NURS 5432 FAMILY I MIDTERM EXAM
2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
Question: A 4-year-old child presents with a temperature of
102.5°F, rhinorrhea, and a harsh, "barking" cough that is
worse at night. The parent reports the child became hoarse
earlier today. What is the priority nursing intervention?
o Answer: Administer humidified oxygen and nebulized
racemic epinephrine as ordered.
o Rationale: This presentation describes moderate to severe
croup (laryngotracheobronchitis). The barking cough,
hoarseness, and stridor indicate upper airway obstruction.
Racemic epinephrine reduces mucosal edema via
vasoconstriction, while cool mist soothes the inflamed airway.
Corticosteroids (e.g., dexamethasone) are also first-line to
reduce inflammation. Avoid throat cultures or sedatives,
which can precipitate complete airway closure.
, Question: A 28-year-old female presents with dysuria,
urinary frequency, and suprapubic tenderness. She has no
vaginal discharge or fever. A urinalysis reveals positive
leukocyte esterase and nitrites. Which organism is the most
likely causative pathogen, and what is the first-line empirical
treatment?
o Answer: Escherichia coli; Nitrofurantoin
monohydrate/macrocrystals (Macrobid) for 5 days.
o Rationale: Uncomplicated cystitis in a non-pregnant female
is most commonly caused by uropathogenic E. coli (80%).
Nitrofurantoin is first-line due to low resistance rates and
minimal systemic side effects. Alternatives include TMP-SMX
(if local resistance <20%) or fosfomycin. Fluoroquinolones are
reserved for pyelonephritis or complicated UTIs.
Question: During a well-child visit, the parents of a 2-month-
old infant ask if they can start rice cereal in the bottle to help
the baby sleep through the night. What is the most
appropriate response?
o Answer: Advise against it, explaining that the infant's
digestive system is not mature enough for solids, and it
poses a choking hazard.
o Rationale: The American Academy of Pediatrics (AAP)
recommends exclusive breastfeeding or formula feeding
until 6 months of age. Introducing cereal early (before 4
months) does not improve sleep and increases the risk of
overfeeding, aspiration, and later obesity. The extrusion reflex
, is still present, and the infant lacks the head control and
swallowing coordination for solids.
Question: A 16-year-old male presents with unilateral
testicular pain that began abruptly 2 hours ago. He reports
nausea and vomiting but denies dysuria. On examination, the
affected testis is tender, swollen, and horizontally oriented.
Cremasteric reflex is absent on that side. What is the priority
action?
o Answer: Immediate surgical consultation for detorsion.
o Rationale: This is a classic presentation of testicular torsion,
a urologic emergency. The sudden onset, horizontal lie (due
to twisting of the spermatic cord), and absent cremasteric
reflex are pathognomonic. Viability of the testis drops
significantly after 4–6 hours of ischemia. Manual detorsion
may be attempted briefly, but emergency surgery is the
definitive standard of care.
Question: A 32-year-old G2P1 woman at 28 weeks gestation
complains of severe, generalized pruritus without a rash,
worse at night, primarily on her palms and soles. Her urine is
dark, and her stools are pale. Which laboratory finding would
confirm the suspected diagnosis?
o Answer: Elevated serum total bile acids (>10–14 µmol/L).
, o Rationale: This presentation is Intrahepatic Cholestasis of
Pregnancy (ICP). Pruritus with elevated bile acids is
diagnostic. ICP is associated with increased fetal risk,
including stillbirth, meconium staining, and preterm delivery.
Liver transaminases (AST/ALT) may also rise, but bile
acids are the most specific diagnostic marker and guide
management (ursodeoxycholic acid).
Question: A 55-year-old male with hypertension and
diabetes asks about his prostate cancer screening. His PSA is
2.8 ng/mL, and a digital rectal exam (DRE) is normal.
According to the USPSTF guidelines, what is the most
appropriate recommendation?
o Answer: Engage in shared decision-making regarding PSA
screening, considering his age and risk factors.
o Rationale: The USPSTF recommends shared decision-
making for men aged 55–69. A PSA <4.0 with a normal DRE
is reassuring but does not eliminate risk. Given his diabetes
and hypertension (which do not inherently increase prostate
cancer risk, but African-American race or family history
would), the provider should discuss the potential benefits
(reducing metastatic cancer) and harms (overdiagnosis, false
positives, biopsy complications) before deciding on a
screening interval (e.g., every 2 years).
2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS ALREADY A
GRADED WITH EXPERT FEEDBACK
|NEW AND REVISED
Question: A 4-year-old child presents with a temperature of
102.5°F, rhinorrhea, and a harsh, "barking" cough that is
worse at night. The parent reports the child became hoarse
earlier today. What is the priority nursing intervention?
o Answer: Administer humidified oxygen and nebulized
racemic epinephrine as ordered.
o Rationale: This presentation describes moderate to severe
croup (laryngotracheobronchitis). The barking cough,
hoarseness, and stridor indicate upper airway obstruction.
Racemic epinephrine reduces mucosal edema via
vasoconstriction, while cool mist soothes the inflamed airway.
Corticosteroids (e.g., dexamethasone) are also first-line to
reduce inflammation. Avoid throat cultures or sedatives,
which can precipitate complete airway closure.
, Question: A 28-year-old female presents with dysuria,
urinary frequency, and suprapubic tenderness. She has no
vaginal discharge or fever. A urinalysis reveals positive
leukocyte esterase and nitrites. Which organism is the most
likely causative pathogen, and what is the first-line empirical
treatment?
o Answer: Escherichia coli; Nitrofurantoin
monohydrate/macrocrystals (Macrobid) for 5 days.
o Rationale: Uncomplicated cystitis in a non-pregnant female
is most commonly caused by uropathogenic E. coli (80%).
Nitrofurantoin is first-line due to low resistance rates and
minimal systemic side effects. Alternatives include TMP-SMX
(if local resistance <20%) or fosfomycin. Fluoroquinolones are
reserved for pyelonephritis or complicated UTIs.
Question: During a well-child visit, the parents of a 2-month-
old infant ask if they can start rice cereal in the bottle to help
the baby sleep through the night. What is the most
appropriate response?
o Answer: Advise against it, explaining that the infant's
digestive system is not mature enough for solids, and it
poses a choking hazard.
o Rationale: The American Academy of Pediatrics (AAP)
recommends exclusive breastfeeding or formula feeding
until 6 months of age. Introducing cereal early (before 4
months) does not improve sleep and increases the risk of
overfeeding, aspiration, and later obesity. The extrusion reflex
, is still present, and the infant lacks the head control and
swallowing coordination for solids.
Question: A 16-year-old male presents with unilateral
testicular pain that began abruptly 2 hours ago. He reports
nausea and vomiting but denies dysuria. On examination, the
affected testis is tender, swollen, and horizontally oriented.
Cremasteric reflex is absent on that side. What is the priority
action?
o Answer: Immediate surgical consultation for detorsion.
o Rationale: This is a classic presentation of testicular torsion,
a urologic emergency. The sudden onset, horizontal lie (due
to twisting of the spermatic cord), and absent cremasteric
reflex are pathognomonic. Viability of the testis drops
significantly after 4–6 hours of ischemia. Manual detorsion
may be attempted briefly, but emergency surgery is the
definitive standard of care.
Question: A 32-year-old G2P1 woman at 28 weeks gestation
complains of severe, generalized pruritus without a rash,
worse at night, primarily on her palms and soles. Her urine is
dark, and her stools are pale. Which laboratory finding would
confirm the suspected diagnosis?
o Answer: Elevated serum total bile acids (>10–14 µmol/L).
, o Rationale: This presentation is Intrahepatic Cholestasis of
Pregnancy (ICP). Pruritus with elevated bile acids is
diagnostic. ICP is associated with increased fetal risk,
including stillbirth, meconium staining, and preterm delivery.
Liver transaminases (AST/ALT) may also rise, but bile
acids are the most specific diagnostic marker and guide
management (ursodeoxycholic acid).
Question: A 55-year-old male with hypertension and
diabetes asks about his prostate cancer screening. His PSA is
2.8 ng/mL, and a digital rectal exam (DRE) is normal.
According to the USPSTF guidelines, what is the most
appropriate recommendation?
o Answer: Engage in shared decision-making regarding PSA
screening, considering his age and risk factors.
o Rationale: The USPSTF recommends shared decision-
making for men aged 55–69. A PSA <4.0 with a normal DRE
is reassuring but does not eliminate risk. Given his diabetes
and hypertension (which do not inherently increase prostate
cancer risk, but African-American race or family history
would), the provider should discuss the potential benefits
(reducing metastatic cancer) and harms (overdiagnosis, false
positives, biopsy complications) before deciding on a
screening interval (e.g., every 2 years).
