NURS 5434 FAMILY III FINAL EXAM 200 ACTUAL QUESTIONS AND
CORRECT AANSWERS WITH RATIONALE LATEST UPDATE
ALREADY GRADED A+ ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions designed for advanced family nursing
practice. Each question presents a realistic clinical scenario across the
lifespan, with a correct answer and a detailed, evidence-based rationale that
explains pathophysiology, pharmacology, and clinical reasoning. Content
covers complex chronic conditions, acute exacerbations, women's health,
geriatrics, rheumatology, endocrinology, cardiology, pulmonology, and
neurology. No questions are repeated, and all text is plain for easy study. This
bank strengthens diagnostic skills, therapeutic decision-making, and
pharmacotherapeutic knowledge essential for family nurse practitioner
certification and high-stakes final examinations.
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with a new onset
of hemoptysis and weight loss. A chest x-ray shows a right hilar mass. Which
diagnostic test is most definitive for diagnosing lung cancer?
A) Sputum cytology
B) Computed tomography of the chest
C) Bronchoscopy with biopsy
D) Positron emission tomography scan
Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic examination,
which is the gold standard for diagnosing lung cancer. Sputum cytology and
imaging studies are suggestive but not definitive. PET scans are used for staging,
not initial diagnosis.
Question 2
A 45-year-old female with a family history of breast cancer presents with a new,
painless, firm breast lump. She has no nipple discharge or skin changes. What is
the most appropriate next step?
A) Reassurance and follow-up in 6 months
B) Prescribe oral contraceptives to reduce hormonal stimulation
,C) Order a diagnostic mammogram and breast ultrasound
D) Refer directly for surgical excision
Answer: C
Rationale: A new, firm, painless lump in a patient with a family history of breast
cancer requires imaging. A diagnostic mammogram and targeted ultrasound are the
standard next steps to evaluate the lump. Biopsy would follow if imaging is
concerning.
Question 3
A 72-year-old male with benign prostatic hyperplasia reports worsening urinary
frequency, nocturia, and a weak stream. His international prostate symptom score
is 22. Which medication is most appropriate as first-line therapy?
A) Finasteride
B) Tamsulosin
C) Dutasteride
D) Oxybutynin
Answer: B
Rationale: Tamsulosin is an alpha-blocker that relaxes smooth muscle in the
prostate and bladder neck, providing rapid symptom relief. Finasteride and
dutasteride (5-alpha-reductase inhibitors) are used for larger prostates and take
months to work. Oxybutynin is for overactive bladder, not obstructive symptoms.
Question 4
A 55-year-old obese female with hypertension and hyperlipidemia presents with
right upper quadrant pain after meals. Ultrasound reveals gallstones. What is the
most appropriate management?
A) Low-fat diet and observation
B) Ursodeoxycholic acid therapy
C) Laparoscopic cholecystectomy
D) Endoscopic retrograde cholangiopancreatography
Answer: C
Rationale: Symptomatic cholelithiasis with postprandial pain is best managed with
laparoscopic cholecystectomy. Observation is for asymptomatic stones.
Ursodeoxycholic acid is used for small cholesterol stones in patients who cannot
have surgery. ERCP is for common bile duct stones.
Question 5
A 65-year-old male with type 2 diabetes has a hemoglobin A1c of 8.5% despite
metformin 2000 mg daily. He has no contraindications. Which medication should
be added as second-line therapy?
,A) Glipizide
B) Pioglitazone
C) Semaglutide
D) Insulin glargine
Answer: C
Rationale: Semaglutide is a GLP-1 receptor agonist that provides significant A1c
reduction and weight loss. It is often preferred over sulfonylureas and
thiazolidinediones due to cardiovascular benefits. Insulin is usually later in the
treatment algorithm.
Question 6
A 28-year-old pregnant female at 34 weeks gestation presents with new onset of
headache, visual disturbances, and blood pressure of 160/100 mm Hg. Urine
protein is 3 grams per 24 hours. What is the most appropriate immediate
management?
A) Oral labetalol and outpatient monitoring
B) Magnesium sulfate and urgent delivery planning
C) Bed rest and dietary sodium restriction
D) Methyldopa and fetal monitoring twice weekly
Answer: B
Rationale: This patient has severe preeclampsia with concerning neurologic
symptoms. Magnesium sulfate is given for seizure prophylaxis, and delivery is the
definitive treatment. Outpatient management is unsafe. Bed rest and sodium
restriction are not effective.
Question 7
A 60-year-old male with a history of chronic obstructive pulmonary disease
presents with worsening dyspnea, increased sputum production, and fever. He is
using accessory muscles and has an oxygen saturation of 89%. What is the most
appropriate initial intervention?
A) Start oral prednisone and antibiotics
B) Initiate noninvasive positive pressure ventilation
C) Administer bronchodilators and systemic corticosteroids
D) Intubate and initiate mechanical ventilation
Answer: C
Rationale: The initial management of an acute exacerbation includes
bronchodilators and systemic corticosteroids. Noninvasive ventilation may be
added if the patient does not respond. Intubation is reserved for failure of
noninvasive ventilation or severe respiratory failure.
, Question 8
A 50-year-old female with a history of systemic lupus erythematosus presents with
joint pain, malar rash, and fatigue. She is on hydroxychloroquine. Which screening
test is essential for this patient?
A) Liver function tests
B) Renal function tests and urinalysis
C) Complete blood count
D) Ophthalmologic examination
Answer: D
Rationale: Hydroxychloroquine can cause retinal toxicity, and patients should have
baseline and annual ophthalmologic examinations. Renal function, CBC, and liver
tests are also important for SLE but are not specific to hydroxychloroquine
monitoring.
Question 9
A 45-year-old male with a history of alcohol use disorder presents with jaundice,
ascites, and confusion. Laboratory tests show elevated ammonia and prolonged
prothrombin time. What is the most appropriate treatment for his confusion?
A) Lactulose
B) Neomycin
C) Rifaximin
D) Spironolactone
Answer: A
Rationale: Lactulose is first-line therapy for hepatic encephalopathy. It acidifies the
colon, traps ammonia, and promotes its excretion. Rifaximin and neomycin are
adjunctive antibiotics. Spironolactone is for ascites, not encephalopathy.
Question 10
A 32-year-old female presents with palpitations, heat intolerance, weight loss, and
a diffuse goiter. Thyroid function tests show low TSH and high free T4. Which
medication is most appropriate for initial management?
A) Propylthiouracil
B) Methimazole
C) Levothyroxine
D) Radioactive iodine
Answer: B
Rationale: Methimazole is the preferred thioamide for hyperthyroidism due to
fewer adverse effects and once-daily dosing. Propylthiouracil is used in the first
trimester of pregnancy. Levothyroxine would worsen hyperthyroidism.
Radioactive iodine is definitive but not first-line for initial control.
CORRECT AANSWERS WITH RATIONALE LATEST UPDATE
ALREADY GRADED A+ ASSURED PASS
This comprehensive examination bank features 200 unique, single-best-
answer multiple-choice questions designed for advanced family nursing
practice. Each question presents a realistic clinical scenario across the
lifespan, with a correct answer and a detailed, evidence-based rationale that
explains pathophysiology, pharmacology, and clinical reasoning. Content
covers complex chronic conditions, acute exacerbations, women's health,
geriatrics, rheumatology, endocrinology, cardiology, pulmonology, and
neurology. No questions are repeated, and all text is plain for easy study. This
bank strengthens diagnostic skills, therapeutic decision-making, and
pharmacotherapeutic knowledge essential for family nurse practitioner
certification and high-stakes final examinations.
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with a new onset
of hemoptysis and weight loss. A chest x-ray shows a right hilar mass. Which
diagnostic test is most definitive for diagnosing lung cancer?
A) Sputum cytology
B) Computed tomography of the chest
C) Bronchoscopy with biopsy
D) Positron emission tomography scan
Answer: C
Rationale: Bronchoscopy with biopsy provides tissue for histologic examination,
which is the gold standard for diagnosing lung cancer. Sputum cytology and
imaging studies are suggestive but not definitive. PET scans are used for staging,
not initial diagnosis.
Question 2
A 45-year-old female with a family history of breast cancer presents with a new,
painless, firm breast lump. She has no nipple discharge or skin changes. What is
the most appropriate next step?
A) Reassurance and follow-up in 6 months
B) Prescribe oral contraceptives to reduce hormonal stimulation
,C) Order a diagnostic mammogram and breast ultrasound
D) Refer directly for surgical excision
Answer: C
Rationale: A new, firm, painless lump in a patient with a family history of breast
cancer requires imaging. A diagnostic mammogram and targeted ultrasound are the
standard next steps to evaluate the lump. Biopsy would follow if imaging is
concerning.
Question 3
A 72-year-old male with benign prostatic hyperplasia reports worsening urinary
frequency, nocturia, and a weak stream. His international prostate symptom score
is 22. Which medication is most appropriate as first-line therapy?
A) Finasteride
B) Tamsulosin
C) Dutasteride
D) Oxybutynin
Answer: B
Rationale: Tamsulosin is an alpha-blocker that relaxes smooth muscle in the
prostate and bladder neck, providing rapid symptom relief. Finasteride and
dutasteride (5-alpha-reductase inhibitors) are used for larger prostates and take
months to work. Oxybutynin is for overactive bladder, not obstructive symptoms.
Question 4
A 55-year-old obese female with hypertension and hyperlipidemia presents with
right upper quadrant pain after meals. Ultrasound reveals gallstones. What is the
most appropriate management?
A) Low-fat diet and observation
B) Ursodeoxycholic acid therapy
C) Laparoscopic cholecystectomy
D) Endoscopic retrograde cholangiopancreatography
Answer: C
Rationale: Symptomatic cholelithiasis with postprandial pain is best managed with
laparoscopic cholecystectomy. Observation is for asymptomatic stones.
Ursodeoxycholic acid is used for small cholesterol stones in patients who cannot
have surgery. ERCP is for common bile duct stones.
Question 5
A 65-year-old male with type 2 diabetes has a hemoglobin A1c of 8.5% despite
metformin 2000 mg daily. He has no contraindications. Which medication should
be added as second-line therapy?
,A) Glipizide
B) Pioglitazone
C) Semaglutide
D) Insulin glargine
Answer: C
Rationale: Semaglutide is a GLP-1 receptor agonist that provides significant A1c
reduction and weight loss. It is often preferred over sulfonylureas and
thiazolidinediones due to cardiovascular benefits. Insulin is usually later in the
treatment algorithm.
Question 6
A 28-year-old pregnant female at 34 weeks gestation presents with new onset of
headache, visual disturbances, and blood pressure of 160/100 mm Hg. Urine
protein is 3 grams per 24 hours. What is the most appropriate immediate
management?
A) Oral labetalol and outpatient monitoring
B) Magnesium sulfate and urgent delivery planning
C) Bed rest and dietary sodium restriction
D) Methyldopa and fetal monitoring twice weekly
Answer: B
Rationale: This patient has severe preeclampsia with concerning neurologic
symptoms. Magnesium sulfate is given for seizure prophylaxis, and delivery is the
definitive treatment. Outpatient management is unsafe. Bed rest and sodium
restriction are not effective.
Question 7
A 60-year-old male with a history of chronic obstructive pulmonary disease
presents with worsening dyspnea, increased sputum production, and fever. He is
using accessory muscles and has an oxygen saturation of 89%. What is the most
appropriate initial intervention?
A) Start oral prednisone and antibiotics
B) Initiate noninvasive positive pressure ventilation
C) Administer bronchodilators and systemic corticosteroids
D) Intubate and initiate mechanical ventilation
Answer: C
Rationale: The initial management of an acute exacerbation includes
bronchodilators and systemic corticosteroids. Noninvasive ventilation may be
added if the patient does not respond. Intubation is reserved for failure of
noninvasive ventilation or severe respiratory failure.
, Question 8
A 50-year-old female with a history of systemic lupus erythematosus presents with
joint pain, malar rash, and fatigue. She is on hydroxychloroquine. Which screening
test is essential for this patient?
A) Liver function tests
B) Renal function tests and urinalysis
C) Complete blood count
D) Ophthalmologic examination
Answer: D
Rationale: Hydroxychloroquine can cause retinal toxicity, and patients should have
baseline and annual ophthalmologic examinations. Renal function, CBC, and liver
tests are also important for SLE but are not specific to hydroxychloroquine
monitoring.
Question 9
A 45-year-old male with a history of alcohol use disorder presents with jaundice,
ascites, and confusion. Laboratory tests show elevated ammonia and prolonged
prothrombin time. What is the most appropriate treatment for his confusion?
A) Lactulose
B) Neomycin
C) Rifaximin
D) Spironolactone
Answer: A
Rationale: Lactulose is first-line therapy for hepatic encephalopathy. It acidifies the
colon, traps ammonia, and promotes its excretion. Rifaximin and neomycin are
adjunctive antibiotics. Spironolactone is for ascites, not encephalopathy.
Question 10
A 32-year-old female presents with palpitations, heat intolerance, weight loss, and
a diffuse goiter. Thyroid function tests show low TSH and high free T4. Which
medication is most appropriate for initial management?
A) Propylthiouracil
B) Methimazole
C) Levothyroxine
D) Radioactive iodine
Answer: B
Rationale: Methimazole is the preferred thioamide for hyperthyroidism due to
fewer adverse effects and once-daily dosing. Propylthiouracil is used in the first
trimester of pregnancy. Levothyroxine would worsen hyperthyroidism.
Radioactive iodine is definitive but not first-line for initial control.
