NR511 Week 4 Midterm Exam Due Complete
Actual Exam Questions 1–100 Verified
Examplify Pack
Practice Exam
1. A primary care provider is evaluating a 58-year-old male with a 20-year history of smoking who
presents with a persistent cough and weight loss. Which finding is most concerning for lung cancer?
A. Productive cough with clear sputum
B. Hemoptysis
C. Wheezing on expiration
D. Chest pain relieved by rest
Correct Answer: B
Rationale: Hemoptysis (coughing up blood) is a red-flag symptom highly
associated with lung cancer, especially in a long-term smoker. While a productive
cough, wheezing, and chest pain can occur with lung cancer, hemoptysis is the
most specific and concerning finding that warrants immediate further evaluation
such as chest X-ray and CT scan.
2. A nurse practitioner is assessing a 45-year-old female with fatigue, weight gain, and cold
intolerance. Which laboratory test should be ordered first?
A. Complete blood count
B. Thyroid-stimulating hormone (TSH)
C. Fasting blood glucose
D. Serum cortisol
Correct Answer: B
Rationale: The presentation of fatigue, weight gain, and cold intolerance is classic
for hypothyroidism. TSH is the most sensitive initial screening test for thyroid
dysfunction. If TSH is elevated, it indicates primary hypothyroidism. A CBC, fasting
glucose, and cortisol may be considered but are not the first-line tests for this
presentation.
,3. A 62-year-old male presents with sudden onset of severe abdominal pain radiating to the back. He
has a history of alcohol abuse. Which condition should be suspected first?
A. Peptic ulcer disease
B. Acute pancreatitis
C. Cholecystitis
D. Appendicitis
Correct Answer: B
Rationale: Acute pancreatitis classically presents with severe epigastric pain
radiating to the back, often in the setting of alcohol abuse or gallstones. Peptic
ulcer disease typically causes burning epigastric pain. Cholecystitis causes right
upper quadrant pain. Appendicitis causes right lower quadrant pain.
4. A 30-year-old female presents with a butterfly-shaped rash on her face, joint pain, and fatigue.
Which autoantibody is most specific for systemic lupus erythematosus (SLE)?
A. Rheumatoid factor
B. Anti-nuclear antibody (ANA)
C. Anti-double-stranded DNA (anti-dsDNA)
D. Anti-CCP antibody
Correct Answer: C
Rationale: Anti-dsDNA is highly specific for SLE and correlates with disease
activity, particularly lupus nephritis. ANA is sensitive but not specific. Rheumatoid
factor and anti-CCP are associated with rheumatoid arthritis.
5. A 55-year-old male with a history of hypertension presents with a blood pressure of 180/110 mm
Hg. He is asymptomatic. What is the most appropriate initial management?
A. Administer intravenous labetalol immediately
B. Start oral antihypertensive therapy and follow up in 1 week
C. Refer to the emergency department for immediate evaluation
D. Recommend lifestyle modifications only
Correct Answer: B
Rationale: This is hypertensive urgency (BP >180/120 without end-organ damage).
Management includes starting or adjusting oral antihypertensive medications and
,close follow-up. Intravenous therapy and emergency department referral are
reserved for hypertensive emergencies with evidence of end-organ damage.
6. A 28-year-old female presents with dysuria, frequency, and urgency. She has no fever or flank pain.
What is the most appropriate treatment?
A. Nitrofurantoin for 5 days
B. Ciprofloxacin for 7 days
C. Intravenous ceftriaxone
D. Wait-and-see approach
Correct Answer: A
Rationale: Uncomplicated cystitis in a healthy female is typically treated with
nitrofurantoin for 5 days. Fluoroquinolones are reserved for complicated
infections. Intravenous antibiotics are not needed. A wait-and-see approach is
inappropriate for symptomatic UTI.
7. A 70-year-old male presents with nocturia, hesitancy, and weak urinary stream. Which condition is
most likely?
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Urinary tract infection
D. Bladder cancer
Correct Answer: B
Rationale: BPH is the most common cause of lower urinary tract symptoms in
older men. Symptoms include nocturia, hesitancy, weak stream, and incomplete
emptying. Prostate cancer may present similarly but is usually suspected when
PSA is elevated or nodules are palpated. UTI causes acute symptoms. Bladder
cancer typically presents with painless hematuria.
8. A 35-year-old female presents with a migraine headache. Which medication is appropriate for acute
treatment?
A. Propranolol
B. Sumatriptan
C. Amitriptyline
D. Topiramate
, Correct Answer: B
Rationale: Sumatriptan is a triptan used for acute migraine treatment.
Propranolol, amitriptyline, and topiramate are used for migraine prophylaxis, not
acute treatment.
9. A 50-year-old male presents with a painless, firm nodule on his neck. He has a history of smoking.
What is the most concerning diagnosis?
A. Lymphoma
B. Thyroid nodule
C. Head and neck cancer
D. Lipoma
Correct Answer: C
Rationale: A painless, firm neck nodule in a smoker is highly suspicious for head
and neck cancer until proven otherwise. Lymphoma, thyroid nodules, and lipomas
may also present as neck masses, but the smoking history and firm, painless
nature raise concern for malignancy.
10. A 25-year-old female presents with a malar rash, photosensitivity, and oral ulcers. Which diagnosis
should be considered?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Dermatomyositis
Correct Answer: B
Rationale: The combination of malar rash, photosensitivity, and oral ulcers meets
several diagnostic criteria for SLE. Rheumatoid arthritis primarily affects joints.
Scleroderma causes skin thickening. Dermatomyositis causes muscle weakness
and characteristic skin findings.
11. A 60-year-old male with diabetes presents with a non-healing ulcer on his foot. Which finding is
most concerning for osteomyelitis?
A. Erythema around the ulcer
B. Purulent drainage
Actual Exam Questions 1–100 Verified
Examplify Pack
Practice Exam
1. A primary care provider is evaluating a 58-year-old male with a 20-year history of smoking who
presents with a persistent cough and weight loss. Which finding is most concerning for lung cancer?
A. Productive cough with clear sputum
B. Hemoptysis
C. Wheezing on expiration
D. Chest pain relieved by rest
Correct Answer: B
Rationale: Hemoptysis (coughing up blood) is a red-flag symptom highly
associated with lung cancer, especially in a long-term smoker. While a productive
cough, wheezing, and chest pain can occur with lung cancer, hemoptysis is the
most specific and concerning finding that warrants immediate further evaluation
such as chest X-ray and CT scan.
2. A nurse practitioner is assessing a 45-year-old female with fatigue, weight gain, and cold
intolerance. Which laboratory test should be ordered first?
A. Complete blood count
B. Thyroid-stimulating hormone (TSH)
C. Fasting blood glucose
D. Serum cortisol
Correct Answer: B
Rationale: The presentation of fatigue, weight gain, and cold intolerance is classic
for hypothyroidism. TSH is the most sensitive initial screening test for thyroid
dysfunction. If TSH is elevated, it indicates primary hypothyroidism. A CBC, fasting
glucose, and cortisol may be considered but are not the first-line tests for this
presentation.
,3. A 62-year-old male presents with sudden onset of severe abdominal pain radiating to the back. He
has a history of alcohol abuse. Which condition should be suspected first?
A. Peptic ulcer disease
B. Acute pancreatitis
C. Cholecystitis
D. Appendicitis
Correct Answer: B
Rationale: Acute pancreatitis classically presents with severe epigastric pain
radiating to the back, often in the setting of alcohol abuse or gallstones. Peptic
ulcer disease typically causes burning epigastric pain. Cholecystitis causes right
upper quadrant pain. Appendicitis causes right lower quadrant pain.
4. A 30-year-old female presents with a butterfly-shaped rash on her face, joint pain, and fatigue.
Which autoantibody is most specific for systemic lupus erythematosus (SLE)?
A. Rheumatoid factor
B. Anti-nuclear antibody (ANA)
C. Anti-double-stranded DNA (anti-dsDNA)
D. Anti-CCP antibody
Correct Answer: C
Rationale: Anti-dsDNA is highly specific for SLE and correlates with disease
activity, particularly lupus nephritis. ANA is sensitive but not specific. Rheumatoid
factor and anti-CCP are associated with rheumatoid arthritis.
5. A 55-year-old male with a history of hypertension presents with a blood pressure of 180/110 mm
Hg. He is asymptomatic. What is the most appropriate initial management?
A. Administer intravenous labetalol immediately
B. Start oral antihypertensive therapy and follow up in 1 week
C. Refer to the emergency department for immediate evaluation
D. Recommend lifestyle modifications only
Correct Answer: B
Rationale: This is hypertensive urgency (BP >180/120 without end-organ damage).
Management includes starting or adjusting oral antihypertensive medications and
,close follow-up. Intravenous therapy and emergency department referral are
reserved for hypertensive emergencies with evidence of end-organ damage.
6. A 28-year-old female presents with dysuria, frequency, and urgency. She has no fever or flank pain.
What is the most appropriate treatment?
A. Nitrofurantoin for 5 days
B. Ciprofloxacin for 7 days
C. Intravenous ceftriaxone
D. Wait-and-see approach
Correct Answer: A
Rationale: Uncomplicated cystitis in a healthy female is typically treated with
nitrofurantoin for 5 days. Fluoroquinolones are reserved for complicated
infections. Intravenous antibiotics are not needed. A wait-and-see approach is
inappropriate for symptomatic UTI.
7. A 70-year-old male presents with nocturia, hesitancy, and weak urinary stream. Which condition is
most likely?
A. Prostate cancer
B. Benign prostatic hyperplasia (BPH)
C. Urinary tract infection
D. Bladder cancer
Correct Answer: B
Rationale: BPH is the most common cause of lower urinary tract symptoms in
older men. Symptoms include nocturia, hesitancy, weak stream, and incomplete
emptying. Prostate cancer may present similarly but is usually suspected when
PSA is elevated or nodules are palpated. UTI causes acute symptoms. Bladder
cancer typically presents with painless hematuria.
8. A 35-year-old female presents with a migraine headache. Which medication is appropriate for acute
treatment?
A. Propranolol
B. Sumatriptan
C. Amitriptyline
D. Topiramate
, Correct Answer: B
Rationale: Sumatriptan is a triptan used for acute migraine treatment.
Propranolol, amitriptyline, and topiramate are used for migraine prophylaxis, not
acute treatment.
9. A 50-year-old male presents with a painless, firm nodule on his neck. He has a history of smoking.
What is the most concerning diagnosis?
A. Lymphoma
B. Thyroid nodule
C. Head and neck cancer
D. Lipoma
Correct Answer: C
Rationale: A painless, firm neck nodule in a smoker is highly suspicious for head
and neck cancer until proven otherwise. Lymphoma, thyroid nodules, and lipomas
may also present as neck masses, but the smoking history and firm, painless
nature raise concern for malignancy.
10. A 25-year-old female presents with a malar rash, photosensitivity, and oral ulcers. Which diagnosis
should be considered?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Scleroderma
D. Dermatomyositis
Correct Answer: B
Rationale: The combination of malar rash, photosensitivity, and oral ulcers meets
several diagnostic criteria for SLE. Rheumatoid arthritis primarily affects joints.
Scleroderma causes skin thickening. Dermatomyositis causes muscle weakness
and characteristic skin findings.
11. A 60-year-old male with diabetes presents with a non-healing ulcer on his foot. Which finding is
most concerning for osteomyelitis?
A. Erythema around the ulcer
B. Purulent drainage
