Adult-Gerontology Primary Care
Nurse Practitioner Certification
Practice Questions with Answers &
Rationales [Most Recent]/Already
Graded A+
Q1:
A 72-year-old patient with a history of hypertension and type 2 diabetes
presents with acute-onset confusion, fever, and urinary incontinence.
Vital signs: temperature 38.9°C, heart rate 110 bpm, blood pressure
90/60 mmHg, respiratory rate 22 breaths/min, oxygen saturation 94% on
room air. Urinalysis shows leukocyte esterase positive, nitrite positive,
and >50 WBCs/hpf. Serum creatinine is 2.1 mg/dL (baseline 0.9 mg/dL).
Which of the following is the most appropriate next step in diagnosis?
A) Obtain a urine culture and sensitivity before initiating antibiotics
B) Perform a lumbar puncture to rule out meningitis
C) Initiate broad-spectrum antibiotics after obtaining blood and urine
cultures
D) Order a CT scan of the head to evaluate for intracranial pathology
Answer: C
Rationale: The patient presents with sepsis likely due to a urinary tract
infection, given the urinalysis findings and acute kidney injury. In sepsis,
prompt initiation of antibiotics after obtaining cultures is critical.
Q2:
A 65-year-old patient with a 40-pack-year smoking history reports a
persistent cough for 8 weeks, occasional hemoptysis, and unintentional
weight loss of 10 pounds over 3 months. Chest X-ray shows a 3 cm
,solitary pulmonary nodule in the right upper lobe. Which diagnostic test
is most appropriate for definitive diagnosis?
A) High-resolution computed tomography (HRCT) of the chest
B) Positron emission tomography (PET) scan
C) CT-guided biopsy of the nodule
D) Sputum cytology
Answer: C
Rationale: For a solitary pulmonary nodule with high suspicion for
malignancy (smoking history, hemoptysis, weight loss), tissue diagnosis
is needed. CT-guided biopsy provides a definitive histologic diagnosis.
Q3:
A 68-year-old patient with osteoarthritis presents with acute-onset right
knee pain, swelling, and erythema without fever. Aspiration of the joint
yields cloudy fluid with 50,000 white blood cells/mm³ (85% neutrophils),
and no crystals are seen on polarized light microscopy. Gram stain is
negative. Which of the following is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Rheumatoid arthritis flare
Answer: C
Rationale: The synovial fluid WBC count >50,000/mm³ with
predominant neutrophils is highly suggestive of septic arthritis, even
with a negative Gram stain.
Q4:
A 70-year-old patient with chronic kidney disease stage 3 (eGFR 45
mL/min/1.73m²) is found to have a serum calcium of 10.8 mg/dL (normal
8.5-10.2) and an intact parathyroid hormone (iPTH) level of 150 pg/mL
,(normal 10-65). Which of the following is the most appropriate next
diagnostic step?
A) 24-hour urine calcium measurement
B) Bone density scan (DXA)
C) Sestamibi scan of the parathyroid glands
D) Serum phosphate and 25-hydroxyvitamin D levels
Answer: D
Rationale: In CKD, secondary hyperparathyroidism is common due to
phosphate retention and vitamin D deficiency. Measuring phosphate and
vitamin D helps differentiate secondary from primary
hyperparathyroidism.
Q5:
A 66-year-old patient with type 2 diabetes and hypertension presents
with bilateral lower extremity edema, foamy urine, and a serum albumin
of 2.8 g/dL. Urinalysis shows 3+ protein. Which of the following
diagnostic tests is most likely to confirm the underlying etiology?
A) 24-hour urine protein excretion
B) Renal ultrasound
C) Kidney biopsy
D) Serum protein electrophoresis
Answer: C
Rationale: The presentation suggests nephrotic syndrome. In a patient
with diabetes, diabetic nephropathy is likely, but the acute onset and
foamy urine raise suspicion for other causes like membranous
nephropathy. Kidney biopsy provides definitive diagnosis of the
glomerular pathology.
Q6:
A 75-year-old patient with atrial fibrillation on warfarin presents with
, acute-onset severe headache, nausea, and blurred vision. Blood pressure
is 220/120 mmHg. Fundoscopic examination reveals arteriovenous
nicking, flame hemorrhages, and papilledema. Which of the following
diagnostic tests should be performed emergently?
A) CT scan of the head without contrast
B) Lumbar puncture
C) Magnetic resonance angiography (MRA) of the head
D) Electroencephalogram (EEG)
Answer: A
Rationale: The patient has hypertensive emergency with papilledema
and neurologic symptoms. Immediate head CT is needed to rule out
intracranial hemorrhage, especially given anticoagulation.
Q7:
A 69-year-old patient with a history of heart failure with reduced ejection
fraction (HFrEF) presents with progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Jugular venous pressure
is elevated at 12 cm H2O. Which diagnostic test is most appropriate to
assess the severity of heart failure and guide management?
A) Echocardiogram
B) B-type natriuretic peptide (BNP)
C) Chest X-ray
D) Cardiac catheterization
Answer: A
Rationale: An echocardiogram is the most appropriate test to assess the
severity of heart failure. It provides information on ejection fraction,
chamber sizes, valvular function, and wall motion abnormalities that are
critical for guiding management. BNP can support the diagnosis but
does not provide the structural and functional detail of an
echocardiogram.
Nurse Practitioner Certification
Practice Questions with Answers &
Rationales [Most Recent]/Already
Graded A+
Q1:
A 72-year-old patient with a history of hypertension and type 2 diabetes
presents with acute-onset confusion, fever, and urinary incontinence.
Vital signs: temperature 38.9°C, heart rate 110 bpm, blood pressure
90/60 mmHg, respiratory rate 22 breaths/min, oxygen saturation 94% on
room air. Urinalysis shows leukocyte esterase positive, nitrite positive,
and >50 WBCs/hpf. Serum creatinine is 2.1 mg/dL (baseline 0.9 mg/dL).
Which of the following is the most appropriate next step in diagnosis?
A) Obtain a urine culture and sensitivity before initiating antibiotics
B) Perform a lumbar puncture to rule out meningitis
C) Initiate broad-spectrum antibiotics after obtaining blood and urine
cultures
D) Order a CT scan of the head to evaluate for intracranial pathology
Answer: C
Rationale: The patient presents with sepsis likely due to a urinary tract
infection, given the urinalysis findings and acute kidney injury. In sepsis,
prompt initiation of antibiotics after obtaining cultures is critical.
Q2:
A 65-year-old patient with a 40-pack-year smoking history reports a
persistent cough for 8 weeks, occasional hemoptysis, and unintentional
weight loss of 10 pounds over 3 months. Chest X-ray shows a 3 cm
,solitary pulmonary nodule in the right upper lobe. Which diagnostic test
is most appropriate for definitive diagnosis?
A) High-resolution computed tomography (HRCT) of the chest
B) Positron emission tomography (PET) scan
C) CT-guided biopsy of the nodule
D) Sputum cytology
Answer: C
Rationale: For a solitary pulmonary nodule with high suspicion for
malignancy (smoking history, hemoptysis, weight loss), tissue diagnosis
is needed. CT-guided biopsy provides a definitive histologic diagnosis.
Q3:
A 68-year-old patient with osteoarthritis presents with acute-onset right
knee pain, swelling, and erythema without fever. Aspiration of the joint
yields cloudy fluid with 50,000 white blood cells/mm³ (85% neutrophils),
and no crystals are seen on polarized light microscopy. Gram stain is
negative. Which of the following is the most likely diagnosis?
A) Gout
B) Pseudogout
C) Septic arthritis
D) Rheumatoid arthritis flare
Answer: C
Rationale: The synovial fluid WBC count >50,000/mm³ with
predominant neutrophils is highly suggestive of septic arthritis, even
with a negative Gram stain.
Q4:
A 70-year-old patient with chronic kidney disease stage 3 (eGFR 45
mL/min/1.73m²) is found to have a serum calcium of 10.8 mg/dL (normal
8.5-10.2) and an intact parathyroid hormone (iPTH) level of 150 pg/mL
,(normal 10-65). Which of the following is the most appropriate next
diagnostic step?
A) 24-hour urine calcium measurement
B) Bone density scan (DXA)
C) Sestamibi scan of the parathyroid glands
D) Serum phosphate and 25-hydroxyvitamin D levels
Answer: D
Rationale: In CKD, secondary hyperparathyroidism is common due to
phosphate retention and vitamin D deficiency. Measuring phosphate and
vitamin D helps differentiate secondary from primary
hyperparathyroidism.
Q5:
A 66-year-old patient with type 2 diabetes and hypertension presents
with bilateral lower extremity edema, foamy urine, and a serum albumin
of 2.8 g/dL. Urinalysis shows 3+ protein. Which of the following
diagnostic tests is most likely to confirm the underlying etiology?
A) 24-hour urine protein excretion
B) Renal ultrasound
C) Kidney biopsy
D) Serum protein electrophoresis
Answer: C
Rationale: The presentation suggests nephrotic syndrome. In a patient
with diabetes, diabetic nephropathy is likely, but the acute onset and
foamy urine raise suspicion for other causes like membranous
nephropathy. Kidney biopsy provides definitive diagnosis of the
glomerular pathology.
Q6:
A 75-year-old patient with atrial fibrillation on warfarin presents with
, acute-onset severe headache, nausea, and blurred vision. Blood pressure
is 220/120 mmHg. Fundoscopic examination reveals arteriovenous
nicking, flame hemorrhages, and papilledema. Which of the following
diagnostic tests should be performed emergently?
A) CT scan of the head without contrast
B) Lumbar puncture
C) Magnetic resonance angiography (MRA) of the head
D) Electroencephalogram (EEG)
Answer: A
Rationale: The patient has hypertensive emergency with papilledema
and neurologic symptoms. Immediate head CT is needed to rule out
intracranial hemorrhage, especially given anticoagulation.
Q7:
A 69-year-old patient with a history of heart failure with reduced ejection
fraction (HFrEF) presents with progressive dyspnea on exertion,
orthopnea, and bilateral lower extremity edema. Jugular venous pressure
is elevated at 12 cm H2O. Which diagnostic test is most appropriate to
assess the severity of heart failure and guide management?
A) Echocardiogram
B) B-type natriuretic peptide (BNP)
C) Chest X-ray
D) Cardiac catheterization
Answer: A
Rationale: An echocardiogram is the most appropriate test to assess the
severity of heart failure. It provides information on ejection fraction,
chamber sizes, valvular function, and wall motion abnormalities that are
critical for guiding management. BNP can support the diagnosis but
does not provide the structural and functional detail of an
echocardiogram.
