NSG 554 EXAM 3 NURSE PRACTITIONERS
IN PRIMARY CARE I QUESTIONS &
ANSWERS + EXPERT RATIONALES
(VERIFIED 2026-2027)
This comprehensive practice bank provides actual board-style multiple-
choice questions complete with correct answers and expert rationales
tailored for primary care nurse practitioner students. It offers in-depth
coverage of high-yield clinical systems including gastrointestinal,
musculoskeletal, infectious diseases, and virology management. Designed
explicitly to align with updated curriculum standards, this material ensures a
mastery of complex diagnostic workflows, physical exam maneuvers, and
primary care pharmacology guidelines.
Part 1: Gastrointestinal & Hepatic Disorders
(Questions 1–15)
Question 1
A 42-year-old male presents with a 3-day history of
fatigue, malaise, and a sudden distaste for his daily
cigarettes. On physical examination, mild scleral
icterus is noted. Laboratory results reveal
significantly elevated ALT and AST. Which of the
following is the most likely diagnosis?
A. Chronic Hepatitis C
B. Acute Hepatitis A
C. Liver Cirrhosis
D. Cholelithiasis
Answer: B
Rationale: Acute Hepatitis A presents abruptly
,with systemic symptoms such as fatigue,
malaise, low-grade fever, nausea, and a unique,
classic symptom: a sudden distaste for smoking.
Scleral icterus and elevated aminotransferases
confirm acute hepatic inflammation. Transmitted
via the fecal-oral route, it does not typically lead
to chronic states like Hepatitis C or Cirrhosis.
Question 2
A 55-year-old female presents for a routine wellness
exam. She reports a history of intravenous drug use
in her early twenties but has been sober for 30
years. Which screening test should the nurse
practitioner order first to evaluate for Hepatitis C?
A. HCV RNA quantitative PCR
B. HCV antibody (anti-HCV) screening
C. Liver biopsy
D. ALT/AST panel only
Answer: B
Rationale: The gold standard initial screening
test for Hepatitis C infection is the HCV antibody
test. If the antibody test returns positive, it must
be followed by a confirmatory HCV RNA
quantitative PCR test to differentiate between a
past resolved infection and an active, chronic
infection.
,Question 3
A patient diagnosed with Peptic Ulcer Disease
(PUD) returns for evaluation. The nurse practitioner
notes the presence of "alarm symptoms" or red flags
that warrant urgent referral for an
esophagogastroduodenoscopy (EGD). Which
symptom represents an alarm criterion?
A. Mild epigastric burning after eating
B. Intermittent non-bloody diarrhea
C. Unexplained weight loss and iron deficiency
anemia
D. Heartburn radiating to the throat
Answer: C
Rationale: Alarm symptoms in PUD and GERD
indicate potential malignancy, perforation, or
severe gastrointestinal bleeding. These include
unexplained weight loss, iron deficiency anemia,
progressive dysphagia, odynophagia, and
recurrent vomiting. Mild burning, heartburn, and
non-bloody diarrhea are standard features that
do not automatically require immediate invasive
scoping.
Question 4
A 28-year-old male complains of severe, burning
epigastric pain that worsens 2 to 3 hours after
, meals. He notes that eating food or taking an
antacid temporarily relieves the discomfort. Which
condition is most consistent with this presentation?
A. Gastric ulcer
B. Duodenal ulcer
C. Acute cholecystitis
D. Acute pancreatitis
Answer: B
Rationale: Duodenal ulcers characteristically
present with pain that occurs a few hours after a
meal when the stomach empty and acid passes
into the duodenum. Eating food buffers the acid,
providing transient relief. Gastric ulcers,
conversely, typically present with pain
immediately after eating, leading to food
avoidance and weight loss.
Question 5
The nurse practitioner is managing a patient with
chronic GERD who has failed lifestyle modifications
and antacids. Following a "step-up" therapeutic
strategy, what is the next most appropriate
pharmacological choice?
A. Daily Proton Pump Inhibitor (PPI)
B. Daily Histamine-2 Receptor Antagonist (H2RA)
C. Intermittent Sucralfate therapy
IN PRIMARY CARE I QUESTIONS &
ANSWERS + EXPERT RATIONALES
(VERIFIED 2026-2027)
This comprehensive practice bank provides actual board-style multiple-
choice questions complete with correct answers and expert rationales
tailored for primary care nurse practitioner students. It offers in-depth
coverage of high-yield clinical systems including gastrointestinal,
musculoskeletal, infectious diseases, and virology management. Designed
explicitly to align with updated curriculum standards, this material ensures a
mastery of complex diagnostic workflows, physical exam maneuvers, and
primary care pharmacology guidelines.
Part 1: Gastrointestinal & Hepatic Disorders
(Questions 1–15)
Question 1
A 42-year-old male presents with a 3-day history of
fatigue, malaise, and a sudden distaste for his daily
cigarettes. On physical examination, mild scleral
icterus is noted. Laboratory results reveal
significantly elevated ALT and AST. Which of the
following is the most likely diagnosis?
A. Chronic Hepatitis C
B. Acute Hepatitis A
C. Liver Cirrhosis
D. Cholelithiasis
Answer: B
Rationale: Acute Hepatitis A presents abruptly
,with systemic symptoms such as fatigue,
malaise, low-grade fever, nausea, and a unique,
classic symptom: a sudden distaste for smoking.
Scleral icterus and elevated aminotransferases
confirm acute hepatic inflammation. Transmitted
via the fecal-oral route, it does not typically lead
to chronic states like Hepatitis C or Cirrhosis.
Question 2
A 55-year-old female presents for a routine wellness
exam. She reports a history of intravenous drug use
in her early twenties but has been sober for 30
years. Which screening test should the nurse
practitioner order first to evaluate for Hepatitis C?
A. HCV RNA quantitative PCR
B. HCV antibody (anti-HCV) screening
C. Liver biopsy
D. ALT/AST panel only
Answer: B
Rationale: The gold standard initial screening
test for Hepatitis C infection is the HCV antibody
test. If the antibody test returns positive, it must
be followed by a confirmatory HCV RNA
quantitative PCR test to differentiate between a
past resolved infection and an active, chronic
infection.
,Question 3
A patient diagnosed with Peptic Ulcer Disease
(PUD) returns for evaluation. The nurse practitioner
notes the presence of "alarm symptoms" or red flags
that warrant urgent referral for an
esophagogastroduodenoscopy (EGD). Which
symptom represents an alarm criterion?
A. Mild epigastric burning after eating
B. Intermittent non-bloody diarrhea
C. Unexplained weight loss and iron deficiency
anemia
D. Heartburn radiating to the throat
Answer: C
Rationale: Alarm symptoms in PUD and GERD
indicate potential malignancy, perforation, or
severe gastrointestinal bleeding. These include
unexplained weight loss, iron deficiency anemia,
progressive dysphagia, odynophagia, and
recurrent vomiting. Mild burning, heartburn, and
non-bloody diarrhea are standard features that
do not automatically require immediate invasive
scoping.
Question 4
A 28-year-old male complains of severe, burning
epigastric pain that worsens 2 to 3 hours after
, meals. He notes that eating food or taking an
antacid temporarily relieves the discomfort. Which
condition is most consistent with this presentation?
A. Gastric ulcer
B. Duodenal ulcer
C. Acute cholecystitis
D. Acute pancreatitis
Answer: B
Rationale: Duodenal ulcers characteristically
present with pain that occurs a few hours after a
meal when the stomach empty and acid passes
into the duodenum. Eating food buffers the acid,
providing transient relief. Gastric ulcers,
conversely, typically present with pain
immediately after eating, leading to food
avoidance and weight loss.
Question 5
The nurse practitioner is managing a patient with
chronic GERD who has failed lifestyle modifications
and antacids. Following a "step-up" therapeutic
strategy, what is the next most appropriate
pharmacological choice?
A. Daily Proton Pump Inhibitor (PPI)
B. Daily Histamine-2 Receptor Antagonist (H2RA)
C. Intermittent Sucralfate therapy
