NURS 5433 UTA FNP II FINAL EXAM 2026/2027 | Questions
with Complete Solutions | University of Texas Arlington |
Pass Guaranteed - A+ Graded
Course: NURS 5433 Family II – Advanced Family Practice Across the Lifespan
Program: Family Nurse Practitioner Track, UTA College of Nursing
Total Questions: 80 | Time Allowed: 120 minutes
Cognitive Levels: 25% Recall / 50% Application / 25% Analysis
Managing Complex Chronic Conditions: Diabetes, Heart Failure, COPD &
Kidney Disease
Advanced chronic disease management – 15 questions covering guideline-directed
therapy, complications, and clinical decision-making
Q1: A 68-year-old with HFrEF (EF 30%), NYHA Class III, already on lisinopril and
metoprolol succinate, presents with continued dyspnea on exertion. According to
current GDMT guidelines, which medication should be added next?
A. Add hydralazine-isosorbide dinitrate immediately
B. Initiate dapagliflozin (SGLT2 inhibitor)
C. Start digoxin for symptom control
D. Add amlodipine for afterload reduction
Correct Answer: B
,Rationale: Current ACC/AHA/HFSA guidelines recommend SGLT2 inhibitors
(dapagliflozin or empagliflozin) as foundational GDMT for HFrEF regardless of diabetes
status, showing mortality and hospitalization benefits. Option A is reserved for Black
patients or ACEI/ARB intolerance. Option C is second-line for symptomatic relief. Option
D is not indicated in HFrEF and may worsen outcomes.
Q2: A 55-year-old with Type 2 diabetes (A1C 9.2%) on metformin 2000mg daily presents
for follow-up. You note eGFR 45 mL/min/1.73m² and UACR 80 mg/g. Which is the most
appropriate next step in management?
A. Continue current therapy and recheck A1C in 3 months
B. Add insulin immediately due to renal impairment
C. Add an SGLT2 inhibitor with proven kidney benefits
D. Discontinue metformin due to eGFR <60
Correct Answer: C
Rationale: SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin) provide kidney
protection and cardiovascular benefits in diabetic kidney disease with albuminuria.
Option A delays necessary intensification. Option B is premature—oral agents are still
appropriate. Option D is incorrect—metformin is safe down to eGFR 30 with dose
reduction.
Q3: A patient with COPD (FEV1 55% predicted) reports daily symptoms and one
exacerbation last year requiring oral steroids. According to GOLD 2024 guidelines,
which inhaler regimen is most appropriate?
A. LABA monotherapy
,B. LAMA monotherapy
C. LABA + LAMA combination
D. LABA + ICS combination
Correct Answer: C
Rationale: This patient is GOLD Group B (mild airflow limitation but high symptom
burden) or Group D depending on exact exacerbation history—either way, initial therapy
is LABA+LAMA. Option A/B are insufficient for this symptom level. Option D adds ICS
without indication (no asthma features, eosinophils <300, or frequent exacerbations).
Q4: A 72-year-old with CKD Stage 3b (eGFR 38) is prescribed metformin for diabetes.
What is the appropriate dose adjustment?
A. Continue 2000mg daily—no adjustment needed
B. Reduce to 1500mg daily and monitor renal function
C. Reduce to 1000mg daily (maximum for eGFR 30-45)
D. Discontinue immediately due to lactic acidosis risk
Correct Answer: C
Rationale: FDA guidelines allow metformin down to eGFR 30, with maximum 1000mg
daily for eGFR 30-45. Option A exceeds safe dosing. Option B is vague and potentially
unsafe. Option D is overly conservative—metformin is contraindicated only when eGFR
<30.
Q5: A patient on insulin pump therapy calls reporting blood glucose 320 mg/dL with
moderate ketones and vomiting. What is your immediate priority instruction?
, A. Change the infusion set and continue normal bolusing
B. Take rapid-acting insulin via injection, check glucose every 2 hours, and seek
emergency care if no improvement
C. Drink large amounts of sugary fluids to prevent dehydration
D. Disconnect the pump and wait for symptoms to resolve
Correct Answer: B
Rationale: Pump failure can cause DKA—injecting insulin ensures delivery, and ketones
with vomiting require aggressive management and possible ED evaluation. Option A
assumes pump malfunction is the only issue. Option C worsens hyperglycemia. Option
D is dangerous without insulin replacement.
Q6: A 64-year-old with HFpEF (EF 55%) presents with worsening dyspnea and peripheral
edema. Which medication has demonstrated outcome benefits specifically for HFpEF?
A. Enalapril
B. Carvedilol
C. Dapagliflozin
D. Digoxin
Correct Answer: C
Rationale: DELIVER and EMPEROR-Preserved trials showed SGLT2 inhibitors reduce
cardiovascular death and HF hospitalization in HFpEF (EF >40%). Options A/B haven't
shown consistent benefit in HFpEF. Option D is not indicated for HFpEF.
with Complete Solutions | University of Texas Arlington |
Pass Guaranteed - A+ Graded
Course: NURS 5433 Family II – Advanced Family Practice Across the Lifespan
Program: Family Nurse Practitioner Track, UTA College of Nursing
Total Questions: 80 | Time Allowed: 120 minutes
Cognitive Levels: 25% Recall / 50% Application / 25% Analysis
Managing Complex Chronic Conditions: Diabetes, Heart Failure, COPD &
Kidney Disease
Advanced chronic disease management – 15 questions covering guideline-directed
therapy, complications, and clinical decision-making
Q1: A 68-year-old with HFrEF (EF 30%), NYHA Class III, already on lisinopril and
metoprolol succinate, presents with continued dyspnea on exertion. According to
current GDMT guidelines, which medication should be added next?
A. Add hydralazine-isosorbide dinitrate immediately
B. Initiate dapagliflozin (SGLT2 inhibitor)
C. Start digoxin for symptom control
D. Add amlodipine for afterload reduction
Correct Answer: B
,Rationale: Current ACC/AHA/HFSA guidelines recommend SGLT2 inhibitors
(dapagliflozin or empagliflozin) as foundational GDMT for HFrEF regardless of diabetes
status, showing mortality and hospitalization benefits. Option A is reserved for Black
patients or ACEI/ARB intolerance. Option C is second-line for symptomatic relief. Option
D is not indicated in HFrEF and may worsen outcomes.
Q2: A 55-year-old with Type 2 diabetes (A1C 9.2%) on metformin 2000mg daily presents
for follow-up. You note eGFR 45 mL/min/1.73m² and UACR 80 mg/g. Which is the most
appropriate next step in management?
A. Continue current therapy and recheck A1C in 3 months
B. Add insulin immediately due to renal impairment
C. Add an SGLT2 inhibitor with proven kidney benefits
D. Discontinue metformin due to eGFR <60
Correct Answer: C
Rationale: SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin) provide kidney
protection and cardiovascular benefits in diabetic kidney disease with albuminuria.
Option A delays necessary intensification. Option B is premature—oral agents are still
appropriate. Option D is incorrect—metformin is safe down to eGFR 30 with dose
reduction.
Q3: A patient with COPD (FEV1 55% predicted) reports daily symptoms and one
exacerbation last year requiring oral steroids. According to GOLD 2024 guidelines,
which inhaler regimen is most appropriate?
A. LABA monotherapy
,B. LAMA monotherapy
C. LABA + LAMA combination
D. LABA + ICS combination
Correct Answer: C
Rationale: This patient is GOLD Group B (mild airflow limitation but high symptom
burden) or Group D depending on exact exacerbation history—either way, initial therapy
is LABA+LAMA. Option A/B are insufficient for this symptom level. Option D adds ICS
without indication (no asthma features, eosinophils <300, or frequent exacerbations).
Q4: A 72-year-old with CKD Stage 3b (eGFR 38) is prescribed metformin for diabetes.
What is the appropriate dose adjustment?
A. Continue 2000mg daily—no adjustment needed
B. Reduce to 1500mg daily and monitor renal function
C. Reduce to 1000mg daily (maximum for eGFR 30-45)
D. Discontinue immediately due to lactic acidosis risk
Correct Answer: C
Rationale: FDA guidelines allow metformin down to eGFR 30, with maximum 1000mg
daily for eGFR 30-45. Option A exceeds safe dosing. Option B is vague and potentially
unsafe. Option D is overly conservative—metformin is contraindicated only when eGFR
<30.
Q5: A patient on insulin pump therapy calls reporting blood glucose 320 mg/dL with
moderate ketones and vomiting. What is your immediate priority instruction?
, A. Change the infusion set and continue normal bolusing
B. Take rapid-acting insulin via injection, check glucose every 2 hours, and seek
emergency care if no improvement
C. Drink large amounts of sugary fluids to prevent dehydration
D. Disconnect the pump and wait for symptoms to resolve
Correct Answer: B
Rationale: Pump failure can cause DKA—injecting insulin ensures delivery, and ketones
with vomiting require aggressive management and possible ED evaluation. Option A
assumes pump malfunction is the only issue. Option C worsens hyperglycemia. Option
D is dangerous without insulin replacement.
Q6: A 64-year-old with HFpEF (EF 55%) presents with worsening dyspnea and peripheral
edema. Which medication has demonstrated outcome benefits specifically for HFpEF?
A. Enalapril
B. Carvedilol
C. Dapagliflozin
D. Digoxin
Correct Answer: C
Rationale: DELIVER and EMPEROR-Preserved trials showed SGLT2 inhibitors reduce
cardiovascular death and HF hospitalization in HFpEF (EF >40%). Options A/B haven't
shown consistent benefit in HFpEF. Option D is not indicated for HFpEF.
