NR 577 Exam 3 V1 | NR 577 Primary Care
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 45-year-old female presents with fatigue, cold intolerance, and weight gain. Her
laboratory results show an elevated Thyroid Stimulating Hormone (TSH) and a low Free T4
level. Which of the following is the most appropriate initial management?
A. Initiate Levothyroxine 1.6 mcg/kg/day
B. Start Methimazole 10 mg daily
C. Repeat laboratory tests in 6 months
D. Order an ultrasound of the thyroid
Correct Answer: A
Explanation: The patient exhibits classic symptoms and laboratory markers of primary
hypothyroidism, specifically an elevated TSH and low T4. The standard of care for replacing
thyroid hormone is Levothyroxine, typically calculated at a dose of 1.6 mcg/kg/day in
healthy adults. Methimazole is used for hyperthyroidism and is not indicated here, while
waiting six months would delay necessary treatment.
,2. When managing a patient with Type 2 Diabetes Mellitus, which of the following glycated
hemoglobin (A1C) targets is generally recommended for a healthy adult with no significant
comorbidities?
A. Less than 8.0%
B. Less than 7.0%
C. Less than 6.0%
D. Less than 9.0%
Correct Answer: B
Explanation: The American Diabetes Association (ADA) generally recommends an A1C
target of less than 7.0% for most non-pregnant adults. This target helps reduce
microvascular complications such as retinopathy and neuropathy. More stringent targets
like 6.5% may be set for younger individuals, whereas less stringent targets like 8.0% are
appropriate for those with limited life expectancy or advanced complications.
3. A patient presents with sharp right upper quadrant (RUQ) pain that radiates to the right
shoulder, occurring after eating a fatty meal. On physical exam, the patient arrests inspiration
upon deep palpation of the RUQ. This clinical finding is known as:
A. Murphy’s Sign
B. Psoas Sign
C. Rovsing’s Sign
D. McBurney’s Sign
,Correct Answer: A
Explanation: Murphy’s sign is highly suggestive of acute cholecystitis, which often occurs
after fatty food ingestion. Rovsing’s sign, Psoas sign, and McBurney’s sign are all clinical
indicators associated with appendicitis rather than gallbladder pathology. Recognizing this
sign is critical in the primary care setting for directing the patient toward an abdominal
ultrasound.
4. A 62-year-old male complains of increased urinary frequency, nocturia, and a weak urinary
stream. Digital rectal exam (DRE) reveals a smooth, firm, and non-tender enlarged prostate.
What is the most appropriate first-line medication to manage these symptoms?
A. Finasteride
B. Tamsulosin
C. Ciprofloxacin
D. Oxybutynin
Correct Answer: B
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of lower urinary
tract symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) by relaxing the
smooth muscle in the prostate and bladder neck. Finasteride is a 5-alpha-reductase
inhibitor that shrinks the prostate but takes 6 to 12 months to show significant effects.
Ciprofloxacin is an antibiotic for prostatitis, and Oxybutynin is used for overactive bladder,
neither of which matches the initial management of BPH.
, 5. Which of the following physical examination findings is most characteristic of
Osteoarthritis (OA) rather than Rheumatoid Arthritis (RA)?
A. Heberden’s nodes at the DIP joints
B. Symmetric joint involvement
C. Morning stiffness lasting more than one hour
D. Positive Rheumatoid Factor (RF)
Correct Answer: A
Explanation: Heberden’s nodes are bony enlargements situated at the distal
interphalangeal (DIP) joints and are classic signs of Osteoarthritis. In contrast, Rheumatoid
Arthritis typically affects the proximal interphalangeal (PIP) and metacarpophalangeal
(MCP) joints symmetrically. RA is also characterized by prolonged morning stiffness and
systemic inflammatory markers, whereas OA stiffness usually resolves within 30 minutes.
6. A patient is being evaluated for Chronic Obstructive Pulmonary Disease (COPD). According
to GOLD guidelines, which of the following is required for a definitive diagnosis?
A. Chest X-ray showing hyperinflation
B. Presence of chronic cough for 3 months
C. Post-bronchodilator FEV1/FVC ratio < 0.70
D. Oxygen saturation less than 90% on room air
Correct Answer: C
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 45-year-old female presents with fatigue, cold intolerance, and weight gain. Her
laboratory results show an elevated Thyroid Stimulating Hormone (TSH) and a low Free T4
level. Which of the following is the most appropriate initial management?
A. Initiate Levothyroxine 1.6 mcg/kg/day
B. Start Methimazole 10 mg daily
C. Repeat laboratory tests in 6 months
D. Order an ultrasound of the thyroid
Correct Answer: A
Explanation: The patient exhibits classic symptoms and laboratory markers of primary
hypothyroidism, specifically an elevated TSH and low T4. The standard of care for replacing
thyroid hormone is Levothyroxine, typically calculated at a dose of 1.6 mcg/kg/day in
healthy adults. Methimazole is used for hyperthyroidism and is not indicated here, while
waiting six months would delay necessary treatment.
,2. When managing a patient with Type 2 Diabetes Mellitus, which of the following glycated
hemoglobin (A1C) targets is generally recommended for a healthy adult with no significant
comorbidities?
A. Less than 8.0%
B. Less than 7.0%
C. Less than 6.0%
D. Less than 9.0%
Correct Answer: B
Explanation: The American Diabetes Association (ADA) generally recommends an A1C
target of less than 7.0% for most non-pregnant adults. This target helps reduce
microvascular complications such as retinopathy and neuropathy. More stringent targets
like 6.5% may be set for younger individuals, whereas less stringent targets like 8.0% are
appropriate for those with limited life expectancy or advanced complications.
3. A patient presents with sharp right upper quadrant (RUQ) pain that radiates to the right
shoulder, occurring after eating a fatty meal. On physical exam, the patient arrests inspiration
upon deep palpation of the RUQ. This clinical finding is known as:
A. Murphy’s Sign
B. Psoas Sign
C. Rovsing’s Sign
D. McBurney’s Sign
,Correct Answer: A
Explanation: Murphy’s sign is highly suggestive of acute cholecystitis, which often occurs
after fatty food ingestion. Rovsing’s sign, Psoas sign, and McBurney’s sign are all clinical
indicators associated with appendicitis rather than gallbladder pathology. Recognizing this
sign is critical in the primary care setting for directing the patient toward an abdominal
ultrasound.
4. A 62-year-old male complains of increased urinary frequency, nocturia, and a weak urinary
stream. Digital rectal exam (DRE) reveals a smooth, firm, and non-tender enlarged prostate.
What is the most appropriate first-line medication to manage these symptoms?
A. Finasteride
B. Tamsulosin
C. Ciprofloxacin
D. Oxybutynin
Correct Answer: B
Explanation: Tamsulosin is an alpha-1 blocker that provides rapid relief of lower urinary
tract symptoms (LUTS) associated with Benign Prostatic Hyperplasia (BPH) by relaxing the
smooth muscle in the prostate and bladder neck. Finasteride is a 5-alpha-reductase
inhibitor that shrinks the prostate but takes 6 to 12 months to show significant effects.
Ciprofloxacin is an antibiotic for prostatitis, and Oxybutynin is used for overactive bladder,
neither of which matches the initial management of BPH.
, 5. Which of the following physical examination findings is most characteristic of
Osteoarthritis (OA) rather than Rheumatoid Arthritis (RA)?
A. Heberden’s nodes at the DIP joints
B. Symmetric joint involvement
C. Morning stiffness lasting more than one hour
D. Positive Rheumatoid Factor (RF)
Correct Answer: A
Explanation: Heberden’s nodes are bony enlargements situated at the distal
interphalangeal (DIP) joints and are classic signs of Osteoarthritis. In contrast, Rheumatoid
Arthritis typically affects the proximal interphalangeal (PIP) and metacarpophalangeal
(MCP) joints symmetrically. RA is also characterized by prolonged morning stiffness and
systemic inflammatory markers, whereas OA stiffness usually resolves within 30 minutes.
6. A patient is being evaluated for Chronic Obstructive Pulmonary Disease (COPD). According
to GOLD guidelines, which of the following is required for a definitive diagnosis?
A. Chest X-ray showing hyperinflation
B. Presence of chronic cough for 3 months
C. Post-bronchodilator FEV1/FVC ratio < 0.70
D. Oxygen saturation less than 90% on room air
Correct Answer: C
