NR 577 Primary Care Management Adolescents Adults
Final Exam Actual 2026/2027 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular & Respiratory Primary Care (Questions
1–14)
Q1: A 58-year-old patient with hypertension presents for a follow-up visit. Their home
blood pressure log shows consistent readings of 138/86 mmHg despite adherence
to lifestyle modifications. According to current ACC/AHA guidelines, which is the
most appropriate next step in management?
A. Continue lifestyle modifications alone for another 6 months
B. Initiate dual antihypertensive therapy with an ACE inhibitor and calcium channel
blocker
C. Initiate single antihypertensive therapy, preferably a thiazide diuretic, ACE inhibitor,
ARB, or calcium channel blocker
D. Order comprehensive metabolic panel and echocardiogram before starting
medication
Correct Answer: C
Rationale: Stage 1 hypertension with a 10-year ASCVD risk ≥10% or established CVD
warrants pharmacologic therapy; first-line options include thiazide diuretics, ACE
inhibitors, ARBs, or calcium channel blockers as monotherapy.
,Q2: A 45-year-old patient with hyperlipidemia has a fasting lipid panel showing LDL-C
of 160 mg/dL, HDL-C of 38 mg/dL, and triglycerides of 220 mg/dL. They have no
history of cardiovascular disease or diabetes. What is the most appropriate initial
management?
A. Initiate high-intensity statin therapy immediately
B. Calculate 10-year ASCVD risk to guide statin intensity decision
C. Initiate ezetimibe as first-line therapy
D. Recommend dietary modification alone and recheck lipids in 1 year
Correct Answer: B
Rationale: The 2018 ACC/AHA cholesterol guidelines recommend calculating
10-year ASCVD risk to determine whether moderate- or high-intensity statin therapy
is indicated for primary prevention in adults with elevated LDL-C.
Q3: A 72-year-old patient with heart failure with reduced ejection fraction (HFrEF) is
currently on lisinopril and metoprolol succinate. Which additional medication, when
added to this regimen, has been shown to reduce mortality and hospitalization in
HFrEF?
A. Diltiazem
B. Sacubitril/valsartan (ARNI)
C. Hydralazine
D. Digoxin
Correct Answer: B
,Rationale: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has
demonstrated significant mortality and morbidity benefits in HFrEF and is
recommended to replace ACE inhibitors in eligible patients.
Q4: A 35-year-old patient with asthma reports using their albuterol inhaler more than
twice weekly for rescue symptoms and waking at night with cough twice monthly.
According to NHLBI asthma guidelines, which step of therapy is most appropriate?
A. Step 1: SABA as needed only
B. Step 2: Low-dose inhaled corticosteroid (ICS) daily plus SABA as needed
C. Step 3: Medium-dose ICS or low-dose ICS/LABA combination
D. Step 4: Medium-dose ICS/LABA combination
Correct Answer: B
Rationale: This patient has mild persistent asthma (symptoms >2 days/week but not
daily, nighttime awakenings 3–4 times/month), which corresponds to Step 2 therapy
requiring daily low-dose ICS plus SABA for rescue.
Q5: A 68-year-old patient with COPD (GOLD Group D) continues to have
exacerbations despite dual bronchodilator therapy. Which medication addition is
recommended to reduce exacerbation frequency?
A. Oral theophylline
B. Inhaled corticosteroid
C. Oral corticosteroid maintenance
D. Long-acting muscarinic antagonist (LAMA)
Correct Answer: B
, Rationale: For GOLD Group D patients with frequent exacerbations despite
LAMA/LABA dual therapy, adding an inhaled corticosteroid (triple therapy) reduces
exacerbation frequency and improves outcomes.
Q6: A 62-year-old patient presents with acute-onset dyspnea, pleuritic chest pain, and
tachycardia. Wells score is calculated as intermediate probability. Which is the most
appropriate next diagnostic step?
A. Start empiric heparin and order ventilation-perfusion scan
B. Order D-dimer testing
C. Proceed directly to CT pulmonary angiography (CTPA)
D. Order chest X-ray and observe
Correct Answer: C
Rationale: For intermediate or high pre-test probability of pulmonary embolism, CTPA
is the diagnostic test of choice; D-dimer is not recommended as it will likely be
elevated and not discriminatory in intermediate/high probability patients.
Q7: A patient with stable coronary artery disease presents for medication review.
Which medication has the strongest evidence for reducing mortality in this
population?
A. Amlodipine
B. Aspirin
C. Atorvastatin (high-intensity statin)
D. Isosorbide mononitrate
Correct Answer: C
Final Exam Actual 2026/2027 with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
SECTION 1: Cardiovascular & Respiratory Primary Care (Questions
1–14)
Q1: A 58-year-old patient with hypertension presents for a follow-up visit. Their home
blood pressure log shows consistent readings of 138/86 mmHg despite adherence
to lifestyle modifications. According to current ACC/AHA guidelines, which is the
most appropriate next step in management?
A. Continue lifestyle modifications alone for another 6 months
B. Initiate dual antihypertensive therapy with an ACE inhibitor and calcium channel
blocker
C. Initiate single antihypertensive therapy, preferably a thiazide diuretic, ACE inhibitor,
ARB, or calcium channel blocker
D. Order comprehensive metabolic panel and echocardiogram before starting
medication
Correct Answer: C
Rationale: Stage 1 hypertension with a 10-year ASCVD risk ≥10% or established CVD
warrants pharmacologic therapy; first-line options include thiazide diuretics, ACE
inhibitors, ARBs, or calcium channel blockers as monotherapy.
,Q2: A 45-year-old patient with hyperlipidemia has a fasting lipid panel showing LDL-C
of 160 mg/dL, HDL-C of 38 mg/dL, and triglycerides of 220 mg/dL. They have no
history of cardiovascular disease or diabetes. What is the most appropriate initial
management?
A. Initiate high-intensity statin therapy immediately
B. Calculate 10-year ASCVD risk to guide statin intensity decision
C. Initiate ezetimibe as first-line therapy
D. Recommend dietary modification alone and recheck lipids in 1 year
Correct Answer: B
Rationale: The 2018 ACC/AHA cholesterol guidelines recommend calculating
10-year ASCVD risk to determine whether moderate- or high-intensity statin therapy
is indicated for primary prevention in adults with elevated LDL-C.
Q3: A 72-year-old patient with heart failure with reduced ejection fraction (HFrEF) is
currently on lisinopril and metoprolol succinate. Which additional medication, when
added to this regimen, has been shown to reduce mortality and hospitalization in
HFrEF?
A. Diltiazem
B. Sacubitril/valsartan (ARNI)
C. Hydralazine
D. Digoxin
Correct Answer: B
,Rationale: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has
demonstrated significant mortality and morbidity benefits in HFrEF and is
recommended to replace ACE inhibitors in eligible patients.
Q4: A 35-year-old patient with asthma reports using their albuterol inhaler more than
twice weekly for rescue symptoms and waking at night with cough twice monthly.
According to NHLBI asthma guidelines, which step of therapy is most appropriate?
A. Step 1: SABA as needed only
B. Step 2: Low-dose inhaled corticosteroid (ICS) daily plus SABA as needed
C. Step 3: Medium-dose ICS or low-dose ICS/LABA combination
D. Step 4: Medium-dose ICS/LABA combination
Correct Answer: B
Rationale: This patient has mild persistent asthma (symptoms >2 days/week but not
daily, nighttime awakenings 3–4 times/month), which corresponds to Step 2 therapy
requiring daily low-dose ICS plus SABA for rescue.
Q5: A 68-year-old patient with COPD (GOLD Group D) continues to have
exacerbations despite dual bronchodilator therapy. Which medication addition is
recommended to reduce exacerbation frequency?
A. Oral theophylline
B. Inhaled corticosteroid
C. Oral corticosteroid maintenance
D. Long-acting muscarinic antagonist (LAMA)
Correct Answer: B
, Rationale: For GOLD Group D patients with frequent exacerbations despite
LAMA/LABA dual therapy, adding an inhaled corticosteroid (triple therapy) reduces
exacerbation frequency and improves outcomes.
Q6: A 62-year-old patient presents with acute-onset dyspnea, pleuritic chest pain, and
tachycardia. Wells score is calculated as intermediate probability. Which is the most
appropriate next diagnostic step?
A. Start empiric heparin and order ventilation-perfusion scan
B. Order D-dimer testing
C. Proceed directly to CT pulmonary angiography (CTPA)
D. Order chest X-ray and observe
Correct Answer: C
Rationale: For intermediate or high pre-test probability of pulmonary embolism, CTPA
is the diagnostic test of choice; D-dimer is not recommended as it will likely be
elevated and not discriminatory in intermediate/high probability patients.
Q7: A patient with stable coronary artery disease presents for medication review.
Which medication has the strongest evidence for reducing mortality in this
population?
A. Amlodipine
B. Aspirin
C. Atorvastatin (high-intensity statin)
D. Isosorbide mononitrate
Correct Answer: C
