UTA NURS 5337 Family Clinical Practice 1: Midterm Exam
(Units 1-7) - Questions with Correct Answers
100 questions
1. A 47-year-old average-risk patient asks when colorectal cancer screening should start. Per
current USPSTF guidance, the FNP explains that screening begins at age:
A. 40
B. 50
C. 55
D. 45
Correct Answer: D. 45
Rationale: The USPSTF lowered the starting age for average-risk adults to 45 in 2021 because
early-onset colorectal cancer is rising, so this patient is already due. Age 50 was the older threshold, and
40 or 55 are not the average-risk starting ages. A first-degree relative diagnosed young would change the
start age, but this patient is average risk.
2. USPSTF recommends screening for latent tuberculosis infection in:
A. All adults every year
B. Adults at increased risk, such as people born in or who lived in high-prevalence countries or in
congregate settings
C. Only health care workers
D. Only people with a chronic cough
Correct Answer: B. Adults at increased risk, such as people born in or who lived in
high-prevalence countries or in congregate settings
Rationale: USPSTF recommends latent TB screening with a tuberculin skin test or interferon-gamma
release assay for adults at increased risk, including people born in or who lived in high-prevalence
countries and those in shelters or correctional facilities. Annual testing of all adults is not recommended.
Health care worker testing is an occupational policy, and a chronic cough calls for evaluation for active TB
rather than screening.
,3. A pertinent negative in a patient presenting with chest pain is best demonstrated by:
A. Reports pain started 2 hours ago
B. Blood pressure 138/84
C. History of hyperlipidemia
D. Denies shortness of breath, diaphoresis, or radiation to the arm
Correct Answer: D. Denies shortness of breath, diaphoresis, or radiation to the arm
Rationale: Pertinent negatives document the absence of findings that would raise suspicion for serious
causes, here acute coronary syndrome. Onset timing is part of the history of present illness, and blood
pressure is objective data. Hyperlipidemia is a pertinent positive risk factor, not a negative.
4. A 65-year-old with no history of falls asks whether she should take daily low-dose aspirin to
prevent a first heart attack. The FNP should advise that:
A. Starting aspirin for primary prevention is not recommended at age 60 or older
B. Everyone over 50 should take aspirin
C. Aspirin is recommended only for women over 65
D. Aspirin should be started if her LDL is above 100
Correct Answer: A. Starting aspirin for primary prevention is not recommended at age 60 or
older
Rationale: The 2022 USPSTF guidance recommends against starting aspirin for primary prevention at 60
and older because bleeding risk outweighs benefit. Blanket aspirin use after 50 is outdated advice. LDL
level alone is not an indication for aspirin, and there is no women-over-65 exception.
5. Motivational interviewing with a patient who smokes and says, I know I should quit, but it's the
only way I deal with stress, is best reflected by:
A. You need to quit today because smoking causes cancer
B. Why haven't you tried harder to quit?
C. Let me just give you a prescription and a pamphlet
D. It sounds like smoking helps you cope, and part of you also wants to quit
Correct Answer: D. It sounds like smoking helps you cope, and part of you also wants to quit
Rationale: A reflective statement that names both sides of the ambivalence is the core of motivational
interviewing and invites change talk. Lecturing about harm provokes resistance, and asking why they
have not tried harder sounds judgmental. Handing over materials without engagement skips the patient's
own motivation.
,6. A 45-year-old asymptomatic adult asks whether hepatitis C testing is needed. The USPSTF
recommends:
A. Screening only for people who inject drugs
B. Screening only for baby boomers born 1945-1965
C. Annual screening for all adults
D. One-time screening for all adults 18 to 79
Correct Answer: D. One-time screening for all adults 18 to 79
Rationale: USPSTF expanded hepatitis C screening in 2020 to all adults 18 to 79 at least once, because
direct-acting antivirals now cure most infections. Limiting it to the birth cohort or to injection drug use
misses many cases. People with ongoing risk need periodic testing, but annual screening for everyone is
not recommended.
7. Which smoking cessation medication is most effective as single-agent therapy?
A. Varenicline
B. Bupropion
C. Nicotine gum alone
D. Clonidine
Correct Answer: A. Varenicline
Rationale: Varenicline, a partial nicotinic agonist, has the highest quit rates as monotherapy, and the
EAGLES trial did not show excess neuropsychiatric events. Bupropion and single-form nicotine
replacement are less effective. Clonidine is a second-line option with more side effects.
8. A 68-year-old man who smoked for 20 years and quit long ago should receive which one-time
screening?
A. Carotid duplex ultrasound
B. Coronary artery calcium score
C. Abdominal aortic ultrasound for aneurysm
D. Ankle-brachial index
Correct Answer: C. Abdominal aortic ultrasound for aneurysm
Rationale: USPSTF recommends a one-time abdominal ultrasound for men 65 to 75 who have ever
smoked, because AAA rupture is often fatal and repair of large aneurysms saves lives. Routine carotid
duplex and ABI screening in asymptomatic adults are not recommended. A calcium score is a
risk-refinement tool, not a population screening test.
, 9. An adult with no documented hepatitis B vaccination asks about the series. Current CDC
guidance is that:
A. Only health care workers need it
B. Only people with HIV need it
C. Adults should be vaccinated only after a needle-stick
D. All adults 19 to 59 should be vaccinated, and those 60 and older with risk factors or on request
Correct Answer: D. All adults 19 to 59 should be vaccinated, and those 60 and older with risk
factors or on request
Rationale: In 2022 ACIP moved to universal hepatitis B vaccination for adults 19 to 59, and those 60 and
older may receive it if at risk or if they wish. Restricting it to health care workers or HIV is the old
risk-based approach that missed many infections. Waiting for an exposure means relying on
post-exposure prophylaxis instead of prevention.
10. The most appropriate time to discuss advance directives with an adult patient is:
A. Only after admission to intensive care
B. Only when the patient turns 85
C. Only if the family requests it
D. During routine visits while the patient is healthy and has decision-making capacity
Correct Answer: D. During routine visits while the patient is healthy and has decision-making
capacity
Rationale: Advance care planning works best when it is done early, repeated over time, and led by the
patient while capacity is intact. Waiting for a crisis often means the patient cannot participate. No age
threshold triggers the conversation, and the family's wishes do not replace the patient's.
11. Primary prevention is best illustrated by:
A. Performing a screening mammogram
B. Starting cardiac rehabilitation after a myocardial infarction
C. Giving the HPV vaccine to an 11-year-old
D. Checking A1c in a patient with diabetes
Correct Answer: C. Giving the HPV vaccine to an 11-year-old
Rationale: Primary prevention stops disease before it occurs, as vaccination does. Screening
mammography is secondary prevention, which aims for early detection. Cardiac rehab and A1c
monitoring in established disease are tertiary prevention to limit complications.
(Units 1-7) - Questions with Correct Answers
100 questions
1. A 47-year-old average-risk patient asks when colorectal cancer screening should start. Per
current USPSTF guidance, the FNP explains that screening begins at age:
A. 40
B. 50
C. 55
D. 45
Correct Answer: D. 45
Rationale: The USPSTF lowered the starting age for average-risk adults to 45 in 2021 because
early-onset colorectal cancer is rising, so this patient is already due. Age 50 was the older threshold, and
40 or 55 are not the average-risk starting ages. A first-degree relative diagnosed young would change the
start age, but this patient is average risk.
2. USPSTF recommends screening for latent tuberculosis infection in:
A. All adults every year
B. Adults at increased risk, such as people born in or who lived in high-prevalence countries or in
congregate settings
C. Only health care workers
D. Only people with a chronic cough
Correct Answer: B. Adults at increased risk, such as people born in or who lived in
high-prevalence countries or in congregate settings
Rationale: USPSTF recommends latent TB screening with a tuberculin skin test or interferon-gamma
release assay for adults at increased risk, including people born in or who lived in high-prevalence
countries and those in shelters or correctional facilities. Annual testing of all adults is not recommended.
Health care worker testing is an occupational policy, and a chronic cough calls for evaluation for active TB
rather than screening.
,3. A pertinent negative in a patient presenting with chest pain is best demonstrated by:
A. Reports pain started 2 hours ago
B. Blood pressure 138/84
C. History of hyperlipidemia
D. Denies shortness of breath, diaphoresis, or radiation to the arm
Correct Answer: D. Denies shortness of breath, diaphoresis, or radiation to the arm
Rationale: Pertinent negatives document the absence of findings that would raise suspicion for serious
causes, here acute coronary syndrome. Onset timing is part of the history of present illness, and blood
pressure is objective data. Hyperlipidemia is a pertinent positive risk factor, not a negative.
4. A 65-year-old with no history of falls asks whether she should take daily low-dose aspirin to
prevent a first heart attack. The FNP should advise that:
A. Starting aspirin for primary prevention is not recommended at age 60 or older
B. Everyone over 50 should take aspirin
C. Aspirin is recommended only for women over 65
D. Aspirin should be started if her LDL is above 100
Correct Answer: A. Starting aspirin for primary prevention is not recommended at age 60 or
older
Rationale: The 2022 USPSTF guidance recommends against starting aspirin for primary prevention at 60
and older because bleeding risk outweighs benefit. Blanket aspirin use after 50 is outdated advice. LDL
level alone is not an indication for aspirin, and there is no women-over-65 exception.
5. Motivational interviewing with a patient who smokes and says, I know I should quit, but it's the
only way I deal with stress, is best reflected by:
A. You need to quit today because smoking causes cancer
B. Why haven't you tried harder to quit?
C. Let me just give you a prescription and a pamphlet
D. It sounds like smoking helps you cope, and part of you also wants to quit
Correct Answer: D. It sounds like smoking helps you cope, and part of you also wants to quit
Rationale: A reflective statement that names both sides of the ambivalence is the core of motivational
interviewing and invites change talk. Lecturing about harm provokes resistance, and asking why they
have not tried harder sounds judgmental. Handing over materials without engagement skips the patient's
own motivation.
,6. A 45-year-old asymptomatic adult asks whether hepatitis C testing is needed. The USPSTF
recommends:
A. Screening only for people who inject drugs
B. Screening only for baby boomers born 1945-1965
C. Annual screening for all adults
D. One-time screening for all adults 18 to 79
Correct Answer: D. One-time screening for all adults 18 to 79
Rationale: USPSTF expanded hepatitis C screening in 2020 to all adults 18 to 79 at least once, because
direct-acting antivirals now cure most infections. Limiting it to the birth cohort or to injection drug use
misses many cases. People with ongoing risk need periodic testing, but annual screening for everyone is
not recommended.
7. Which smoking cessation medication is most effective as single-agent therapy?
A. Varenicline
B. Bupropion
C. Nicotine gum alone
D. Clonidine
Correct Answer: A. Varenicline
Rationale: Varenicline, a partial nicotinic agonist, has the highest quit rates as monotherapy, and the
EAGLES trial did not show excess neuropsychiatric events. Bupropion and single-form nicotine
replacement are less effective. Clonidine is a second-line option with more side effects.
8. A 68-year-old man who smoked for 20 years and quit long ago should receive which one-time
screening?
A. Carotid duplex ultrasound
B. Coronary artery calcium score
C. Abdominal aortic ultrasound for aneurysm
D. Ankle-brachial index
Correct Answer: C. Abdominal aortic ultrasound for aneurysm
Rationale: USPSTF recommends a one-time abdominal ultrasound for men 65 to 75 who have ever
smoked, because AAA rupture is often fatal and repair of large aneurysms saves lives. Routine carotid
duplex and ABI screening in asymptomatic adults are not recommended. A calcium score is a
risk-refinement tool, not a population screening test.
, 9. An adult with no documented hepatitis B vaccination asks about the series. Current CDC
guidance is that:
A. Only health care workers need it
B. Only people with HIV need it
C. Adults should be vaccinated only after a needle-stick
D. All adults 19 to 59 should be vaccinated, and those 60 and older with risk factors or on request
Correct Answer: D. All adults 19 to 59 should be vaccinated, and those 60 and older with risk
factors or on request
Rationale: In 2022 ACIP moved to universal hepatitis B vaccination for adults 19 to 59, and those 60 and
older may receive it if at risk or if they wish. Restricting it to health care workers or HIV is the old
risk-based approach that missed many infections. Waiting for an exposure means relying on
post-exposure prophylaxis instead of prevention.
10. The most appropriate time to discuss advance directives with an adult patient is:
A. Only after admission to intensive care
B. Only when the patient turns 85
C. Only if the family requests it
D. During routine visits while the patient is healthy and has decision-making capacity
Correct Answer: D. During routine visits while the patient is healthy and has decision-making
capacity
Rationale: Advance care planning works best when it is done early, repeated over time, and led by the
patient while capacity is intact. Waiting for a crisis often means the patient cannot participate. No age
threshold triggers the conversation, and the family's wishes do not replace the patient's.
11. Primary prevention is best illustrated by:
A. Performing a screening mammogram
B. Starting cardiac rehabilitation after a myocardial infarction
C. Giving the HPV vaccine to an 11-year-old
D. Checking A1c in a patient with diabetes
Correct Answer: C. Giving the HPV vaccine to an 11-year-old
Rationale: Primary prevention stops disease before it occurs, as vaccination does. Screening
mammography is secondary prevention, which aims for early detection. Cardiac rehab and A1c
monitoring in established disease are tertiary prevention to limit complications.
