NURS 5434 Final Exam 2026: Family Nurse Practitioner III (Family
III) Test Bank | University of Texas at Arlington (UTA) EXAM with
Questions and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Management and Hypertension Pathophysiology
2. Dyslipidemia and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Reduction
3. Diabetes Mellitus Management, Pharmacotherapy, and Glycemic Control
4. Psychiatric Disorders in Primary Care: Depression, Anxiety, and Insomnia
5. Neurological and Headache Disorders: Migraine, Tension, and Cluster Management
6. Musculoskeletal Conditions and Rheumatic Disease Evaluations
7. Preventive Medicine, Health Maintenance, and USPSTF Screening Guidelines
8. Respiratory, Endocrine, and Complex Multi-System Chronic Disease Care
9. Pharmacology, Drug Interactions, and Adverse Effect Monitoring in Advanced Practice
1. A 58-year-old man with a history of hypertension presents with sudden onset tearing chest pain
radiating to the back. His blood pressure is 180/110 mm Hg in the right arm and 100/60 mm Hg
in the left arm. What is the most appropriate next diagnostic step?
A. Obtain a 12-lead electrocardiogram (ECG) and serial cardiac troponins.
B. Order an immediate upright portable chest X-ray.
C. Perform emergent contrast-enhanced computed tomography (CT) angiography of the
chest.
, D. Consult cardiothoracic surgery immediately prior to imaging confirmation.
CORRECT ANSWER : C
Rationale: Significant blood pressure discrepancies between arms combined with tearing chest
pain radiating to the back strongly suggest an acute aortic dissection. CT angiography is the
definitive, rapid imaging modality of choice to establish the diagnosis before surgical
intervention.
2. Which medication class is proven to reduce mortality in chronic heart failure with reduced
ejection fraction (HFrEF) and should be initiated early in stable patients?
A. Thiazide diuretics
B. Beta-blockers (e.g., carvedilol, metoprolol succinate, bisoprolol)
C. Dihydropyridine calcium channel blockers
D. Short-acting oral nitrates
CORRECT ANSWER : B
Rationale: Evidence-based guidelines mandate the early use of specific evidence-based beta-
blockers (carvedilol, metoprolol succinate, or bisoprolol) in HFrEF to decrease sympathetic
overactivity, reverse left ventricular remodeling, and reduce sudden cardiac death.
3. A 52-year-old African American male presents for a routine physical examination. His blood
pressure readings over three separate clinical visits average 142/90 mm Hg. He has no significant
past medical history, takes no medications, and has a BMI of 28 kg/m². According to the 2017
ACC/AHA guidelines, how should his blood pressure be classified?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
CORRECT ANSWER : C
Rationale: According to the 2017 ACC/AHA guidelines, Stage 1 hypertension is defined as a
systolic blood pressure of 130 to 139 mm Hg OR a diastolic blood pressure of 80 to 89 mm Hg.
Although his systolic average touches Stage 2 thresholds, standard classification rules
categorize consistent readings in this bracket as Stage 1 hypertension.
,4. A 68-year-old woman is diagnosed with polymyalgia rheumatica (PMR). The nurse practitioner
is discussing first-line pharmacological management options with the patient. Which medication
is the cornerstone of initial treatment for PMR?
A. High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) alone
B. Low-to-moderate dose systemic oral corticosteroids (e.g., prednisone)
C. Biologic tumor necrosis factor (TNF) inhibitors
D. Long-acting biologic interleukin-6 receptor antagonists
CORRECT ANSWER : B
Rationale: Low-to-moderate dose systemic corticosteroids (such as prednisone 10 to 20 mg
daily) produce dramatic and rapid symptomatic relief in polymyalgia rheumatica and remain the
gold-standard first-line treatment.
5. A 48-year-old Black male with uncomplicated hypertension is being initiated on
pharmacotherapy. Based on evidence-based guidelines and physiological factors common in this
population (such as enhanced renal sodium reabsorption), which initial drug classes are
recommended?
A. Angiotensin-converting enzyme (ACE) inhibitors alone
B. Beta-blockers as monotherapy
C. Thiazide diuretics or calcium channel blockers (CCBs)
D. Direct renin inhibitors
CORRECT ANSWER : C
Rationale: Clinical guidelines recommend initiating antihypertensive therapy in Black patients
with either a thiazide diuretic or a calcium channel blocker as first-line agents, as they
demonstrate superior blood pressure reduction due to lower baseline renin profiles.
6. A middle-aged woman who has taken a therapeutic dose of lorazepam daily for the past 6 years
wishes to discontinue the medication. You advise her regarding discontinuation:
A. She can discontinue the drug immediately if she believes it no longer helps her symptoms.
B. She should undergo a slow, structured taper over weeks to months to avoid severe
withdrawal symptoms like tremors and seizures.
, C. Rapid withdrawal in this situation is completely safe and typically results only in mild
gastrointestinal upset.
D. Benzodiazepines do not require tapering regardless of duration of use.
CORRECT ANSWER : B
Rationale: Long-term benzodiazepine use induces physical dependence; abrupt cessation can
trigger severe, life-threatening withdrawal symptoms, including tremors, hallucinations,
seizures, and severe anxiety. A gradual taper is mandatory.
7. A patient with type 2 diabetes mellitus is started on basal insulin in addition to three oral
antidiabetic medications. To minimize hypoglycemia risk and optimize rational polypharmacy
according to clinical pearls, which oral agent category should typically be reduced or
discontinued?
A. Metformin
B. Sulfonylureas (e.g., glipizide)
C. Sodium-glucose cotransporter 2 (SGLT2) inhibitors
D. Glucagon- like peptide-1 (GLP-1) receptor agonists
CORRECT ANSWER : B
Rationale: Sulfonylureas stimulate insulin secretion independently of blood glucose levels,
carrying a high risk of hypoglycemia when combined with exogenous basal insulin. Metformin
and SGLT2 inhibitors have low intrinsic hypoglycemia risk.
8. When prescribing a nutritional and meal plan for a type 2 diabetic patient, which macronutrient
is primarily responsible for postprandial hyperglycemia?
A. Dietary fats
B. Lean proteins
C. Carbohydrates
D. Complex saturated lipids
CORRECT ANSWER : C
Rationale: Dietary carbohydrates are broken down directly into glucose during digestion,
making them the primary macronutrient driving postprandial blood glucose elevations in
individuals with diabetes.
III) Test Bank | University of Texas at Arlington (UTA) EXAM with
Questions and Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Advanced Cardiovascular Management and Hypertension Pathophysiology
2. Dyslipidemia and Atherosclerotic Cardiovascular Disease (ASCVD) Risk Reduction
3. Diabetes Mellitus Management, Pharmacotherapy, and Glycemic Control
4. Psychiatric Disorders in Primary Care: Depression, Anxiety, and Insomnia
5. Neurological and Headache Disorders: Migraine, Tension, and Cluster Management
6. Musculoskeletal Conditions and Rheumatic Disease Evaluations
7. Preventive Medicine, Health Maintenance, and USPSTF Screening Guidelines
8. Respiratory, Endocrine, and Complex Multi-System Chronic Disease Care
9. Pharmacology, Drug Interactions, and Adverse Effect Monitoring in Advanced Practice
1. A 58-year-old man with a history of hypertension presents with sudden onset tearing chest pain
radiating to the back. His blood pressure is 180/110 mm Hg in the right arm and 100/60 mm Hg
in the left arm. What is the most appropriate next diagnostic step?
A. Obtain a 12-lead electrocardiogram (ECG) and serial cardiac troponins.
B. Order an immediate upright portable chest X-ray.
C. Perform emergent contrast-enhanced computed tomography (CT) angiography of the
chest.
, D. Consult cardiothoracic surgery immediately prior to imaging confirmation.
CORRECT ANSWER : C
Rationale: Significant blood pressure discrepancies between arms combined with tearing chest
pain radiating to the back strongly suggest an acute aortic dissection. CT angiography is the
definitive, rapid imaging modality of choice to establish the diagnosis before surgical
intervention.
2. Which medication class is proven to reduce mortality in chronic heart failure with reduced
ejection fraction (HFrEF) and should be initiated early in stable patients?
A. Thiazide diuretics
B. Beta-blockers (e.g., carvedilol, metoprolol succinate, bisoprolol)
C. Dihydropyridine calcium channel blockers
D. Short-acting oral nitrates
CORRECT ANSWER : B
Rationale: Evidence-based guidelines mandate the early use of specific evidence-based beta-
blockers (carvedilol, metoprolol succinate, or bisoprolol) in HFrEF to decrease sympathetic
overactivity, reverse left ventricular remodeling, and reduce sudden cardiac death.
3. A 52-year-old African American male presents for a routine physical examination. His blood
pressure readings over three separate clinical visits average 142/90 mm Hg. He has no significant
past medical history, takes no medications, and has a BMI of 28 kg/m². According to the 2017
ACC/AHA guidelines, how should his blood pressure be classified?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
CORRECT ANSWER : C
Rationale: According to the 2017 ACC/AHA guidelines, Stage 1 hypertension is defined as a
systolic blood pressure of 130 to 139 mm Hg OR a diastolic blood pressure of 80 to 89 mm Hg.
Although his systolic average touches Stage 2 thresholds, standard classification rules
categorize consistent readings in this bracket as Stage 1 hypertension.
,4. A 68-year-old woman is diagnosed with polymyalgia rheumatica (PMR). The nurse practitioner
is discussing first-line pharmacological management options with the patient. Which medication
is the cornerstone of initial treatment for PMR?
A. High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) alone
B. Low-to-moderate dose systemic oral corticosteroids (e.g., prednisone)
C. Biologic tumor necrosis factor (TNF) inhibitors
D. Long-acting biologic interleukin-6 receptor antagonists
CORRECT ANSWER : B
Rationale: Low-to-moderate dose systemic corticosteroids (such as prednisone 10 to 20 mg
daily) produce dramatic and rapid symptomatic relief in polymyalgia rheumatica and remain the
gold-standard first-line treatment.
5. A 48-year-old Black male with uncomplicated hypertension is being initiated on
pharmacotherapy. Based on evidence-based guidelines and physiological factors common in this
population (such as enhanced renal sodium reabsorption), which initial drug classes are
recommended?
A. Angiotensin-converting enzyme (ACE) inhibitors alone
B. Beta-blockers as monotherapy
C. Thiazide diuretics or calcium channel blockers (CCBs)
D. Direct renin inhibitors
CORRECT ANSWER : C
Rationale: Clinical guidelines recommend initiating antihypertensive therapy in Black patients
with either a thiazide diuretic or a calcium channel blocker as first-line agents, as they
demonstrate superior blood pressure reduction due to lower baseline renin profiles.
6. A middle-aged woman who has taken a therapeutic dose of lorazepam daily for the past 6 years
wishes to discontinue the medication. You advise her regarding discontinuation:
A. She can discontinue the drug immediately if she believes it no longer helps her symptoms.
B. She should undergo a slow, structured taper over weeks to months to avoid severe
withdrawal symptoms like tremors and seizures.
, C. Rapid withdrawal in this situation is completely safe and typically results only in mild
gastrointestinal upset.
D. Benzodiazepines do not require tapering regardless of duration of use.
CORRECT ANSWER : B
Rationale: Long-term benzodiazepine use induces physical dependence; abrupt cessation can
trigger severe, life-threatening withdrawal symptoms, including tremors, hallucinations,
seizures, and severe anxiety. A gradual taper is mandatory.
7. A patient with type 2 diabetes mellitus is started on basal insulin in addition to three oral
antidiabetic medications. To minimize hypoglycemia risk and optimize rational polypharmacy
according to clinical pearls, which oral agent category should typically be reduced or
discontinued?
A. Metformin
B. Sulfonylureas (e.g., glipizide)
C. Sodium-glucose cotransporter 2 (SGLT2) inhibitors
D. Glucagon- like peptide-1 (GLP-1) receptor agonists
CORRECT ANSWER : B
Rationale: Sulfonylureas stimulate insulin secretion independently of blood glucose levels,
carrying a high risk of hypoglycemia when combined with exogenous basal insulin. Metformin
and SGLT2 inhibitors have low intrinsic hypoglycemia risk.
8. When prescribing a nutritional and meal plan for a type 2 diabetic patient, which macronutrient
is primarily responsible for postprandial hyperglycemia?
A. Dietary fats
B. Lean proteins
C. Carbohydrates
D. Complex saturated lipids
CORRECT ANSWER : C
Rationale: Dietary carbohydrates are broken down directly into glucose during digestion,
making them the primary macronutrient driving postprandial blood glucose elevations in
individuals with diabetes.
