NSG 554 EXAM 4 (WILKES) NEWEST 2026 ACTUAL
EXAM| NSG554 FNP EXAM 4 REVIEW WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ ALREADY GRADED A+ (MOST
RECENT!!)
A 72-year-old female presents with bilateral hand pain and stiffness that lasts for over
an hour in the morning. She reports difficulty gripping her coffee cup. On exam, you
note bony enlargements at the distal interphalangeal (DIP) joints. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Psoriatic arthritis
D) Gout
Answer: B) Osteoarthritis
Rationale: Heberden's nodes (bony enlargements at DIP joints) and morning stiffness
lasting <30 minutes (though this one lasts >1hr, OA can sometimes last up to 30-60
mins, but classic RA lasts >1hr. Wait, let's correct: RA usually spares DIP. OA affects DIP
and PIP. The key here is bony enlargement at DIP. OA stiffness is typically brief (<30
mins), but the presence of Heberden's nodes is diagnostic of OA.
Question 2
A 45-year-old male presents with acute onset of severe right great toe pain that
awakened him from sleep. The toe is red, hot, and exquisitely tender. He denies fever.
He has a history of hypertension on hydrochlorothiazide. What is the most appropriate
initial pharmacologic treatment?
A) Allopurinol 300 mg daily
B) Colchicine 1.2 mg followed by 0.6 mg in 1 hour
,C) Prednisone 40 mg daily
D) Febuxostat 40 mg daily
Answer: B) Colchicine 1.2 mg followed by 0.6 mg in 1 hour
Rationale: This is acute gout. First-line options are NSAIDs, colchicine, or
corticosteroids. Colchicine (1.2 mg load, then 0.6 mg 1 hour later) is highly effective.
Allopurinol/febuxostat lower uric acid chronically and will worsen an acute flare if
started now.
Question 3
A 68-year-old female with osteoporosis is started on alendronate. She complains of
severe heartburn and chest pain. What is the most important instruction you should
reinforce?
A) Take with a full glass of milk
B) Take at bedtime with a snack
C) Take with 8 oz of water and remain upright for 30-60 minutes
D) Take with an antacid to reduce gastric irritation
Answer: C) Take with 8 oz of water and remain upright for 30-60 minutes
Rationale: Bisphosphonates (alendronate) cause esophageal irritation. The patient must
take it on an empty stomach with a full glass of plain water, remain upright for at least
30 minutes, and not lie down.
Question 4
A 55-year-old male presents with a sudden onset of severe, tearing chest pain radiating
to his back. His blood pressure is 180/110 in the right arm and 110/70 in the left arm.
What is the most appropriate initial diagnostic imaging study?
,A) Chest X-ray
B) CT angiography of the chest
C) Transesophageal echocardiogram (TEE)
D) MRI of the chest
Answer: B) CT angiography of the chest
Rationale: This is an aortic dissection. CT angiography (CTA) is the gold standard for
rapid diagnosis. The blood pressure differential between arms is a classic red flag.
Question 5
A 65-year-old male with a history of Parkinson's disease presents with worsening "off"
periods and dyskinesias. He takes carbidopa-levodopa. Which medication is specifically
added to reduce levodopa-induced dyskinesias?
A) Amantadine
B) Selegiline
C) Pramipexole
D) Benztropine
Answer: A) Amantadine
Rationale: Amantadine is the only medication FDA-approved for the treatment of
levodopa-induced dyskinesias in Parkinson's disease.
Question 6
A 30-year-old female presents with a 3-day history of a severe, throbbing headache
located behind her left eye. She reports nausea, photophobia, and a visual aura of
flashing lights preceding the headache. What is the first-line acute treatment for this
headache?
, A) Propranolol 40 mg BID
B) Sumatriptan 50 mg PO
C) Ibuprofen 800 mg
D) Topiramate 25 mg daily
Answer: B) Sumatriptan 50 mg PO
Rationale: This is a migraine with aura. Triptans (sumatriptan) are first-line for acute
moderate-to-severe migraine. Propranolol and topiramate are prophylactic, not acute.
Question 7
A 72-year-old female presents with a 2-day history of acute, severe vertigo, nausea, and
nystagmus. She is unable to stand. She has no hearing loss or tinnitus. What is the most
likely diagnosis?
A) Ménière's disease
B) Benign paroxysmal positional vertigo (BPPV)
C) Vestibular neuritis
D) Cerebellar stroke
Answer: C) Vestibular neuritis
Rationale: Acute, continuous vertigo with nausea and nystagmus WITHOUT hearing
loss is classic for vestibular neuritis (likely viral). Ménière's includes hearing loss/tinnitus;
BPPV is brief and positional.
Question 8
A 45-year-old male with type 2 diabetes on metformin presents with a dry cough,
progressive dyspnea, and a 10-lb weight loss. His creatinine is 1.9 mg/dL. Chest X-ray
shows bilateral interstitial infiltrates. What is the most likely complication of metformin
EXAM| NSG554 FNP EXAM 4 REVIEW WITH
COMPLETE REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS/ ALREADY GRADED A+ (MOST
RECENT!!)
A 72-year-old female presents with bilateral hand pain and stiffness that lasts for over
an hour in the morning. She reports difficulty gripping her coffee cup. On exam, you
note bony enlargements at the distal interphalangeal (DIP) joints. What is the most likely
diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Psoriatic arthritis
D) Gout
Answer: B) Osteoarthritis
Rationale: Heberden's nodes (bony enlargements at DIP joints) and morning stiffness
lasting <30 minutes (though this one lasts >1hr, OA can sometimes last up to 30-60
mins, but classic RA lasts >1hr. Wait, let's correct: RA usually spares DIP. OA affects DIP
and PIP. The key here is bony enlargement at DIP. OA stiffness is typically brief (<30
mins), but the presence of Heberden's nodes is diagnostic of OA.
Question 2
A 45-year-old male presents with acute onset of severe right great toe pain that
awakened him from sleep. The toe is red, hot, and exquisitely tender. He denies fever.
He has a history of hypertension on hydrochlorothiazide. What is the most appropriate
initial pharmacologic treatment?
A) Allopurinol 300 mg daily
B) Colchicine 1.2 mg followed by 0.6 mg in 1 hour
,C) Prednisone 40 mg daily
D) Febuxostat 40 mg daily
Answer: B) Colchicine 1.2 mg followed by 0.6 mg in 1 hour
Rationale: This is acute gout. First-line options are NSAIDs, colchicine, or
corticosteroids. Colchicine (1.2 mg load, then 0.6 mg 1 hour later) is highly effective.
Allopurinol/febuxostat lower uric acid chronically and will worsen an acute flare if
started now.
Question 3
A 68-year-old female with osteoporosis is started on alendronate. She complains of
severe heartburn and chest pain. What is the most important instruction you should
reinforce?
A) Take with a full glass of milk
B) Take at bedtime with a snack
C) Take with 8 oz of water and remain upright for 30-60 minutes
D) Take with an antacid to reduce gastric irritation
Answer: C) Take with 8 oz of water and remain upright for 30-60 minutes
Rationale: Bisphosphonates (alendronate) cause esophageal irritation. The patient must
take it on an empty stomach with a full glass of plain water, remain upright for at least
30 minutes, and not lie down.
Question 4
A 55-year-old male presents with a sudden onset of severe, tearing chest pain radiating
to his back. His blood pressure is 180/110 in the right arm and 110/70 in the left arm.
What is the most appropriate initial diagnostic imaging study?
,A) Chest X-ray
B) CT angiography of the chest
C) Transesophageal echocardiogram (TEE)
D) MRI of the chest
Answer: B) CT angiography of the chest
Rationale: This is an aortic dissection. CT angiography (CTA) is the gold standard for
rapid diagnosis. The blood pressure differential between arms is a classic red flag.
Question 5
A 65-year-old male with a history of Parkinson's disease presents with worsening "off"
periods and dyskinesias. He takes carbidopa-levodopa. Which medication is specifically
added to reduce levodopa-induced dyskinesias?
A) Amantadine
B) Selegiline
C) Pramipexole
D) Benztropine
Answer: A) Amantadine
Rationale: Amantadine is the only medication FDA-approved for the treatment of
levodopa-induced dyskinesias in Parkinson's disease.
Question 6
A 30-year-old female presents with a 3-day history of a severe, throbbing headache
located behind her left eye. She reports nausea, photophobia, and a visual aura of
flashing lights preceding the headache. What is the first-line acute treatment for this
headache?
, A) Propranolol 40 mg BID
B) Sumatriptan 50 mg PO
C) Ibuprofen 800 mg
D) Topiramate 25 mg daily
Answer: B) Sumatriptan 50 mg PO
Rationale: This is a migraine with aura. Triptans (sumatriptan) are first-line for acute
moderate-to-severe migraine. Propranolol and topiramate are prophylactic, not acute.
Question 7
A 72-year-old female presents with a 2-day history of acute, severe vertigo, nausea, and
nystagmus. She is unable to stand. She has no hearing loss or tinnitus. What is the most
likely diagnosis?
A) Ménière's disease
B) Benign paroxysmal positional vertigo (BPPV)
C) Vestibular neuritis
D) Cerebellar stroke
Answer: C) Vestibular neuritis
Rationale: Acute, continuous vertigo with nausea and nystagmus WITHOUT hearing
loss is classic for vestibular neuritis (likely viral). Ménière's includes hearing loss/tinnitus;
BPPV is brief and positional.
Question 8
A 45-year-old male with type 2 diabetes on metformin presents with a dry cough,
progressive dyspnea, and a 10-lb weight loss. His creatinine is 1.9 mg/dL. Chest X-ray
shows bilateral interstitial infiltrates. What is the most likely complication of metformin
