NR 577 Exam 3 V3 | NR 577 Primary Care
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 55-year-old male with a history of COPD presents with increased sputum purulence and
increased dyspnea. According to the GOLD guidelines, which of the following is the most
appropriate initial pharmacological intervention for a patient in Group B?
A. SABA as needed only
B. Theophylline therapy
C. LAMA plus LABA plus ICS
D. LAMA or LABA
Correct Answer: D
Explanation: For patients classified in GOLD Group B, the recommendation is a long-acting
bronchodilator, either a LAMA or a LABA. This management aims to reduce symptoms and
the risk of future exacerbations. Patients should also be monitored for symptom relief and
have their inhaler technique validated regularly.
2. Which of the following physical examination findings is most specific for a diagnosis of
acute cholecystitis?
A. McBurney’s point tenderness
B. Rovsing’s sign
,C. Psoas sign
D. Murphy’s sign
Correct Answer: D
Explanation: Murphy’s sign is identified when a patient halts inspiration during deep
palpation of the right upper quadrant due to pain. This finding has high specificity for acute
inflammation of the gallbladder. Other signs listed, such as McBurney’s or Rovsing’s, are
typically associated with acute appendicitis.
3. A 24-year-old female presents for a follow-up after a positive Chlamydia trachomatis test.
She has no known allergies. What is the current CDC recommended first-line treatment?
A. Doxycycline 100mg orally twice daily for 7 days
B. Ciprofloxacin 500mg BID for 7 days
C. Azithromycin 1g orally in a single dose
D. Ceftriaxone 500mg IM single dose
Correct Answer: A
Explanation: Current CDC guidelines have transitioned to Doxycycline 100mg twice daily
for 7 days as the first-line treatment for uncomplicated chlamydial infections. Azithromycin
is now considered an alternative due to concerns regarding efficacy and resistance.
Partners should also be treated to prevent reinfection and further transmission.
, 4. When evaluating a patient with microcytic, hypochromic anemia, which laboratory value is
the most sensitive indicator of iron deficiency?
A. Serum iron
B. Total iron-binding capacity (TIBC)
C. Serum ferritin
D. Transferrin saturation
Correct Answer: C
Explanation: Serum ferritin levels reflect the body’s total iron stores and are the most
sensitive test for iron deficiency anemia. Low ferritin levels almost always indicate iron
deficiency even before the hemoglobin levels drop. However, ferritin is an acute-phase
reactant and can be falsely elevated in inflammatory states.
5. A 68-year-old female with hypertension and heart failure presents for a routine visit. On
auscultation, the NP hears a low-pitched sound early in diastole. This is most likely:
A. An S4 gallop
B. An S3 gallop
C. An opening snap
D. An ejection click
Correct Answer: B
Management of Adolescents and Adults | Actual
Q&A with Rationale (NR577 Exam 3) |
Chamberlain University
1. A 55-year-old male with a history of COPD presents with increased sputum purulence and
increased dyspnea. According to the GOLD guidelines, which of the following is the most
appropriate initial pharmacological intervention for a patient in Group B?
A. SABA as needed only
B. Theophylline therapy
C. LAMA plus LABA plus ICS
D. LAMA or LABA
Correct Answer: D
Explanation: For patients classified in GOLD Group B, the recommendation is a long-acting
bronchodilator, either a LAMA or a LABA. This management aims to reduce symptoms and
the risk of future exacerbations. Patients should also be monitored for symptom relief and
have their inhaler technique validated regularly.
2. Which of the following physical examination findings is most specific for a diagnosis of
acute cholecystitis?
A. McBurney’s point tenderness
B. Rovsing’s sign
,C. Psoas sign
D. Murphy’s sign
Correct Answer: D
Explanation: Murphy’s sign is identified when a patient halts inspiration during deep
palpation of the right upper quadrant due to pain. This finding has high specificity for acute
inflammation of the gallbladder. Other signs listed, such as McBurney’s or Rovsing’s, are
typically associated with acute appendicitis.
3. A 24-year-old female presents for a follow-up after a positive Chlamydia trachomatis test.
She has no known allergies. What is the current CDC recommended first-line treatment?
A. Doxycycline 100mg orally twice daily for 7 days
B. Ciprofloxacin 500mg BID for 7 days
C. Azithromycin 1g orally in a single dose
D. Ceftriaxone 500mg IM single dose
Correct Answer: A
Explanation: Current CDC guidelines have transitioned to Doxycycline 100mg twice daily
for 7 days as the first-line treatment for uncomplicated chlamydial infections. Azithromycin
is now considered an alternative due to concerns regarding efficacy and resistance.
Partners should also be treated to prevent reinfection and further transmission.
, 4. When evaluating a patient with microcytic, hypochromic anemia, which laboratory value is
the most sensitive indicator of iron deficiency?
A. Serum iron
B. Total iron-binding capacity (TIBC)
C. Serum ferritin
D. Transferrin saturation
Correct Answer: C
Explanation: Serum ferritin levels reflect the body’s total iron stores and are the most
sensitive test for iron deficiency anemia. Low ferritin levels almost always indicate iron
deficiency even before the hemoglobin levels drop. However, ferritin is an acute-phase
reactant and can be falsely elevated in inflammatory states.
5. A 68-year-old female with hypertension and heart failure presents for a routine visit. On
auscultation, the NP hears a low-pitched sound early in diastole. This is most likely:
A. An S4 gallop
B. An S3 gallop
C. An opening snap
D. An ejection click
Correct Answer: B
