NURS 5433 FINAL EXAM 2026/2027 | Actual Exam with
Complete Questions & Correct Detailed Answers | 100%
Verified | Already Graded A+ | Brand New | Pass Guaranteed
Course: NURS 5433 Family II – Advanced Family Practice
Institution: University of Texas at Arlington, College of Nursing and Health Innovation
Total Questions: 100 | Time Allowed: 150 minutes
Cognitive Levels: 25% Recall / 55% Application / 20% Analysis
Advanced Cardiovascular & Hypertension Management
16 questions covering guideline-directed therapy, arrhythmias, valvular disease, and
complex hypertension
Q1: A 68-year-old with resistant hypertension (BP 158/92 on HCTZ, lisinopril, and
amlodipine) has serum potassium 3.2 mEq/L. Which medication adjustment is most
appropriate?
A. Add clonidine for additional BP control
B. Discontinue HCTZ and substitute chlorthalidone
C. Discontinue HCTZ and add spironolactone 25mg daily
D. Increase lisinopril to maximum dose of 80mg daily
Correct Answer: C
,Rationale: The PATHWAY-2 trial demonstrated spironolactone as the most effective
add-on for resistant hypertension, particularly with thiazide-induced hypokalemia.
Spironolactone addresses both the BP and potassium issues. Option A adds central
alpha-agonist with side effect burden. Option B substitutes one thiazide for another
without addressing the underlying resistance mechanism. Option D risks hyperkalemia
and cough without guaranteed efficacy.
Q2: A 72-year-old with HFrEF (EF 32%) on lisinopril 20mg and carvedilol 12.5mg BID
presents with persistent NYHA Class III symptoms. Current labs show K 4.8, Cr 1.3.
Which GDMT addition is indicated?
A. Add hydralazine-isosorbide dinitrate combination
B. Initiate dapagliflozin 10mg daily regardless of diabetes status
C. Start digoxin 0.25mg daily for inotropic support
D. Add amlodipine for afterload reduction
Correct Answer: B
Rationale: The DAPA-HF and DELIVER trials established SGLT2 inhibitors (dapagliflozin
or empagliflozin) as foundational GDMT for HFrEF, reducing CV death and
hospitalization independent of diabetes. Option A is reserved for Black patients or
ACEI/ARB intolerance. Option C is second-line for symptomatic control. Option D
(dihydropyridine CCBs) lacks mortality benefit in HFrEF and may worsen edema.
Q3: A 58-year-old with atrial fibrillation (CHADS₂-VASc score 4) has history of GI
bleeding (Hgb 8.5 requiring transfusion 6 months ago). Which anticoagulation strategy
is safest?
A. Aspirin 325mg daily alone
,B. Apixaban 5mg BID (reduced dose to 2.5mg if meets criteria)
C. Warfarin with INR target 1.5-2.0
D. Dabigatran 150mg BID with PPI
Correct Answer: B
Rationale: Apixaban demonstrates lower bleeding rates than warfarin and other DOACs
in high-risk patients, with specific dose reduction criteria (age >80, weight <60kg,
creatinine >1.5). Option A provides inadequate stroke prevention (CHA₂DS₂-VASc 4
indicates high risk). Option C uses incorrect INR target (should be 2-3). Option D still
carries higher GI bleeding risk than apixaban.
Q4: A patient with ASCVD (prior MI) has LDL 95 on atorvastatin 40mg. According to
2018 AHA/ACC guidelines, what is the target?
A. LDL <100 mg/dL
B. LDL <70 mg/dL or add ezetimibe if not achieved on maximally tolerated statin
C. LDL <50 mg/dL requiring PCSK9 inhibitor
D. HDL >40 mg/dL regardless of LDL
Correct Answer: B
Rationale: Very high-risk ASCVD patients require LDL <70; if <70 not achieved on
maximally tolerated statin, adding ezetimibe is recommended before considering
PCSK9 inhibitors. Option A is outdated target. Option C is excessive initial step. Option
D focuses on wrong parameter—HDL is not a treatment target.
, Q5: A 65-year-old with severe aortic stenosis (valve area 0.8 cm², mean gradient 42
mmHg) reports syncope on exertion. Which management is indicated?
A. Start beta-blocker to reduce myocardial oxygen demand
B. Urgent cardiology referral for TAVR or surgical valve replacement evaluation
C. Diuretics for afterload reduction
D. Monitor with annual echocardiograms
Correct Answer: B
Rationale: Syncope, angina, or dyspnea in severe AS indicates symptomatic disease
requiring valve replacement (TAVR or SAVR). Without intervention, 50% mortality at 2
years. Option A may precipitate syncope by blocking compensatory tachycardia. Option
C reduces preload, worsening fixed obstruction. Option D delays life-saving intervention.
Q6: A 55-year-old with PAD (ABI 0.62) has calf claudication after 2 blocks. Which
medication reduces cardiovascular events and may improve walking distance?
A. Aspirin 81mg daily plus supervised exercise therapy
B. Clopidogrel 75mg only
C. Warfarin anticoagulation
D. Calcium channel blockers for vasodilation
Correct Answer: A
Rationale: Antiplatelet therapy (aspirin or clopidogrel) plus supervised exercise is
first-line for claudication, reducing MACE and improving functional status. Option B is
Complete Questions & Correct Detailed Answers | 100%
Verified | Already Graded A+ | Brand New | Pass Guaranteed
Course: NURS 5433 Family II – Advanced Family Practice
Institution: University of Texas at Arlington, College of Nursing and Health Innovation
Total Questions: 100 | Time Allowed: 150 minutes
Cognitive Levels: 25% Recall / 55% Application / 20% Analysis
Advanced Cardiovascular & Hypertension Management
16 questions covering guideline-directed therapy, arrhythmias, valvular disease, and
complex hypertension
Q1: A 68-year-old with resistant hypertension (BP 158/92 on HCTZ, lisinopril, and
amlodipine) has serum potassium 3.2 mEq/L. Which medication adjustment is most
appropriate?
A. Add clonidine for additional BP control
B. Discontinue HCTZ and substitute chlorthalidone
C. Discontinue HCTZ and add spironolactone 25mg daily
D. Increase lisinopril to maximum dose of 80mg daily
Correct Answer: C
,Rationale: The PATHWAY-2 trial demonstrated spironolactone as the most effective
add-on for resistant hypertension, particularly with thiazide-induced hypokalemia.
Spironolactone addresses both the BP and potassium issues. Option A adds central
alpha-agonist with side effect burden. Option B substitutes one thiazide for another
without addressing the underlying resistance mechanism. Option D risks hyperkalemia
and cough without guaranteed efficacy.
Q2: A 72-year-old with HFrEF (EF 32%) on lisinopril 20mg and carvedilol 12.5mg BID
presents with persistent NYHA Class III symptoms. Current labs show K 4.8, Cr 1.3.
Which GDMT addition is indicated?
A. Add hydralazine-isosorbide dinitrate combination
B. Initiate dapagliflozin 10mg daily regardless of diabetes status
C. Start digoxin 0.25mg daily for inotropic support
D. Add amlodipine for afterload reduction
Correct Answer: B
Rationale: The DAPA-HF and DELIVER trials established SGLT2 inhibitors (dapagliflozin
or empagliflozin) as foundational GDMT for HFrEF, reducing CV death and
hospitalization independent of diabetes. Option A is reserved for Black patients or
ACEI/ARB intolerance. Option C is second-line for symptomatic control. Option D
(dihydropyridine CCBs) lacks mortality benefit in HFrEF and may worsen edema.
Q3: A 58-year-old with atrial fibrillation (CHADS₂-VASc score 4) has history of GI
bleeding (Hgb 8.5 requiring transfusion 6 months ago). Which anticoagulation strategy
is safest?
A. Aspirin 325mg daily alone
,B. Apixaban 5mg BID (reduced dose to 2.5mg if meets criteria)
C. Warfarin with INR target 1.5-2.0
D. Dabigatran 150mg BID with PPI
Correct Answer: B
Rationale: Apixaban demonstrates lower bleeding rates than warfarin and other DOACs
in high-risk patients, with specific dose reduction criteria (age >80, weight <60kg,
creatinine >1.5). Option A provides inadequate stroke prevention (CHA₂DS₂-VASc 4
indicates high risk). Option C uses incorrect INR target (should be 2-3). Option D still
carries higher GI bleeding risk than apixaban.
Q4: A patient with ASCVD (prior MI) has LDL 95 on atorvastatin 40mg. According to
2018 AHA/ACC guidelines, what is the target?
A. LDL <100 mg/dL
B. LDL <70 mg/dL or add ezetimibe if not achieved on maximally tolerated statin
C. LDL <50 mg/dL requiring PCSK9 inhibitor
D. HDL >40 mg/dL regardless of LDL
Correct Answer: B
Rationale: Very high-risk ASCVD patients require LDL <70; if <70 not achieved on
maximally tolerated statin, adding ezetimibe is recommended before considering
PCSK9 inhibitors. Option A is outdated target. Option C is excessive initial step. Option
D focuses on wrong parameter—HDL is not a treatment target.
, Q5: A 65-year-old with severe aortic stenosis (valve area 0.8 cm², mean gradient 42
mmHg) reports syncope on exertion. Which management is indicated?
A. Start beta-blocker to reduce myocardial oxygen demand
B. Urgent cardiology referral for TAVR or surgical valve replacement evaluation
C. Diuretics for afterload reduction
D. Monitor with annual echocardiograms
Correct Answer: B
Rationale: Syncope, angina, or dyspnea in severe AS indicates symptomatic disease
requiring valve replacement (TAVR or SAVR). Without intervention, 50% mortality at 2
years. Option A may precipitate syncope by blocking compensatory tachycardia. Option
C reduces preload, worsening fixed obstruction. Option D delays life-saving intervention.
Q6: A 55-year-old with PAD (ABI 0.62) has calf claudication after 2 blocks. Which
medication reduces cardiovascular events and may improve walking distance?
A. Aspirin 81mg daily plus supervised exercise therapy
B. Clopidogrel 75mg only
C. Warfarin anticoagulation
D. Calcium channel blockers for vasodilation
Correct Answer: A
Rationale: Antiplatelet therapy (aspirin or clopidogrel) plus supervised exercise is
first-line for claudication, reducing MACE and improving functional status. Option B is
