UTA NURS 5337 Family Clinical Practice 1: Exam 3 - Questions
with Correct Answers
100 questions
1. Shared decision-making for prostate cancer screening with PSA applies to men aged:
A. 40 to 49
B. 55 to 69
C. 70 and older
D. All men over 30
Correct Answer: B. 55 to 69
Rationale: USPSTF gives PSA screening a Grade C for men 55 to 69, meaning the decision should be
individualized after discussing benefits and harms such as overdiagnosis. For men 70 and older it
recommends against screening (Grade D). There is no general recommendation to screen younger
average-risk men.
2. A 62-year-old with a 25 pack-year history who quit smoking 8 years ago asks about lung
cancer screening. The FNP should recommend:
A. Annual low-dose CT
B. A chest x-ray every year
C. Sputum cytology
D. No screening, because she has quit
Correct Answer: A. Annual low-dose CT
Rationale: USPSTF recommends annual low-dose CT for adults 50 to 80 with a 20 pack-year history who
smoke now or quit within the past 15 years, and she meets all three criteria. Chest x-ray and sputum
cytology have not reduced lung cancer mortality. Quitting 8 years ago still keeps her in the eligible
window.
,3. Using the Ottawa ankle rules, an ankle x-ray is indicated when the patient has:
A. Swelling over the anterior talofibular ligament only
B. Bruising without bone tenderness
C. Pain only with plantar flexion
D. Bone tenderness at the posterior edge of the lateral malleolus
Correct Answer: D. Bone tenderness at the posterior edge of the lateral malleolus
Rationale: Ottawa ankle rules call for imaging with malleolar pain plus bone tenderness at the posterior
edge or tip of either malleolus, or inability to bear weight 4 steps. Ligament swelling, bruising and pain on
motion without bony tenderness are typical of sprains and do not require x-ray. The rules safely reduce
unnecessary films.
4. Anchoring bias in clinical reasoning occurs when a clinician:
A. Considers too many diagnoses at once
B. Relies on a validated decision rule
C. Orders confirmatory testing
D. Locks onto an early impression and fails to adjust to new data
Correct Answer: D. Locks onto an early impression and fails to adjust to new data
Rationale: Anchoring is premature fixation on an initial diagnosis despite conflicting evidence, a common
cause of missed diagnoses. Considering several diagnoses is the remedy, not the bias. Validated
decision rules and confirmatory tests are tools that reduce cognitive error.
5. A 52-year-old woman with no risk factors asks how often she needs a mammogram. Current
USPSTF guidance recommends screening mammography:
A. Every 2 years from age 40 through 74
B. Every year from age 50 through 74
C. Every 3 years from age 40 through 69
D. Only when a breast mass is found
Correct Answer: A. Every 2 years from age 40 through 74
Rationale: The 2024 USPSTF update moved the start to age 40 with biennial screening through 74
(Grade B). Annual screening is not the USPSTF interval. Waiting for a palpable mass is diagnostic
evaluation, not screening, and would miss earlier, more treatable cancers.
,6. Positive predictive value of a screening test increases when:
A. The test sensitivity is lowered
B. The population screened is very low risk
C. The cutoff is changed to increase false positives
D. The disease prevalence in the population is higher
Correct Answer: D. The disease prevalence in the population is higher
Rationale: PPV depends on prevalence: in a higher-risk population a positive result is more likely to be a
true positive. Screening low-risk groups lowers PPV and generates more false positives. Lowering
sensitivity or deliberately adding false positives does not improve PPV.
7. A 24-year-old who never started the HPV series asks whether it is still useful. The FNP
explains that:
A. HPV vaccine is only given before age 15
B. HPV vaccine is not useful after sexual debut
C. She needs only one dose at her age
D. Routine catch-up vaccination is recommended through age 26
Correct Answer: D. Routine catch-up vaccination is recommended through age 26
Rationale: ACIP recommends catch-up HPV vaccination for everyone through 26; shared
decision-making applies from 27 to 45. Starting after 15 requires 3 doses, not 1 or 2. Even after sexual
debut the vaccine protects against types not yet acquired.
8. A 22-year-old woman is asked whether she needs HPV testing as part of cervical screening.
The FNP explains that for ages 21 to 29 the recommended test is:
A. HPV co-testing every 5 years
B. Cytology alone every 3 years
C. Primary HPV testing every year
D. No screening until age 30
Correct Answer: B. Cytology alone every 3 years
Rationale: Transient HPV infection is very common in people in their twenties and usually clears, so
routine HPV testing at this age leads to overtreatment. Cytology every 3 years is recommended for 21 to
29. Co-testing is reserved for age 30 and older, and screening does begin at 21.
, 9. A 45-year-old has an LDL of 195 mg/dL. Without calculating risk, the FNP should:
A. Recommend diet alone for 1 year
B. Start a high-intensity statin
C. Start ezetimibe alone
D. Start niacin
Correct Answer: B. Start a high-intensity statin
Rationale: An LDL of 190 or higher signals likely familial hypercholesterolemia and warrants
high-intensity statin therapy regardless of risk score. Diet alone is not enough at this level. Ezetimibe is an
add-on, and niacin has not reduced events on top of statins.
10. The DASH diet emphasizes:
A. Fruits, vegetables, low-fat dairy, and reduced saturated fat
B. High-protein, very low carbohydrate meals
C. Unlimited sodium with potassium supplements
D. Fasting 2 days a week
Correct Answer: A. Fruits, vegetables, low-fat dairy, and reduced saturated fat
Rationale: DASH lowers systolic BP by about 8 to 14 mmHg through more fruits, vegetables, whole
grains and low-fat dairy and less saturated fat. It is not a low-carb or fasting plan. Sodium restriction adds
to its benefit rather than being unlimited.
11. A 50-year-old with stage 1 hypertension and a 10-year cardiovascular risk below the
treatment threshold, with no diabetes or CKD, should initially receive:
A. Two antihypertensives immediately
B. A beta blocker
C. No follow-up
D. Lifestyle changes with BP recheck in 3 to 6 months
Correct Answer: D. Lifestyle changes with BP recheck in 3 to 6 months
Rationale: For low-risk stage 1 hypertension, nonpharmacologic therapy is recommended first, with
reassessment in 3 to 6 months. Medication is added if the patient has clinical CVD, diabetes, CKD or
elevated risk, or if BP stays above goal. Dual therapy is for stage 2 well above goal.
with Correct Answers
100 questions
1. Shared decision-making for prostate cancer screening with PSA applies to men aged:
A. 40 to 49
B. 55 to 69
C. 70 and older
D. All men over 30
Correct Answer: B. 55 to 69
Rationale: USPSTF gives PSA screening a Grade C for men 55 to 69, meaning the decision should be
individualized after discussing benefits and harms such as overdiagnosis. For men 70 and older it
recommends against screening (Grade D). There is no general recommendation to screen younger
average-risk men.
2. A 62-year-old with a 25 pack-year history who quit smoking 8 years ago asks about lung
cancer screening. The FNP should recommend:
A. Annual low-dose CT
B. A chest x-ray every year
C. Sputum cytology
D. No screening, because she has quit
Correct Answer: A. Annual low-dose CT
Rationale: USPSTF recommends annual low-dose CT for adults 50 to 80 with a 20 pack-year history who
smoke now or quit within the past 15 years, and she meets all three criteria. Chest x-ray and sputum
cytology have not reduced lung cancer mortality. Quitting 8 years ago still keeps her in the eligible
window.
,3. Using the Ottawa ankle rules, an ankle x-ray is indicated when the patient has:
A. Swelling over the anterior talofibular ligament only
B. Bruising without bone tenderness
C. Pain only with plantar flexion
D. Bone tenderness at the posterior edge of the lateral malleolus
Correct Answer: D. Bone tenderness at the posterior edge of the lateral malleolus
Rationale: Ottawa ankle rules call for imaging with malleolar pain plus bone tenderness at the posterior
edge or tip of either malleolus, or inability to bear weight 4 steps. Ligament swelling, bruising and pain on
motion without bony tenderness are typical of sprains and do not require x-ray. The rules safely reduce
unnecessary films.
4. Anchoring bias in clinical reasoning occurs when a clinician:
A. Considers too many diagnoses at once
B. Relies on a validated decision rule
C. Orders confirmatory testing
D. Locks onto an early impression and fails to adjust to new data
Correct Answer: D. Locks onto an early impression and fails to adjust to new data
Rationale: Anchoring is premature fixation on an initial diagnosis despite conflicting evidence, a common
cause of missed diagnoses. Considering several diagnoses is the remedy, not the bias. Validated
decision rules and confirmatory tests are tools that reduce cognitive error.
5. A 52-year-old woman with no risk factors asks how often she needs a mammogram. Current
USPSTF guidance recommends screening mammography:
A. Every 2 years from age 40 through 74
B. Every year from age 50 through 74
C. Every 3 years from age 40 through 69
D. Only when a breast mass is found
Correct Answer: A. Every 2 years from age 40 through 74
Rationale: The 2024 USPSTF update moved the start to age 40 with biennial screening through 74
(Grade B). Annual screening is not the USPSTF interval. Waiting for a palpable mass is diagnostic
evaluation, not screening, and would miss earlier, more treatable cancers.
,6. Positive predictive value of a screening test increases when:
A. The test sensitivity is lowered
B. The population screened is very low risk
C. The cutoff is changed to increase false positives
D. The disease prevalence in the population is higher
Correct Answer: D. The disease prevalence in the population is higher
Rationale: PPV depends on prevalence: in a higher-risk population a positive result is more likely to be a
true positive. Screening low-risk groups lowers PPV and generates more false positives. Lowering
sensitivity or deliberately adding false positives does not improve PPV.
7. A 24-year-old who never started the HPV series asks whether it is still useful. The FNP
explains that:
A. HPV vaccine is only given before age 15
B. HPV vaccine is not useful after sexual debut
C. She needs only one dose at her age
D. Routine catch-up vaccination is recommended through age 26
Correct Answer: D. Routine catch-up vaccination is recommended through age 26
Rationale: ACIP recommends catch-up HPV vaccination for everyone through 26; shared
decision-making applies from 27 to 45. Starting after 15 requires 3 doses, not 1 or 2. Even after sexual
debut the vaccine protects against types not yet acquired.
8. A 22-year-old woman is asked whether she needs HPV testing as part of cervical screening.
The FNP explains that for ages 21 to 29 the recommended test is:
A. HPV co-testing every 5 years
B. Cytology alone every 3 years
C. Primary HPV testing every year
D. No screening until age 30
Correct Answer: B. Cytology alone every 3 years
Rationale: Transient HPV infection is very common in people in their twenties and usually clears, so
routine HPV testing at this age leads to overtreatment. Cytology every 3 years is recommended for 21 to
29. Co-testing is reserved for age 30 and older, and screening does begin at 21.
, 9. A 45-year-old has an LDL of 195 mg/dL. Without calculating risk, the FNP should:
A. Recommend diet alone for 1 year
B. Start a high-intensity statin
C. Start ezetimibe alone
D. Start niacin
Correct Answer: B. Start a high-intensity statin
Rationale: An LDL of 190 or higher signals likely familial hypercholesterolemia and warrants
high-intensity statin therapy regardless of risk score. Diet alone is not enough at this level. Ezetimibe is an
add-on, and niacin has not reduced events on top of statins.
10. The DASH diet emphasizes:
A. Fruits, vegetables, low-fat dairy, and reduced saturated fat
B. High-protein, very low carbohydrate meals
C. Unlimited sodium with potassium supplements
D. Fasting 2 days a week
Correct Answer: A. Fruits, vegetables, low-fat dairy, and reduced saturated fat
Rationale: DASH lowers systolic BP by about 8 to 14 mmHg through more fruits, vegetables, whole
grains and low-fat dairy and less saturated fat. It is not a low-carb or fasting plan. Sodium restriction adds
to its benefit rather than being unlimited.
11. A 50-year-old with stage 1 hypertension and a 10-year cardiovascular risk below the
treatment threshold, with no diabetes or CKD, should initially receive:
A. Two antihypertensives immediately
B. A beta blocker
C. No follow-up
D. Lifestyle changes with BP recheck in 3 to 6 months
Correct Answer: D. Lifestyle changes with BP recheck in 3 to 6 months
Rationale: For low-risk stage 1 hypertension, nonpharmacologic therapy is recommended first, with
reassessment in 3 to 6 months. Medication is added if the patient has clinical CVD, diabetes, CKD or
elevated risk, or if BP stays above goal. Dual therapy is for stage 2 well above goal.
