NURS 5432 Final Exam V3 | NURS 5432
Family I (FNP 1) | Actual Q&A with
Rationale (NURS5432 Final Exam) | The
University of Texas at Arlington
1. A 62-year-old male with a history of hypertension and tobacco use presents with a sudden
onset of ‘the worst headache of my life.’ On examination, he has nuchal rigidity. What is the
most likely diagnosis?
A. Migraine headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Tension-type headache
Answer: C
Rationale: Subarachnoid hemorrhage typically presents with a ‘thunderclap’ headache,
often described as the worst headache ever experienced. Nuchal rigidity is a common
finding due to meningeal irritation from blood in the subarachnoid space. Immediate
neurosurgical consultation and imaging are required to manage this life-threatening
condition.
2. According to the JNC 8 guidelines, what is the goal blood pressure for a 65-year-old patient
with no history of diabetes or chronic kidney disease?
A. < 120/80 mmHg
,B. < 130/80 mmHg
C. < 140/90 mmHg
D. < 150/90 mmHg
Answer: D
Rationale: The JNC 8 guidelines specify a blood pressure goal of less than 150/90 mmHg
for adults aged 60 and older who do not have diabetes or CKD. This recommendation aims
to balance the benefits of blood pressure reduction against the risks of hypotension and
polypharmacy in older populations. More aggressive targets may be considered based on
individual clinical judgment and newer guidelines, but JNC 8 remains a foundational
syllabus point.
3. A 45-year-old female presents with fatigue, cold intolerance, and weight gain. Lab results
show an elevated TSH and a low Free T4. Which of the following is the most appropriate
initial treatment?
A. Methimazole
B. Levothyroxine 1.6 mcg/kg/day
C. Radioactive iodine ablation
D. Propranolol
Answer: B
, Rationale: Levothyroxine is the standard of care for primary hypothyroidism,
characterized by high TSH and low T4. The full replacement dose for a healthy adult is
approximately 1.6 mcg/kg/day based on ideal body weight. It is crucial to monitor TSH
levels every 6 to 8 weeks after initiation or dose adjustments to ensure therapeutic efficacy.
4. In a patient diagnosed with Community-Acquired Pneumonia (CAP) who is healthy and has
no recent antibiotic use, what is the first-line empirical antibiotic choice per current
guidelines?
A. Levofloxacin
B. Amoxicillin 1g TID
C. Ciprofloxacin
D. Vancomycin
Answer: B
Rationale: Current ATS/IDSA guidelines for CAP in outpatient settings now recommend
high-dose Amoxicillin as a primary option for healthy individuals without comorbidities.
Macrolides are only recommended if local pneumococcal resistance is less than 25 percent.
Fluoroquinolones like Levofloxacin are reserved for patients with significant comorbidities
or recent antibiotic use.
5. A patient presents with a ‘honey-colored’ crusted lesion around the nose and mouth.
Which pathogen is most likely responsible for this condition?
A. Streptococcus pyogenes
Family I (FNP 1) | Actual Q&A with
Rationale (NURS5432 Final Exam) | The
University of Texas at Arlington
1. A 62-year-old male with a history of hypertension and tobacco use presents with a sudden
onset of ‘the worst headache of my life.’ On examination, he has nuchal rigidity. What is the
most likely diagnosis?
A. Migraine headache
B. Cluster headache
C. Subarachnoid hemorrhage
D. Tension-type headache
Answer: C
Rationale: Subarachnoid hemorrhage typically presents with a ‘thunderclap’ headache,
often described as the worst headache ever experienced. Nuchal rigidity is a common
finding due to meningeal irritation from blood in the subarachnoid space. Immediate
neurosurgical consultation and imaging are required to manage this life-threatening
condition.
2. According to the JNC 8 guidelines, what is the goal blood pressure for a 65-year-old patient
with no history of diabetes or chronic kidney disease?
A. < 120/80 mmHg
,B. < 130/80 mmHg
C. < 140/90 mmHg
D. < 150/90 mmHg
Answer: D
Rationale: The JNC 8 guidelines specify a blood pressure goal of less than 150/90 mmHg
for adults aged 60 and older who do not have diabetes or CKD. This recommendation aims
to balance the benefits of blood pressure reduction against the risks of hypotension and
polypharmacy in older populations. More aggressive targets may be considered based on
individual clinical judgment and newer guidelines, but JNC 8 remains a foundational
syllabus point.
3. A 45-year-old female presents with fatigue, cold intolerance, and weight gain. Lab results
show an elevated TSH and a low Free T4. Which of the following is the most appropriate
initial treatment?
A. Methimazole
B. Levothyroxine 1.6 mcg/kg/day
C. Radioactive iodine ablation
D. Propranolol
Answer: B
, Rationale: Levothyroxine is the standard of care for primary hypothyroidism,
characterized by high TSH and low T4. The full replacement dose for a healthy adult is
approximately 1.6 mcg/kg/day based on ideal body weight. It is crucial to monitor TSH
levels every 6 to 8 weeks after initiation or dose adjustments to ensure therapeutic efficacy.
4. In a patient diagnosed with Community-Acquired Pneumonia (CAP) who is healthy and has
no recent antibiotic use, what is the first-line empirical antibiotic choice per current
guidelines?
A. Levofloxacin
B. Amoxicillin 1g TID
C. Ciprofloxacin
D. Vancomycin
Answer: B
Rationale: Current ATS/IDSA guidelines for CAP in outpatient settings now recommend
high-dose Amoxicillin as a primary option for healthy individuals without comorbidities.
Macrolides are only recommended if local pneumococcal resistance is less than 25 percent.
Fluoroquinolones like Levofloxacin are reserved for patients with significant comorbidities
or recent antibiotic use.
5. A patient presents with a ‘honey-colored’ crusted lesion around the nose and mouth.
Which pathogen is most likely responsible for this condition?
A. Streptococcus pyogenes
