
progression in patients with eGFR ≥20 mL/min/1.73m² and albuminuria, and guidelines
,recommend SGLT2 inhibitors for T2DM patients with CKD regardless of glycemic
control.
Q3: A 52-year-old female is newly diagnosed with type 2 diabetes mellitus (A1c 8.5%,
fasting glucose 168 mg/dL). Her BMI is 32 and eGFR is 68 mL/min/1.73m². Which is
the most appropriate initial management?
A. Insulin glargine 10 units daily
B. Metformin 500 mg daily plus lifestyle modification [CORRECT]
C. Sitagliptin 100 mg daily
D. Glyburide 5 mg daily
Correct Answer: B
Rationale: Correct because metformin remains first-line pharmacotherapy for type 2
diabetes unless contraindicated, combined with lifestyle modification; it is
weight-neutral, does not cause hypoglycemia, and is effective for A1c reduction in newly
diagnosed patients.
Q4: A 60-year-old male with ASCVD (prior MI 2 years ago) is taking atorvastatin 20 mg
daily. His LDL cholesterol is 92 mg/dL. Which is the most appropriate management?
A. Continue atorvastatin 20 mg
B. Increase to atorvastatin 40-80 mg [CORRECT]
C. Add fenofibrate 145 mg daily
D. Switch to pravastatin 40 mg
Correct Answer: B
Rationale: Correct because secondary prevention in ASCVD requires high-intensity
statin therapy (atorvastatin 40-80 mg or rosuvastatin 20-40 mg); moderate-intensity
dosing is insufficient for this very high-risk population.
Q5: A 68-year-old male with COPD has an FEV1 of 52% predicted, mMRC dyspnea score
of 2, and 2 exacerbations in the past year. His blood eosinophil count is 350/µL. Which
initial therapy is most appropriate?
A. SABA PRN only
B. LAMA monotherapy
C. LABA/LAMA combination [CORRECT]
D. LABA/ICS combination
Correct Answer: C
, Rationale: Correct because this patient has GOLD Group D COPD with frequent
exacerbations, and initial therapy with LABA/LAMA is recommended; ICS may be
considered but LABA/LAMA is first-line for frequent exacerbators.
Q6: A 26-year-old female with persistent asthma uses low-dose inhaled corticosteroids
daily with albuterol as needed. She reports nighttime awakenings twice weekly and
decreased exercise tolerance. Which adjustment is most appropriate?
A. Switch to albuterol-only therapy
B. Increase to medium-dose ICS alone
C. Add LABA to low-dose ICS [CORRECT]
D. Start oral prednisone 10 mg daily
Correct Answer: C
Rationale: Correct because according to NAEPP stepwise guidelines for adults, adding a
long-acting beta-agonist to low-dose inhaled corticosteroids (Step 3) is preferred over
increasing ICS alone for patients with persistent symptoms on low-dose ICS.
Q7: A 64-year-old male with HFrEF (EF 32%), NYHA Class II, is already on lisinopril 20
mg and metoprolol succinate 100 mg. His BP is 108/68 mmHg, potassium 4.2 mEq/L,
and eGFR 48 mL/min/1.73m². Which addition is most appropriate?
A. Add hydralazine/isosorbide dinitrate
B. Add spironolactone 25 mg daily [CORRECT]
C. Add digoxin 0.125 mg daily
D. Increase lisinopril to 40 mg daily
Correct Answer: B
Rationale: Correct because mineralocorticoid receptor antagonists reduce mortality in
HFrEF when added to ACE inhibitors and beta-blockers, provided potassium and renal
function are monitored.
Q8: A 58-year-old obese female (BMI 34) has knee osteoarthritis with pain rated 6/10.
She has failed acetaminophen 3 g daily and topical diclofenac. She has controlled
hypertension. Which is the most appropriate next step?
A. Oral ibuprofen 600 mg TID
B. Intra-articular corticosteroid injection [CORRECT]
C. Intra-articular hyaluronic acid
D. Refer for total knee arthroplasty
Correct Answer: B
