Nurse Practitioners in Primary
Care I
Wilkes University
NSG554/NSG 554 Exam 4
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Musculoskeletal and Rheumatologic Disorders
(Questions 1-15)
Question 1
A 45-year-old female presents with bilateral joint pain, stiffness,
and swelling in her hands, wrists, and knees. Morning stiffness
lasts for 2 hours. Laboratory tests show elevated ESR and CRP,
and positive rheumatoid factor. What is the most likely diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Systemic lupus erythematosus
Answer: B. Rheumatoid arthritis
Rationale: Rheumatoid arthritis (RA) is a chronic, systemic
autoimmune disorder characterized by symmetric polyarthritis,
morning stiffness lasting more than 1 hour, elevated
inflammatory markers (ESR, CRP), and positive rheumatoid factor
and anti-CCP antibodies. Osteoarthritis has morning stiffness less
than 30 minutes, is not associated with systemic inflammation,
and affects different joints (DIP joints, knees, hips). Gout is
typically monoarticular with acute onset.
Question 2
A 55-year-old male presents with acute onset of severe pain,
swelling, and redness in his right great toe. He reports the pain
,started suddenly at night. He has a history of hypertension and
takes hydrochlorothiazide. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout
Answer: C. Gout
Rationale: Acute gout presents with sudden onset of severe
pain, swelling, and erythema in a single joint, most commonly the
first metatarsophalangeal joint (podagra). Risk factors include
male gender, hypertension, diuretic use (hydrochlorothiazide),
and hyperuricemia. Pseudogout affects larger joints (knee, wrist)
and is more common in older adults.
Question 3
A 65-year-old female with osteoarthritis presents with knee pain.
She has tried acetaminophen with minimal relief. What is the
most appropriate next step?
A. Start ibuprofen
B. Start a COX-2 inhibitor
C. Start tramadol
D. Refer for knee replacement
Answer: A. Start ibuprofen
Rationale: For osteoarthritis, if acetaminophen is insufficient,
NSAIDs (ibuprofen, naproxen) are the next step. They provide
both analgesic and anti-inflammatory effects. COX-2 inhibitors
, (celecoxib) may be considered for patients at risk of GI bleeding.
Tramadol is a weak opioid for patients who cannot take NSAIDs.
Knee replacement is for end-stage disease.
Question 4
A 70-year-old female with osteoporosis has a DEXA T-score of -
2.8 at the femoral neck. What is the most appropriate first-line
pharmacologic treatment?
A. Calcium and vitamin D supplementation only
B. Alendronate
C. Raloxifene
D. Denosumab
Answer: B. Alendronate
Rationale: Alendronate, a bisphosphonate, is first-line
pharmacologic therapy for osteoporosis. T-score ≤ -2.5 indicates
osteoporosis. Bisphosphonates reduce fracture risk by inhibiting
osteoclast-mediated bone resorption. Calcium and vitamin D are
adjunctive, not sole therapy. Raloxifene is less effective.
Denosumab is typically used when bisphosphonates are not
tolerated.
Question 5
What is the most common cause of disability in older adults?
A. Osteoporosis
B. Osteoarthritis
Care I
Wilkes University
NSG554/NSG 554 Exam 4
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Musculoskeletal and Rheumatologic Disorders
(Questions 1-15)
Question 1
A 45-year-old female presents with bilateral joint pain, stiffness,
and swelling in her hands, wrists, and knees. Morning stiffness
lasts for 2 hours. Laboratory tests show elevated ESR and CRP,
and positive rheumatoid factor. What is the most likely diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Systemic lupus erythematosus
Answer: B. Rheumatoid arthritis
Rationale: Rheumatoid arthritis (RA) is a chronic, systemic
autoimmune disorder characterized by symmetric polyarthritis,
morning stiffness lasting more than 1 hour, elevated
inflammatory markers (ESR, CRP), and positive rheumatoid factor
and anti-CCP antibodies. Osteoarthritis has morning stiffness less
than 30 minutes, is not associated with systemic inflammation,
and affects different joints (DIP joints, knees, hips). Gout is
typically monoarticular with acute onset.
Question 2
A 55-year-old male presents with acute onset of severe pain,
swelling, and redness in his right great toe. He reports the pain
,started suddenly at night. He has a history of hypertension and
takes hydrochlorothiazide. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout
Answer: C. Gout
Rationale: Acute gout presents with sudden onset of severe
pain, swelling, and erythema in a single joint, most commonly the
first metatarsophalangeal joint (podagra). Risk factors include
male gender, hypertension, diuretic use (hydrochlorothiazide),
and hyperuricemia. Pseudogout affects larger joints (knee, wrist)
and is more common in older adults.
Question 3
A 65-year-old female with osteoarthritis presents with knee pain.
She has tried acetaminophen with minimal relief. What is the
most appropriate next step?
A. Start ibuprofen
B. Start a COX-2 inhibitor
C. Start tramadol
D. Refer for knee replacement
Answer: A. Start ibuprofen
Rationale: For osteoarthritis, if acetaminophen is insufficient,
NSAIDs (ibuprofen, naproxen) are the next step. They provide
both analgesic and anti-inflammatory effects. COX-2 inhibitors
, (celecoxib) may be considered for patients at risk of GI bleeding.
Tramadol is a weak opioid for patients who cannot take NSAIDs.
Knee replacement is for end-stage disease.
Question 4
A 70-year-old female with osteoporosis has a DEXA T-score of -
2.8 at the femoral neck. What is the most appropriate first-line
pharmacologic treatment?
A. Calcium and vitamin D supplementation only
B. Alendronate
C. Raloxifene
D. Denosumab
Answer: B. Alendronate
Rationale: Alendronate, a bisphosphonate, is first-line
pharmacologic therapy for osteoporosis. T-score ≤ -2.5 indicates
osteoporosis. Bisphosphonates reduce fracture risk by inhibiting
osteoclast-mediated bone resorption. Calcium and vitamin D are
adjunctive, not sole therapy. Raloxifene is less effective.
Denosumab is typically used when bisphosphonates are not
tolerated.
Question 5
What is the most common cause of disability in older adults?
A. Osteoporosis
B. Osteoarthritis
