NURS 5434 FNP III UTA Family Nursing
Comprehensive Resource
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Covering Prevention, Wellness, Cardiometabolic, Psychiatric, Acute & Chronic
Conditions, USPSTF Guidelines, and Advanced Primary Care Management
1. A 68-year-old woman presents with hypertension and blood pressure
readings of 152-158/92-96 mmHg documented over two months on three
different occasions. ECG and creatinine are normal, and she has no proteinuria.
Clinical findings include BMI 26.4 kg/m², no S3, S4, or murmur, and the point of
maximal impulse is within normal range. Which of the following represents the
best initial intervention?
A. DASH Diet and Lifestyle Modifications
B. Initiate Metoprolol
C. Initiate HCTZ
D. Initiate Clonidine
Valid answer:: C
Explanation: Based on the 2017 ACC/AHA Hypertension Guidelines, this patient
has Stage 1 hypertension (130-139/80-89 mmHg) with an elevated 10-year ASCVD
risk or Stage 2 hypertension (≥140/90 mmHg). Thiazide diuretics such as HCTZ are
recommended as first-line therapy for hypertension in patients without compelling
indications. Lifestyle modifications alone would be insufficient given the sustained
elevated readings over two months. Beta-blockers like Metoprolol are not first-line
unless there is a compelling indication such as heart failure or coronary artery
disease. Clonidine is not a first-line agent for initial hypertension management.
2. A patient is started on Escitalopram for depression. The patient returns 48
hours later and reports feeling "worse" with increased anxiety, insomnia, and
,restlessness. What is the most appropriate response by the FNP?
A. Discontinue the medication immediately and switch to a different SSRI
B. Reassure the patient that these symptoms are common during the first 1-2
weeks of therapy and may improve
C. Increase the dose to accelerate therapeutic effect
D. Add a benzodiazepine for immediate symptom control
Valid answer:: B
Explanation: Escitalopram, like other SSRIs, can cause initial side effects
including increased anxiety, agitation, and insomnia during the first 1-2 weeks of
treatment before therapeutic benefits are realized. This is a well-documented
phenomenon. Reassurance and monitoring are appropriate. Discontinuing
abruptly is not indicated unless symptoms are severe. Increasing the dose too
quickly can worsen side effects. Adding a benzodiazepine may be considered in
severe cases but is not the most appropriate initial response.
3. Which of the following waist circumference measurements qualifies a man for
a diagnosis of Metabolic Syndrome according to the National Cholesterol
Education Program ATP III criteria?
A. ≥ 28 inches
B. ≥ 30 inches
C. ≥ 35 inches
D. ≥ 40 inches
Valid answer:: D
Explanation: The NCEP ATP III criteria define Metabolic Syndrome as the
presence of three or more of the following: waist circumference ≥40 inches (102
cm) in men or ≥35 inches (88 cm) in women, triglycerides ≥150 mg/dL, HDL <40
mg/dL in men or <50 mg/dL in women, blood pressure ≥130/85 mmHg, and
fasting glucose ≥100 mg/dL. A waist circumference ≥40 inches is the threshold for
men.
,4. Reactive arthritis (Reiter Syndrome) is characterized by which of the following
classic triad of symptoms?
A. Eczema, neuropathy, and tendonitis
B. Carditis, glomerulonephritis, and psoriasis
C. Arthritis, conjunctivitis, and urethritis
D. Pruritus, psoriasis, and ulcerative colitis
Valid answer:: C
Explanation: Reactive arthritis (Reiter Syndrome) is classically characterized by
the triad of arthritis, conjunctivitis, and urethritis. The mnemonic "Can't pee, can't
see, can't climb a tree" helps recall urethritis, conjunctivitis, and arthritis. It
typically occurs following a gastrointestinal or genitourinary infection.
5. A patient asks the FNP about the difference between a Family Nurse
Practitioner (FNP) and a Physician Assistant (PA). Which of the following
statements is most accurate regarding the educational preparation of FNPs?
A. FNPs are trained in the medical model; PAs are trained in the nursing model
B. FNPs are trained in the nursing model with a focus on holistic, patient-centered
care
C. FNPs cannot prescribe controlled substances
D. FNPs are required to complete a medical residency
Valid answer:: B
Explanation: FNPs are educated in the nursing model, which emphasizes holistic,
patient-centered care, health promotion, and disease prevention. PAs are trained
in the medical model. FNPs can prescribe controlled substances in all states (with
appropriate DEA registration). FNPs do not complete medical residencies; they
complete advanced practice clinical training as part of their graduate education.
6. A patient presents with anterior lymphadenopathy. Which of the following is
the most common associated etiology?
A. Epstein-Barr virus infection
, B. Streptococcus pharyngitis
C. HIV infection
D. Tuberculosis
Valid answer:: B
Explanation: Anterior cervical lymphadenopathy is most commonly associated
with Streptococcus pharyngitis (strep throat). While Epstein-Barr virus
(mononucleosis) can cause lymphadenopathy, it more commonly presents with
posterior cervical lymphadenopathy. HIV and tuberculosis can also cause
lymphadenopathy but are less common causes of isolated anterior cervical
lymphadenopathy.
7. According to the USPSTF grading system, which of the following grades
indicates a recommendation to "offer or provide this service"?
A. Grade A
B. Grade B
C. Grade C
D. Grades A and B
Valid answer:: D
Explanation: The USPSTF assigns Grade A (high certainty of substantial net
benefit) and Grade B (high certainty of moderate net benefit or moderate certainty
of moderate to substantial net benefit) to services that are recommended. Grade C
indicates selective offering based on professional judgment and patient
preferences.
8. A 55-year-old male with a 30-pack-year smoking history presents for a routine
health maintenance visit. According to USPSTF guidelines, which of the
following screening tests should be recommended?
A. Annual chest X-ray
B. Low-dose CT scan annually for lung cancer
C. Sputum cytology annually
Comprehensive Resource
Questions 1 - 200
Advanced / Hard / Mixed Difficulty
Covering Prevention, Wellness, Cardiometabolic, Psychiatric, Acute & Chronic
Conditions, USPSTF Guidelines, and Advanced Primary Care Management
1. A 68-year-old woman presents with hypertension and blood pressure
readings of 152-158/92-96 mmHg documented over two months on three
different occasions. ECG and creatinine are normal, and she has no proteinuria.
Clinical findings include BMI 26.4 kg/m², no S3, S4, or murmur, and the point of
maximal impulse is within normal range. Which of the following represents the
best initial intervention?
A. DASH Diet and Lifestyle Modifications
B. Initiate Metoprolol
C. Initiate HCTZ
D. Initiate Clonidine
Valid answer:: C
Explanation: Based on the 2017 ACC/AHA Hypertension Guidelines, this patient
has Stage 1 hypertension (130-139/80-89 mmHg) with an elevated 10-year ASCVD
risk or Stage 2 hypertension (≥140/90 mmHg). Thiazide diuretics such as HCTZ are
recommended as first-line therapy for hypertension in patients without compelling
indications. Lifestyle modifications alone would be insufficient given the sustained
elevated readings over two months. Beta-blockers like Metoprolol are not first-line
unless there is a compelling indication such as heart failure or coronary artery
disease. Clonidine is not a first-line agent for initial hypertension management.
2. A patient is started on Escitalopram for depression. The patient returns 48
hours later and reports feeling "worse" with increased anxiety, insomnia, and
,restlessness. What is the most appropriate response by the FNP?
A. Discontinue the medication immediately and switch to a different SSRI
B. Reassure the patient that these symptoms are common during the first 1-2
weeks of therapy and may improve
C. Increase the dose to accelerate therapeutic effect
D. Add a benzodiazepine for immediate symptom control
Valid answer:: B
Explanation: Escitalopram, like other SSRIs, can cause initial side effects
including increased anxiety, agitation, and insomnia during the first 1-2 weeks of
treatment before therapeutic benefits are realized. This is a well-documented
phenomenon. Reassurance and monitoring are appropriate. Discontinuing
abruptly is not indicated unless symptoms are severe. Increasing the dose too
quickly can worsen side effects. Adding a benzodiazepine may be considered in
severe cases but is not the most appropriate initial response.
3. Which of the following waist circumference measurements qualifies a man for
a diagnosis of Metabolic Syndrome according to the National Cholesterol
Education Program ATP III criteria?
A. ≥ 28 inches
B. ≥ 30 inches
C. ≥ 35 inches
D. ≥ 40 inches
Valid answer:: D
Explanation: The NCEP ATP III criteria define Metabolic Syndrome as the
presence of three or more of the following: waist circumference ≥40 inches (102
cm) in men or ≥35 inches (88 cm) in women, triglycerides ≥150 mg/dL, HDL <40
mg/dL in men or <50 mg/dL in women, blood pressure ≥130/85 mmHg, and
fasting glucose ≥100 mg/dL. A waist circumference ≥40 inches is the threshold for
men.
,4. Reactive arthritis (Reiter Syndrome) is characterized by which of the following
classic triad of symptoms?
A. Eczema, neuropathy, and tendonitis
B. Carditis, glomerulonephritis, and psoriasis
C. Arthritis, conjunctivitis, and urethritis
D. Pruritus, psoriasis, and ulcerative colitis
Valid answer:: C
Explanation: Reactive arthritis (Reiter Syndrome) is classically characterized by
the triad of arthritis, conjunctivitis, and urethritis. The mnemonic "Can't pee, can't
see, can't climb a tree" helps recall urethritis, conjunctivitis, and arthritis. It
typically occurs following a gastrointestinal or genitourinary infection.
5. A patient asks the FNP about the difference between a Family Nurse
Practitioner (FNP) and a Physician Assistant (PA). Which of the following
statements is most accurate regarding the educational preparation of FNPs?
A. FNPs are trained in the medical model; PAs are trained in the nursing model
B. FNPs are trained in the nursing model with a focus on holistic, patient-centered
care
C. FNPs cannot prescribe controlled substances
D. FNPs are required to complete a medical residency
Valid answer:: B
Explanation: FNPs are educated in the nursing model, which emphasizes holistic,
patient-centered care, health promotion, and disease prevention. PAs are trained
in the medical model. FNPs can prescribe controlled substances in all states (with
appropriate DEA registration). FNPs do not complete medical residencies; they
complete advanced practice clinical training as part of their graduate education.
6. A patient presents with anterior lymphadenopathy. Which of the following is
the most common associated etiology?
A. Epstein-Barr virus infection
, B. Streptococcus pharyngitis
C. HIV infection
D. Tuberculosis
Valid answer:: B
Explanation: Anterior cervical lymphadenopathy is most commonly associated
with Streptococcus pharyngitis (strep throat). While Epstein-Barr virus
(mononucleosis) can cause lymphadenopathy, it more commonly presents with
posterior cervical lymphadenopathy. HIV and tuberculosis can also cause
lymphadenopathy but are less common causes of isolated anterior cervical
lymphadenopathy.
7. According to the USPSTF grading system, which of the following grades
indicates a recommendation to "offer or provide this service"?
A. Grade A
B. Grade B
C. Grade C
D. Grades A and B
Valid answer:: D
Explanation: The USPSTF assigns Grade A (high certainty of substantial net
benefit) and Grade B (high certainty of moderate net benefit or moderate certainty
of moderate to substantial net benefit) to services that are recommended. Grade C
indicates selective offering based on professional judgment and patient
preferences.
8. A 55-year-old male with a 30-pack-year smoking history presents for a routine
health maintenance visit. According to USPSTF guidelines, which of the
following screening tests should be recommended?
A. Annual chest X-ray
B. Low-dose CT scan annually for lung cancer
C. Sputum cytology annually
