NSG 554 EXAM 4 V3 - NURSE
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with a cough, chest tightness, and wheezing that occurs 3
times per week. They wake up due to symptoms twice a month. Their FEV1 is 85% of
predicted. How should this asthma be classified according to NAEPP guidelines?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
Answer: D
Conceptual Explanation: Mild persistent asthma is characterized by symptoms occurring
more than 2 days per week but not daily, and nighttime awakenings 3-4 times per month.
FEV1 is typically >80% predicted.
,2. Which of the following is a definitive diagnostic requirement for Chronic Obstructive
Pulmonary Disease (COPD) according to GOLD guidelines?
A. A history of smoking more than 20 pack-years
B. A post-bronchodilator FEV1/FVC ratio of less than 0.70
C. Presence of a chronic productive cough for 3 months in 2 consecutive years
D. Total Lung Capacity (TLC) greater than 120% of predicted
Answer: B
Conceptual Explanation: The GOLD criteria require a post-bronchodilator FEV1/FVC <
0.70 to confirm the presence of persistent airflow limitation, which is the hallmark of
COPD.
3. A 62-year-old male with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF) presents for follow-up. Which medication class is contraindicated as a first-
line agent for his hypertension?
A. ACE Inhibitors
B. Beta-Blockers
C. Nondihydropyridine Calcium Channel Blockers
D. Aldosterone Antagonists
Answer: C
, Conceptual Explanation: Nondihydropyridine CCBs (like verapamil and diltiazem) have
negative inotropic effects and are generally contraindicated in patients with HFrEF.
4. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck and in
the axilla. This clinical finding, acanthosis nigricans, is most strongly associated with which
condition?
A. Insulin Resistance
B. Systemic Lupus Erythematosus
C. Hypothyroidism
D. Vitamin B12 Deficiency
Answer: A
Conceptual Explanation: Acanthosis nigricans is a common cutaneous marker of
hyperinsulinemia and insulin resistance, often seen in Type 2 Diabetes and obesity.
5. In the treatment of Community-Acquired Pneumonia (CAP) in a healthy adult with no
comorbidities and no recent antibiotic use, what is the first-line recommended treatment
according to current ATS/IDSA guidelines?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Cephalexin 500mg QID
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with a cough, chest tightness, and wheezing that occurs 3
times per week. They wake up due to symptoms twice a month. Their FEV1 is 85% of
predicted. How should this asthma be classified according to NAEPP guidelines?
A. Intermittent
B. Severe Persistent
C. Moderate Persistent
D. Mild Persistent
Answer: D
Conceptual Explanation: Mild persistent asthma is characterized by symptoms occurring
more than 2 days per week but not daily, and nighttime awakenings 3-4 times per month.
FEV1 is typically >80% predicted.
,2. Which of the following is a definitive diagnostic requirement for Chronic Obstructive
Pulmonary Disease (COPD) according to GOLD guidelines?
A. A history of smoking more than 20 pack-years
B. A post-bronchodilator FEV1/FVC ratio of less than 0.70
C. Presence of a chronic productive cough for 3 months in 2 consecutive years
D. Total Lung Capacity (TLC) greater than 120% of predicted
Answer: B
Conceptual Explanation: The GOLD criteria require a post-bronchodilator FEV1/FVC <
0.70 to confirm the presence of persistent airflow limitation, which is the hallmark of
COPD.
3. A 62-year-old male with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF) presents for follow-up. Which medication class is contraindicated as a first-
line agent for his hypertension?
A. ACE Inhibitors
B. Beta-Blockers
C. Nondihydropyridine Calcium Channel Blockers
D. Aldosterone Antagonists
Answer: C
, Conceptual Explanation: Nondihydropyridine CCBs (like verapamil and diltiazem) have
negative inotropic effects and are generally contraindicated in patients with HFrEF.
4. A patient presents with a ‘velvety,’ hyperpigmented plaque on the back of the neck and in
the axilla. This clinical finding, acanthosis nigricans, is most strongly associated with which
condition?
A. Insulin Resistance
B. Systemic Lupus Erythematosus
C. Hypothyroidism
D. Vitamin B12 Deficiency
Answer: A
Conceptual Explanation: Acanthosis nigricans is a common cutaneous marker of
hyperinsulinemia and insulin resistance, often seen in Type 2 Diabetes and obesity.
5. In the treatment of Community-Acquired Pneumonia (CAP) in a healthy adult with no
comorbidities and no recent antibiotic use, what is the first-line recommended treatment
according to current ATS/IDSA guidelines?
A. Ciprofloxacin 500mg BID
B. Levofloxacin 750mg daily
C. Amoxicillin 1g TID
D. Cephalexin 500mg QID
