🩺 NURS 5434 Family Nurse Practitioner III – 250-Question
Master Practice Exam
NURS 5434 (Family III) is typically a terminal, high-acuity clinical course within
Family Nurse Practitioner (FNP) graduate programs. This course builds upon
foundational primary care knowledge, shifting focus toward complex, multi-
system, chronic illnesses and acute presentations across the lifespan (pediatric,
adult, and geriatric populations).
1. A 64-year-old male presents for a routine check-up. His blood pressure readings today
average 142/88 mmHg. A review of his chart reveals three separate readings over the
last two months averaging 144/92 mmHg. He has no history of diabetes or chronic
kidney disease. According to current ACC/AHA guidelines, what is the most appropriate
next step?
A) Recheck his blood pressure in 6 months
B) Initiate lifestyle modifications only and recheck in 3 months
C) Initiate lifestyle modifications and prescribe a low-dose thiazide diuretic or
ACE inhibitor
D) Initiate dual therapy with an ACE inhibitor and an ARB
Rationale: Stage 2 hypertension is defined as a sustained systolic BP of 140 mmHg or
higher, or a diastolic BP of 90 mmHg or higher. For patients with Stage 2 hypertension
and no compelling contraindications, initiation of both non-pharmacological and
pharmacological therapy is indicated.
2. A 52-year-old female with a history of type 2 diabetes presents with a 3-day history of
burning with urination, frequency, and urgent voiding. She denies fever, chills, flank
pain, or nausea. A urine dipstick is positive for leukocytes and nitrites. What is the
preferred empirical first-line oral antibiotic treatment for this patient?
A) Amoxicillin 500 mg TID for 7 days
B) Nitrofurantoin Monohydrate/Macrocrystals 100 mg BID for 5 days
C) Ciprofloxacin 500 mg BID for 3 days
D) Cephalexin 500 mg BID for 10 days
Rationale: Nitrofurantoin is an established first-line agent for uncomplicated lower
urinary tract infections (cystitis). Fluoroquinolones like ciprofloxacin should be reserved
for complicated infections or when first-line agents cannot be used.
3. A 45-year-old male presents with acute, severe pain, redness, and swelling in his left
great toe that began suddenly last night. He reports consuming a heavy steak dinner
with several beers prior to the onset. Joint aspirate reveals negatively birefringent,
needle-shaped crystals. What is the most appropriate first-line treatment for this acute
flare?
, A) Allopurinol 100 mg daily
B) Indomethacin 50 mg TID
C) Probenecid 250 mg BID
D) Febuxostat 40 mg daily
Rationale: Acute gout flares require anti-inflammatory treatment using NSAIDs (such as
indomethacin), colchicine, or systemic corticosteroids. Urate-lowering therapies like
allopurinol should not be initiated during an acute flare as sudden shifts in uric acid can
worsen symptoms.
4. A 28-year-old pregnant female at 24 weeks gestation is diagnosed with a urinary tract
infection. Which of the following antibiotics is completely contraindicated during the third
trimester of pregnancy due to the risk of neonatal hemolysis?
A) Amoxicillin-Clavulanate
B) Cephalexin
C) Nitrofurantoin
D) Fosfomycin
Rationale: Nitrofurantoin is generally safe in early pregnancy but is contraindicated at
term (38–42 weeks gestation) and during labor because it can induce hemolytic anemia
in the newborn due to immature erythrocyte enzyme systems.
5. A 68-year-old female presents with complaints of worsening bilateral knee pain that is
most severe after walking or standing for long periods. She notes stiffness in the
morning that resolves within 15 to 20 minutes of waking. Physical exam reveals crepitus
and bony enlargements at the distal interphalangeal joints. What is the first-line
pharmacological agent recommended for symptom management?
A) Oral prednisone 10 mg daily
B) Methotrexate 7.5 mg weekly
C) Scheduled Acetaminophen or topical NSAIDs
D) Infliximab infusions
Rationale: Osteoarthritis is characterized by morning stiffness lasting less than 30
minutes, pain with joint use, and Heberden's nodes (DIP joints). First-line therapy
focuses on conservative measures, topical NSAIDs, or acetaminophen before
progressing to oral systemic NSAIDs.
6. A 58-year-old male with a 30 pack-year smoking history presents with progressive
dyspnea on exertion and a chronic, non-productive cough. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62. What does this objective spirometry finding
confirm?
A) Restrictive lung disease
B) Normal age-related lung volume decline
C) Persistent airflow limitation consistent with COPD
D) Acute reversible bronchospasm
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
presence of persistent airflow limitation, which is the diagnostic gold standard for
Chronic Obstructive Pulmonary Disease (COPD).
7. A 35-year-old female presents with a 4-month history of widespread musculoskeletal
pain, fatigue, unrefreshing sleep, and cognitive difficulties. A thorough physical exam
reveals no joint inflammation, and extensive laboratory evaluations (including CBC,
TSH, ESR, and ANA) are completely normal. What is the most likely diagnosis?
, A) Rheumatoid Arthritis
B) Systemic Lupus Erythematosus
C) Polymyalgia Rheumatica
D) Fibromyalgia
Rationale: Fibromyalgia is characterized by chronic widespread pain lasting over 3
months, fatigue, and sleep disturbances, without objective evidence of systemic
inflammation or structural tissue abnormalities.
8. A 22-year-old male with a history of intermittent asthma presents stating he uses his
Albuterol rescue inhaler 3 to 4 times per week to manage chest tightness and wheezing.
He wakes up with coughing fits twice a month. How should this patient's asthma
severity be classified?
A) Intermittent Asthma
B) Mild Persistent Asthma
C) Moderate Persistent Asthma
D) Severe Persistent Asthma
Rationale: Asthma symptoms occurring more than 2 days per week (but not daily) and
nighttime awakenings 1–4 times per month fulfill the clinical criteria for mild persistent
asthma, requiring the addition of a daily controller.
9. Following the classification of the 22-year-old male in the previous question as having
mild persistent asthma, what is the most appropriate preferred controller therapy
addition?
A) Long-acting beta2-agonist (LABA) monotherapy
B) Oral leukotriene receptor antagonist monotherapy
C) Low-dose Inhaled Corticosteroid (ICS) daily
D) Long-acting muscarinic antagonist (LAMA) daily
Rationale: The preferred step-2 controller therapy for mild persistent asthma is a low-
dose daily inhaled corticosteroid (ICS) to reduce airway hyperresponsiveness and
underlying chronic inflammation.
10. A 72-year-old male presents with a sudden onset of left-sided facial drooping, slurred
speech, and weakness in his left arm that began 45 minutes ago. What is the most
urgent intervention required by the family nurse practitioner?
A) Order an outpatient MRI of the brain to be completed within 24 hours
B) Administer 325 mg of oral aspirin in the clinic immediately
C) Activate Emergency Medical Services (EMS) for immediate transfer to a stroke
center
D) Perform an extensive cranial nerve exam and re-evaluate the patient tomorrow
Rationale: Acute stroke symptoms require immediate activation of emergency protocols
to ensure the patient arrives at a stroke center within the tight window required for
potential thrombolytic therapy or mechanical thrombectomy.
11. A 31-year-old female presents with a 2-week history of a warm, tender, uniformly
enlarged thyroid gland, palpitations, and heat intolerance. She notes she had a severe
upper respiratory viral infection 3 weeks ago. Her lab panels show a suppressed TSH
and elevated Free T4. What is the most likely diagnosis?
A) Graves' Disease
B) Hashimoto's Thyroiditis
C) Subacute Granulomatous Thyroiditis (De Quervain's)
, D) Toxic Multinodular Goiter
Rationale: Subacute thyroiditis typically follows a viral upper respiratory infection and
presents with a painful, tender thyroid gland accompanied by a transient hyperthyroid
phase due to the leakage of preformed thyroid hormones.
12. A 62-year-old female with a history of chronic heart failure with reduced ejection fraction
(HREFr) presents for evaluation. Which of the following medication classes is
completely contraindicated in this patient due to its potential to cause fluid retention and
precipitate acute heart failure exacerbations?
A) Beta-blockers
B) ACE inhibitors
C) Thiazolidinediones (Pioglitazone)
D) Mineralocorticoid receptor antagonists
Rationale: Thiazolidinediones (such as pioglitazone) cause significant sodium and fluid
retention, which can exacerbate underlying congestive heart failure. They are
contraindicated in patients with NYHA Class III or IV heart failure.
13. A 40-year-old male presents with a 2-month history of epigastric burning pain that
occurs 2 to 3 hours after meals and is temporarily relieved by food or antacids. A urea
breath test is positive for Helicobacter pylori. What constitutes standard first-line triple
eradication therapy?
A) Amoxicillin, Clarithromycin, and Metronidazole for 7 days
B) Proton Pump Inhibitor (PPI), Amoxicillin 1g BID, and Clarithromycin 500mg BID
for 14 days
C) PPI, Bismuth Subsalicylate, Metronidazole, and Tetracycline for 10 days
D) Omeprazole and Famotidine daily for 4 weeks
Rationale: Standard clarithromycin-based triple therapy consists of a PPI combined with
amoxicillin and clarithromycin taken BID for 14 days, provided local resistance rates to
clarithromycin do not exceed 15%.
14. A 19-year-old college student presents for an urgent care visit complaining of a severe
sore throat, fever, marked fatigue, and generalized lymphadenopathy for 5 days.
Physical exam reveals pharyngeal erythema with tonsillar exudates and palpable
splenomegaly. A heterophile antibody test (Monospot) is positive. What critical patient
education must be provided?
A) Take amoxicillin regularly for the next 10 days
B) Avoid contact sports and heavy lifting for at least 3 to 4 weeks
C) Return to the campus gym immediately to combat fatigue
D) Maintain absolute isolation for the next 30 days
Rationale: Infectious mononucleosis carries a risk of splenic rupture due to transient
splenomegaly. Patients must strictly avoid contact sports, vigorous activity, or heavy
lifting for a minimum of 3 to 4 weeks from symptom onset.
15. A 48-year-old female presents with a 6-month history of joint pain and morning stiffness
lasting over an hour in her bilateral wrists and metacarpophalangeal (MCP) joints.
Physical exam reveals symmetrical joint swelling and warmth. Labs show an elevated
Rheumatoid Factor (RF) and positive anti-cyclic citrullinated peptide (anti-CCP)
antibodies. What is the gold-standard first-line disease-modifying antirheumatic drug
(DMARD) for this condition?
A) Hydroxychloroquine
Master Practice Exam
NURS 5434 (Family III) is typically a terminal, high-acuity clinical course within
Family Nurse Practitioner (FNP) graduate programs. This course builds upon
foundational primary care knowledge, shifting focus toward complex, multi-
system, chronic illnesses and acute presentations across the lifespan (pediatric,
adult, and geriatric populations).
1. A 64-year-old male presents for a routine check-up. His blood pressure readings today
average 142/88 mmHg. A review of his chart reveals three separate readings over the
last two months averaging 144/92 mmHg. He has no history of diabetes or chronic
kidney disease. According to current ACC/AHA guidelines, what is the most appropriate
next step?
A) Recheck his blood pressure in 6 months
B) Initiate lifestyle modifications only and recheck in 3 months
C) Initiate lifestyle modifications and prescribe a low-dose thiazide diuretic or
ACE inhibitor
D) Initiate dual therapy with an ACE inhibitor and an ARB
Rationale: Stage 2 hypertension is defined as a sustained systolic BP of 140 mmHg or
higher, or a diastolic BP of 90 mmHg or higher. For patients with Stage 2 hypertension
and no compelling contraindications, initiation of both non-pharmacological and
pharmacological therapy is indicated.
2. A 52-year-old female with a history of type 2 diabetes presents with a 3-day history of
burning with urination, frequency, and urgent voiding. She denies fever, chills, flank
pain, or nausea. A urine dipstick is positive for leukocytes and nitrites. What is the
preferred empirical first-line oral antibiotic treatment for this patient?
A) Amoxicillin 500 mg TID for 7 days
B) Nitrofurantoin Monohydrate/Macrocrystals 100 mg BID for 5 days
C) Ciprofloxacin 500 mg BID for 3 days
D) Cephalexin 500 mg BID for 10 days
Rationale: Nitrofurantoin is an established first-line agent for uncomplicated lower
urinary tract infections (cystitis). Fluoroquinolones like ciprofloxacin should be reserved
for complicated infections or when first-line agents cannot be used.
3. A 45-year-old male presents with acute, severe pain, redness, and swelling in his left
great toe that began suddenly last night. He reports consuming a heavy steak dinner
with several beers prior to the onset. Joint aspirate reveals negatively birefringent,
needle-shaped crystals. What is the most appropriate first-line treatment for this acute
flare?
, A) Allopurinol 100 mg daily
B) Indomethacin 50 mg TID
C) Probenecid 250 mg BID
D) Febuxostat 40 mg daily
Rationale: Acute gout flares require anti-inflammatory treatment using NSAIDs (such as
indomethacin), colchicine, or systemic corticosteroids. Urate-lowering therapies like
allopurinol should not be initiated during an acute flare as sudden shifts in uric acid can
worsen symptoms.
4. A 28-year-old pregnant female at 24 weeks gestation is diagnosed with a urinary tract
infection. Which of the following antibiotics is completely contraindicated during the third
trimester of pregnancy due to the risk of neonatal hemolysis?
A) Amoxicillin-Clavulanate
B) Cephalexin
C) Nitrofurantoin
D) Fosfomycin
Rationale: Nitrofurantoin is generally safe in early pregnancy but is contraindicated at
term (38–42 weeks gestation) and during labor because it can induce hemolytic anemia
in the newborn due to immature erythrocyte enzyme systems.
5. A 68-year-old female presents with complaints of worsening bilateral knee pain that is
most severe after walking or standing for long periods. She notes stiffness in the
morning that resolves within 15 to 20 minutes of waking. Physical exam reveals crepitus
and bony enlargements at the distal interphalangeal joints. What is the first-line
pharmacological agent recommended for symptom management?
A) Oral prednisone 10 mg daily
B) Methotrexate 7.5 mg weekly
C) Scheduled Acetaminophen or topical NSAIDs
D) Infliximab infusions
Rationale: Osteoarthritis is characterized by morning stiffness lasting less than 30
minutes, pain with joint use, and Heberden's nodes (DIP joints). First-line therapy
focuses on conservative measures, topical NSAIDs, or acetaminophen before
progressing to oral systemic NSAIDs.
6. A 58-year-old male with a 30 pack-year smoking history presents with progressive
dyspnea on exertion and a chronic, non-productive cough. Spirometry reveals a post-
bronchodilator FEV1/FVC ratio of 0.62. What does this objective spirometry finding
confirm?
A) Restrictive lung disease
B) Normal age-related lung volume decline
C) Persistent airflow limitation consistent with COPD
D) Acute reversible bronchospasm
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 0.70 confirms the
presence of persistent airflow limitation, which is the diagnostic gold standard for
Chronic Obstructive Pulmonary Disease (COPD).
7. A 35-year-old female presents with a 4-month history of widespread musculoskeletal
pain, fatigue, unrefreshing sleep, and cognitive difficulties. A thorough physical exam
reveals no joint inflammation, and extensive laboratory evaluations (including CBC,
TSH, ESR, and ANA) are completely normal. What is the most likely diagnosis?
, A) Rheumatoid Arthritis
B) Systemic Lupus Erythematosus
C) Polymyalgia Rheumatica
D) Fibromyalgia
Rationale: Fibromyalgia is characterized by chronic widespread pain lasting over 3
months, fatigue, and sleep disturbances, without objective evidence of systemic
inflammation or structural tissue abnormalities.
8. A 22-year-old male with a history of intermittent asthma presents stating he uses his
Albuterol rescue inhaler 3 to 4 times per week to manage chest tightness and wheezing.
He wakes up with coughing fits twice a month. How should this patient's asthma
severity be classified?
A) Intermittent Asthma
B) Mild Persistent Asthma
C) Moderate Persistent Asthma
D) Severe Persistent Asthma
Rationale: Asthma symptoms occurring more than 2 days per week (but not daily) and
nighttime awakenings 1–4 times per month fulfill the clinical criteria for mild persistent
asthma, requiring the addition of a daily controller.
9. Following the classification of the 22-year-old male in the previous question as having
mild persistent asthma, what is the most appropriate preferred controller therapy
addition?
A) Long-acting beta2-agonist (LABA) monotherapy
B) Oral leukotriene receptor antagonist monotherapy
C) Low-dose Inhaled Corticosteroid (ICS) daily
D) Long-acting muscarinic antagonist (LAMA) daily
Rationale: The preferred step-2 controller therapy for mild persistent asthma is a low-
dose daily inhaled corticosteroid (ICS) to reduce airway hyperresponsiveness and
underlying chronic inflammation.
10. A 72-year-old male presents with a sudden onset of left-sided facial drooping, slurred
speech, and weakness in his left arm that began 45 minutes ago. What is the most
urgent intervention required by the family nurse practitioner?
A) Order an outpatient MRI of the brain to be completed within 24 hours
B) Administer 325 mg of oral aspirin in the clinic immediately
C) Activate Emergency Medical Services (EMS) for immediate transfer to a stroke
center
D) Perform an extensive cranial nerve exam and re-evaluate the patient tomorrow
Rationale: Acute stroke symptoms require immediate activation of emergency protocols
to ensure the patient arrives at a stroke center within the tight window required for
potential thrombolytic therapy or mechanical thrombectomy.
11. A 31-year-old female presents with a 2-week history of a warm, tender, uniformly
enlarged thyroid gland, palpitations, and heat intolerance. She notes she had a severe
upper respiratory viral infection 3 weeks ago. Her lab panels show a suppressed TSH
and elevated Free T4. What is the most likely diagnosis?
A) Graves' Disease
B) Hashimoto's Thyroiditis
C) Subacute Granulomatous Thyroiditis (De Quervain's)
, D) Toxic Multinodular Goiter
Rationale: Subacute thyroiditis typically follows a viral upper respiratory infection and
presents with a painful, tender thyroid gland accompanied by a transient hyperthyroid
phase due to the leakage of preformed thyroid hormones.
12. A 62-year-old female with a history of chronic heart failure with reduced ejection fraction
(HREFr) presents for evaluation. Which of the following medication classes is
completely contraindicated in this patient due to its potential to cause fluid retention and
precipitate acute heart failure exacerbations?
A) Beta-blockers
B) ACE inhibitors
C) Thiazolidinediones (Pioglitazone)
D) Mineralocorticoid receptor antagonists
Rationale: Thiazolidinediones (such as pioglitazone) cause significant sodium and fluid
retention, which can exacerbate underlying congestive heart failure. They are
contraindicated in patients with NYHA Class III or IV heart failure.
13. A 40-year-old male presents with a 2-month history of epigastric burning pain that
occurs 2 to 3 hours after meals and is temporarily relieved by food or antacids. A urea
breath test is positive for Helicobacter pylori. What constitutes standard first-line triple
eradication therapy?
A) Amoxicillin, Clarithromycin, and Metronidazole for 7 days
B) Proton Pump Inhibitor (PPI), Amoxicillin 1g BID, and Clarithromycin 500mg BID
for 14 days
C) PPI, Bismuth Subsalicylate, Metronidazole, and Tetracycline for 10 days
D) Omeprazole and Famotidine daily for 4 weeks
Rationale: Standard clarithromycin-based triple therapy consists of a PPI combined with
amoxicillin and clarithromycin taken BID for 14 days, provided local resistance rates to
clarithromycin do not exceed 15%.
14. A 19-year-old college student presents for an urgent care visit complaining of a severe
sore throat, fever, marked fatigue, and generalized lymphadenopathy for 5 days.
Physical exam reveals pharyngeal erythema with tonsillar exudates and palpable
splenomegaly. A heterophile antibody test (Monospot) is positive. What critical patient
education must be provided?
A) Take amoxicillin regularly for the next 10 days
B) Avoid contact sports and heavy lifting for at least 3 to 4 weeks
C) Return to the campus gym immediately to combat fatigue
D) Maintain absolute isolation for the next 30 days
Rationale: Infectious mononucleosis carries a risk of splenic rupture due to transient
splenomegaly. Patients must strictly avoid contact sports, vigorous activity, or heavy
lifting for a minimum of 3 to 4 weeks from symptom onset.
15. A 48-year-old female presents with a 6-month history of joint pain and morning stiffness
lasting over an hour in her bilateral wrists and metacarpophalangeal (MCP) joints.
Physical exam reveals symmetrical joint swelling and warmth. Labs show an elevated
Rheumatoid Factor (RF) and positive anti-cyclic citrullinated peptide (anti-CCP)
antibodies. What is the gold-standard first-line disease-modifying antirheumatic drug
(DMARD) for this condition?
A) Hydroxychloroquine
