UTA NURS 5337 Family Clinical Practice 1: Final Exam
(Comprehensive) - Questions with Correct Answers
100 questions
1. A patient on apixaban asks how it differs from warfarin. The FNP explains that apixaban:
A. Inhibits vitamin K-dependent factors and needs weekly INR
B. Is reversed with vitamin K
C. Is an antiplatelet drug
D. Directly inhibits factor Xa and does not need INR monitoring
Correct Answer: D. Directly inhibits factor Xa and does not need INR monitoring
Rationale: Apixaban is a direct factor Xa inhibitor with predictable dosing and no INR monitoring;
andexanet alfa or PCC is used to reverse it in major bleeding. Warfarin blocks vitamin K-dependent
factors and needs INR checks. It is not reversed by vitamin K and is not an antiplatelet.
2. A patient with heart failure has an S3 gallop. This finding indicates:
A. Normal finding in all adults over 60
B. Aortic stenosis
C. Volume overload and rapid ventricular filling
D. Pericardial effusion
Correct Answer: C. Volume overload and rapid ventricular filling
Rationale: An S3 in adults over 40 suggests elevated filling pressures from volume overload, typical of
decompensated systolic HF. It can be normal in children, young adults and pregnancy, but not in older
adults. Aortic stenosis produces a systolic ejection murmur, and effusion causes muffled heart sounds.
3. A 60-year-old with progressive exertional dyspnea, dry cough, and bibasilar velcro-like
crackles most likely has:
A. Idiopathic pulmonary fibrosis
B. Asthma
C. Acute bronchitis
D. Pneumothorax
Correct Answer: A. Idiopathic pulmonary fibrosis
Rationale: Fine inspiratory velcro crackles and progressive dyspnea in an older adult suggest interstitial
lung disease, confirmed with high-resolution CT; clubbing is common. Asthma causes wheeze, bronchitis
is acute, and pneumothorax causes sudden pain with diminished breath sounds.
,4. In COPD, roflumilast is used to:
A. Treat acute bronchospasm
B. Replace long-acting bronchodilators
C. Treat alpha-1 deficiency
D. Reduce exacerbations in patients with chronic bronchitis and severe airflow limitation
Correct Answer: D. Reduce exacerbations in patients with chronic bronchitis and severe
airflow limitation
Rationale: Roflumilast, a PDE-4 inhibitor, reduces exacerbations in patients with FEV1 under 50%,
chronic bronchitis and prior exacerbations. It does not relieve acute bronchospasm. It is add-on therapy,
causes weight loss and diarrhea, and does not treat alpha-1 deficiency.
5. Pioglitazone should be avoided in a patient with:
A. Hyperlipidemia
B. Obesity
C. Hypertension
D. Heart failure
Correct Answer: D. Heart failure
Rationale: Thiazolidinediones cause fluid retention and can precipitate heart failure; they carry a boxed
warning for NYHA class III-IV HF. They also raise fracture risk and may be linked to bladder cancer.
Hyperlipidemia, obesity and hypertension are not contraindications.
6. The patient should take oral alendronate:
A. With a full glass of plain water, upright for 30 minutes, before food or other medications
B. At bedtime lying down
C. With breakfast and calcium
D. With orange juice
Correct Answer: A. With a full glass of plain water, upright for 30 minutes, before food or
other medications
Rationale: Bisphosphonates are poorly absorbed and can cause esophagitis, so they are taken first thing
in the morning with plain water and the patient stays upright for at least 30 minutes. Food, calcium and
juice block absorption. Lying down increases esophageal injury.
,7. A patient with type 2 diabetes takes insulin glargine and asks about tirzepatide. The FNP
explains that tirzepatide:
A. Is a basal insulin
B. Is an SGLT2 inhibitor
C. Is a dual GIP and GLP-1 receptor agonist that lowers A1c and weight
D. Increases hypoglycemia unawareness by blocking adrenaline
Correct Answer: C. Is a dual GIP and GLP-1 receptor agonist that lowers A1c and weight
Rationale: Tirzepatide activates both GIP and GLP-1 receptors, producing large A1c and weight
reductions; when added to insulin, the insulin dose may need to be lowered to avoid hypoglycemia. It is
not an insulin or SGLT2 inhibitor and does not block adrenaline.
8. A traveler returning from Mexico has 3 days of watery diarrhea without fever or blood. The
most likely cause and treatment is:
A. Enterotoxigenic E. coli treated with hydration and loperamide, with azithromycin if severe
B. Shigella requiring IV antibiotics
C. Giardia requiring metronidazole immediately
D. Hepatitis A requiring vaccine
Correct Answer: A. Enterotoxigenic E. coli treated with hydration and loperamide, with
azithromycin if severe
Rationale: ETEC is the most common cause of traveler's diarrhea, and most cases resolve with fluids
and loperamide; azithromycin is preferred if antibiotics are needed. Shigella causes dysentery with fever.
Giardia causes prolonged bloating and greasy stools, and hepatitis A causes jaundice.
9. A patient has watery diarrhea, bloating, and foul-smelling greasy stools for 3 weeks after
drinking stream water while camping. The likely pathogen is:
A. Giardia lamblia
B. Campylobacter
C. Norovirus
D. Clostridium perfringens
Correct Answer: A. Giardia lamblia
Rationale: Giardia is acquired from untreated water and causes prolonged malabsorptive diarrhea with
bloating and steatorrhea; stool antigen or PCR confirms it, and tinidazole or metronidazole treats it.
Campylobacter causes bloody diarrhea, norovirus resolves in days, and C. perfringens causes short-lived
food poisoning.
, 10. An AST:ALT ratio greater than 2 with elevated GGT suggests:
A. Viral hepatitis
B. Nonalcoholic fatty liver disease
C. Alcohol-associated liver disease
D. Acetaminophen toxicity
Correct Answer: C. Alcohol-associated liver disease
Rationale: In alcohol-associated liver injury, AST typically exceeds ALT by 2:1 or more and GGT is
elevated. Viral hepatitis and fatty liver usually show ALT greater than AST. Acetaminophen toxicity
produces very high transaminases in the thousands.
11. HIV pre-exposure prophylaxis (PrEP) with daily oral tenofovir-emtricitabine requires baseline
and periodic:
A. Liver biopsy
B. HIV testing and renal function monitoring
C. Chest x-ray
D. Echocardiogram
Correct Answer: B. HIV testing and renal function monitoring
Rationale: Before starting and every 3 months, HIV testing confirms the person remains negative (PrEP
alone would select resistance in undiagnosed HIV), and creatinine is monitored because of tenofovir's
renal effects. STI testing is also done. Biopsy, chest x-ray and echo are not required.
12. Red blood cell casts on urinalysis suggest:
A. Uncomplicated cystitis
B. Kidney stone
C. Glomerulonephritis
D. Benign prostatic hyperplasia
Correct Answer: C. Glomerulonephritis
Rationale: RBC casts form in the tubules when red cells leak through damaged glomeruli, indicating
glomerulonephritis that needs urgent workup and nephrology referral. Cystitis, stones and BPH can cause
hematuria but not casts.
(Comprehensive) - Questions with Correct Answers
100 questions
1. A patient on apixaban asks how it differs from warfarin. The FNP explains that apixaban:
A. Inhibits vitamin K-dependent factors and needs weekly INR
B. Is reversed with vitamin K
C. Is an antiplatelet drug
D. Directly inhibits factor Xa and does not need INR monitoring
Correct Answer: D. Directly inhibits factor Xa and does not need INR monitoring
Rationale: Apixaban is a direct factor Xa inhibitor with predictable dosing and no INR monitoring;
andexanet alfa or PCC is used to reverse it in major bleeding. Warfarin blocks vitamin K-dependent
factors and needs INR checks. It is not reversed by vitamin K and is not an antiplatelet.
2. A patient with heart failure has an S3 gallop. This finding indicates:
A. Normal finding in all adults over 60
B. Aortic stenosis
C. Volume overload and rapid ventricular filling
D. Pericardial effusion
Correct Answer: C. Volume overload and rapid ventricular filling
Rationale: An S3 in adults over 40 suggests elevated filling pressures from volume overload, typical of
decompensated systolic HF. It can be normal in children, young adults and pregnancy, but not in older
adults. Aortic stenosis produces a systolic ejection murmur, and effusion causes muffled heart sounds.
3. A 60-year-old with progressive exertional dyspnea, dry cough, and bibasilar velcro-like
crackles most likely has:
A. Idiopathic pulmonary fibrosis
B. Asthma
C. Acute bronchitis
D. Pneumothorax
Correct Answer: A. Idiopathic pulmonary fibrosis
Rationale: Fine inspiratory velcro crackles and progressive dyspnea in an older adult suggest interstitial
lung disease, confirmed with high-resolution CT; clubbing is common. Asthma causes wheeze, bronchitis
is acute, and pneumothorax causes sudden pain with diminished breath sounds.
,4. In COPD, roflumilast is used to:
A. Treat acute bronchospasm
B. Replace long-acting bronchodilators
C. Treat alpha-1 deficiency
D. Reduce exacerbations in patients with chronic bronchitis and severe airflow limitation
Correct Answer: D. Reduce exacerbations in patients with chronic bronchitis and severe
airflow limitation
Rationale: Roflumilast, a PDE-4 inhibitor, reduces exacerbations in patients with FEV1 under 50%,
chronic bronchitis and prior exacerbations. It does not relieve acute bronchospasm. It is add-on therapy,
causes weight loss and diarrhea, and does not treat alpha-1 deficiency.
5. Pioglitazone should be avoided in a patient with:
A. Hyperlipidemia
B. Obesity
C. Hypertension
D. Heart failure
Correct Answer: D. Heart failure
Rationale: Thiazolidinediones cause fluid retention and can precipitate heart failure; they carry a boxed
warning for NYHA class III-IV HF. They also raise fracture risk and may be linked to bladder cancer.
Hyperlipidemia, obesity and hypertension are not contraindications.
6. The patient should take oral alendronate:
A. With a full glass of plain water, upright for 30 minutes, before food or other medications
B. At bedtime lying down
C. With breakfast and calcium
D. With orange juice
Correct Answer: A. With a full glass of plain water, upright for 30 minutes, before food or
other medications
Rationale: Bisphosphonates are poorly absorbed and can cause esophagitis, so they are taken first thing
in the morning with plain water and the patient stays upright for at least 30 minutes. Food, calcium and
juice block absorption. Lying down increases esophageal injury.
,7. A patient with type 2 diabetes takes insulin glargine and asks about tirzepatide. The FNP
explains that tirzepatide:
A. Is a basal insulin
B. Is an SGLT2 inhibitor
C. Is a dual GIP and GLP-1 receptor agonist that lowers A1c and weight
D. Increases hypoglycemia unawareness by blocking adrenaline
Correct Answer: C. Is a dual GIP and GLP-1 receptor agonist that lowers A1c and weight
Rationale: Tirzepatide activates both GIP and GLP-1 receptors, producing large A1c and weight
reductions; when added to insulin, the insulin dose may need to be lowered to avoid hypoglycemia. It is
not an insulin or SGLT2 inhibitor and does not block adrenaline.
8. A traveler returning from Mexico has 3 days of watery diarrhea without fever or blood. The
most likely cause and treatment is:
A. Enterotoxigenic E. coli treated with hydration and loperamide, with azithromycin if severe
B. Shigella requiring IV antibiotics
C. Giardia requiring metronidazole immediately
D. Hepatitis A requiring vaccine
Correct Answer: A. Enterotoxigenic E. coli treated with hydration and loperamide, with
azithromycin if severe
Rationale: ETEC is the most common cause of traveler's diarrhea, and most cases resolve with fluids
and loperamide; azithromycin is preferred if antibiotics are needed. Shigella causes dysentery with fever.
Giardia causes prolonged bloating and greasy stools, and hepatitis A causes jaundice.
9. A patient has watery diarrhea, bloating, and foul-smelling greasy stools for 3 weeks after
drinking stream water while camping. The likely pathogen is:
A. Giardia lamblia
B. Campylobacter
C. Norovirus
D. Clostridium perfringens
Correct Answer: A. Giardia lamblia
Rationale: Giardia is acquired from untreated water and causes prolonged malabsorptive diarrhea with
bloating and steatorrhea; stool antigen or PCR confirms it, and tinidazole or metronidazole treats it.
Campylobacter causes bloody diarrhea, norovirus resolves in days, and C. perfringens causes short-lived
food poisoning.
, 10. An AST:ALT ratio greater than 2 with elevated GGT suggests:
A. Viral hepatitis
B. Nonalcoholic fatty liver disease
C. Alcohol-associated liver disease
D. Acetaminophen toxicity
Correct Answer: C. Alcohol-associated liver disease
Rationale: In alcohol-associated liver injury, AST typically exceeds ALT by 2:1 or more and GGT is
elevated. Viral hepatitis and fatty liver usually show ALT greater than AST. Acetaminophen toxicity
produces very high transaminases in the thousands.
11. HIV pre-exposure prophylaxis (PrEP) with daily oral tenofovir-emtricitabine requires baseline
and periodic:
A. Liver biopsy
B. HIV testing and renal function monitoring
C. Chest x-ray
D. Echocardiogram
Correct Answer: B. HIV testing and renal function monitoring
Rationale: Before starting and every 3 months, HIV testing confirms the person remains negative (PrEP
alone would select resistance in undiagnosed HIV), and creatinine is monitored because of tenofovir's
renal effects. STI testing is also done. Biopsy, chest x-ray and echo are not required.
12. Red blood cell casts on urinalysis suggest:
A. Uncomplicated cystitis
B. Kidney stone
C. Glomerulonephritis
D. Benign prostatic hyperplasia
Correct Answer: C. Glomerulonephritis
Rationale: RBC casts form in the tubules when red cells leak through damaged glomeruli, indicating
glomerulonephritis that needs urgent workup and nephrology referral. Cystitis, stones and BPH can cause
hematuria but not casts.
