NRNP 6531 FINAL / NRNP 6531 FINAL 2025/2026
EXAM QUESTIONS WITH VERIFIED ANSWERS
GRADED A+| ASSURED SUCCESS
Question 1
A 72-year-old male with hypertension reports dizziness when standing up. His BP
supine is 140/90, standing 100/70. What is the most appropriate initial
management?
A) Increase his lisinopril
B) Add hydrochlorothiazide
C) Review and reduce antihypertensive medications
D) Order a head CT
Correct Answer: C
Explanation: Orthostatic hypotension in elderly on antihypertensives is often
medication-induced. Reviewing and reducing medications is first-line, not
increasing or adding agents.
Question 2
A 55-year-old female with type 2 diabetes has an eGFR of 28 mL/min. Which
medication should be avoided?
A) Metformin
B) Liraglutide
C) Sitagliptin
D) Pioglitazone
Correct Answer: A
*Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of
,lactic acidosis. Other agents may need dose adjustment but are not absolutely
avoided.*
Question 3
A 68-year-old male presents with acute onset of severe left lower quadrant pain,
fever, and constipation. CT shows diverticulitis with a small abscess. What is the
next step?
A) Oral antibiotics and outpatient follow-up
B) IV antibiotics and percutaneous drainage
C) Immediate surgical resection
D) Colonoscopy
Correct Answer: B
Explanation: Complicated diverticulitis with abscess requires IV antibiotics and
percutaneous drainage. Surgery is reserved for peritonitis or failed medical
management.
Question 4
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin.
TSH is 12 mIU/L (normal 0.4-4). Free T4 is low. What is the treatment?
A) Levothyroxine 1.6 mcg/kg/day
B) Methimazole 10 mg daily
C) Levothyroxine 25 mcg daily start
D) Radioactive iodine
Correct Answer: C
*Explanation: Overt hypothyroidism in young adults starts with low-dose
levothyroxine (25-50 mcg) to avoid cardiac stress, then titrate. Full dose 1.6
mcg/kg is for healthy young.*
Question 5
Which finding on a knee exam suggests a medial meniscus tear?
A) Anterior drawer test positive
B) McMurray test with medial joint line pain and click
,C) Patellar apprehension test positive
D) Lachman test positive
Correct Answer: B
Explanation: McMurray test specifically loads the meniscus; medial joint line
pain/click indicates medial meniscus tear. Anterior drawer and Lachman test ACL
integrity.
Question 6
A 70-year-old with chronic kidney disease stage 4 and heart failure with reduced
ejection fraction (HFrEF) is on furosemide. Which medication improves mortality
and is safe in CKD?
A) Hydrochlorothiazide
B) Spironolactone
C) Metolazone
D) Carvedilol
Correct Answer: D
*Explanation: Carvedilol (beta-blocker) improves mortality in HFrEF and is safe in
CKD. Spironolactone risks hyperkalemia in CKD stage 4.*
Question 7
A 35-year-old male has a painful, swollen right great toe. Serum uric acid is 9.5
mg/dL. What is first-line acute treatment?
A) Allopurinol 300 mg daily
B) Colchicine 0.6 mg BID
C) NSAIDs (e.g., indomethacin)
D) Febuxostat
Correct Answer: C
Explanation: NSAIDs are first-line for acute gout if no contraindications. Colchicine
is alternative; allopurinol is for chronic management and can worsen acute flare if
started during attack.
Question 8
, A 60-year-old female with osteoporosis has a T-score of -3.0 at the femoral neck.
She has no prior fractures. Which medication is first-line?
A) Raloxifene
B) Alendronate
C) Teriparatide
D) Denosumab
Correct Answer: B
*Explanation: Alendronate (bisphosphonate) is first-line for osteoporosis with T-
score < -2.5. Teriparatide is for severe or treatment failure; denosumab second-
line.*
Question 9
A 50-year-old male with COPD has worsening dyspnea, increased sputum
purulence, and volume. He is afebrile with normal mental status. What is the best
initial antibiotic?
A) Azithromycin
B) Levofloxacin
C) Amoxicillin-clavulanate
D) Doxycycline
Correct Answer: D
Explanation: For mild acute exacerbation of COPD without risk factors for
Pseudomonas, doxycycline or macrolides are first-line. Quinolones reserved for
mod-severe or comorbidities.
Question 10
A 25-year-old female presents with palpitations, heat intolerance, weight loss, and
tremor. TSH <0.01, free T4 elevated. What is the most likely diagnosis?
A) Subacute thyroiditis
B) Graves’ disease
C) Toxic multinodular goiter
D) Pituitary adenoma
EXAM QUESTIONS WITH VERIFIED ANSWERS
GRADED A+| ASSURED SUCCESS
Question 1
A 72-year-old male with hypertension reports dizziness when standing up. His BP
supine is 140/90, standing 100/70. What is the most appropriate initial
management?
A) Increase his lisinopril
B) Add hydrochlorothiazide
C) Review and reduce antihypertensive medications
D) Order a head CT
Correct Answer: C
Explanation: Orthostatic hypotension in elderly on antihypertensives is often
medication-induced. Reviewing and reducing medications is first-line, not
increasing or adding agents.
Question 2
A 55-year-old female with type 2 diabetes has an eGFR of 28 mL/min. Which
medication should be avoided?
A) Metformin
B) Liraglutide
C) Sitagliptin
D) Pioglitazone
Correct Answer: A
*Explanation: Metformin is contraindicated when eGFR <30 mL/min due to risk of
,lactic acidosis. Other agents may need dose adjustment but are not absolutely
avoided.*
Question 3
A 68-year-old male presents with acute onset of severe left lower quadrant pain,
fever, and constipation. CT shows diverticulitis with a small abscess. What is the
next step?
A) Oral antibiotics and outpatient follow-up
B) IV antibiotics and percutaneous drainage
C) Immediate surgical resection
D) Colonoscopy
Correct Answer: B
Explanation: Complicated diverticulitis with abscess requires IV antibiotics and
percutaneous drainage. Surgery is reserved for peritonitis or failed medical
management.
Question 4
A 45-year-old female reports fatigue, weight gain, cold intolerance, and dry skin.
TSH is 12 mIU/L (normal 0.4-4). Free T4 is low. What is the treatment?
A) Levothyroxine 1.6 mcg/kg/day
B) Methimazole 10 mg daily
C) Levothyroxine 25 mcg daily start
D) Radioactive iodine
Correct Answer: C
*Explanation: Overt hypothyroidism in young adults starts with low-dose
levothyroxine (25-50 mcg) to avoid cardiac stress, then titrate. Full dose 1.6
mcg/kg is for healthy young.*
Question 5
Which finding on a knee exam suggests a medial meniscus tear?
A) Anterior drawer test positive
B) McMurray test with medial joint line pain and click
,C) Patellar apprehension test positive
D) Lachman test positive
Correct Answer: B
Explanation: McMurray test specifically loads the meniscus; medial joint line
pain/click indicates medial meniscus tear. Anterior drawer and Lachman test ACL
integrity.
Question 6
A 70-year-old with chronic kidney disease stage 4 and heart failure with reduced
ejection fraction (HFrEF) is on furosemide. Which medication improves mortality
and is safe in CKD?
A) Hydrochlorothiazide
B) Spironolactone
C) Metolazone
D) Carvedilol
Correct Answer: D
*Explanation: Carvedilol (beta-blocker) improves mortality in HFrEF and is safe in
CKD. Spironolactone risks hyperkalemia in CKD stage 4.*
Question 7
A 35-year-old male has a painful, swollen right great toe. Serum uric acid is 9.5
mg/dL. What is first-line acute treatment?
A) Allopurinol 300 mg daily
B) Colchicine 0.6 mg BID
C) NSAIDs (e.g., indomethacin)
D) Febuxostat
Correct Answer: C
Explanation: NSAIDs are first-line for acute gout if no contraindications. Colchicine
is alternative; allopurinol is for chronic management and can worsen acute flare if
started during attack.
Question 8
, A 60-year-old female with osteoporosis has a T-score of -3.0 at the femoral neck.
She has no prior fractures. Which medication is first-line?
A) Raloxifene
B) Alendronate
C) Teriparatide
D) Denosumab
Correct Answer: B
*Explanation: Alendronate (bisphosphonate) is first-line for osteoporosis with T-
score < -2.5. Teriparatide is for severe or treatment failure; denosumab second-
line.*
Question 9
A 50-year-old male with COPD has worsening dyspnea, increased sputum
purulence, and volume. He is afebrile with normal mental status. What is the best
initial antibiotic?
A) Azithromycin
B) Levofloxacin
C) Amoxicillin-clavulanate
D) Doxycycline
Correct Answer: D
Explanation: For mild acute exacerbation of COPD without risk factors for
Pseudomonas, doxycycline or macrolides are first-line. Quinolones reserved for
mod-severe or comorbidities.
Question 10
A 25-year-old female presents with palpitations, heat intolerance, weight loss, and
tremor. TSH <0.01, free T4 elevated. What is the most likely diagnosis?
A) Subacute thyroiditis
B) Graves’ disease
C) Toxic multinodular goiter
D) Pituitary adenoma
