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NURS 5338 FAMILY CLINICAL PRACTICE II FINAL EXAM
GRADUATE-LEVEL ADVANCED PRACTICE NURSING
COMPLETE (140) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
NURSING
Prepare effectively for the NURS 5338 Family Clinical Practice II Final Exam with this
focused study resource. It supports review of advanced family practice concepts,
health assessment, diagnosis, treatment planning, clinical management, and
evidence-based patient care. Use the material to reinforce your clinical knowledge,
review key topics, and identify areas that may require additional study. This resource
is suited for graduate-level advanced practice nursing students, family nurse
practitioner learners, and candidates preparing for the NURS 5338 final examination.
MULTIPLE CHOICE.
Section 1: Cardiovascular Disorders – Advanced Primary Care
Management (Questions 1-20)
1. A 62-year-old male with a history of hypertension presents with a blood
pressure of 152/94 mmHg on three separate occasions. He has no other
comorbidities. According to the Eighth Joint National Committee (JNC 8)
guidelines, what is the initial treatment goal for this patient?
A) < 130/80 mmHg
B) < 140/90 mmHg
C) < 150/90 mmHg
D) < 160/100 mmHg
Answer: B
Rationale: For adults aged < 60 years, the JNC 8 guideline recommends a
blood pressure target of < 140/90 mmHg. For adults aged ≥ 60 years, the
target is < 150/90 mmHg.
2. A 55-year-old male with a 30-pack-year smoking history presents with
intermittent chest pressure that occurs with exertion and is relieved by
rest. He has risk factors including hypertension and hyperlipidemia. What
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is the most appropriate initial diagnostic test?
A) Exercise stress test
B) Coronary angiography
C) Resting electrocardiogram (ECG)
D) Chest X-ray
Answer: A
Rationale: Exercise stress testing is the initial diagnostic test of choice for
stable angina, as it assesses for inducible ischemia. A resting ECG may be
normal in stable angina.
3. A 68-year-old female with a history of heart failure presents with
worsening dyspnea, orthopnea, and bilateral lower extremity edema. She
has gained 5 pounds in the past week. Which medication should be
considered first to manage her volume overload?
A) Digoxin
B) Metoprolol
C) Furosemide
D) Lisinopril
Answer: C
Rationale: Furosemide is a loop diuretic that reduces volume overload in
acute heart failure exacerbations by promoting sodium and water
excretion, relieving symptoms of dyspnea and edema.
4. A 65-year-old female with a history of hypertension and diabetes
presents with sudden-onset, painless vision loss in her right eye.
Fundoscopic examination reveals a pale retina with a cherry-red spot.
What is the most likely diagnosis?
A) Retinal vein occlusion
B) Central retinal artery occlusion
C) Glaucoma
D) Diabetic retinopathy
Answer: B
Rationale: Central retinal artery occlusion presents with sudden, painless
vision loss and a cherry-red spot on fundoscopic exam. This is an ocular
emergency requiring immediate referral.
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5. A 75-year-old male with atrial fibrillation is prescribed warfarin for
stroke prevention. His International Normalized Ratio (INR) is 4.5. He has
no signs of bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg orally
B) Hold warfarin and recheck INR in 1–2 days
C) Administer fresh frozen plasma
D) Increase the warfarin dose
Answer: B
Rationale: For an asymptomatic INR between 4.0 and 5.0, holding warfarin
and rechecking INR in 1–2 days is appropriate. Vitamin K is reserved for
INR > 5.0 with bleeding risk or active bleeding.
6. A 60-year-old female presents with palpitations, fatigue, and mild
shortness of breath. Her ECG shows an irregularly irregular rhythm with
no discernible P waves. What is the most appropriate initial
pharmacological management?
A) Amiodarone
B) Digoxin
C) Metoprolol
D) Diltiazem
Answer: C
Rationale: Metoprolol (a beta-blocker) is first-line for rate control in atrial
fibrillation. Diltiazem can also be used for rate control, but beta-blockers
are preferred in patients with coronary artery disease or heart failure.
7. A 58-year-old male with a history of hypertension presents with a blood
pressure of 145/92 mmHg. His serum creatinine is 1.4 mg/dL. Which
antihypertensive class is preferred in patients with chronic kidney
disease?
A) ACE inhibitors or ARBs
B) Thiazide diuretics
C) Beta-blockers
D) Calcium channel blockers
Answer: A
Rationale: ACE inhibitors and ARBs have renoprotective effects and are
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preferred in patients with chronic kidney disease (CKD) and proteinuria,
as they reduce intraglomerular pressure and slow CKD progression.
8. A 70-year-old female presents with acute-onset chest pain,
diaphoresis, and nausea. ECG shows ST-segment elevation in the anterior
leads. What is the most appropriate immediate management?
A) Aspirin, nitroglycerin, morphine, and primary percutaneous coronary
intervention (PCI)
B) Aspirin and observation
C) Nitroglycerin and discharge
D) Oral anticoagulation and discharge
Answer: A
Rationale: STEMI requires immediate reperfusion therapy. Primary PCI is
preferred if available within 90 minutes. Aspirin, nitroglycerin, and
morphine are adjunctive therapies.
9. A 62-year-old male presents with a blood pressure of 188/110 mmHg on
two separate occasions. He is asymptomatic. What is the most
appropriate initial management?
A) Admit to the hospital for intravenous antihypertensive therapy
B) Start oral antihypertensive therapy and monitor closely
C) Recheck blood pressure in 1 week
D) Order a computed tomography (CT) scan of the head
Answer: B
Rationale: Asymptomatic severe hypertension (stage 2) can be managed
with oral antihypertensive therapy in the outpatient setting. Hypertensive
emergency requires admission and parenteral therapy.
10. A 65-year-old female with hyperlipidemia is started on atorvastatin 20
mg daily. She reports new-onset muscle aches and weakness. Her
creatine kinase (CK) level is elevated. What is the most appropriate next
step?
A) Increase the atorvastatin dose
B) Discontinue atorvastatin and monitor symptoms
C) Add ezetimibe to the regimen
D) Prescribe a non-steroidal anti-inflammatory drug (NSAID) for pain
NURS 5338 FAMILY CLINICAL PRACTICE II FINAL EXAM
GRADUATE-LEVEL ADVANCED PRACTICE NURSING
COMPLETE (140) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
NURSING
Prepare effectively for the NURS 5338 Family Clinical Practice II Final Exam with this
focused study resource. It supports review of advanced family practice concepts,
health assessment, diagnosis, treatment planning, clinical management, and
evidence-based patient care. Use the material to reinforce your clinical knowledge,
review key topics, and identify areas that may require additional study. This resource
is suited for graduate-level advanced practice nursing students, family nurse
practitioner learners, and candidates preparing for the NURS 5338 final examination.
MULTIPLE CHOICE.
Section 1: Cardiovascular Disorders – Advanced Primary Care
Management (Questions 1-20)
1. A 62-year-old male with a history of hypertension presents with a blood
pressure of 152/94 mmHg on three separate occasions. He has no other
comorbidities. According to the Eighth Joint National Committee (JNC 8)
guidelines, what is the initial treatment goal for this patient?
A) < 130/80 mmHg
B) < 140/90 mmHg
C) < 150/90 mmHg
D) < 160/100 mmHg
Answer: B
Rationale: For adults aged < 60 years, the JNC 8 guideline recommends a
blood pressure target of < 140/90 mmHg. For adults aged ≥ 60 years, the
target is < 150/90 mmHg.
2. A 55-year-old male with a 30-pack-year smoking history presents with
intermittent chest pressure that occurs with exertion and is relieved by
rest. He has risk factors including hypertension and hyperlipidemia. What
, Page 2 of 49
is the most appropriate initial diagnostic test?
A) Exercise stress test
B) Coronary angiography
C) Resting electrocardiogram (ECG)
D) Chest X-ray
Answer: A
Rationale: Exercise stress testing is the initial diagnostic test of choice for
stable angina, as it assesses for inducible ischemia. A resting ECG may be
normal in stable angina.
3. A 68-year-old female with a history of heart failure presents with
worsening dyspnea, orthopnea, and bilateral lower extremity edema. She
has gained 5 pounds in the past week. Which medication should be
considered first to manage her volume overload?
A) Digoxin
B) Metoprolol
C) Furosemide
D) Lisinopril
Answer: C
Rationale: Furosemide is a loop diuretic that reduces volume overload in
acute heart failure exacerbations by promoting sodium and water
excretion, relieving symptoms of dyspnea and edema.
4. A 65-year-old female with a history of hypertension and diabetes
presents with sudden-onset, painless vision loss in her right eye.
Fundoscopic examination reveals a pale retina with a cherry-red spot.
What is the most likely diagnosis?
A) Retinal vein occlusion
B) Central retinal artery occlusion
C) Glaucoma
D) Diabetic retinopathy
Answer: B
Rationale: Central retinal artery occlusion presents with sudden, painless
vision loss and a cherry-red spot on fundoscopic exam. This is an ocular
emergency requiring immediate referral.
, Page 3 of 49
5. A 75-year-old male with atrial fibrillation is prescribed warfarin for
stroke prevention. His International Normalized Ratio (INR) is 4.5. He has
no signs of bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg orally
B) Hold warfarin and recheck INR in 1–2 days
C) Administer fresh frozen plasma
D) Increase the warfarin dose
Answer: B
Rationale: For an asymptomatic INR between 4.0 and 5.0, holding warfarin
and rechecking INR in 1–2 days is appropriate. Vitamin K is reserved for
INR > 5.0 with bleeding risk or active bleeding.
6. A 60-year-old female presents with palpitations, fatigue, and mild
shortness of breath. Her ECG shows an irregularly irregular rhythm with
no discernible P waves. What is the most appropriate initial
pharmacological management?
A) Amiodarone
B) Digoxin
C) Metoprolol
D) Diltiazem
Answer: C
Rationale: Metoprolol (a beta-blocker) is first-line for rate control in atrial
fibrillation. Diltiazem can also be used for rate control, but beta-blockers
are preferred in patients with coronary artery disease or heart failure.
7. A 58-year-old male with a history of hypertension presents with a blood
pressure of 145/92 mmHg. His serum creatinine is 1.4 mg/dL. Which
antihypertensive class is preferred in patients with chronic kidney
disease?
A) ACE inhibitors or ARBs
B) Thiazide diuretics
C) Beta-blockers
D) Calcium channel blockers
Answer: A
Rationale: ACE inhibitors and ARBs have renoprotective effects and are
, Page 4 of 49
preferred in patients with chronic kidney disease (CKD) and proteinuria,
as they reduce intraglomerular pressure and slow CKD progression.
8. A 70-year-old female presents with acute-onset chest pain,
diaphoresis, and nausea. ECG shows ST-segment elevation in the anterior
leads. What is the most appropriate immediate management?
A) Aspirin, nitroglycerin, morphine, and primary percutaneous coronary
intervention (PCI)
B) Aspirin and observation
C) Nitroglycerin and discharge
D) Oral anticoagulation and discharge
Answer: A
Rationale: STEMI requires immediate reperfusion therapy. Primary PCI is
preferred if available within 90 minutes. Aspirin, nitroglycerin, and
morphine are adjunctive therapies.
9. A 62-year-old male presents with a blood pressure of 188/110 mmHg on
two separate occasions. He is asymptomatic. What is the most
appropriate initial management?
A) Admit to the hospital for intravenous antihypertensive therapy
B) Start oral antihypertensive therapy and monitor closely
C) Recheck blood pressure in 1 week
D) Order a computed tomography (CT) scan of the head
Answer: B
Rationale: Asymptomatic severe hypertension (stage 2) can be managed
with oral antihypertensive therapy in the outpatient setting. Hypertensive
emergency requires admission and parenteral therapy.
10. A 65-year-old female with hyperlipidemia is started on atorvastatin 20
mg daily. She reports new-onset muscle aches and weakness. Her
creatine kinase (CK) level is elevated. What is the most appropriate next
step?
A) Increase the atorvastatin dose
B) Discontinue atorvastatin and monitor symptoms
C) Add ezetimibe to the regimen
D) Prescribe a non-steroidal anti-inflammatory drug (NSAID) for pain
