1
NURS 5434 FAMILY III MIDTERM AND 75 ACTUAL EXAM (UTA)
NEWEST 2025/ 2026 | COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+|
NURS 5434 FNP III FINAL EXAM PREP (BRAND NEW!!)
NURS 5434 Family III: Comprehensive Exam Preparation
Section 1: Cardiovascular Conditions (Questions 1-15)
1. A 62-year-old male with hypertension, diabetes, and a 40-pack-year smoking
history presents with 45 minutes of crushing substernal chest pain radiating to
the left shoulder, associated with diaphoresis and nausea. BP 108/70 mmHg, HR
52 bpm. ECG reveals 3 mm ST-segment elevation in leads II, III, and aVF with
reciprocal ST depression in I and aVL. What is the MOST critical immediate next
step?
A. Administer sublingual nitroglycerin 0.4 mg
B. Administer morphine sulfate 2-4 mg IV
C. Activate EMS for immediate transport to a PCI-capable facility
D. Administer clopidogrel 600 mg loading dose
Answer: C. Activate EMS for immediate transport to a PCI-capable facility
RATIONALE: This is an acute inferior STEMI. According to ACC/AHA guidelines,
primary PCI is the preferred reperfusion strategy with a goal first medical contact-
to-device time ≤ 90 minutes. Every 30-minute delay in reperfusion increases 1-
year mortality by approximately 7.5%. Activating EMS for transport to a PCI-
capable facility is the most time-sensitive, mortality-reducing intervention.
• A: Nitroglycerin - Incorrect. Relatively contraindicated in suspected right
ventricular infarction, which complicates up to 40% of inferior MIs. The
bradycardia and borderline hypotension are red flags for RV involvement.
NTG's preload reduction could precipitate cardiovascular collapse in this
preload-dependent state.
• B: Morphine - Incorrect. A Class IIa recommendation for pain refractory to
nitrates but not the most critical step. It has been associated with slower
pg. 1
,2
onset of oral antiplatelet agents and potentially worse outcomes in
observational studies.
• D: Clopidogrel - Incorrect. DAPT is essential for STEMI management but
does not take precedence over arranging timely reperfusion therapy.
2. A 72-year-old female with heart failure with reduced ejection fraction (LVEF
30%) presents with progressive dyspnea, orthopnea, and bilateral pedal edema.
Auscultation reveals an S3 gallop, JVD, and bilateral crackles. BNP is 1,200
pg/mL. Which medication is CONTRAINDICATED in the acute management of
this exacerbation?
A. IV furosemide
B. IV nitroglycerin
C. Metoprolol (beta-blocker)
D. Morphine sulfate
Answer: C. Metoprolol (beta-blocker)
RATIONALE: Beta-blockers have negative inotropic effects and should NOT be
initiated or increased during acute decompensated heart failure. They can further
reduce cardiac output and precipitate cardiogenic shock. While beta-blockers are
a cornerstone of chronic HFrEF management (reducing mortality), they should be
initiated when the patient is euvolemic and stable, not during an acute
exacerbation.
• A: IV furosemide - Incorrect. Loop diuretics are first-line for acute
decompensated heart failure to reduce preload through diuresis.
• B: IV nitroglycerin - Incorrect. A first-line agent that reduces preload and
afterload, rapidly relieving pulmonary congestion.
• D: Morphine - Incorrect. May be used cautiously for pain and anxiety,
though it is no longer routinely recommended.
3. A 58-year-old male with diabetes, hypertension, and NSTEMI has an
echocardiogram showing LVEF 30%. His HbA1c is 9.5% on metformin and
glimepiride. Which diabetes medication should be ADDED to reduce
cardiovascular mortality?
A. Insulin glargine
pg. 2
,3
B. Empagliflozin (SGLT2 inhibitor)
C. Pioglitazone
D. Sitagliptin (DPP-4 inhibitor)
Answer: B. Empagliflozin (SGLT2 inhibitor)
RATIONALE: This patient has established ASCVD with recent NSTEMI and HFrEF.
According to ADA/EASD and AHA/ACC guidelines, an SGLT2 inhibitor
(empagliflozin, dapagliflozin) or GLP-1 receptor agonist with proven
cardiovascular benefit should be added. The EMPA-REG OUTCOME trial
demonstrated significant reduction in cardiovascular death (38% RRR) and heart
failure hospitalizations (35% RRR) with empagliflozin. Given concurrent HFrEF, an
SGLT2 inhibitor is the preferred agent because it is now a cornerstone of GDMT
for HFrEF regardless of diabetes status.
• A: Insulin glargine - Incorrect. Insulin effectively lowers glucose but does
not provide cardiovascular mortality benefit in this high-risk population.
• C: Pioglitazone - Incorrect. TZDs cause fluid retention and are potentially
dangerous in HFrEF. Contraindicated in NYHA Class III-IV heart failure.
• D: Sitagliptin - Incorrect. DPP-4 inhibitors have neutral cardiovascular
effects and do not provide mortality benefit.
4. A 48-year-old female presents with acute onset of "tearing" interscapular
back pain while lifting furniture. BP 190/110 mmHg right arm, 150/80 mmHg left
arm. Chest X-ray shows widened mediastinum. While awaiting CT angiogram for
suspected aortic dissection, what is the MOST critical hemodynamic goal?
A. Reduce systolic BP to < 120 mmHg with IV nitroprusside immediately
B. Aggressive fluid resuscitation to maintain urine output > 0.5 mL/kg/hr
C. Administer IV beta-blocker (esmolol or labetalol) to reduce HR to < 60 bpm,
then target systolic BP < 120 mmHg
D. Start heparin infusion to prevent thrombotic complications
Answer: C. Administer IV beta-blocker to reduce HR to < 60 bpm, then target
systolic BP < 120 mmHg
RATIONALE: The goal of medical management in acute aortic dissection is to
reduce the force of left ventricular contraction and the steepness of the pressure
pg. 3
, 4
wave (dP/dt), which propagates the dissection flap. IV beta-blockers are the life-
saving, first-line therapy. The target is HR < 60 bpm BEFORE arterial vasodilators
are started. Using vasodilators alone can cause reflex tachycardia and increased
myocardial contractility, worsening the dissection.
• A: Nitroprusside immediately - Incorrect. This is a classic board exam trap.
Nitroprusside alone causes reflex tachycardia and increased dP/dt,
propagating the dissection. Beta-blockade must precede vasodilation.
• B: Aggressive fluid resuscitation - Incorrect. Harmful in a hypertensive
emergency with aortic dissection; increases cardiac output and shear
stress.
• D: Heparin infusion - Incorrect. Anticoagulation is contraindicated in aortic
dissection as it worsens bleeding into the aortic wall.
5. A 68-year-old female with chronic atrial fibrillation (on rivaroxaban) presents
with palpitations and dyspnea. ECG shows AF with ventricular rate 135 bpm. BP
105/70 mmHg. She has been in this rhythm for at least 24 hours. What is the
MOST appropriate initial management?
A. Immediate direct-current synchronized cardioversion
B. IV diltiazem bolus followed by continuous infusion
C. Transesophageal echocardiogram followed by cardioversion
D. Administer amiodarone 150 mg IV bolus
Answer: B. IV diltiazem bolus followed by continuous infusion
RATIONALE: The patient has symptomatic AF with RVR and is hemodynamically
stable. The immediate first step is RATE CONTROL. IV diltiazem (non-
dihydropyridine CCB) or IV metoprolol is the first-line agent to slow AV nodal
conduction and reduce ventricular rate, improving cardiac output by allowing
longer diastolic filling time and reducing myocardial oxygen demand.
• A: Immediate cardioversion - Incorrect. Urgent cardioversion is only for
unstable patients. She has been in AF > 24 hours, so immediate
cardioversion without TEE or 3 weeks of anticoagulation risks
thromboembolic stroke.
pg. 4
NURS 5434 FAMILY III MIDTERM AND 75 ACTUAL EXAM (UTA)
NEWEST 2025/ 2026 | COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY GRADED A+|
NURS 5434 FNP III FINAL EXAM PREP (BRAND NEW!!)
NURS 5434 Family III: Comprehensive Exam Preparation
Section 1: Cardiovascular Conditions (Questions 1-15)
1. A 62-year-old male with hypertension, diabetes, and a 40-pack-year smoking
history presents with 45 minutes of crushing substernal chest pain radiating to
the left shoulder, associated with diaphoresis and nausea. BP 108/70 mmHg, HR
52 bpm. ECG reveals 3 mm ST-segment elevation in leads II, III, and aVF with
reciprocal ST depression in I and aVL. What is the MOST critical immediate next
step?
A. Administer sublingual nitroglycerin 0.4 mg
B. Administer morphine sulfate 2-4 mg IV
C. Activate EMS for immediate transport to a PCI-capable facility
D. Administer clopidogrel 600 mg loading dose
Answer: C. Activate EMS for immediate transport to a PCI-capable facility
RATIONALE: This is an acute inferior STEMI. According to ACC/AHA guidelines,
primary PCI is the preferred reperfusion strategy with a goal first medical contact-
to-device time ≤ 90 minutes. Every 30-minute delay in reperfusion increases 1-
year mortality by approximately 7.5%. Activating EMS for transport to a PCI-
capable facility is the most time-sensitive, mortality-reducing intervention.
• A: Nitroglycerin - Incorrect. Relatively contraindicated in suspected right
ventricular infarction, which complicates up to 40% of inferior MIs. The
bradycardia and borderline hypotension are red flags for RV involvement.
NTG's preload reduction could precipitate cardiovascular collapse in this
preload-dependent state.
• B: Morphine - Incorrect. A Class IIa recommendation for pain refractory to
nitrates but not the most critical step. It has been associated with slower
pg. 1
,2
onset of oral antiplatelet agents and potentially worse outcomes in
observational studies.
• D: Clopidogrel - Incorrect. DAPT is essential for STEMI management but
does not take precedence over arranging timely reperfusion therapy.
2. A 72-year-old female with heart failure with reduced ejection fraction (LVEF
30%) presents with progressive dyspnea, orthopnea, and bilateral pedal edema.
Auscultation reveals an S3 gallop, JVD, and bilateral crackles. BNP is 1,200
pg/mL. Which medication is CONTRAINDICATED in the acute management of
this exacerbation?
A. IV furosemide
B. IV nitroglycerin
C. Metoprolol (beta-blocker)
D. Morphine sulfate
Answer: C. Metoprolol (beta-blocker)
RATIONALE: Beta-blockers have negative inotropic effects and should NOT be
initiated or increased during acute decompensated heart failure. They can further
reduce cardiac output and precipitate cardiogenic shock. While beta-blockers are
a cornerstone of chronic HFrEF management (reducing mortality), they should be
initiated when the patient is euvolemic and stable, not during an acute
exacerbation.
• A: IV furosemide - Incorrect. Loop diuretics are first-line for acute
decompensated heart failure to reduce preload through diuresis.
• B: IV nitroglycerin - Incorrect. A first-line agent that reduces preload and
afterload, rapidly relieving pulmonary congestion.
• D: Morphine - Incorrect. May be used cautiously for pain and anxiety,
though it is no longer routinely recommended.
3. A 58-year-old male with diabetes, hypertension, and NSTEMI has an
echocardiogram showing LVEF 30%. His HbA1c is 9.5% on metformin and
glimepiride. Which diabetes medication should be ADDED to reduce
cardiovascular mortality?
A. Insulin glargine
pg. 2
,3
B. Empagliflozin (SGLT2 inhibitor)
C. Pioglitazone
D. Sitagliptin (DPP-4 inhibitor)
Answer: B. Empagliflozin (SGLT2 inhibitor)
RATIONALE: This patient has established ASCVD with recent NSTEMI and HFrEF.
According to ADA/EASD and AHA/ACC guidelines, an SGLT2 inhibitor
(empagliflozin, dapagliflozin) or GLP-1 receptor agonist with proven
cardiovascular benefit should be added. The EMPA-REG OUTCOME trial
demonstrated significant reduction in cardiovascular death (38% RRR) and heart
failure hospitalizations (35% RRR) with empagliflozin. Given concurrent HFrEF, an
SGLT2 inhibitor is the preferred agent because it is now a cornerstone of GDMT
for HFrEF regardless of diabetes status.
• A: Insulin glargine - Incorrect. Insulin effectively lowers glucose but does
not provide cardiovascular mortality benefit in this high-risk population.
• C: Pioglitazone - Incorrect. TZDs cause fluid retention and are potentially
dangerous in HFrEF. Contraindicated in NYHA Class III-IV heart failure.
• D: Sitagliptin - Incorrect. DPP-4 inhibitors have neutral cardiovascular
effects and do not provide mortality benefit.
4. A 48-year-old female presents with acute onset of "tearing" interscapular
back pain while lifting furniture. BP 190/110 mmHg right arm, 150/80 mmHg left
arm. Chest X-ray shows widened mediastinum. While awaiting CT angiogram for
suspected aortic dissection, what is the MOST critical hemodynamic goal?
A. Reduce systolic BP to < 120 mmHg with IV nitroprusside immediately
B. Aggressive fluid resuscitation to maintain urine output > 0.5 mL/kg/hr
C. Administer IV beta-blocker (esmolol or labetalol) to reduce HR to < 60 bpm,
then target systolic BP < 120 mmHg
D. Start heparin infusion to prevent thrombotic complications
Answer: C. Administer IV beta-blocker to reduce HR to < 60 bpm, then target
systolic BP < 120 mmHg
RATIONALE: The goal of medical management in acute aortic dissection is to
reduce the force of left ventricular contraction and the steepness of the pressure
pg. 3
, 4
wave (dP/dt), which propagates the dissection flap. IV beta-blockers are the life-
saving, first-line therapy. The target is HR < 60 bpm BEFORE arterial vasodilators
are started. Using vasodilators alone can cause reflex tachycardia and increased
myocardial contractility, worsening the dissection.
• A: Nitroprusside immediately - Incorrect. This is a classic board exam trap.
Nitroprusside alone causes reflex tachycardia and increased dP/dt,
propagating the dissection. Beta-blockade must precede vasodilation.
• B: Aggressive fluid resuscitation - Incorrect. Harmful in a hypertensive
emergency with aortic dissection; increases cardiac output and shear
stress.
• D: Heparin infusion - Incorrect. Anticoagulation is contraindicated in aortic
dissection as it worsens bleeding into the aortic wall.
5. A 68-year-old female with chronic atrial fibrillation (on rivaroxaban) presents
with palpitations and dyspnea. ECG shows AF with ventricular rate 135 bpm. BP
105/70 mmHg. She has been in this rhythm for at least 24 hours. What is the
MOST appropriate initial management?
A. Immediate direct-current synchronized cardioversion
B. IV diltiazem bolus followed by continuous infusion
C. Transesophageal echocardiogram followed by cardioversion
D. Administer amiodarone 150 mg IV bolus
Answer: B. IV diltiazem bolus followed by continuous infusion
RATIONALE: The patient has symptomatic AF with RVR and is hemodynamically
stable. The immediate first step is RATE CONTROL. IV diltiazem (non-
dihydropyridine CCB) or IV metoprolol is the first-line agent to slow AV nodal
conduction and reduce ventricular rate, improving cardiac output by allowing
longer diastolic filling time and reducing myocardial oxygen demand.
• A: Immediate cardioversion - Incorrect. Urgent cardioversion is only for
unstable patients. She has been in AF > 24 hours, so immediate
cardioversion without TEE or 3 weeks of anticoagulation risks
thromboembolic stroke.
pg. 4
