NURS 5433 FNP II Final Exam Review Family
Nursing Actual Exam 2026/2027 – University of
Texas at Arlington UTA – Complete Questions
and Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
=====================================================
===========
DOMAIN 1: Acute & Episodic Conditions in Primary Care (30
Questions)
Q1: A 6-year-old male presents with fever, sore throat, and difficulty swallowing for 2
days. He has no cough or rhinorrhea. Vitals: Temp 102.5°F, HR 110, RR 20. Exam
reveals Tonsillar exudates and tender anterior cervical adenopathy. A rapid strep
antigen test is positive. What is the MOST appropriate treatment?
A. Supportive care only [CORRECT]
B. Amoxicillin 50 mg/kg/day once daily for 10 days
C. Azithromycin 5 mg/kg/day for 5 days
D. Cephalexin 25 mg/kg/day divided BID for 10 days
Correct Answer: B
Rationale: Per IDSA guidelines, amoxicillin is the first-line treatment for Group A
Streptococcal pharyngitis due to its efficacy, narrow spectrum, and safety profile. The
once-daily dosing option (50 mg/kg) improves adherence. Azithromycin is not first-line
due to macrolide resistance, and Cephalexin is not the drug of choice for GAS (though
effective for other conditions). Supportive care is insufficient for confirmed GAS to
prevent rheumatic fever.
FNP Pearl: Amoxicillin can be given once daily for GAS pharyngitis (not BID), which is a
major "board pearl" to remember.
Q2: A 34-year-old female presents with 7 days of nasal congestion, purulent nasal
discharge, and maxillary tooth pain. She reports double sickening (improvement then
worsening). What is the NEXT best step in management?
A. Amoxicillin-clavulanate (Augmentin) 875/125 mg BID for 5-7 days
B. Nasal endoscopy
,C. CT Sinus without contrast
D. Supportive care and reassurance [CORRECT]
Correct Answer: A
Rationale: This patient meets clinical criteria for acute bacterial rhinosinusitis (ABRS):
persistent symptoms >10 days OR onset with severe symptoms/fever >39°C OR
"double sickening." She has double sickening for 7 days with purulence and tooth pain
(odontogenic pain suggests maxillary involvement). First-line therapy is
Amoxicillin-clavulanate. Imaging (CT/Endoscopy) is reserved for complicated cases or
treatment failure. Supportive care is incorrect as she meets criteria for antibiotics.
FNP Pearl: "Double sickening" is a classic board buzzword for bacterial sinusitis
requiring antibiotics.
Q3: A 2-year-old female is diagnosed with Acute Otitis Media (AOM). She has no
history of recurrent otitis media or penicillin allergy. She is febrile and irritable. What is
the first-line treatment?
A. Amoxicillin 80-90 mg/kg/day divided BID for 5-7 days [CORRECT]
B. Azithromycin 10 mg/kg Day 1, then 5 mg/kg Days 2-5
C. Amoxicillin-clavulanate 90 mg/kg/day divided BID
D. Cefdinir 14 mg/kg/day divided BID
Correct Answer: A
Rationale: The 2023 AAP guidelines for AOM recommend high-dose Amoxicillin (80-90
mg/kg/day) as first-line for uncomplicated AOM in children without penicillin allergy or
recent amoxicillin use (within 30 days). Duration is 5-7 days for children 2-12 years.
Azithromycin and Cefdinir are second-line. Amoxicillin-clavulanate is reserved for
treatment failure or recent antibiotic use.
FNP Pearl: High-dose amoxicillin is needed to overcome resistant S. pneumoniae in the
middle ear.
Q4 (SATA): A 65-year-old male presents with sudden onset cough, fever (101°F), and
rigors. Vitals: BP 130/80, HR 100, RR 24, O2 Sat 92% on room air. Exam reveals rales
in the right lower lobe. CURB-65 score is calculated. Which of the following factors are
included in the CURB-65 score?
A. Confusion [CORRECT]
B. Urea >19 mg/dL (or BUN >20 mg/dL) [CORRECT]
C. Respiratory Rate ≥ 30 [CORRECT]
D. Systolic BP < 90 mmHg or Diastolic ≤ 60 mmHg [CORRECT]
E. Age ≥ 65 [CORRECT]
Correct Answer: A, B, C, D, E
Rationale: CURB-65 is a mortality risk stratification tool for Community-Acquired
Pneumonia (CAP). It stands for Confusion, Urea, Respiratory rate, Blood pressure, and
age 65+. A score of 0-1 usually allows outpatient treatment; score ≥2 requires
,hospitalization consideration. This patient has RR 24 (not ≥30), BP normal, Age 65, no
mention of confusion or Urea. His score is 1 (Age), likely qualifying for outpatient
treatment if stable.
FNP Pearl: Know the cutoffs strictly. RR must be 30 or more to score a point in
CURB-65.
Q5: A 25-year-old female presents with dysuria, urinary frequency, and suprapubic pain
for 2 days. She has no fever or flank pain. Urinalysis shows leukocyte esterase positive
and nitrite positive. She has no known drug allergies. What is the best treatment?
A. Nitrofurantoin 100 mg BID for 5 days [CORRECT]
B. Ciprofloxacin 500 mg daily for 3 days
C. Trimethoprim-sulfamethoxazole (TMP-SMX) DS BID for 3 days
D. Amoxicillin-clavulanate 875 mg BID for 7 days
Correct Answer: A
Rationale: This is uncomplicated cystitis. First-line agents include Nitrofurantoin,
TMP-SMX (if local resistance <20%), and Fosfomycin. Nitrofluantoin is a safe,
broad-spectrum choice for cystitis (does not achieve good tissue levels for
pyelonephritis). Ciprofloxacin is a fluoroquinolone; guidelines restrict its use for
uncomplicated UTIs due to side effects and resistance concerns.
Amoxicillin-clavulanate has poor efficacy for E. coli in the bladder.
FNP Pearl: Fluoroquinolones (Levaquin/Cipro) should be avoided for simple
uncomplicated cystitis unless no other options exist (resistance/allergy).
Q6 (Calculation): A 4-year-old male (15 kg) is diagnosed with Acute Otitis Media. You
prescribe high-dose Amoxicillin (90 mg/kg/day). The pharmacy stocks Amoxicillin
suspension 400mg/5mL. What is the volume per dose (BID dosing)?
A. 3.75 mL
B. 4.7 mL
C. 8.4 mL [CORRECT]
D. 10 mL
Correct Answer: C
*Rationale:
1. Calculate total daily dose: 15 kg x 90 mg/kg = 1350 mg/day.
2. Divide for BID dosing: 1350 mg / 2 = 675 mg per dose.
3. Calculate concentration: 400 mg / 5 mL = 80 mg/mL.
Calculate volume: 675 mg / 80 mg/mL = 8.4375 mL.
4. FNP Pearl: Always double-check if the prescription is for the total daily dose or
per dose. AOM dosing is typically divided BID.
, Q7: A 40-year-old female presents with a painful, red, swollen area on her right leg. She
has a fever of 100.8°F and significant warmth. No purulence or drainage is noted. What
is the most appropriate diagnosis and treatment?
A. Erysipelas; Cephalexin 500 mg QID
B. Cellulitis; Cephalexin 500 mg QID [CORRECT]
C. Necrotizing fasciitis; Immediate surgical consult
D. Contact dermatitis; Topical steroid
Correct Answer: B
Rationale: The presentation is consistent with non-purulent cellulitis. Systemic signs
(fever) are present, indicating oral antibiotics are needed. Cephalexin (1st gen
cephalosporin) covers Strep and Staph (MSSA). Erysipelas is a superficial cellulitis with
distinct raised margins; treatment is similar, but Cellulitis is the broader, more common
term. Necrotizing fasciitis would present with profound pain, out of proportion to exam,
crepitus, and systemic toxicity.
FNP Pearl: For purulent cellulitis (abscess/pus), think MRSA (TMP-SMX/Clindamycin).
For non-purulent, think Strep (Cephalexin/Dicloxacillin).
Q8 (SATA): A 22-year-old male presents with severe perirectal pain. Exam reveals a
fluctuant, tender, indurated mass near the anus. He has no fever. What are the
appropriate management steps?
A. Incision and Drainage (I&D) [CORRECT]
B. Culture of the purulent fluid [CORRECT]
C. Prescription for Cephalexin
D. Packing of the wound [CORRECT]
E. MRI of the pelvis
Correct Answer: A, B, D
Rationale: This is a perirectal abscess. The primary treatment is I&D. Cultures are
recommended, especially for recurrent MRSA concerns. Wound packing may be
indicated depending on the size, though simple I&D is often sufficient for small
abscesses. Antibiotics are NOT routinely indicated for simple abscess I&D unless the
patient has systemic signs of infection (fever, tachycardia), extensive cellulitis, or
comorbidities (diabetes, immunocompromised). This patient is afebrile and healthy. MRI
is for suspected deep space infection (perianal fistula/complex abscess) which is not
indicated here.
FNP Pearl: "The knife heals." I&D is the treatment for an abscess. Antibiotics are
adjunctive only in specific systemic cases.
Q9: A 29-year-old female presents with RLQ pain, nausea, and anorexia. Vitals: Temp
100.5°F. Exam reveals positive McBurney’s point tenderness and positive Rovsing’s
sign. What is the diagnostic test of choice?
A. Abdominal Ultrasound
Nursing Actual Exam 2026/2027 – University of
Texas at Arlington UTA – Complete Questions
and Answers with Detailed Rationales – Pass
Guaranteed – A+ Graded
=====================================================
===========
DOMAIN 1: Acute & Episodic Conditions in Primary Care (30
Questions)
Q1: A 6-year-old male presents with fever, sore throat, and difficulty swallowing for 2
days. He has no cough or rhinorrhea. Vitals: Temp 102.5°F, HR 110, RR 20. Exam
reveals Tonsillar exudates and tender anterior cervical adenopathy. A rapid strep
antigen test is positive. What is the MOST appropriate treatment?
A. Supportive care only [CORRECT]
B. Amoxicillin 50 mg/kg/day once daily for 10 days
C. Azithromycin 5 mg/kg/day for 5 days
D. Cephalexin 25 mg/kg/day divided BID for 10 days
Correct Answer: B
Rationale: Per IDSA guidelines, amoxicillin is the first-line treatment for Group A
Streptococcal pharyngitis due to its efficacy, narrow spectrum, and safety profile. The
once-daily dosing option (50 mg/kg) improves adherence. Azithromycin is not first-line
due to macrolide resistance, and Cephalexin is not the drug of choice for GAS (though
effective for other conditions). Supportive care is insufficient for confirmed GAS to
prevent rheumatic fever.
FNP Pearl: Amoxicillin can be given once daily for GAS pharyngitis (not BID), which is a
major "board pearl" to remember.
Q2: A 34-year-old female presents with 7 days of nasal congestion, purulent nasal
discharge, and maxillary tooth pain. She reports double sickening (improvement then
worsening). What is the NEXT best step in management?
A. Amoxicillin-clavulanate (Augmentin) 875/125 mg BID for 5-7 days
B. Nasal endoscopy
,C. CT Sinus without contrast
D. Supportive care and reassurance [CORRECT]
Correct Answer: A
Rationale: This patient meets clinical criteria for acute bacterial rhinosinusitis (ABRS):
persistent symptoms >10 days OR onset with severe symptoms/fever >39°C OR
"double sickening." She has double sickening for 7 days with purulence and tooth pain
(odontogenic pain suggests maxillary involvement). First-line therapy is
Amoxicillin-clavulanate. Imaging (CT/Endoscopy) is reserved for complicated cases or
treatment failure. Supportive care is incorrect as she meets criteria for antibiotics.
FNP Pearl: "Double sickening" is a classic board buzzword for bacterial sinusitis
requiring antibiotics.
Q3: A 2-year-old female is diagnosed with Acute Otitis Media (AOM). She has no
history of recurrent otitis media or penicillin allergy. She is febrile and irritable. What is
the first-line treatment?
A. Amoxicillin 80-90 mg/kg/day divided BID for 5-7 days [CORRECT]
B. Azithromycin 10 mg/kg Day 1, then 5 mg/kg Days 2-5
C. Amoxicillin-clavulanate 90 mg/kg/day divided BID
D. Cefdinir 14 mg/kg/day divided BID
Correct Answer: A
Rationale: The 2023 AAP guidelines for AOM recommend high-dose Amoxicillin (80-90
mg/kg/day) as first-line for uncomplicated AOM in children without penicillin allergy or
recent amoxicillin use (within 30 days). Duration is 5-7 days for children 2-12 years.
Azithromycin and Cefdinir are second-line. Amoxicillin-clavulanate is reserved for
treatment failure or recent antibiotic use.
FNP Pearl: High-dose amoxicillin is needed to overcome resistant S. pneumoniae in the
middle ear.
Q4 (SATA): A 65-year-old male presents with sudden onset cough, fever (101°F), and
rigors. Vitals: BP 130/80, HR 100, RR 24, O2 Sat 92% on room air. Exam reveals rales
in the right lower lobe. CURB-65 score is calculated. Which of the following factors are
included in the CURB-65 score?
A. Confusion [CORRECT]
B. Urea >19 mg/dL (or BUN >20 mg/dL) [CORRECT]
C. Respiratory Rate ≥ 30 [CORRECT]
D. Systolic BP < 90 mmHg or Diastolic ≤ 60 mmHg [CORRECT]
E. Age ≥ 65 [CORRECT]
Correct Answer: A, B, C, D, E
Rationale: CURB-65 is a mortality risk stratification tool for Community-Acquired
Pneumonia (CAP). It stands for Confusion, Urea, Respiratory rate, Blood pressure, and
age 65+. A score of 0-1 usually allows outpatient treatment; score ≥2 requires
,hospitalization consideration. This patient has RR 24 (not ≥30), BP normal, Age 65, no
mention of confusion or Urea. His score is 1 (Age), likely qualifying for outpatient
treatment if stable.
FNP Pearl: Know the cutoffs strictly. RR must be 30 or more to score a point in
CURB-65.
Q5: A 25-year-old female presents with dysuria, urinary frequency, and suprapubic pain
for 2 days. She has no fever or flank pain. Urinalysis shows leukocyte esterase positive
and nitrite positive. She has no known drug allergies. What is the best treatment?
A. Nitrofurantoin 100 mg BID for 5 days [CORRECT]
B. Ciprofloxacin 500 mg daily for 3 days
C. Trimethoprim-sulfamethoxazole (TMP-SMX) DS BID for 3 days
D. Amoxicillin-clavulanate 875 mg BID for 7 days
Correct Answer: A
Rationale: This is uncomplicated cystitis. First-line agents include Nitrofurantoin,
TMP-SMX (if local resistance <20%), and Fosfomycin. Nitrofluantoin is a safe,
broad-spectrum choice for cystitis (does not achieve good tissue levels for
pyelonephritis). Ciprofloxacin is a fluoroquinolone; guidelines restrict its use for
uncomplicated UTIs due to side effects and resistance concerns.
Amoxicillin-clavulanate has poor efficacy for E. coli in the bladder.
FNP Pearl: Fluoroquinolones (Levaquin/Cipro) should be avoided for simple
uncomplicated cystitis unless no other options exist (resistance/allergy).
Q6 (Calculation): A 4-year-old male (15 kg) is diagnosed with Acute Otitis Media. You
prescribe high-dose Amoxicillin (90 mg/kg/day). The pharmacy stocks Amoxicillin
suspension 400mg/5mL. What is the volume per dose (BID dosing)?
A. 3.75 mL
B. 4.7 mL
C. 8.4 mL [CORRECT]
D. 10 mL
Correct Answer: C
*Rationale:
1. Calculate total daily dose: 15 kg x 90 mg/kg = 1350 mg/day.
2. Divide for BID dosing: 1350 mg / 2 = 675 mg per dose.
3. Calculate concentration: 400 mg / 5 mL = 80 mg/mL.
Calculate volume: 675 mg / 80 mg/mL = 8.4375 mL.
4. FNP Pearl: Always double-check if the prescription is for the total daily dose or
per dose. AOM dosing is typically divided BID.
, Q7: A 40-year-old female presents with a painful, red, swollen area on her right leg. She
has a fever of 100.8°F and significant warmth. No purulence or drainage is noted. What
is the most appropriate diagnosis and treatment?
A. Erysipelas; Cephalexin 500 mg QID
B. Cellulitis; Cephalexin 500 mg QID [CORRECT]
C. Necrotizing fasciitis; Immediate surgical consult
D. Contact dermatitis; Topical steroid
Correct Answer: B
Rationale: The presentation is consistent with non-purulent cellulitis. Systemic signs
(fever) are present, indicating oral antibiotics are needed. Cephalexin (1st gen
cephalosporin) covers Strep and Staph (MSSA). Erysipelas is a superficial cellulitis with
distinct raised margins; treatment is similar, but Cellulitis is the broader, more common
term. Necrotizing fasciitis would present with profound pain, out of proportion to exam,
crepitus, and systemic toxicity.
FNP Pearl: For purulent cellulitis (abscess/pus), think MRSA (TMP-SMX/Clindamycin).
For non-purulent, think Strep (Cephalexin/Dicloxacillin).
Q8 (SATA): A 22-year-old male presents with severe perirectal pain. Exam reveals a
fluctuant, tender, indurated mass near the anus. He has no fever. What are the
appropriate management steps?
A. Incision and Drainage (I&D) [CORRECT]
B. Culture of the purulent fluid [CORRECT]
C. Prescription for Cephalexin
D. Packing of the wound [CORRECT]
E. MRI of the pelvis
Correct Answer: A, B, D
Rationale: This is a perirectal abscess. The primary treatment is I&D. Cultures are
recommended, especially for recurrent MRSA concerns. Wound packing may be
indicated depending on the size, though simple I&D is often sufficient for small
abscesses. Antibiotics are NOT routinely indicated for simple abscess I&D unless the
patient has systemic signs of infection (fever, tachycardia), extensive cellulitis, or
comorbidities (diabetes, immunocompromised). This patient is afebrile and healthy. MRI
is for suspected deep space infection (perianal fistula/complex abscess) which is not
indicated here.
FNP Pearl: "The knife heals." I&D is the treatment for an abscess. Antibiotics are
adjunctive only in specific systemic cases.
Q9: A 29-year-old female presents with RLQ pain, nausea, and anorexia. Vitals: Temp
100.5°F. Exam reveals positive McBurney’s point tenderness and positive Rovsing’s
sign. What is the diagnostic test of choice?
A. Abdominal Ultrasound
