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TEST BANK FOR PRIMARY CARE: ART
AND SCIENCE OF ADVANCED
PRACTICE NURSING, 6TH EDITION
Authors: Debera J. Dunphy, Lynne M. Dunphy, Jill E. Winland-Brown, Brian O. Porter, and
Deborah J. Thomas
The following is an original, advanced-level practice question bank designed around major
primary care and advanced practice nursing competencies. It emphasizes clinical reasoning,
differential diagnosis, evidence-based management, prevention, pharmacology, and patient-
centered care. These are study questions.
1. Introduction
Primary care is a central component of advanced practice nursing, requiring clinicians to
integrate scientific knowledge, clinical judgment, patient preferences, and evidence-based
interventions across the lifespan. This practice bank is designed for nurse practitioner students
and advanced practice nursing learners studying the principles associated with Primary Care: The
Art and Science of Advanced Practice Nursing—An Interprofessional Approach, 6th Edition.
The questions emphasize complex clinical scenarios that require learners to assess presenting
symptoms, interpret diagnostic findings, prioritize competing diagnoses, select appropriate
investigations, and formulate safe management plans. Additional areas include health promotion,
disease prevention, chronic disease management, pharmacological decision-making, behavioral
health, cultural competence, and interprofessional collaboration.
Each question includes four answer options, one best answer, and a detailed rationale explaining
the clinical reasoning behind the correct choice and the limitations of the alternatives. The
questions are intended to help students identify knowledge gaps, strengthen clinical judgment,
and prepare systematically for course examinations. Learners should supplement this material
with assigned textbook chapters, current clinical guidelines, and applicable prescribing and
practice standards. Repeated practice and careful review of rationales can support stronger
clinical decision-making and examination readiness.
2. Content Area Overview
The following is a study-oriented blueprint of major primary care competencies. The weights are
illustrative study allocations, not official textbook examination weights.
CONTENT AREA — QUESTIONS — KEY TOPICS —
WEIGHT
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Content area Questions Key topics Weight
History, examination, differential
Clinical assessment and reasoning 1–15 15%
diagnosis, clinical red flags
Hypertension, coronary disease, heart
Cardiovascular care 16–25 10%
failure, dyslipidemia
Diabetes, thyroid disorders, obesity,
Endocrine and metabolic care 26–35 10%
metabolic risk
Asthma, COPD, pneumonia, antimicrobial
Respiratory and infectious disease 36–45 10%
stewardship
Abdominal symptoms, kidney disease,
Gastrointestinal and renal care 46–55 10%
urinary disorders
Neurological and musculoskeletal Headaches, stroke warning signs, joint
56–65 10%
care and back pain
Women's, men's and reproductive Screening, contraception, reproductive
66–75 10%
health and sexual health
Development, geriatric syndromes,
Older adults and pediatrics 76–85 10%
medication safety
Behavioral, preventive and Mental health, immunization, prevention,
86–100 15%
interprofessional care ethics and coordination
The ranges above provide an organizing framework for this practice set. They are not validated
predictions of the distribution of questions on any official examination.
3. Questions Section
QUESTIONS 1–100
Clinical Assessment and Reasoning
Q1: A 58-year-old patient presents with three weeks of fatigue, unintentional weight loss, and
progressive difficulty swallowing solid foods. The patient reports that liquids are now becoming
difficult to swallow. Which is the most appropriate next step?
A) Begin an empirical proton pump inhibitor and reassess in three months.
B) Arrange urgent upper gastrointestinal evaluation, including endoscopy, for possible
obstructing pathology.
C) Recommend dietary modification and monitor symptoms for six weeks.
D) Prescribe an antispasmodic for presumed esophageal motility dysfunction.
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Rationale: B is correct because progressive dysphagia, particularly when accompanied by weight
loss, is an alarm presentation requiring prompt investigation for malignancy or other structural
obstruction. A may delay diagnosis. C is inappropriate because the alarm features make routine
observation unsafe. D assumes a motility disorder without first excluding a structural lesion.
Q2: A 64-year-old patient with diabetes presents with new confusion, fever, tachycardia, and a
blood pressure of 84/50 mmHg. Which action should the primary care clinician prioritize?
A) Arrange routine outpatient blood testing.
B) Administer an oral antipyretic and reassess in one hour.
C) Activate emergency transfer for suspected sepsis with circulatory instability.
D) Schedule a follow-up visit the next morning.
Rationale: C is correct because hypotension, altered mental status, fever, and tachycardia suggest
a potentially life-threatening infection with organ dysfunction. A delays emergency assessment.
B does not address shock or the need for urgent resuscitation. D exposes the patient to dangerous
delay.
Q3: A 47-year-old patient reports intermittent chest pressure during brisk walking that resolves
with rest. The patient has hypertension and a family history of premature coronary disease. What
is the most appropriate clinical interpretation?
A) The symptoms are most consistent with gastroesophageal reflux.
B) The symptoms can be attributed to anxiety without further testing.
C) The patient has a musculoskeletal disorder because symptoms are intermittent.
D) Myocardial ischemia is a significant possibility and warrants prompt cardiovascular
assessment.
Rationale: D is correct because exertional pressure relieved by rest is concerning for angina,
particularly with cardiovascular risk factors. A is possible in other presentations but should not
be presumed here. B prematurely attributes symptoms to a psychological cause. C does not
explain the classic exertional pattern. Ongoing or recurrent chest pain at rest requires emergency
assessment.
Q4: A 35-year-old patient presents with fatigue, pallor, and exertional dyspnea. Laboratory
results show hemoglobin 9.2 g/dL, mean corpuscular volume 70 fL, and low ferritin. Which
additional step is most important?
A) Prescribe vitamin B12 without further evaluation.
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B) Reassure the patient that microcytosis is usually benign.
C) Investigate the source of iron deficiency, including blood loss and relevant gastrointestinal
causes.
D) Diagnose thalassemia solely from the low mean corpuscular volume.
Rationale: C is correct because low ferritin and microcytic anemia support iron deficiency, which
requires treatment and investigation of its cause. A addresses a different deficiency. B ignores
clinically significant anemia. D is not supported by the results and could overlook occult
bleeding.
Q5: A patient develops sudden severe headache reaching maximum intensity within seconds,
with vomiting and neck stiffness. Neurological examination is initially nonfocal. What is the best
next action?
A) Diagnose migraine and prescribe a triptan.
B) Recommend oral hydration and rest.
C) Arrange immediate emergency evaluation for subarachnoid hemorrhage and other dangerous
causes.
D) Schedule outpatient brain imaging next week.
Rationale: C is correct because a thunderclap headache is a neurological emergency even when
focal deficits are absent. A assumes a primary headache without excluding hemorrhage. B is
inadequate for the presentation. D delays evaluation of a potentially fatal condition.
Q6: A 52-year-old patient reports episodic dizziness when standing. The patient takes several
antihypertensives and a diuretic. Blood pressure decreases substantially after standing and
reproduces symptoms. What should the clinician do first?
A) Diagnose an inner-ear disorder and prescribe vestibular suppressants.
B) Review orthostatic measurements, hydration, medications, and fall risk before adjusting
treatment.
C) Increase the diuretic to control possible fluid retention.
D) Recommend strict bed rest indefinitely.
Rationale: B is correct because the symptoms and blood pressure change suggest orthostatic
hypotension, potentially related to medications or volume depletion. A overlooks the
documented positional blood pressure findings. C may worsen hypotension. D promotes
deconditioning and does not address the cause.
TEST BANK FOR PRIMARY CARE: ART
AND SCIENCE OF ADVANCED
PRACTICE NURSING, 6TH EDITION
Authors: Debera J. Dunphy, Lynne M. Dunphy, Jill E. Winland-Brown, Brian O. Porter, and
Deborah J. Thomas
The following is an original, advanced-level practice question bank designed around major
primary care and advanced practice nursing competencies. It emphasizes clinical reasoning,
differential diagnosis, evidence-based management, prevention, pharmacology, and patient-
centered care. These are study questions.
1. Introduction
Primary care is a central component of advanced practice nursing, requiring clinicians to
integrate scientific knowledge, clinical judgment, patient preferences, and evidence-based
interventions across the lifespan. This practice bank is designed for nurse practitioner students
and advanced practice nursing learners studying the principles associated with Primary Care: The
Art and Science of Advanced Practice Nursing—An Interprofessional Approach, 6th Edition.
The questions emphasize complex clinical scenarios that require learners to assess presenting
symptoms, interpret diagnostic findings, prioritize competing diagnoses, select appropriate
investigations, and formulate safe management plans. Additional areas include health promotion,
disease prevention, chronic disease management, pharmacological decision-making, behavioral
health, cultural competence, and interprofessional collaboration.
Each question includes four answer options, one best answer, and a detailed rationale explaining
the clinical reasoning behind the correct choice and the limitations of the alternatives. The
questions are intended to help students identify knowledge gaps, strengthen clinical judgment,
and prepare systematically for course examinations. Learners should supplement this material
with assigned textbook chapters, current clinical guidelines, and applicable prescribing and
practice standards. Repeated practice and careful review of rationales can support stronger
clinical decision-making and examination readiness.
2. Content Area Overview
The following is a study-oriented blueprint of major primary care competencies. The weights are
illustrative study allocations, not official textbook examination weights.
CONTENT AREA — QUESTIONS — KEY TOPICS —
WEIGHT
,2|Page
Content area Questions Key topics Weight
History, examination, differential
Clinical assessment and reasoning 1–15 15%
diagnosis, clinical red flags
Hypertension, coronary disease, heart
Cardiovascular care 16–25 10%
failure, dyslipidemia
Diabetes, thyroid disorders, obesity,
Endocrine and metabolic care 26–35 10%
metabolic risk
Asthma, COPD, pneumonia, antimicrobial
Respiratory and infectious disease 36–45 10%
stewardship
Abdominal symptoms, kidney disease,
Gastrointestinal and renal care 46–55 10%
urinary disorders
Neurological and musculoskeletal Headaches, stroke warning signs, joint
56–65 10%
care and back pain
Women's, men's and reproductive Screening, contraception, reproductive
66–75 10%
health and sexual health
Development, geriatric syndromes,
Older adults and pediatrics 76–85 10%
medication safety
Behavioral, preventive and Mental health, immunization, prevention,
86–100 15%
interprofessional care ethics and coordination
The ranges above provide an organizing framework for this practice set. They are not validated
predictions of the distribution of questions on any official examination.
3. Questions Section
QUESTIONS 1–100
Clinical Assessment and Reasoning
Q1: A 58-year-old patient presents with three weeks of fatigue, unintentional weight loss, and
progressive difficulty swallowing solid foods. The patient reports that liquids are now becoming
difficult to swallow. Which is the most appropriate next step?
A) Begin an empirical proton pump inhibitor and reassess in three months.
B) Arrange urgent upper gastrointestinal evaluation, including endoscopy, for possible
obstructing pathology.
C) Recommend dietary modification and monitor symptoms for six weeks.
D) Prescribe an antispasmodic for presumed esophageal motility dysfunction.
,3|Page
Rationale: B is correct because progressive dysphagia, particularly when accompanied by weight
loss, is an alarm presentation requiring prompt investigation for malignancy or other structural
obstruction. A may delay diagnosis. C is inappropriate because the alarm features make routine
observation unsafe. D assumes a motility disorder without first excluding a structural lesion.
Q2: A 64-year-old patient with diabetes presents with new confusion, fever, tachycardia, and a
blood pressure of 84/50 mmHg. Which action should the primary care clinician prioritize?
A) Arrange routine outpatient blood testing.
B) Administer an oral antipyretic and reassess in one hour.
C) Activate emergency transfer for suspected sepsis with circulatory instability.
D) Schedule a follow-up visit the next morning.
Rationale: C is correct because hypotension, altered mental status, fever, and tachycardia suggest
a potentially life-threatening infection with organ dysfunction. A delays emergency assessment.
B does not address shock or the need for urgent resuscitation. D exposes the patient to dangerous
delay.
Q3: A 47-year-old patient reports intermittent chest pressure during brisk walking that resolves
with rest. The patient has hypertension and a family history of premature coronary disease. What
is the most appropriate clinical interpretation?
A) The symptoms are most consistent with gastroesophageal reflux.
B) The symptoms can be attributed to anxiety without further testing.
C) The patient has a musculoskeletal disorder because symptoms are intermittent.
D) Myocardial ischemia is a significant possibility and warrants prompt cardiovascular
assessment.
Rationale: D is correct because exertional pressure relieved by rest is concerning for angina,
particularly with cardiovascular risk factors. A is possible in other presentations but should not
be presumed here. B prematurely attributes symptoms to a psychological cause. C does not
explain the classic exertional pattern. Ongoing or recurrent chest pain at rest requires emergency
assessment.
Q4: A 35-year-old patient presents with fatigue, pallor, and exertional dyspnea. Laboratory
results show hemoglobin 9.2 g/dL, mean corpuscular volume 70 fL, and low ferritin. Which
additional step is most important?
A) Prescribe vitamin B12 without further evaluation.
, 4|Page
B) Reassure the patient that microcytosis is usually benign.
C) Investigate the source of iron deficiency, including blood loss and relevant gastrointestinal
causes.
D) Diagnose thalassemia solely from the low mean corpuscular volume.
Rationale: C is correct because low ferritin and microcytic anemia support iron deficiency, which
requires treatment and investigation of its cause. A addresses a different deficiency. B ignores
clinically significant anemia. D is not supported by the results and could overlook occult
bleeding.
Q5: A patient develops sudden severe headache reaching maximum intensity within seconds,
with vomiting and neck stiffness. Neurological examination is initially nonfocal. What is the best
next action?
A) Diagnose migraine and prescribe a triptan.
B) Recommend oral hydration and rest.
C) Arrange immediate emergency evaluation for subarachnoid hemorrhage and other dangerous
causes.
D) Schedule outpatient brain imaging next week.
Rationale: C is correct because a thunderclap headache is a neurological emergency even when
focal deficits are absent. A assumes a primary headache without excluding hemorrhage. B is
inadequate for the presentation. D delays evaluation of a potentially fatal condition.
Q6: A 52-year-old patient reports episodic dizziness when standing. The patient takes several
antihypertensives and a diuretic. Blood pressure decreases substantially after standing and
reproduces symptoms. What should the clinician do first?
A) Diagnose an inner-ear disorder and prescribe vestibular suppressants.
B) Review orthostatic measurements, hydration, medications, and fall risk before adjusting
treatment.
C) Increase the diuretic to control possible fluid retention.
D) Recommend strict bed rest indefinitely.
Rationale: B is correct because the symptoms and blood pressure change suggest orthostatic
hypotension, potentially related to medications or volume depletion. A overlooks the
documented positional blood pressure findings. C may worsen hypotension. D promotes
deconditioning and does not address the cause.
