NURS 5432 Family I Midterm Exam University of Texas at
Arlington (UTA). This exam includes Modules 1-6
Questions With Complete Solutions.
Instructions: This examination contains exactly 50 questions. Select the best answer for each
item. Questions include multiple-choice (4 options), select-all-that-apply (SATA), case study
scenarios, and calculation-based items. Time limit: 2 hours.
DOMAIN 1: FNP Role, Scope of Practice & Evidence-Based Practice (5 Questions)
Question 1 (Multiple-Choice) — APRN Consensus Model
A 35-year-old patient asks the FNP why they are being seen by a nurse practitioner rather
than a physician. According to the APRN Consensus Model, which response best describes the
FNP's scope of practice?
A) "I practice under the direct supervision of a physician and can only perform tasks they
delegate to me."
B) "As an FNP, I am licensed to diagnose, prescribe, and manage patients independently
within my population-focused scope."
C) "Nurse practitioners in Texas must have a collaborative practice agreement with a physician
for all clinical decisions."
D) "My role is limited to health promotion and disease prevention; I refer all diagnostic and
treatment decisions to physicians."
[CORRECT] B
Rationale: The APRN Consensus Model (2008, implemented across states) establishes that
FNPs are licensed independent practitioners with a population-focused scope
(family/individual across lifespan). FNPs are educated and nationally certified to diagnose,
prescribe pharmacologic/non-pharmacologic interventions, and manage acute and chronic
conditions. While Texas requires a practice agreement for prescriptive authority, the FNP
scope is not "supervised" in the traditional hierarchical sense—it is independent practice
within regulatory parameters. Option A reflects outdated physician-delegation models.
Option C conflues prescriptive collaboration with overall practice independence. Option D
inaccurately limits the FNP role.
Question 2 (SATA) — Evidence-Based Practice
,Which of the following are core components of evidence-based practice (EBP) in primary
care? Select all that apply.
A) Integration of the best available research evidence
B) The clinician's expertise and clinical judgment
C) Patient values, preferences, and circumstances
D) Cost-containment as the primary decision driver
E) Standardized protocols applied uniformly to all patients
F) Consideration of the clinical setting and available resources
[CORRECT] A, B, C, F
Rationale: Evidence-based practice, as defined by Sackett et al., integrates three fundamental
pillars: (1) best available research evidence, (2) clinical expertise, and (3) patient values and
preferences . Option F is also correct as EBP must be feasible within the clinical context and
resource constraints. Cost-containment (D) may be a practical consideration but is not a core
EBP component. Uniform protocol application (E) violates the patient-centered nature of EBP,
which requires individualized care.
Question 3 (Case Study) — Evidence-Based Practice & Clinical Guidelines
A 58-year-old male with a 30 pack-year smoking history currently smokes 1 pack/day. He is
asymptomatic and requests lung cancer screening. His last chest X-ray 2 years ago was
normal. According to current USPSTF recommendations, what is the appropriate
management?
A) Reassure the patient that chest X-ray is sufficient; no additional screening needed
B) Order annual low-dose CT (LDCT) and counsel on smoking cessation
C) Order LDCT now, then every 2 years if negative
D) Screen with LDCT only if he has additional risk factors such as family history
[CORRECT] B
Rationale: The USPSTF recommends annual lung cancer screening with LDCT for adults aged
50-80 years with a ≥20 pack-year smoking history who currently smoke or have quit within
the past 15 years (Grade B recommendation) . Screening should continue annually until the
patient has not smoked for 15 years or develops a health problem that substantially limits life
expectancy or willingness to have curative lung surgery. Chest X-ray is not an acceptable
,screening modality for lung cancer. Annual (not biennial) screening is recommended. The
recommendation applies based on age and smoking history alone—family history is not
required.
Question 4 (Multiple-Choice) — Ethical Principles
An 82-year-old patient with advanced dementia has aspiration pneumonia. The family insists
on aggressive antibiotic treatment and hospitalization, but the palliative care consultant
recommends comfort measures only, noting the patient's previously documented wishes.
Which ethical principle is most directly in conflict?
A) Autonomy versus Beneficence
B) Nonmaleficence versus Justice
C) Autonomy versus Nonmaleficence
D) Beneficence versus Justice
[CORRECT] A
Rationale: This scenario presents a conflict between Autonomy (the patient's previously
expressed wishes for no aggressive intervention at end-of-life) and Beneficence (the family's
desire to act in what they believe is the patient's best interest by pursuing treatment). While
nonmaleficence (avoiding harm from unnecessary hospitalization) is relevant, the central
tension is between respecting the patient's autonomous wishes and the family's beneficent
intent. Justice (fair distribution of resources) is least applicable here. The FNP's role includes
facilitating advance care planning discussions and advocating for the patient's documented
preferences.
Question 5 (Multiple-Choice) — Cultural Competence
A 24-year-old Somali refugee presents for her first well-woman exam. She requests a female
provider, declines pelvic examination, and asks her husband to remain in the room during
history-taking. Which response demonstrates culturally competent care?
A) Explain that pelvic exams are mandatory for all new patients and ask the husband to wait
outside per clinic policy
B) Honor the request for a female provider, conduct history with husband present, and defer
pelvic exam while discussing its importance for future visits
C) Agree to all requests without discussion to avoid appearing culturally insensitive
, D) Schedule the patient with a male provider to challenge gender bias and encourage
autonomy
[CORRECT] B
Rationale: Cultural competence requires balancing respect for cultural practices with
evidence-based care. The correct response honors the patient's preference for a female
provider (consistent with Islamic modesty norms), respects the family-centered decision-
making model common in Somali culture by allowing the husband's presence, and takes a
patient-centered approach to the pelvic exam by deferring while establishing trust and
education for future compliance. Option A imposes Western norms and risks losing the
patient to care. Option C abandons clinical responsibility. Option D is culturally insensitive and
counterproductive.
DOMAIN 2: Health Promotion & Screening Across the Lifespan (10 Questions)
Question 6 (Multiple-Choice) — USPSTF Screening
According to current USPSTF Grade A or B recommendations, which screening test should be
offered to a 45-year-old African American woman with BMI 32 and family history of type 2
diabetes?
A) Fasting plasma glucose or HbA1c for abnormal blood glucose
B) Coronary artery calcium scoring
C) Thyroid-stimulating hormone (TSH)
D) Carotid duplex ultrasound
[CORRECT] A
Rationale: The USPSTF recommends screening for abnormal blood glucose as part of
cardiovascular risk assessment in adults aged 40-70 years who are overweight or obese (BMI
≥25) (Grade B recommendation) . This patient meets criteria (age 45, BMI 32). The USPSTF
also recommends intensive behavioral counseling interventions for those with abnormal
blood glucose. Coronary artery calcium scoring (B), TSH screening in asymptomatic adults (C),
and carotid duplex ultrasound in asymptomatic persons (D) are not USPSTF-recommended
screening tests for this population.
Question 7 (SATA) — USPSTF Screening Guidelines
Which of the following are current USPSTF Grade A or B recommendations for a 55-year-old
woman with average risk? Select all that apply.
Arlington (UTA). This exam includes Modules 1-6
Questions With Complete Solutions.
Instructions: This examination contains exactly 50 questions. Select the best answer for each
item. Questions include multiple-choice (4 options), select-all-that-apply (SATA), case study
scenarios, and calculation-based items. Time limit: 2 hours.
DOMAIN 1: FNP Role, Scope of Practice & Evidence-Based Practice (5 Questions)
Question 1 (Multiple-Choice) — APRN Consensus Model
A 35-year-old patient asks the FNP why they are being seen by a nurse practitioner rather
than a physician. According to the APRN Consensus Model, which response best describes the
FNP's scope of practice?
A) "I practice under the direct supervision of a physician and can only perform tasks they
delegate to me."
B) "As an FNP, I am licensed to diagnose, prescribe, and manage patients independently
within my population-focused scope."
C) "Nurse practitioners in Texas must have a collaborative practice agreement with a physician
for all clinical decisions."
D) "My role is limited to health promotion and disease prevention; I refer all diagnostic and
treatment decisions to physicians."
[CORRECT] B
Rationale: The APRN Consensus Model (2008, implemented across states) establishes that
FNPs are licensed independent practitioners with a population-focused scope
(family/individual across lifespan). FNPs are educated and nationally certified to diagnose,
prescribe pharmacologic/non-pharmacologic interventions, and manage acute and chronic
conditions. While Texas requires a practice agreement for prescriptive authority, the FNP
scope is not "supervised" in the traditional hierarchical sense—it is independent practice
within regulatory parameters. Option A reflects outdated physician-delegation models.
Option C conflues prescriptive collaboration with overall practice independence. Option D
inaccurately limits the FNP role.
Question 2 (SATA) — Evidence-Based Practice
,Which of the following are core components of evidence-based practice (EBP) in primary
care? Select all that apply.
A) Integration of the best available research evidence
B) The clinician's expertise and clinical judgment
C) Patient values, preferences, and circumstances
D) Cost-containment as the primary decision driver
E) Standardized protocols applied uniformly to all patients
F) Consideration of the clinical setting and available resources
[CORRECT] A, B, C, F
Rationale: Evidence-based practice, as defined by Sackett et al., integrates three fundamental
pillars: (1) best available research evidence, (2) clinical expertise, and (3) patient values and
preferences . Option F is also correct as EBP must be feasible within the clinical context and
resource constraints. Cost-containment (D) may be a practical consideration but is not a core
EBP component. Uniform protocol application (E) violates the patient-centered nature of EBP,
which requires individualized care.
Question 3 (Case Study) — Evidence-Based Practice & Clinical Guidelines
A 58-year-old male with a 30 pack-year smoking history currently smokes 1 pack/day. He is
asymptomatic and requests lung cancer screening. His last chest X-ray 2 years ago was
normal. According to current USPSTF recommendations, what is the appropriate
management?
A) Reassure the patient that chest X-ray is sufficient; no additional screening needed
B) Order annual low-dose CT (LDCT) and counsel on smoking cessation
C) Order LDCT now, then every 2 years if negative
D) Screen with LDCT only if he has additional risk factors such as family history
[CORRECT] B
Rationale: The USPSTF recommends annual lung cancer screening with LDCT for adults aged
50-80 years with a ≥20 pack-year smoking history who currently smoke or have quit within
the past 15 years (Grade B recommendation) . Screening should continue annually until the
patient has not smoked for 15 years or develops a health problem that substantially limits life
expectancy or willingness to have curative lung surgery. Chest X-ray is not an acceptable
,screening modality for lung cancer. Annual (not biennial) screening is recommended. The
recommendation applies based on age and smoking history alone—family history is not
required.
Question 4 (Multiple-Choice) — Ethical Principles
An 82-year-old patient with advanced dementia has aspiration pneumonia. The family insists
on aggressive antibiotic treatment and hospitalization, but the palliative care consultant
recommends comfort measures only, noting the patient's previously documented wishes.
Which ethical principle is most directly in conflict?
A) Autonomy versus Beneficence
B) Nonmaleficence versus Justice
C) Autonomy versus Nonmaleficence
D) Beneficence versus Justice
[CORRECT] A
Rationale: This scenario presents a conflict between Autonomy (the patient's previously
expressed wishes for no aggressive intervention at end-of-life) and Beneficence (the family's
desire to act in what they believe is the patient's best interest by pursuing treatment). While
nonmaleficence (avoiding harm from unnecessary hospitalization) is relevant, the central
tension is between respecting the patient's autonomous wishes and the family's beneficent
intent. Justice (fair distribution of resources) is least applicable here. The FNP's role includes
facilitating advance care planning discussions and advocating for the patient's documented
preferences.
Question 5 (Multiple-Choice) — Cultural Competence
A 24-year-old Somali refugee presents for her first well-woman exam. She requests a female
provider, declines pelvic examination, and asks her husband to remain in the room during
history-taking. Which response demonstrates culturally competent care?
A) Explain that pelvic exams are mandatory for all new patients and ask the husband to wait
outside per clinic policy
B) Honor the request for a female provider, conduct history with husband present, and defer
pelvic exam while discussing its importance for future visits
C) Agree to all requests without discussion to avoid appearing culturally insensitive
, D) Schedule the patient with a male provider to challenge gender bias and encourage
autonomy
[CORRECT] B
Rationale: Cultural competence requires balancing respect for cultural practices with
evidence-based care. The correct response honors the patient's preference for a female
provider (consistent with Islamic modesty norms), respects the family-centered decision-
making model common in Somali culture by allowing the husband's presence, and takes a
patient-centered approach to the pelvic exam by deferring while establishing trust and
education for future compliance. Option A imposes Western norms and risks losing the
patient to care. Option C abandons clinical responsibility. Option D is culturally insensitive and
counterproductive.
DOMAIN 2: Health Promotion & Screening Across the Lifespan (10 Questions)
Question 6 (Multiple-Choice) — USPSTF Screening
According to current USPSTF Grade A or B recommendations, which screening test should be
offered to a 45-year-old African American woman with BMI 32 and family history of type 2
diabetes?
A) Fasting plasma glucose or HbA1c for abnormal blood glucose
B) Coronary artery calcium scoring
C) Thyroid-stimulating hormone (TSH)
D) Carotid duplex ultrasound
[CORRECT] A
Rationale: The USPSTF recommends screening for abnormal blood glucose as part of
cardiovascular risk assessment in adults aged 40-70 years who are overweight or obese (BMI
≥25) (Grade B recommendation) . This patient meets criteria (age 45, BMI 32). The USPSTF
also recommends intensive behavioral counseling interventions for those with abnormal
blood glucose. Coronary artery calcium scoring (B), TSH screening in asymptomatic adults (C),
and carotid duplex ultrasound in asymptomatic persons (D) are not USPSTF-recommended
screening tests for this population.
Question 7 (SATA) — USPSTF Screening Guidelines
Which of the following are current USPSTF Grade A or B recommendations for a 55-year-old
woman with average risk? Select all that apply.
