UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
UTA NURS 5433 FNP II FINAL EXAM REVIEW
(2026/2027)
FAMILY NURSING - UNIVERSITY OF TEXAS AT
ARLINGTON
Family Nurse Practitioner II Final Examination Preparation - Primary Care Across the Lifespan
155 Questions | 10 Sections | Cardiovascular, Respiratory, Endocrine, GI/GU, MSK/Neuro, Women's/Men's Health, Mental
Health, Derm/HEENT/Pediatric, Geriatric
Cognitive Mix: ~30% Recall • ~50% Application • ~20% Analysis • ~80% Scenario-Based / ~20% Direct Recall
Instructions: For each question, select the single best answer. Each question provides four options (A–D); the correct option
is marked [CORRECT]. Detailed rationales explain why the correct answer is right and why the distractors are wrong,
including clinical practice guidelines, pathophysiologic mechanisms, diagnostic criteria, pharmacologic principles, and
patient safety considerations. Use this packet for NURS 5433 FNP II final exam preparation and self-assessment.
# Section Q Range Count
1 Advanced Assessment and Diagnostic Reasoning in Family Practice Q1-Q15 15
2 Cardiovascular Disorders in Family Practice Q16-Q35 20
3 Respiratory Disorders in Family Practice Q36-Q54 19
4 Endocrine and Metabolic Disorders Q55-Q74 20
5 Gastrointestinal and Genitourinary Disorders Q75-Q92 18
6 Musculoskeletal and Neurological Disorders Q93-Q110 18
7 Women's Health, Men's Health, and Reproductive Issues Q111-Q125 15
8 Mental Health Disorders in Primary Care Q126-Q138 13
9 Dermatologic, HEENT, and Pediatric Considerations Q139-Q148 10
10 Health Promotion, Geriatric Care, and Complex Case Management Q149-Q155 7
TOTAL Q1-Q155 155
Section 1: Advanced Assessment and Diagnostic Reasoning in Family
Practice
Questions Q1-Q15 | 15 Questions
Q1. A 52-year-old male presents with fatigue and exertional dyspnea. Which component of the
comprehensive history is MOST important for narrowing the differential diagnosis?
A. Family history of distant relatives
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 1
,UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
B. Detailed HPI including onset, duration, character, aggravating/relieving factors, and associated
symptoms (SOCRATES) [CORRECT]
C. Travel history from 10 years ago
D. Dietary preferences in childhood
Correct Answer: B
Rationale: The HPI (History of Present Illness) using SOCRATES (Site, Onset, Character, Radiation,
Associated symptoms, Timing, Exacerbating/relieving factors, Severity) is the most critical component for
differential diagnosis. For fatigue and dyspnea, onset (acute vs. chronic), character (exertional vs. rest), and
associated symptoms (chest pain, orthopnea, edema) help distinguish cardiac, pulmonary, hematologic, or
systemic causes. Study note: HPI quality directly determines diagnostic accuracy.
Q2. A 45-year-old female presents with acute onset severe headache described as 'the worst headache of
my life.' What is the MOST appropriate immediate action?
A. Prescribe ibuprofen and schedule follow-up in 2 weeks.
B. Refer to neurology as an outpatient.
C. Recognize this as a red flag (thunderclap headache) requiring immediate emergency referral/CT to
rule out subarachnoid hemorrhage. [CORRECT]
D. Recommend stress reduction techniques.
Correct Answer: C
Rationale: A thunderclap headache ('worst headache of my life') is a classic red flag for subarachnoid
hemorrhage (SAH), requiring immediate emergency evaluation with non-contrast CT head (sensitivity ~100%
in first 6 hours) and possible lumbar puncture if CT is negative. Delaying evaluation risks catastrophic outcome.
This is a life-threatening condition requiring emergency referral, not outpatient management.
Q3. When developing a differential diagnosis, which approach is MOST systematic and evidence-based?
A. Selecting the first diagnosis that comes to mind.
B. Using VINDICATE mnemonic (Vascular, Infectious, Neoplastic, Degenerative,
Intoxication/Iatrogenic, Congenital, Autoimmune, Trauma, Endocrine) to generate a comprehensive
list. [CORRECT]
C. Selecting only the most common diagnosis.
D. Ordering extensive laboratory panels before forming any hypothesis.
Correct Answer: B
Rationale: The VINDICATE mnemonic provides a systematic framework for generating a comprehensive
differential diagnosis by disease category, ensuring no major category is missed. This structured approach
prevents premature closure (a common diagnostic error) and supports thorough evaluation. The FNP should
prioritize differentials based on prevalence, severity (life-threatening first), and patient risk factors.
Q4. A 60-year-old male presents with new-onset confusion. Which finding most strongly suggests delirium
rather than dementia?
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 2
,UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
A. Gradual onset over 2 years with preserved attention.
B. Acute onset over hours to days with fluctuating attention and altered level of consciousness.
[CORRECT]
C. Slowly progressive memory loss.
D. Stable cognitive deficits present since young adulthood.
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and altered level of
consciousness — often triggered by an underlying medical condition (infection, medication, dehydration,
hypoxia). Dementia is gradual and progressive with relatively preserved attention early. Delirium is a medical
emergency requiring urgent evaluation for reversible causes. Differentiating delirium from dementia is critical
because untreated delirium carries high morbidity and mortality.
Q5. A 35-year-old female presents with pleuritic chest pain and dyspnea. The Wells score is 4.5 (PE likely).
What is the MOST appropriate diagnostic next step?
A. Reassure and discharge with NSAIDs.
B. Order D-dimer only and discharge if negative.
C. Proceed to CT pulmonary angiography (CTPA) given intermediate-high pretest probability, or V/Q
scan if CT contraindicated. [CORRECT]
D. Order a chest X-ray and discharge if normal.
Correct Answer: C
Rationale: With a Wells PE score >4 (PE likely), the FNP should proceed directly to imaging (CTPA preferred,
V/Q scan if contrast contraindicated or pregnancy). D-dimer is reserved for low pretest probability (Wells ≤4) to
rule out PE; a positive D-dimer in intermediate-high risk requires imaging. CTPA has high sensitivity/specificity
and also evaluates for alternative diagnoses. Start empiric anticoagulation if high suspicion and no
contraindication pending imaging.
Q6. Which physical exam finding is MOST consistent with consolidation due to bacterial pneumonia?
A. Decreased tactile fremitus, hyperresonance to percussion, and wheezing.
B. Increased tactile fremitus, dullness to percussion, egophony, and bronchial breath sounds over the
affected area. [CORRECT]
C. Diffuse wheezing bilaterally with prolonged expiration.
D. Absent breath sounds unilaterally with tracheal deviation.
Correct Answer: B
Rationale: Consolidation (pneumonia) causes increased tactile fremitus (sound transmission through solid
tissue), dullness to percussion (fluid/solid replaces air), egophony (E-to-A change), and bronchial breath sounds
over consolidated lung. Decreased fremitus/hyperresonance suggests pleural effusion or pneumothorax. Diffuse
wheezing suggests asthma/COPD. Absent breath sounds with tracheal deviation suggests tension pneumothorax
(emergency).
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 3
, UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
Q7. A 70-year-old male presents with acute monarticular arthritis of the right knee. The joint is warm,
swollen, and exquisitely tender. Synovial fluid analysis shows 65,000 WBC/µL with 80% neutrophils. What
is the MOST likely diagnosis?
A. Osteoarthritis (non-inflammatory, WBC <2,000)
B. Gout (negatively birefringent needle-shaped crystals)
C. Septic arthritis until proven otherwise (WBC >50,000 with neutrophil predominance, even with
negative Gram stain) [CORRECT]
D. Rheumatoid arthritis
Correct Answer: C
Rationale: Acute monoarticular arthritis with synovial WBC >50,000/µL and neutrophil predominance is septic
arthritis until proven otherwise — an orthopedic emergency. Even with a negative Gram stain (sensitivity
~75%), the WBC count and clinical picture mandate presumptive treatment for infection. Gram stain and culture
still guide therapy. Gout would show crystals. OA has non-inflammatory fluid (<2,000 WBC). This patient
needs immediate orthopedic consultation, IV antibiotics, and joint drainage.
Q8. A 28-year-old female presents with abdominal pain. Which finding is a RED FLAG requiring
immediate referral?
A. Mild nausea without vomiting.
B. Intermittent cramping pain relieved by bowel movement (suggests IBS).
C. Severe tenderness with guarding and rebound tenderness, fever, and hypotension. [CORRECT]
D. Bloating after eating dairy products.
Correct Answer: C
Rationale: Guarding, rebound tenderness, fever, and hypotension indicate peritonitis and possible perforation
— a surgical emergency requiring immediate referral. Peritoneal signs (rigidity, rebound) reflect parietal
peritoneal inflammation. Other red flags: hematemesis, melena, severe anemia, weight loss, progressive
jaundice, or persistent vomiting. IBS and lactose intolerance lack these signs. The FNP must recognize
peritoneal signs to avoid delayed diagnosis of life-threatening conditions.
Q9. When assessing a patient with suspected anemia, which lab value BEST distinguishes iron deficiency
anemia from anemia of chronic disease?
A. Hemoglobin alone.
B. Serum ferritin and TIBC: iron deficiency has low ferritin (<30 ng/mL) and high TIBC; anemia of
chronic disease has normal/high ferritin and low TIBC. [CORRECT]
C. MCV alone.
D. RDW alone.
Correct Answer: B
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 4
155 Questions | 10 Sections | Primary Care Across the Lifespan
UTA NURS 5433 FNP II FINAL EXAM REVIEW
(2026/2027)
FAMILY NURSING - UNIVERSITY OF TEXAS AT
ARLINGTON
Family Nurse Practitioner II Final Examination Preparation - Primary Care Across the Lifespan
155 Questions | 10 Sections | Cardiovascular, Respiratory, Endocrine, GI/GU, MSK/Neuro, Women's/Men's Health, Mental
Health, Derm/HEENT/Pediatric, Geriatric
Cognitive Mix: ~30% Recall • ~50% Application • ~20% Analysis • ~80% Scenario-Based / ~20% Direct Recall
Instructions: For each question, select the single best answer. Each question provides four options (A–D); the correct option
is marked [CORRECT]. Detailed rationales explain why the correct answer is right and why the distractors are wrong,
including clinical practice guidelines, pathophysiologic mechanisms, diagnostic criteria, pharmacologic principles, and
patient safety considerations. Use this packet for NURS 5433 FNP II final exam preparation and self-assessment.
# Section Q Range Count
1 Advanced Assessment and Diagnostic Reasoning in Family Practice Q1-Q15 15
2 Cardiovascular Disorders in Family Practice Q16-Q35 20
3 Respiratory Disorders in Family Practice Q36-Q54 19
4 Endocrine and Metabolic Disorders Q55-Q74 20
5 Gastrointestinal and Genitourinary Disorders Q75-Q92 18
6 Musculoskeletal and Neurological Disorders Q93-Q110 18
7 Women's Health, Men's Health, and Reproductive Issues Q111-Q125 15
8 Mental Health Disorders in Primary Care Q126-Q138 13
9 Dermatologic, HEENT, and Pediatric Considerations Q139-Q148 10
10 Health Promotion, Geriatric Care, and Complex Case Management Q149-Q155 7
TOTAL Q1-Q155 155
Section 1: Advanced Assessment and Diagnostic Reasoning in Family
Practice
Questions Q1-Q15 | 15 Questions
Q1. A 52-year-old male presents with fatigue and exertional dyspnea. Which component of the
comprehensive history is MOST important for narrowing the differential diagnosis?
A. Family history of distant relatives
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 1
,UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
B. Detailed HPI including onset, duration, character, aggravating/relieving factors, and associated
symptoms (SOCRATES) [CORRECT]
C. Travel history from 10 years ago
D. Dietary preferences in childhood
Correct Answer: B
Rationale: The HPI (History of Present Illness) using SOCRATES (Site, Onset, Character, Radiation,
Associated symptoms, Timing, Exacerbating/relieving factors, Severity) is the most critical component for
differential diagnosis. For fatigue and dyspnea, onset (acute vs. chronic), character (exertional vs. rest), and
associated symptoms (chest pain, orthopnea, edema) help distinguish cardiac, pulmonary, hematologic, or
systemic causes. Study note: HPI quality directly determines diagnostic accuracy.
Q2. A 45-year-old female presents with acute onset severe headache described as 'the worst headache of
my life.' What is the MOST appropriate immediate action?
A. Prescribe ibuprofen and schedule follow-up in 2 weeks.
B. Refer to neurology as an outpatient.
C. Recognize this as a red flag (thunderclap headache) requiring immediate emergency referral/CT to
rule out subarachnoid hemorrhage. [CORRECT]
D. Recommend stress reduction techniques.
Correct Answer: C
Rationale: A thunderclap headache ('worst headache of my life') is a classic red flag for subarachnoid
hemorrhage (SAH), requiring immediate emergency evaluation with non-contrast CT head (sensitivity ~100%
in first 6 hours) and possible lumbar puncture if CT is negative. Delaying evaluation risks catastrophic outcome.
This is a life-threatening condition requiring emergency referral, not outpatient management.
Q3. When developing a differential diagnosis, which approach is MOST systematic and evidence-based?
A. Selecting the first diagnosis that comes to mind.
B. Using VINDICATE mnemonic (Vascular, Infectious, Neoplastic, Degenerative,
Intoxication/Iatrogenic, Congenital, Autoimmune, Trauma, Endocrine) to generate a comprehensive
list. [CORRECT]
C. Selecting only the most common diagnosis.
D. Ordering extensive laboratory panels before forming any hypothesis.
Correct Answer: B
Rationale: The VINDICATE mnemonic provides a systematic framework for generating a comprehensive
differential diagnosis by disease category, ensuring no major category is missed. This structured approach
prevents premature closure (a common diagnostic error) and supports thorough evaluation. The FNP should
prioritize differentials based on prevalence, severity (life-threatening first), and patient risk factors.
Q4. A 60-year-old male presents with new-onset confusion. Which finding most strongly suggests delirium
rather than dementia?
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 2
,UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
A. Gradual onset over 2 years with preserved attention.
B. Acute onset over hours to days with fluctuating attention and altered level of consciousness.
[CORRECT]
C. Slowly progressive memory loss.
D. Stable cognitive deficits present since young adulthood.
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating course, inattention, and altered level of
consciousness — often triggered by an underlying medical condition (infection, medication, dehydration,
hypoxia). Dementia is gradual and progressive with relatively preserved attention early. Delirium is a medical
emergency requiring urgent evaluation for reversible causes. Differentiating delirium from dementia is critical
because untreated delirium carries high morbidity and mortality.
Q5. A 35-year-old female presents with pleuritic chest pain and dyspnea. The Wells score is 4.5 (PE likely).
What is the MOST appropriate diagnostic next step?
A. Reassure and discharge with NSAIDs.
B. Order D-dimer only and discharge if negative.
C. Proceed to CT pulmonary angiography (CTPA) given intermediate-high pretest probability, or V/Q
scan if CT contraindicated. [CORRECT]
D. Order a chest X-ray and discharge if normal.
Correct Answer: C
Rationale: With a Wells PE score >4 (PE likely), the FNP should proceed directly to imaging (CTPA preferred,
V/Q scan if contrast contraindicated or pregnancy). D-dimer is reserved for low pretest probability (Wells ≤4) to
rule out PE; a positive D-dimer in intermediate-high risk requires imaging. CTPA has high sensitivity/specificity
and also evaluates for alternative diagnoses. Start empiric anticoagulation if high suspicion and no
contraindication pending imaging.
Q6. Which physical exam finding is MOST consistent with consolidation due to bacterial pneumonia?
A. Decreased tactile fremitus, hyperresonance to percussion, and wheezing.
B. Increased tactile fremitus, dullness to percussion, egophony, and bronchial breath sounds over the
affected area. [CORRECT]
C. Diffuse wheezing bilaterally with prolonged expiration.
D. Absent breath sounds unilaterally with tracheal deviation.
Correct Answer: B
Rationale: Consolidation (pneumonia) causes increased tactile fremitus (sound transmission through solid
tissue), dullness to percussion (fluid/solid replaces air), egophony (E-to-A change), and bronchial breath sounds
over consolidated lung. Decreased fremitus/hyperresonance suggests pleural effusion or pneumothorax. Diffuse
wheezing suggests asthma/COPD. Absent breath sounds with tracheal deviation suggests tension pneumothorax
(emergency).
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 3
, UTA NURS 5433 FNP II Final Exam Review Family Nursing (2026/2027)
155 Questions | 10 Sections | Primary Care Across the Lifespan
Q7. A 70-year-old male presents with acute monarticular arthritis of the right knee. The joint is warm,
swollen, and exquisitely tender. Synovial fluid analysis shows 65,000 WBC/µL with 80% neutrophils. What
is the MOST likely diagnosis?
A. Osteoarthritis (non-inflammatory, WBC <2,000)
B. Gout (negatively birefringent needle-shaped crystals)
C. Septic arthritis until proven otherwise (WBC >50,000 with neutrophil predominance, even with
negative Gram stain) [CORRECT]
D. Rheumatoid arthritis
Correct Answer: C
Rationale: Acute monoarticular arthritis with synovial WBC >50,000/µL and neutrophil predominance is septic
arthritis until proven otherwise — an orthopedic emergency. Even with a negative Gram stain (sensitivity
~75%), the WBC count and clinical picture mandate presumptive treatment for infection. Gram stain and culture
still guide therapy. Gout would show crystals. OA has non-inflammatory fluid (<2,000 WBC). This patient
needs immediate orthopedic consultation, IV antibiotics, and joint drainage.
Q8. A 28-year-old female presents with abdominal pain. Which finding is a RED FLAG requiring
immediate referral?
A. Mild nausea without vomiting.
B. Intermittent cramping pain relieved by bowel movement (suggests IBS).
C. Severe tenderness with guarding and rebound tenderness, fever, and hypotension. [CORRECT]
D. Bloating after eating dairy products.
Correct Answer: C
Rationale: Guarding, rebound tenderness, fever, and hypotension indicate peritonitis and possible perforation
— a surgical emergency requiring immediate referral. Peritoneal signs (rigidity, rebound) reflect parietal
peritoneal inflammation. Other red flags: hematemesis, melena, severe anemia, weight loss, progressive
jaundice, or persistent vomiting. IBS and lactose intolerance lack these signs. The FNP must recognize
peritoneal signs to avoid delayed diagnosis of life-threatening conditions.
Q9. When assessing a patient with suspected anemia, which lab value BEST distinguishes iron deficiency
anemia from anemia of chronic disease?
A. Hemoglobin alone.
B. Serum ferritin and TIBC: iron deficiency has low ferritin (<30 ng/mL) and high TIBC; anemia of
chronic disease has normal/high ferritin and low TIBC. [CORRECT]
C. MCV alone.
D. RDW alone.
Correct Answer: B
UTA NURS 5433 FNP II Final Exam Review
Family Nurse Practitioner II - Primary Care Clinical Reasoning Page 4
