NURS 5434 Final Exam Test Bank (2026) | Family Nurse Practitioner III
(Family III) | University of Texas at Arlington (UTA) – Complete Questions,
Verified Answers & Rationales Guide
Question 1
A 54-year-old male presents with acute, severe pain, redness, and swelling in his
right first metatarsophalangeal (MTP) joint that woke him up from sleep. Joint
aspirate reveals needle-shaped, negatively birefringent crystals under polarized
light. Which of the following is the most appropriate first-line pharmacologic
treatment for this acute episode?
A) Allopurinol 100 mg daily
B) Indomethacin 50 mg three times daily
C) Febuxostat 40 mg daily
D) Probenecid 250 mg twice daily
VERIFIED ANSWER: B) Indomethacin 50 mg three times daily
EXPLANATION: The clinical presentation and joint aspirate findings are
diagnostic for an acute gouty arthritis flare. First-line treatment for an
acute gout attack includes Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
such as indomethacin, systemic or intra-articular corticosteroids, or low-
dose colchicine. Urate-lowering therapies (ULT) like allopurinol and
febuxostat, or uricosuric drugs like probenecid, should not be initiated or
altered during an acute flare as sudden shifts in serum urate levels can
prolong or worsen the active attack.
Question 2
,A 68-year-old female with a history of hypertension and chronic kidney disease
(CKD Stage 3) presents with a new onset of severe, unilateral temporal headache,
scalp tenderness when brushing her hair, and jaw claudication while chewing. Her
erythrocyte sedimentation rate (ESR) is markedly elevated at 95 mm/hr. What is
the most critical immediate next step in management to prevent irreversible
complications?
A) Schedule an outpatient temporal artery biopsy within 2 weeks and await results
before treating.
B) Initiate high-dose systemic corticosteroid therapy (e.g., Prednisone 40–60 mg
daily) immediately.
) Order an urgent brain MRI with contrast to rule out an ischemic stroke.
D) Prescribe Sumatriptan 50 mg at the onset of the next headache episode.
VERIFIED ANSWER: B) Initiate high-dose systemic corticosteroid therapy
(e.g., Prednisone 40–60 mg daily) immediately.
EXPLANATION: The patient’s clinical picture is highly suggestive of Giant Cell
Arteritis (GCA) or Temporal Arteritis, a medical emergency. The most
severe complication of untreated GCA is permanent, irreversible blindness
due to anterior ischemic optic neuropathy. Because of this risk, high-dose
systemic corticosteroids must be started immediately upon clinical
suspicion, even before a temporal artery biopsy is performed to confirm
the diagnosis.
Question 3
A 32-year-old female presents to the clinic complaining of symmetrical joint
stiffness and pain in her bilateral wrists, MCP, and PIP joints for the past 8 weeks.
She notes that her morning stiffness lasts for more than an hour before
,improving with activity. Laboratory testing is positive for Rheumatoid Factor (RF)
and Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies. Which class of
medication should be initiated early to retard structural joint damage?
A) Intermittent oral acetaminophen
B) Disease-Modifying Antirheumatic Drugs (DMARDs) such as methotrexate
C) Long-term oral prednisone monotherapy
D) Schedulable high-dose naproxen
VERIFIED ANSWER: B) Disease-Modifying Antirheumatic Drugs (DMARDs)
such as methotrexate
EXPLANATION: The patient meets the diagnostic criteria for Rheumatoid
Arthritis (RA) based on symptom duration (>6 weeks), symmetrical small
joint involvement, and positive serology (RF and highly specific anti-CCP).
Current guidelines mandate the early introduction of non-biologic DMARDs,
primarily methotrexate, within 3 months of diagnosis to slow or arrest
disease progression and prevent irreversible joint erosions and
deformities. NSAIDs and steroids are used purely as bridging therapies for
symptomatic relief.
Question 4
A 45-year-old female patient complains of profound fatigue, widespread
musculoskeletal pain in 12 distinct anatomical zones for over 6 months, and
unrefreshing sleep. Physical examination reveals localized tenderness upon digital
palpation of specific tender points without any signs of joint inflammation,
swelling, or structural deformity. Comprehensive lab work (CBC, CMP, TSH, ESR,
and ANA) is entirely normal. Which of the following represents the most
appropriate initial management strategy?
, A) Initiating long-term oral opioid therapy for comprehensive pain control.
B) Prescribing low-dose Amitriptyline at bedtime along with a graded aerobic
exercise program.
C) Ordering a repeat autoimmune panel in 4 weeks to identify late-onset systemic
lupus erythematosus.
D) Instructing the patient to rest completely and avoid all physical exertion.
VERIFIED ANSWER: B) Prescribing low-dose Amitriptyline at bedtime along
with a graded aerobic exercise program.
EXPLANATION: This clinical presentation matches Fibromyalgia, a central
pain amplification disorder characterized by widespread pain, fatigue, sleep
disturbances, and normal inflammatory markers. Management is
multifaceted, focusing on non-pharmacologic and pharmacologic
interventions. Low-dose tricyclic antidepressants (like amitriptyline)
improve sleep architecture and modulate pain pathways. Graded aerobic
exercise (such as swimming or walking) is highly evidence-based to reduce
symptoms, while opioids are strongly discouraged.
Question 5
A 23-year-old male presents with gradual onset of dull, lower back pain and
severe morning stiffness over the past 9 months. He reports that the pain
improves significantly with physical activity and hot showers but worsens with
periods of prolonged rest. A pelvic X-ray reveals bilateral sacroiliitis. Which
genetic marker is most strongly associated with this condition?
A) HLA-DR4
B) HLA-B27
(Family III) | University of Texas at Arlington (UTA) – Complete Questions,
Verified Answers & Rationales Guide
Question 1
A 54-year-old male presents with acute, severe pain, redness, and swelling in his
right first metatarsophalangeal (MTP) joint that woke him up from sleep. Joint
aspirate reveals needle-shaped, negatively birefringent crystals under polarized
light. Which of the following is the most appropriate first-line pharmacologic
treatment for this acute episode?
A) Allopurinol 100 mg daily
B) Indomethacin 50 mg three times daily
C) Febuxostat 40 mg daily
D) Probenecid 250 mg twice daily
VERIFIED ANSWER: B) Indomethacin 50 mg three times daily
EXPLANATION: The clinical presentation and joint aspirate findings are
diagnostic for an acute gouty arthritis flare. First-line treatment for an
acute gout attack includes Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
such as indomethacin, systemic or intra-articular corticosteroids, or low-
dose colchicine. Urate-lowering therapies (ULT) like allopurinol and
febuxostat, or uricosuric drugs like probenecid, should not be initiated or
altered during an acute flare as sudden shifts in serum urate levels can
prolong or worsen the active attack.
Question 2
,A 68-year-old female with a history of hypertension and chronic kidney disease
(CKD Stage 3) presents with a new onset of severe, unilateral temporal headache,
scalp tenderness when brushing her hair, and jaw claudication while chewing. Her
erythrocyte sedimentation rate (ESR) is markedly elevated at 95 mm/hr. What is
the most critical immediate next step in management to prevent irreversible
complications?
A) Schedule an outpatient temporal artery biopsy within 2 weeks and await results
before treating.
B) Initiate high-dose systemic corticosteroid therapy (e.g., Prednisone 40–60 mg
daily) immediately.
) Order an urgent brain MRI with contrast to rule out an ischemic stroke.
D) Prescribe Sumatriptan 50 mg at the onset of the next headache episode.
VERIFIED ANSWER: B) Initiate high-dose systemic corticosteroid therapy
(e.g., Prednisone 40–60 mg daily) immediately.
EXPLANATION: The patient’s clinical picture is highly suggestive of Giant Cell
Arteritis (GCA) or Temporal Arteritis, a medical emergency. The most
severe complication of untreated GCA is permanent, irreversible blindness
due to anterior ischemic optic neuropathy. Because of this risk, high-dose
systemic corticosteroids must be started immediately upon clinical
suspicion, even before a temporal artery biopsy is performed to confirm
the diagnosis.
Question 3
A 32-year-old female presents to the clinic complaining of symmetrical joint
stiffness and pain in her bilateral wrists, MCP, and PIP joints for the past 8 weeks.
She notes that her morning stiffness lasts for more than an hour before
,improving with activity. Laboratory testing is positive for Rheumatoid Factor (RF)
and Anti-Cyclic Citrullinated Peptide (anti-CCP) antibodies. Which class of
medication should be initiated early to retard structural joint damage?
A) Intermittent oral acetaminophen
B) Disease-Modifying Antirheumatic Drugs (DMARDs) such as methotrexate
C) Long-term oral prednisone monotherapy
D) Schedulable high-dose naproxen
VERIFIED ANSWER: B) Disease-Modifying Antirheumatic Drugs (DMARDs)
such as methotrexate
EXPLANATION: The patient meets the diagnostic criteria for Rheumatoid
Arthritis (RA) based on symptom duration (>6 weeks), symmetrical small
joint involvement, and positive serology (RF and highly specific anti-CCP).
Current guidelines mandate the early introduction of non-biologic DMARDs,
primarily methotrexate, within 3 months of diagnosis to slow or arrest
disease progression and prevent irreversible joint erosions and
deformities. NSAIDs and steroids are used purely as bridging therapies for
symptomatic relief.
Question 4
A 45-year-old female patient complains of profound fatigue, widespread
musculoskeletal pain in 12 distinct anatomical zones for over 6 months, and
unrefreshing sleep. Physical examination reveals localized tenderness upon digital
palpation of specific tender points without any signs of joint inflammation,
swelling, or structural deformity. Comprehensive lab work (CBC, CMP, TSH, ESR,
and ANA) is entirely normal. Which of the following represents the most
appropriate initial management strategy?
, A) Initiating long-term oral opioid therapy for comprehensive pain control.
B) Prescribing low-dose Amitriptyline at bedtime along with a graded aerobic
exercise program.
C) Ordering a repeat autoimmune panel in 4 weeks to identify late-onset systemic
lupus erythematosus.
D) Instructing the patient to rest completely and avoid all physical exertion.
VERIFIED ANSWER: B) Prescribing low-dose Amitriptyline at bedtime along
with a graded aerobic exercise program.
EXPLANATION: This clinical presentation matches Fibromyalgia, a central
pain amplification disorder characterized by widespread pain, fatigue, sleep
disturbances, and normal inflammatory markers. Management is
multifaceted, focusing on non-pharmacologic and pharmacologic
interventions. Low-dose tricyclic antidepressants (like amitriptyline)
improve sleep architecture and modulate pain pathways. Graded aerobic
exercise (such as swimming or walking) is highly evidence-based to reduce
symptoms, while opioids are strongly discouraged.
Question 5
A 23-year-old male presents with gradual onset of dull, lower back pain and
severe morning stiffness over the past 9 months. He reports that the pain
improves significantly with physical activity and hot showers but worsens with
periods of prolonged rest. A pelvic X-ray reveals bilateral sacroiliitis. Which
genetic marker is most strongly associated with this condition?
A) HLA-DR4
B) HLA-B27
