UT Arlington NURS 5434 Family III Exam 2 (pdf) | 2026/2027 | FNP III
Q&A | Nursing
1. Which of the following statements accurately describes the primary focus
of NURS 5434: Family Nurse Practitioner III according to the UT Arlington
catalog?
A) Advanced pathophysiology of acute and chronic disease processes
B) Advanced concepts for primary care management of designated acute,
chronic, and complex health problems of individuals and families across the
lifespan
C) Leadership and administration in family practice settings
D) Clinical management of psychiatric emergencies in acute care settings
Correct Answer: Advanced concepts for primary care management of
designated acute, chronic, and complex health problems of individuals and
families across the lifespan
Rationale: The UT Arlington catalog states that NURS 5434 focuses on
"advanced concepts and knowledge for nurse practitioner primary care
management of designated acute, chronic and complex health problems of
individuals and families across the lifespan".
2. A 71-year-old female with COPD (GOLD group E, post-bronchodilator FEV1
45% predicted) presents with increased dyspnea, purulent sputum, and no
fever. She has had 2 exacerbations in the past year requiring antibiotics. She
is currently on triple therapy (ICS/LAMA/LABA). According to GOLD
guidelines, which antibiotic is most appropriate for the current exacerbation?
A) Azithromycin 500 mg on day 1, then 250 mg daily for 4 days
B) Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
C) Levofloxacin 750 mg daily for 5 days
D) Doxycycline 100 mg twice daily for 10 days
Correct Answer: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
Rationale: For a COPD exacerbation with purulent sputum and risk factors
(FEV1 < 50%, multiple exacerbations, prior antibiotic use), amoxicillin-
clavulanate is recommended as first-line antibiotic. Macrolides are associated
,with increased resistant organisms, and fluoroquinolones are generally
reserved for failure of first-line therapy or beta-lactam allergy.
3. A 78-year-old male with a history of coronary artery disease and mild
cognitive impairment presents with persistent depressive symptoms (PHQ-9
score 14) for 3 weeks, with insomnia and poor appetite. He is on aspirin,
atorvastatin, and metoprolol. Which antidepressant is most appropriate due
to its favorable side effect profile and low drug interaction risk?
A) Sertraline 25 mg daily
B) Bupropion XL 150 mg daily
C) Mirtazapine 15 mg at bedtime
D) Venlafaxine XR 37.5 mg daily
Correct Answer: Mirtazapine 15 mg at bedtime
Rationale: In elderly patients with depression and insomnia, mirtazapine is
beneficial due to its sedating properties at low doses and appetite
stimulation, with minimal interactions with cardiovascular medications.
Bupropion can lower seizure threshold and is not ideal in elderly with
cognitive issues.
4. A 52-year-old male with type 2 diabetes (HbA1c 9.2%), hypertension (BP
148/92 mmHg on lisinopril 20 mg daily), and eGFR 42 mL/min/1.73m² is
started on metformin. Three months later, HbA1c is 8.5%. According to
ADA/EASD consensus, what is the most appropriate next step?
A) Add a GLP-1 receptor agonist with proven cardiovascular benefit
B) Discontinue metformin and start insulin glargine
C) Add pioglitazone 15 mg daily
D) Increase lisinopril to 40 mg daily and initiate an SGLT2 inhibitor
Correct Answer: Add a GLP-1 receptor agonist with proven cardiovascular
benefit
Rationale: For patients with type 2 diabetes and established cardiovascular
disease or high risk (CKD and hypertension), ADA/EASD recommends adding
an agent with proven cardiovascular benefit, such as a GLP-1 receptor
,agonist. SGLT2 inhibitors are less effective at lower eGFR and may not be
appropriate when eGFR < 45.
5. A 65-year-old African American woman with stage 3 CKD (eGFR 45
mL/min/1.73m²) and hypertension (BP 160/95 mmHg) is on lisinopril 40 mg
daily. She has no history of diabetes or heart failure. Which antihypertensive
regimen is most appropriate to achieve target BP and provide renal
protection?
A) Add amlodipine 5 mg daily
B) Add hydrochlorothiazide 25 mg daily
C) Add spironolactone 25 mg daily
D) Add atenolol 50 mg daily
Correct Answer: Add amlodipine 5 mg daily
Rationale: In African American patients with CKD, combination therapy with
an ACE inhibitor (or ARB) plus a calcium channel blocker is recommended for
BP control and renal protection. Thiazide diuretics are less effective when
eGFR < 30-45.
6. A 34-year-old female with persistent asthma (previously well-controlled on
low-dose ICS-formoterol) reports using her rescue inhaler 3-4 times per week
for the past month, and she wakes up with cough twice a week. Spirometry
shows FEV1 78% predicted. According to NAEPP EPR-4 guidelines, what is the
recommended step-up therapy?
A) Increase to medium-dose ICS-formoterol as single maintenance and
reliever therapy (SMART)
B) Add tiotropium bromide 1.25 mcg daily
C) Add a leukotriene receptor antagonist (LTRA)
D) Discontinue ICS-formoterol and begin a short course of oral prednisone
Correct Answer: Increase to medium-dose ICS-formoterol as single
maintenance and reliever therapy (SMART)
Rationale: With symptoms indicating step-up, NAEPP recommends increasing
to medium-dose ICS-formoterol using SMART (single maintenance and
, reliever therapy), which reduces exacerbations and improves control.
Tiotropium is an add-on option for step 4 or higher.
7. A 58-year-old male with heart failure with reduced ejection fraction (LVEF
30%) and NYHA class III symptoms is on lisinopril 10 mg daily, carvedilol 12.5
mg twice daily, and furosemide 40 mg daily. He has a history of gout. Which
medication, when added, has been shown to reduce mortality in this
population?
A) Spironolactone 25 mg daily
B) Sacubitril/valsartan 24/26 mg twice daily
C) Dapagliflozin 10 mg daily
D) Hydralazine 50 mg three times daily plus isosorbide dinitrate 30 mg three
times daily
Correct Answer: Sacubitril/valsartan 24/26 mg twice daily
Rationale: In HFrEF patients with NYHA class II-III who tolerate an ACE
inhibitor/ARB, switching to sacubitril/valsartan (ARNI) reduces cardiovascular
mortality and heart failure hospitalizations compared to ACE inhibitor alone.
Spironolactone may be less preferred due to history of gout (risk of
hyperuricemia).
8. A 45-year-old male with chronic low back pain for 6 months receives a
prescription for an NSAID. He has a history of peptic ulcer disease (PUD) 2
years ago, now resolved. Which is the most appropriate management to
prevent recurrence of PUD while on NSAID therapy?
A) Add misoprostol 200 mcg orally four times daily
B) Add omeprazole 20 mg daily
C) Use a selective COX-2 inhibitor instead of a non-selective NSAID
D) Prescribe a topical NSAID and avoid oral therapy
Correct Answer: Add omeprazole 20 mg daily
Rationale: In patients with prior PUD requiring NSAID therapy, the
combination of a non-selective NSAID with a proton pump inhibitor is
Q&A | Nursing
1. Which of the following statements accurately describes the primary focus
of NURS 5434: Family Nurse Practitioner III according to the UT Arlington
catalog?
A) Advanced pathophysiology of acute and chronic disease processes
B) Advanced concepts for primary care management of designated acute,
chronic, and complex health problems of individuals and families across the
lifespan
C) Leadership and administration in family practice settings
D) Clinical management of psychiatric emergencies in acute care settings
Correct Answer: Advanced concepts for primary care management of
designated acute, chronic, and complex health problems of individuals and
families across the lifespan
Rationale: The UT Arlington catalog states that NURS 5434 focuses on
"advanced concepts and knowledge for nurse practitioner primary care
management of designated acute, chronic and complex health problems of
individuals and families across the lifespan".
2. A 71-year-old female with COPD (GOLD group E, post-bronchodilator FEV1
45% predicted) presents with increased dyspnea, purulent sputum, and no
fever. She has had 2 exacerbations in the past year requiring antibiotics. She
is currently on triple therapy (ICS/LAMA/LABA). According to GOLD
guidelines, which antibiotic is most appropriate for the current exacerbation?
A) Azithromycin 500 mg on day 1, then 250 mg daily for 4 days
B) Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
C) Levofloxacin 750 mg daily for 5 days
D) Doxycycline 100 mg twice daily for 10 days
Correct Answer: Amoxicillin-clavulanate 875/125 mg twice daily for 5-7 days
Rationale: For a COPD exacerbation with purulent sputum and risk factors
(FEV1 < 50%, multiple exacerbations, prior antibiotic use), amoxicillin-
clavulanate is recommended as first-line antibiotic. Macrolides are associated
,with increased resistant organisms, and fluoroquinolones are generally
reserved for failure of first-line therapy or beta-lactam allergy.
3. A 78-year-old male with a history of coronary artery disease and mild
cognitive impairment presents with persistent depressive symptoms (PHQ-9
score 14) for 3 weeks, with insomnia and poor appetite. He is on aspirin,
atorvastatin, and metoprolol. Which antidepressant is most appropriate due
to its favorable side effect profile and low drug interaction risk?
A) Sertraline 25 mg daily
B) Bupropion XL 150 mg daily
C) Mirtazapine 15 mg at bedtime
D) Venlafaxine XR 37.5 mg daily
Correct Answer: Mirtazapine 15 mg at bedtime
Rationale: In elderly patients with depression and insomnia, mirtazapine is
beneficial due to its sedating properties at low doses and appetite
stimulation, with minimal interactions with cardiovascular medications.
Bupropion can lower seizure threshold and is not ideal in elderly with
cognitive issues.
4. A 52-year-old male with type 2 diabetes (HbA1c 9.2%), hypertension (BP
148/92 mmHg on lisinopril 20 mg daily), and eGFR 42 mL/min/1.73m² is
started on metformin. Three months later, HbA1c is 8.5%. According to
ADA/EASD consensus, what is the most appropriate next step?
A) Add a GLP-1 receptor agonist with proven cardiovascular benefit
B) Discontinue metformin and start insulin glargine
C) Add pioglitazone 15 mg daily
D) Increase lisinopril to 40 mg daily and initiate an SGLT2 inhibitor
Correct Answer: Add a GLP-1 receptor agonist with proven cardiovascular
benefit
Rationale: For patients with type 2 diabetes and established cardiovascular
disease or high risk (CKD and hypertension), ADA/EASD recommends adding
an agent with proven cardiovascular benefit, such as a GLP-1 receptor
,agonist. SGLT2 inhibitors are less effective at lower eGFR and may not be
appropriate when eGFR < 45.
5. A 65-year-old African American woman with stage 3 CKD (eGFR 45
mL/min/1.73m²) and hypertension (BP 160/95 mmHg) is on lisinopril 40 mg
daily. She has no history of diabetes or heart failure. Which antihypertensive
regimen is most appropriate to achieve target BP and provide renal
protection?
A) Add amlodipine 5 mg daily
B) Add hydrochlorothiazide 25 mg daily
C) Add spironolactone 25 mg daily
D) Add atenolol 50 mg daily
Correct Answer: Add amlodipine 5 mg daily
Rationale: In African American patients with CKD, combination therapy with
an ACE inhibitor (or ARB) plus a calcium channel blocker is recommended for
BP control and renal protection. Thiazide diuretics are less effective when
eGFR < 30-45.
6. A 34-year-old female with persistent asthma (previously well-controlled on
low-dose ICS-formoterol) reports using her rescue inhaler 3-4 times per week
for the past month, and she wakes up with cough twice a week. Spirometry
shows FEV1 78% predicted. According to NAEPP EPR-4 guidelines, what is the
recommended step-up therapy?
A) Increase to medium-dose ICS-formoterol as single maintenance and
reliever therapy (SMART)
B) Add tiotropium bromide 1.25 mcg daily
C) Add a leukotriene receptor antagonist (LTRA)
D) Discontinue ICS-formoterol and begin a short course of oral prednisone
Correct Answer: Increase to medium-dose ICS-formoterol as single
maintenance and reliever therapy (SMART)
Rationale: With symptoms indicating step-up, NAEPP recommends increasing
to medium-dose ICS-formoterol using SMART (single maintenance and
, reliever therapy), which reduces exacerbations and improves control.
Tiotropium is an add-on option for step 4 or higher.
7. A 58-year-old male with heart failure with reduced ejection fraction (LVEF
30%) and NYHA class III symptoms is on lisinopril 10 mg daily, carvedilol 12.5
mg twice daily, and furosemide 40 mg daily. He has a history of gout. Which
medication, when added, has been shown to reduce mortality in this
population?
A) Spironolactone 25 mg daily
B) Sacubitril/valsartan 24/26 mg twice daily
C) Dapagliflozin 10 mg daily
D) Hydralazine 50 mg three times daily plus isosorbide dinitrate 30 mg three
times daily
Correct Answer: Sacubitril/valsartan 24/26 mg twice daily
Rationale: In HFrEF patients with NYHA class II-III who tolerate an ACE
inhibitor/ARB, switching to sacubitril/valsartan (ARNI) reduces cardiovascular
mortality and heart failure hospitalizations compared to ACE inhibitor alone.
Spironolactone may be less preferred due to history of gout (risk of
hyperuricemia).
8. A 45-year-old male with chronic low back pain for 6 months receives a
prescription for an NSAID. He has a history of peptic ulcer disease (PUD) 2
years ago, now resolved. Which is the most appropriate management to
prevent recurrence of PUD while on NSAID therapy?
A) Add misoprostol 200 mcg orally four times daily
B) Add omeprazole 20 mg daily
C) Use a selective COX-2 inhibitor instead of a non-selective NSAID
D) Prescribe a topical NSAID and avoid oral therapy
Correct Answer: Add omeprazole 20 mg daily
Rationale: In patients with prior PUD requiring NSAID therapy, the
combination of a non-selective NSAID with a proton pump inhibitor is
