1
NURS 5434 FAMILY III FINAL AND PRACTICE EXAM (UTA)
NEWEST 2025/ 2026 TEST BANK| COMPLETE 180 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+| NURS 5434 FNP III FINAL EXAM
PREP (BRAND NEW!!)
Question 1
A 58-year-old man with hypertension, type 2 diabetes, and chronic kidney disease (eGFR 42
mL/min/1.73 m²) has an office blood pressure of 148/88 mmHg. He takes lisinopril 20 mg daily and
amlodipine 10 mg daily. His serum potassium is 4.9 mEq/L. What is the most appropriate next step in
management?
A. Add chlorthalidone 12.5 mg daily
B. Add spironolactone 25 mg daily
C. Increase lisinopril to 40 mg daily
D. Add hydralazine 25 mg three times daily
Answer: A
Rationale: This patient has resistant hypertension on an ACE inhibitor and calcium channel blocker.
eGFR >30 allows thiazide-type diuretic (chlorthalidone preferred over hydrochlorothiazide).
Spironolactone would be an excellent add-on for resistant hypertension, but potassium is 4.9, and with
CKD on an ACE inhibitor, risk of hyperkalemia is elevated; spironolactone is relatively contraindicated.
Increasing lisinopril provides minimal additional BP lowering and raises hyperkalemia risk. Hydralazine is
third/fourth line. Chlorthalidone is the guideline-recommended third agent when eGFR ≥30 and
potassium is acceptable.
Question 2
A 72-year-old woman with atrial fibrillation (CHA₂DS₂-VASc score = 5) takes warfarin. Her INR today is
1.8 (target 2.0–3.0). She has no bleeding. Which of the following adjustments should be made?
A. Increase weekly warfarin dose by 10–15% and recheck INR in 1–2 weeks
B. Add aspirin 81 mg daily
C. Switch to apixaban 5 mg twice daily without bridging
D. Administer vitamin K 2.5 mg orally
Answer: A
Rationale: Subtherapeutic INR in a stable warfarin patient without bleeding or thrombosis is managed
pg. 1
,2
by a modest dose increase (10–15% of total weekly dose) and rechecking INR in 1–2 weeks. Adding
aspirin increases bleeding risk without proven efficacy for stroke prevention in AF. Switching to a DOAC
is an option but not an “adjustment” of the current regimen; it requires a transition plan. Vitamin K is
given only if INR is supratherapeutic with bleeding. A simple dose increase is appropriate.
Question 3
A 26-year-old woman with moderate persistent asthma reports using her albuterol inhaler 4–5 times per
week during the day and waking once weekly with cough. She currently takes low-dose inhaled
budesonide (200 mcg daily). Spirometry shows FEV₁ 78% predicted. What is the preferred next step
according to GINA guidelines?
A. Increase budesonide to high dose
B. Add a long-acting beta-agonist (LABA) to low-dose budesonide in a single inhaler
C. Add montelukast 10 mg daily
D. Add tiotropium Respimat
Answer: B
Rationale: The patient’s symptoms and FEV₁ indicate poorly controlled moderate persistent asthma.
GINA Step 3 (for adults/adolescents) is low-dose ICS-LABA combination, preferably as single-inhaler
maintenance and reliever therapy (SMART). Montelukast is a less effective option (Step 2 alternative).
High-dose ICS is Step 4. Tiotropium is add-on at Step 4/5. The best next step is adding a LABA to low-
dose ICS.
Question 4
A 65-year-old man with type 2 diabetes (A1C 8.7%) and established atherosclerotic cardiovascular
disease (prior MI) is on metformin 1000 mg BID. His eGFR is 58 mL/min. Which additional medication
has the strongest evidence to reduce cardiovascular death?
A. Glimepiride 2 mg daily
B. Empagliflozin 10 mg daily
C. Sitagliptin 100 mg daily
D. Pioglitazone 30 mg daily
Answer: B
Rationale: In patients with ASCVD, SGLT2 inhibitors (empagliflozin, canagliflozin) and GLP-1 receptor
agonists demonstrate cardiovascular mortality reduction. Empagliflozin has a class I recommendation.
Glimepiride (sulfonylurea) has no CV benefit; sitagliptin (DPP-4) is CV-neutral; pioglitazone may reduce
atherosclerotic events but can worsen heart failure and does not show CV mortality benefit. SGLT2i is
the priority add-on after metformin.
Question 5
pg. 2
,3
A 48-year-old woman presents with fatigue, weight gain, dry skin, and constipation. Labs: TSH 14.2
mIU/L (0.5–4.5), free T4 0.6 ng/dL (0.8–1.8). She is started on levothyroxine. Which of the following is
the most appropriate monitoring strategy?
A. Recheck TSH in 1–2 weeks after dose change
B. Recheck TSH in 6–8 weeks after dose change
C. Recheck free T4 in 1 week; adjust to normalize free T4
D. Recheck TSH and free T3 every 3 months
Answer: B
Rationale: After initiating or adjusting levothyroxine, TSH should be rechecked in 6–8 weeks, the time
needed to reach steady state. Checking too soon leads to inappropriate dose changes. Free T4 is not
routinely needed for monitoring once treatment is established, and TSH is the primary marker. Free T3
monitoring is not recommended. The correct interval is 6–8 weeks.
Question 6
A 74-year-old man with COPD (FEV₁ 45% predicted, two exacerbations in the past year) on LAMA/LABA
therapy presents with increased dyspnea. Oxygen saturation is 89% on room air. Which additional
therapy is indicated?
A. Inhaled corticosteroid (ICS) added to LAMA/LABA
B. Chronic oral prednisone 5 mg daily
C. Home oxygen therapy
D. Azithromycin 250 mg daily for exacerbation prevention
Answer: C
Rationale: Oxygen saturation ≤88% or PaO₂ ≤55 mmHg qualifies for long-term oxygen therapy (LTOT) in
COPD, which improves survival. While ICS may be added for frequent exacerbations (blood eosinophils
≥100 cells/µL), oxygen is the immediate priority based on hypoxemia. Chronic prednisone is not
recommended. Azithromycin prophylaxis is an option for frequent exacerbations but not first-line over
oxygen when hypoxemia is present.
Question 7
A 55-year-old woman with a 35-pack-year smoking history asks if she should undergo lung cancer
screening. She quit smoking 12 years ago. She has no symptoms. What does USPSTF recommend?
A. Annual low-dose CT (LDCT) for ages 50–80 with ≥20 pack-year history, if quit within 15 years
B. Annual chest X-ray
C. LDCT only if she has a first-degree relative with lung cancer
D. No screening because she quit >10 years ago
Answer: A
Rationale: USPSTF 2021 recommends annual LDCT for adults aged 50–80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. She qualifies (quit 12 years
pg. 3
, 4
ago, 35 pack-years). Chest X-ray is not recommended for screening. Family history expands risk but is
not required for the general screening criterion; she meets criteria anyway.
Question 8
A 30-year-old woman at 32 weeks gestation presents with severe headache, blood pressure 162/104
mmHg, 3+ proteinuria, and hyperreflexia. Which antihypertensive is the first-line agent for acute severe
hypertension in this setting?
A. Oral labetalol 200 mg
B. Intravenous hydralazine 5–10 mg
C. Oral nifedipine immediate-release 10 mg
D. Either IV labetalol or IV hydralazine
Answer: D
Rationale: For acute-onset severe hypertension in preeclampsia, ACOG recommends IV labetalol, IV
hydralazine, or immediate-release oral nifedipine as first-line agents. The question specifically asks for
first-line agent, but many guidelines list IV labetalol and IV hydralazine as equal options. Option D most
correctly reflects that both are acceptable. Oral labetalol onset is slower; oral nifedipine is also first-line
but not offered in a single choice. “Either IV labetalol or IV hydralazine” is the best answer.
Question 9
A 68-year-old man with heart failure with preserved ejection fraction (HFpEF, EF 58%) has persistent
dyspnea despite furosemide and lisinopril. Blood pressure is 130/76 mmHg, eGFR 50. Which medication
class has the strongest evidence for reducing heart failure hospitalizations in HFpEF?
A. Beta-blocker (metoprolol succinate)
B. SGLT2 inhibitor (dapagliflozin)
C. Aldosterone antagonist (spironolactone)
D. Digoxin
Answer: B
Rationale: In HFpEF, SGLT2 inhibitors (dapagliflozin, empagliflozin) have demonstrated a significant
reduction in heart failure hospitalizations (DELIVER, EMPEROR-Preserved trials). Beta-blockers have no
morbidity/mortality benefit in HFpEF. Spironolactone showed a modest reduction in HF hospitalizations
in TOPCAT but only in those with EF <55% in some analyses; SGLT2i now has stronger guideline
endorsement. Digoxin is not indicated. Thus, SGLT2 inhibitor is the most evidence-based addition.
Question 10
A 45-year-old woman with chronic migraine (≥15 headache days per month) has failed trials of
propranolol and topiramate. She currently takes sumatriptan as needed but experiences medication-
overuse headaches. What is the most appropriate preventive strategy?
pg. 4
NURS 5434 FAMILY III FINAL AND PRACTICE EXAM (UTA)
NEWEST 2025/ 2026 TEST BANK| COMPLETE 180 REAL
EXAM QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+| NURS 5434 FNP III FINAL EXAM
PREP (BRAND NEW!!)
Question 1
A 58-year-old man with hypertension, type 2 diabetes, and chronic kidney disease (eGFR 42
mL/min/1.73 m²) has an office blood pressure of 148/88 mmHg. He takes lisinopril 20 mg daily and
amlodipine 10 mg daily. His serum potassium is 4.9 mEq/L. What is the most appropriate next step in
management?
A. Add chlorthalidone 12.5 mg daily
B. Add spironolactone 25 mg daily
C. Increase lisinopril to 40 mg daily
D. Add hydralazine 25 mg three times daily
Answer: A
Rationale: This patient has resistant hypertension on an ACE inhibitor and calcium channel blocker.
eGFR >30 allows thiazide-type diuretic (chlorthalidone preferred over hydrochlorothiazide).
Spironolactone would be an excellent add-on for resistant hypertension, but potassium is 4.9, and with
CKD on an ACE inhibitor, risk of hyperkalemia is elevated; spironolactone is relatively contraindicated.
Increasing lisinopril provides minimal additional BP lowering and raises hyperkalemia risk. Hydralazine is
third/fourth line. Chlorthalidone is the guideline-recommended third agent when eGFR ≥30 and
potassium is acceptable.
Question 2
A 72-year-old woman with atrial fibrillation (CHA₂DS₂-VASc score = 5) takes warfarin. Her INR today is
1.8 (target 2.0–3.0). She has no bleeding. Which of the following adjustments should be made?
A. Increase weekly warfarin dose by 10–15% and recheck INR in 1–2 weeks
B. Add aspirin 81 mg daily
C. Switch to apixaban 5 mg twice daily without bridging
D. Administer vitamin K 2.5 mg orally
Answer: A
Rationale: Subtherapeutic INR in a stable warfarin patient without bleeding or thrombosis is managed
pg. 1
,2
by a modest dose increase (10–15% of total weekly dose) and rechecking INR in 1–2 weeks. Adding
aspirin increases bleeding risk without proven efficacy for stroke prevention in AF. Switching to a DOAC
is an option but not an “adjustment” of the current regimen; it requires a transition plan. Vitamin K is
given only if INR is supratherapeutic with bleeding. A simple dose increase is appropriate.
Question 3
A 26-year-old woman with moderate persistent asthma reports using her albuterol inhaler 4–5 times per
week during the day and waking once weekly with cough. She currently takes low-dose inhaled
budesonide (200 mcg daily). Spirometry shows FEV₁ 78% predicted. What is the preferred next step
according to GINA guidelines?
A. Increase budesonide to high dose
B. Add a long-acting beta-agonist (LABA) to low-dose budesonide in a single inhaler
C. Add montelukast 10 mg daily
D. Add tiotropium Respimat
Answer: B
Rationale: The patient’s symptoms and FEV₁ indicate poorly controlled moderate persistent asthma.
GINA Step 3 (for adults/adolescents) is low-dose ICS-LABA combination, preferably as single-inhaler
maintenance and reliever therapy (SMART). Montelukast is a less effective option (Step 2 alternative).
High-dose ICS is Step 4. Tiotropium is add-on at Step 4/5. The best next step is adding a LABA to low-
dose ICS.
Question 4
A 65-year-old man with type 2 diabetes (A1C 8.7%) and established atherosclerotic cardiovascular
disease (prior MI) is on metformin 1000 mg BID. His eGFR is 58 mL/min. Which additional medication
has the strongest evidence to reduce cardiovascular death?
A. Glimepiride 2 mg daily
B. Empagliflozin 10 mg daily
C. Sitagliptin 100 mg daily
D. Pioglitazone 30 mg daily
Answer: B
Rationale: In patients with ASCVD, SGLT2 inhibitors (empagliflozin, canagliflozin) and GLP-1 receptor
agonists demonstrate cardiovascular mortality reduction. Empagliflozin has a class I recommendation.
Glimepiride (sulfonylurea) has no CV benefit; sitagliptin (DPP-4) is CV-neutral; pioglitazone may reduce
atherosclerotic events but can worsen heart failure and does not show CV mortality benefit. SGLT2i is
the priority add-on after metformin.
Question 5
pg. 2
,3
A 48-year-old woman presents with fatigue, weight gain, dry skin, and constipation. Labs: TSH 14.2
mIU/L (0.5–4.5), free T4 0.6 ng/dL (0.8–1.8). She is started on levothyroxine. Which of the following is
the most appropriate monitoring strategy?
A. Recheck TSH in 1–2 weeks after dose change
B. Recheck TSH in 6–8 weeks after dose change
C. Recheck free T4 in 1 week; adjust to normalize free T4
D. Recheck TSH and free T3 every 3 months
Answer: B
Rationale: After initiating or adjusting levothyroxine, TSH should be rechecked in 6–8 weeks, the time
needed to reach steady state. Checking too soon leads to inappropriate dose changes. Free T4 is not
routinely needed for monitoring once treatment is established, and TSH is the primary marker. Free T3
monitoring is not recommended. The correct interval is 6–8 weeks.
Question 6
A 74-year-old man with COPD (FEV₁ 45% predicted, two exacerbations in the past year) on LAMA/LABA
therapy presents with increased dyspnea. Oxygen saturation is 89% on room air. Which additional
therapy is indicated?
A. Inhaled corticosteroid (ICS) added to LAMA/LABA
B. Chronic oral prednisone 5 mg daily
C. Home oxygen therapy
D. Azithromycin 250 mg daily for exacerbation prevention
Answer: C
Rationale: Oxygen saturation ≤88% or PaO₂ ≤55 mmHg qualifies for long-term oxygen therapy (LTOT) in
COPD, which improves survival. While ICS may be added for frequent exacerbations (blood eosinophils
≥100 cells/µL), oxygen is the immediate priority based on hypoxemia. Chronic prednisone is not
recommended. Azithromycin prophylaxis is an option for frequent exacerbations but not first-line over
oxygen when hypoxemia is present.
Question 7
A 55-year-old woman with a 35-pack-year smoking history asks if she should undergo lung cancer
screening. She quit smoking 12 years ago. She has no symptoms. What does USPSTF recommend?
A. Annual low-dose CT (LDCT) for ages 50–80 with ≥20 pack-year history, if quit within 15 years
B. Annual chest X-ray
C. LDCT only if she has a first-degree relative with lung cancer
D. No screening because she quit >10 years ago
Answer: A
Rationale: USPSTF 2021 recommends annual LDCT for adults aged 50–80 years who have a 20 pack-year
smoking history and currently smoke or have quit within the past 15 years. She qualifies (quit 12 years
pg. 3
, 4
ago, 35 pack-years). Chest X-ray is not recommended for screening. Family history expands risk but is
not required for the general screening criterion; she meets criteria anyway.
Question 8
A 30-year-old woman at 32 weeks gestation presents with severe headache, blood pressure 162/104
mmHg, 3+ proteinuria, and hyperreflexia. Which antihypertensive is the first-line agent for acute severe
hypertension in this setting?
A. Oral labetalol 200 mg
B. Intravenous hydralazine 5–10 mg
C. Oral nifedipine immediate-release 10 mg
D. Either IV labetalol or IV hydralazine
Answer: D
Rationale: For acute-onset severe hypertension in preeclampsia, ACOG recommends IV labetalol, IV
hydralazine, or immediate-release oral nifedipine as first-line agents. The question specifically asks for
first-line agent, but many guidelines list IV labetalol and IV hydralazine as equal options. Option D most
correctly reflects that both are acceptable. Oral labetalol onset is slower; oral nifedipine is also first-line
but not offered in a single choice. “Either IV labetalol or IV hydralazine” is the best answer.
Question 9
A 68-year-old man with heart failure with preserved ejection fraction (HFpEF, EF 58%) has persistent
dyspnea despite furosemide and lisinopril. Blood pressure is 130/76 mmHg, eGFR 50. Which medication
class has the strongest evidence for reducing heart failure hospitalizations in HFpEF?
A. Beta-blocker (metoprolol succinate)
B. SGLT2 inhibitor (dapagliflozin)
C. Aldosterone antagonist (spironolactone)
D. Digoxin
Answer: B
Rationale: In HFpEF, SGLT2 inhibitors (dapagliflozin, empagliflozin) have demonstrated a significant
reduction in heart failure hospitalizations (DELIVER, EMPEROR-Preserved trials). Beta-blockers have no
morbidity/mortality benefit in HFpEF. Spironolactone showed a modest reduction in HF hospitalizations
in TOPCAT but only in those with EF <55% in some analyses; SGLT2i now has stronger guideline
endorsement. Digoxin is not indicated. Thus, SGLT2 inhibitor is the most evidence-based addition.
Question 10
A 45-year-old woman with chronic migraine (≥15 headache days per month) has failed trials of
propranolol and topiramate. She currently takes sumatriptan as needed but experiences medication-
overuse headaches. What is the most appropriate preventive strategy?
pg. 4
