NURS 5432 Final Exam V2 | NURS 5432
Family I (FNP 1) | Actual Q&A with
Rationale (NURS5432 Final Exam) | The
University of Texas at Arlington
1. A 45-year-old male presents for a routine physical examination. His blood pressure is
152/94 mmHg today and was 148/92 mmHg at a previous visit. According to current
guidelines, what is the most appropriate next step in management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Start a thiazide diuretic and recommend lifestyle changes.
C. Begin dual therapy with an ACE inhibitor and a calcium channel blocker.
D. Perform an EKG and schedule a stress test immediately.
Answer: B
Rationale: For a patient with Stage 2 hypertension, defined as a blood pressure of 140/90
mmHg or higher, pharmacological intervention is indicated. Current clinical guidelines
recommend starting a single antihypertensive agent, such as a thiazide diuretic, alongside
significant lifestyle modifications. It is essential for the Family Nurse Practitioner to
monitor the patient’s response and adjust therapy to reach a goal of less than 130/80
mmHg.
,2. A 4-year-old child is brought to the clinic for a well-child visit. The mother asks which
vaccines are typically administered at this age. Which of the following is correct?
A. Hepatitis B, Rotavirus, and Hib
B. DTaP, IPV, MMR, and Varicella
C. Meningococcal and Tdap
D. Pneumococcal and HPV
Answer: B
Rationale: At the 4-to-6-year-old well-child visit, children typically receive the boosters for
DTaP, IPV, MMR, and Varicella. These immunizations are required by most school systems
to ensure community immunity before entering kindergarten. The Family Nurse
Practitioner must document these correctly and educate the parent on potential side
effects like mild fever or soreness at the injection site.
3. A 32-year-old female presents with a 3-day history of burning with urination and increased
frequency. She denies fever, chills, or flank pain. A urinalysis reveals positive nitrites and
leukocyte esterase. What is the most likely diagnosis?
A. Acute Pyelonephritis
B. Interstitual Cystitis
C. Uncomplicated Urinary Tract Infection
D. Asymptomatic Bacteriuria
,Answer: C
Rationale: The presence of dysuria, frequency, and positive nitrites/leukocyte esterase in
the absence of systemic symptoms like fever or flank pain is classic for an uncomplicated
UTI. Escherichia coli is the most common causative pathogen in women of childbearing age.
Treatment typically involves a short course of Nitrofurantoin or Trimethoprim-
sulfamethoxazole depending on local resistance patterns.
4. During a respiratory assessment, a patient is asked to say ‘99’ while the clinician palpates
the posterior thorax. The clinician notes increased tactile fremitus over the right lower lobe.
This finding is most suggestive of:
A. Pneumothorax
B. Pleural Effusion
C. Lobar Pneumonia
D. Chronic Obstructive Pulmonary Disease
Answer: C
Rationale: Increased tactile fremitus occurs when there is consolidation of lung tissue,
such as in lobar pneumonia, which conducts sound vibrations more effectively. Conversely,
conditions that trap air or fluid in the pleural space, like pneumothorax or effusion, will
decrease fremitus. The clinician must correlate this finding with percussion notes and
auscultatory sounds like crackles or bronchial breath sounds.
, 5. A 60-year-old female with a history of type 2 diabetes presents for a follow-up. Her A1c is
8.2% despite being on Metformin 1000mg twice daily. She has a history of atherosclerotic
cardiovascular disease (ASCVD). Which medication class should be added next?
A. Sulfonylureas
B. GLP-1 Receptor Agonist
C. DPP-4 Inhibitor
D. Insulin Glargine
Answer: B
Rationale: For patients with type 2 diabetes and established ASCVD, GLP-1 receptor
agonists or SGLT2 inhibitors with proven cardiovascular benefit are recommended as
second-line therapy after metformin. These agents have been shown to reduce major
adverse cardiovascular events in addition to lowering glucose levels. The Family Nurse
Practitioner should prioritize these classes over sulfonylureas or insulin in this specific
patient population.
6. Which of the following physical exam findings is most characteristic of Osteoarthritis (OA)
rather than Rheumatoid Arthritis (RA)?
A. Symmetrical joint involvement
B. Morning stiffness lasting more than 1 hour
C. Heberden’s nodes at the distal interphalangeal joints
D. Swan-neck deformities
Family I (FNP 1) | Actual Q&A with
Rationale (NURS5432 Final Exam) | The
University of Texas at Arlington
1. A 45-year-old male presents for a routine physical examination. His blood pressure is
152/94 mmHg today and was 148/92 mmHg at a previous visit. According to current
guidelines, what is the most appropriate next step in management?
A. Initiate lifestyle modifications only and recheck in 6 months.
B. Start a thiazide diuretic and recommend lifestyle changes.
C. Begin dual therapy with an ACE inhibitor and a calcium channel blocker.
D. Perform an EKG and schedule a stress test immediately.
Answer: B
Rationale: For a patient with Stage 2 hypertension, defined as a blood pressure of 140/90
mmHg or higher, pharmacological intervention is indicated. Current clinical guidelines
recommend starting a single antihypertensive agent, such as a thiazide diuretic, alongside
significant lifestyle modifications. It is essential for the Family Nurse Practitioner to
monitor the patient’s response and adjust therapy to reach a goal of less than 130/80
mmHg.
,2. A 4-year-old child is brought to the clinic for a well-child visit. The mother asks which
vaccines are typically administered at this age. Which of the following is correct?
A. Hepatitis B, Rotavirus, and Hib
B. DTaP, IPV, MMR, and Varicella
C. Meningococcal and Tdap
D. Pneumococcal and HPV
Answer: B
Rationale: At the 4-to-6-year-old well-child visit, children typically receive the boosters for
DTaP, IPV, MMR, and Varicella. These immunizations are required by most school systems
to ensure community immunity before entering kindergarten. The Family Nurse
Practitioner must document these correctly and educate the parent on potential side
effects like mild fever or soreness at the injection site.
3. A 32-year-old female presents with a 3-day history of burning with urination and increased
frequency. She denies fever, chills, or flank pain. A urinalysis reveals positive nitrites and
leukocyte esterase. What is the most likely diagnosis?
A. Acute Pyelonephritis
B. Interstitual Cystitis
C. Uncomplicated Urinary Tract Infection
D. Asymptomatic Bacteriuria
,Answer: C
Rationale: The presence of dysuria, frequency, and positive nitrites/leukocyte esterase in
the absence of systemic symptoms like fever or flank pain is classic for an uncomplicated
UTI. Escherichia coli is the most common causative pathogen in women of childbearing age.
Treatment typically involves a short course of Nitrofurantoin or Trimethoprim-
sulfamethoxazole depending on local resistance patterns.
4. During a respiratory assessment, a patient is asked to say ‘99’ while the clinician palpates
the posterior thorax. The clinician notes increased tactile fremitus over the right lower lobe.
This finding is most suggestive of:
A. Pneumothorax
B. Pleural Effusion
C. Lobar Pneumonia
D. Chronic Obstructive Pulmonary Disease
Answer: C
Rationale: Increased tactile fremitus occurs when there is consolidation of lung tissue,
such as in lobar pneumonia, which conducts sound vibrations more effectively. Conversely,
conditions that trap air or fluid in the pleural space, like pneumothorax or effusion, will
decrease fremitus. The clinician must correlate this finding with percussion notes and
auscultatory sounds like crackles or bronchial breath sounds.
, 5. A 60-year-old female with a history of type 2 diabetes presents for a follow-up. Her A1c is
8.2% despite being on Metformin 1000mg twice daily. She has a history of atherosclerotic
cardiovascular disease (ASCVD). Which medication class should be added next?
A. Sulfonylureas
B. GLP-1 Receptor Agonist
C. DPP-4 Inhibitor
D. Insulin Glargine
Answer: B
Rationale: For patients with type 2 diabetes and established ASCVD, GLP-1 receptor
agonists or SGLT2 inhibitors with proven cardiovascular benefit are recommended as
second-line therapy after metformin. These agents have been shown to reduce major
adverse cardiovascular events in addition to lowering glucose levels. The Family Nurse
Practitioner should prioritize these classes over sulfonylureas or insulin in this specific
patient population.
6. Which of the following physical exam findings is most characteristic of Osteoarthritis (OA)
rather than Rheumatoid Arthritis (RA)?
A. Symmetrical joint involvement
B. Morning stiffness lasting more than 1 hour
C. Heberden’s nodes at the distal interphalangeal joints
D. Swan-neck deformities
