NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
NURS 5433
Family Nurse Practitioner II
Comprehensive Final Examination
Questions With Complete Solutions
Academic Year
Course NURS 5433 - Family Nurse Practitioner II (FNP II)
Credit Hours 4 Credit Hours
Institution University of Texas at Arlington (UTA)
Total Questions 150 Multiple-Choice Questions
Format 7 Sections - Sequential Question Format
Cognitive Levels 15% Recall | 50% Application | 35% Analysis
Question Style 75% Scenario-Based | 25% Direct Knowledge
Aligned With: NURS 5433 Family II Course Syllabus | NONPF Family Nurse Practitioner Core Competencies |
Evidence-Based Primary Care Management Standards | ACC/AHA | ADA | GOLD | GINA | USPSTF | ACOG | AAP |
IDSA
COMPLETE EXAM - 150 QUESTIONS WITH DETAILED RATIONALES
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 1
Competencies
,NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
SECTION 1: EENT (Eye, Ear, Nose, and Throat) Disorders
Q1: A 4-year-old boy presents with 2 days of ear pain, fever (101.5°F), and irritability. Examination reveals a
bulging, erythematous right tympanic membrane with decreased mobility on pneumatic otoscopy. What is the
most appropriate first-line treatment?
A. Observation without antibiotics for 48-72 hours
B. Amoxicillin 80-90 mg/kg/day divided BID for 10 days *[CORRECT]*
C. Amoxicillin-clavulanate 45 mg/kg/day BID for 10 days
D. Azithromycin 10 mg/kg on day 1, then 5 mg/kg daily for 4 days
Correct Answer: B
Rationale: Per AAP 2013 guidelines, high-dose amoxicillin (80-90 mg/kg/day) is first-line for uncomplicated acute
otitis media in children without penicillin allergy. Observation is reserved for children ≥2 years with unilateral mild
symptoms. Amoxicillin-clavulanate is reserved for treatment failure or severe symptoms. Azithromycin is for
penicillin-allergic patients only.
Q2: A 3-year-old is diagnosed with otitis media with effusion (OME) after a recent URI. The mother reports
no fever, no ear pain, and the child is not pulling at the ear. What is the most appropriate management?
A. Immediate antibiotic therapy with amoxicillin
B. Tympanostomy tube placement referral
C. Watchful waiting for 3 months with re-evaluation *[CORRECT]*
D. Decongestants and antihistamines for 2 weeks
Correct Answer: C
Rationale: Per AAP guidelines, OME without acute infection should be observed for 3 months before intervention, as
most effusions resolve spontaneously. Antibiotics are NOT indicated for OME alone. Tympanostomy tubes are
considered only after ≥3 months of persistent bilateral OME with hearing loss. Decongestants/antihistamines lack
evidence of efficacy.
Q3: A 28-year-old woman presents with itchy eyes, sneezing, and clear nasal drainage every spring for the
past 4 years. She has pale, boggy nasal turbinates on examination. What is the most effective first-line
pharmacologic therapy?
A. Oral second-generation antihistamine such as loratadine
B. Intranasal corticosteroid such as fluticasone *[CORRECT]*
C. Oral pseudoephedrine
D. Intranasal cromolyn sodium
Correct Answer: B
Rationale: Per ARIA guidelines, intranasal corticosteroids (e.g., fluticasone) are the most effective monotherapy for
moderate-to-severe allergic rhinitis due to their potent anti-inflammatory action. Oral antihistamines are appropriate for
mild symptoms. Pseudoephedrine provides only symptomatic decongestion without treating the underlying allergic
response. Cromolyn has limited efficacy.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 2
Competencies
,NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
Q4: A 42-year-old man presents with facial pressure, purulent nasal discharge, and maxillary tooth pain
lasting 12 days after a viral URI. He has tenderness over the maxillary sinuses. What is the most appropriate
first-line antibiotic?
A. Amoxicillin-clavulanate 875/125 mg BID for 5-7 days *[CORRECT]*
B. Azithromycin 500 mg daily for 3 days
C. Ciprofloxacin 500 mg BID for 10 days
D. Doxycycline 100 mg BID for 14 days
Correct Answer: A
Rationale: Per IDSA 2012 guidelines, amoxicillin-clavulanate is first-line for acute bacterial rhinosinusitis (ABRS)
lasting ≥10 days, severe symptoms, or worsening after initial improvement ("double sickening"). Azithromycin has
high S. pneumoniae resistance. Ciprofloxacin lacks gram-positive coverage. Doxycycline is an alternative for
penicillin-allergic patients.
Q5: A 7-year-old boy presents with fever, sore throat, and anterior cervical adenopathy without cough or
rhinorrhea. Examination reveals tonsillar exudates. His Centor score is 4. What is the next step?
A. Symptomatic treatment only; no testing needed
B. Empiric antibiotic therapy without testing
C. Rapid antigen detection test (RADT) and culture if RADT negative *[CORRECT]*
D. Throat culture alone, wait for results before treating
Correct Answer: C
Rationale: Per IDSA 2012 guidelines, a Centor score ≥4 warrants microbiologic confirmation via RADT, with backup
throat culture if RADT negative. Empiric treatment without testing is not recommended in children. Symptomatic-only
treatment is inappropriate given high pretest probability. Waiting for culture alone delays appropriate therapy.
Q6: A 35-year-old presents with severe sore throat, muffled voice, trismus, and uvular deviation to the right.
She has a temperature of 39°C. What is the most likely diagnosis and appropriate management?
A. Acute tonsillitis; prescribe oral penicillin V
B. Peritonsillar abscess; immediate referral for needle aspiration or I&D; *[CORRECT]*
C. Epiglottitis; prepare for emergent airway management
D. Mononucleosis; supportive care with corticosteroids
Correct Answer: B
Rationale: Trismus, uvular deviation, muffled "hot potato" voice, and fever are classic for peritonsillar abscess
(Quinsy). Management requires needle aspiration, incision and drainage, or tonsillectomy plus antibiotics. Simple
tonsillitis would not cause trismus or uvular deviation. Epiglottitis presents with drooling, tripoding, and inspiratory
stridor.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 3
Competencies
, NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
Q7: A 68-year-old with COPD presents with fever, productive cough, dyspnea, pleuritic chest pain, and right
lower lobe crackles. CURB-65 score is 2. What is the most appropriate treatment setting?
A. Outpatient management with oral azithromycin
B. Outpatient management with oral amoxicillin-clavulanate
C. Hospital admission with IV ceftriaxone and azithromycin *[CORRECT]*
D. ICU admission with mechanical ventilation
Correct Answer: C
Rationale: Per ATS/IDSA 2019 CAP guidelines, CURB-65 score ≥2 generally warrants hospital admission. A score of
2 indicates inpatient management with IV therapy. Outpatient oral therapy is appropriate only for CURB-65 0-1. ICU
admission is reserved for CURB-65 ≥3 or hemodynamic/respiratory failure. The patient has underlying COPD
increasing risk.
Q8: A 25-year-old contact lens wearer presents with red, painful right eye and purulent discharge.
Fluorescein staining shows a corneal ulcer. What is the most appropriate management?
A. Topical erythromycin ointment and follow up in 1 week
B. Immediate ophthalmology referral for evaluation and culture *[CORRECT]*
C. Topical prednisolone drops to reduce inflammation
D. Oral doxycycline 100 mg BID for 7 days
Correct Answer: B
Rationale: Corneal ulcer in a contact lens wearer raises concern for Pseudomonas infection, which can rapidly progress
to corneal perforation. Immediate ophthalmology referral is mandatory for culture and tailored antibiotic therapy
(typically fluoroquinolone). Topical erythromycin is insufficient. Corticosteroids are contraindicated in active
infection. Oral doxycycline does not achieve adequate ocular levels.
Q9: A 65-year-old man has recurrent epistaxis from the anterior Kiesselbach's plexus. Direct pressure for 20
minutes fails to control bleeding. What is the next step?
A. Posterior packing and immediate ENT referral
B. Chemical cautery with silver nitrate and/or anterior nasal packing *[CORRECT]*
C. Topical phenylephrine spray only
D. Nasal cautery with electrocautery under local anesthesia
Correct Answer: B
Rationale: For persistent anterior epistaxis unresponsive to pressure, chemical cautery with silver nitrate followed by
anterior nasal packing is the standard next step. Posterior packing and ENT referral are reserved for posterior bleeds.
Phenylephrine alone is insufficient for control. Electrocautery risks septal perforation and is typically ENT-performed.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 4
Competencies
NURS 5433
Family Nurse Practitioner II
Comprehensive Final Examination
Questions With Complete Solutions
Academic Year
Course NURS 5433 - Family Nurse Practitioner II (FNP II)
Credit Hours 4 Credit Hours
Institution University of Texas at Arlington (UTA)
Total Questions 150 Multiple-Choice Questions
Format 7 Sections - Sequential Question Format
Cognitive Levels 15% Recall | 50% Application | 35% Analysis
Question Style 75% Scenario-Based | 25% Direct Knowledge
Aligned With: NURS 5433 Family II Course Syllabus | NONPF Family Nurse Practitioner Core Competencies |
Evidence-Based Primary Care Management Standards | ACC/AHA | ADA | GOLD | GINA | USPSTF | ACOG | AAP |
IDSA
COMPLETE EXAM - 150 QUESTIONS WITH DETAILED RATIONALES
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 1
Competencies
,NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
SECTION 1: EENT (Eye, Ear, Nose, and Throat) Disorders
Q1: A 4-year-old boy presents with 2 days of ear pain, fever (101.5°F), and irritability. Examination reveals a
bulging, erythematous right tympanic membrane with decreased mobility on pneumatic otoscopy. What is the
most appropriate first-line treatment?
A. Observation without antibiotics for 48-72 hours
B. Amoxicillin 80-90 mg/kg/day divided BID for 10 days *[CORRECT]*
C. Amoxicillin-clavulanate 45 mg/kg/day BID for 10 days
D. Azithromycin 10 mg/kg on day 1, then 5 mg/kg daily for 4 days
Correct Answer: B
Rationale: Per AAP 2013 guidelines, high-dose amoxicillin (80-90 mg/kg/day) is first-line for uncomplicated acute
otitis media in children without penicillin allergy. Observation is reserved for children ≥2 years with unilateral mild
symptoms. Amoxicillin-clavulanate is reserved for treatment failure or severe symptoms. Azithromycin is for
penicillin-allergic patients only.
Q2: A 3-year-old is diagnosed with otitis media with effusion (OME) after a recent URI. The mother reports
no fever, no ear pain, and the child is not pulling at the ear. What is the most appropriate management?
A. Immediate antibiotic therapy with amoxicillin
B. Tympanostomy tube placement referral
C. Watchful waiting for 3 months with re-evaluation *[CORRECT]*
D. Decongestants and antihistamines for 2 weeks
Correct Answer: C
Rationale: Per AAP guidelines, OME without acute infection should be observed for 3 months before intervention, as
most effusions resolve spontaneously. Antibiotics are NOT indicated for OME alone. Tympanostomy tubes are
considered only after ≥3 months of persistent bilateral OME with hearing loss. Decongestants/antihistamines lack
evidence of efficacy.
Q3: A 28-year-old woman presents with itchy eyes, sneezing, and clear nasal drainage every spring for the
past 4 years. She has pale, boggy nasal turbinates on examination. What is the most effective first-line
pharmacologic therapy?
A. Oral second-generation antihistamine such as loratadine
B. Intranasal corticosteroid such as fluticasone *[CORRECT]*
C. Oral pseudoephedrine
D. Intranasal cromolyn sodium
Correct Answer: B
Rationale: Per ARIA guidelines, intranasal corticosteroids (e.g., fluticasone) are the most effective monotherapy for
moderate-to-severe allergic rhinitis due to their potent anti-inflammatory action. Oral antihistamines are appropriate for
mild symptoms. Pseudoephedrine provides only symptomatic decongestion without treating the underlying allergic
response. Cromolyn has limited efficacy.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 2
Competencies
,NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
Q4: A 42-year-old man presents with facial pressure, purulent nasal discharge, and maxillary tooth pain
lasting 12 days after a viral URI. He has tenderness over the maxillary sinuses. What is the most appropriate
first-line antibiotic?
A. Amoxicillin-clavulanate 875/125 mg BID for 5-7 days *[CORRECT]*
B. Azithromycin 500 mg daily for 3 days
C. Ciprofloxacin 500 mg BID for 10 days
D. Doxycycline 100 mg BID for 14 days
Correct Answer: A
Rationale: Per IDSA 2012 guidelines, amoxicillin-clavulanate is first-line for acute bacterial rhinosinusitis (ABRS)
lasting ≥10 days, severe symptoms, or worsening after initial improvement ("double sickening"). Azithromycin has
high S. pneumoniae resistance. Ciprofloxacin lacks gram-positive coverage. Doxycycline is an alternative for
penicillin-allergic patients.
Q5: A 7-year-old boy presents with fever, sore throat, and anterior cervical adenopathy without cough or
rhinorrhea. Examination reveals tonsillar exudates. His Centor score is 4. What is the next step?
A. Symptomatic treatment only; no testing needed
B. Empiric antibiotic therapy without testing
C. Rapid antigen detection test (RADT) and culture if RADT negative *[CORRECT]*
D. Throat culture alone, wait for results before treating
Correct Answer: C
Rationale: Per IDSA 2012 guidelines, a Centor score ≥4 warrants microbiologic confirmation via RADT, with backup
throat culture if RADT negative. Empiric treatment without testing is not recommended in children. Symptomatic-only
treatment is inappropriate given high pretest probability. Waiting for culture alone delays appropriate therapy.
Q6: A 35-year-old presents with severe sore throat, muffled voice, trismus, and uvular deviation to the right.
She has a temperature of 39°C. What is the most likely diagnosis and appropriate management?
A. Acute tonsillitis; prescribe oral penicillin V
B. Peritonsillar abscess; immediate referral for needle aspiration or I&D; *[CORRECT]*
C. Epiglottitis; prepare for emergent airway management
D. Mononucleosis; supportive care with corticosteroids
Correct Answer: B
Rationale: Trismus, uvular deviation, muffled "hot potato" voice, and fever are classic for peritonsillar abscess
(Quinsy). Management requires needle aspiration, incision and drainage, or tonsillectomy plus antibiotics. Simple
tonsillitis would not cause trismus or uvular deviation. Epiglottitis presents with drooling, tripoding, and inspiratory
stridor.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 3
Competencies
, NURS 5433 - Family Nurse Practitioner II - Final Examination University of Texas at Arlington - 2026/2027
Q7: A 68-year-old with COPD presents with fever, productive cough, dyspnea, pleuritic chest pain, and right
lower lobe crackles. CURB-65 score is 2. What is the most appropriate treatment setting?
A. Outpatient management with oral azithromycin
B. Outpatient management with oral amoxicillin-clavulanate
C. Hospital admission with IV ceftriaxone and azithromycin *[CORRECT]*
D. ICU admission with mechanical ventilation
Correct Answer: C
Rationale: Per ATS/IDSA 2019 CAP guidelines, CURB-65 score ≥2 generally warrants hospital admission. A score of
2 indicates inpatient management with IV therapy. Outpatient oral therapy is appropriate only for CURB-65 0-1. ICU
admission is reserved for CURB-65 ≥3 or hemodynamic/respiratory failure. The patient has underlying COPD
increasing risk.
Q8: A 25-year-old contact lens wearer presents with red, painful right eye and purulent discharge.
Fluorescein staining shows a corneal ulcer. What is the most appropriate management?
A. Topical erythromycin ointment and follow up in 1 week
B. Immediate ophthalmology referral for evaluation and culture *[CORRECT]*
C. Topical prednisolone drops to reduce inflammation
D. Oral doxycycline 100 mg BID for 7 days
Correct Answer: B
Rationale: Corneal ulcer in a contact lens wearer raises concern for Pseudomonas infection, which can rapidly progress
to corneal perforation. Immediate ophthalmology referral is mandatory for culture and tailored antibiotic therapy
(typically fluoroquinolone). Topical erythromycin is insufficient. Corticosteroids are contraindicated in active
infection. Oral doxycycline does not achieve adequate ocular levels.
Q9: A 65-year-old man has recurrent epistaxis from the anterior Kiesselbach's plexus. Direct pressure for 20
minutes fails to control bleeding. What is the next step?
A. Posterior packing and immediate ENT referral
B. Chemical cautery with silver nitrate and/or anterior nasal packing *[CORRECT]*
C. Topical phenylephrine spray only
D. Nasal cautery with electrocautery under local anesthesia
Correct Answer: B
Rationale: For persistent anterior epistaxis unresponsive to pressure, chemical cautery with silver nitrate followed by
anterior nasal packing is the standard next step. Posterior packing and ENT referral are reserved for posterior bleeds.
Phenylephrine alone is insufficient for control. Electrocautery risks septal perforation and is typically ENT-performed.
Comprehensive Solutions - 150 Questions - Aligned with NONPF CorePage 4
Competencies
