NRNP6552 EXAM WITH COMPLETE QUESTIONS AND ANSWERS 2024
UPDATE
Question: A 52-year-old patient presents with a new onset of chest pain. The pain is described
as a pressure sensation that radiates to the left arm. The patient has a history of hypertension
and diabetes. What are the key differential diagnoses you should consider, and what initial tests
would you order to narrow down the diagnosis?
Answer: Key differential diagnoses for chest pain include:
1. Acute Myocardial Infarction (AMI): Given the patient's history of hypertension and
diabetes, AMI is a significant concern.
2. Angina Pectoris: This can also present with chest pain and is related to coronary artery
disease.
3. Pulmonary Embolism (PE): Can cause chest pain and may be associated with
shortness of breath.
4. Aortic Dissection: Severe chest pain that may radiate to the back; requires immediate
attention.
5. Gastroesophageal Reflux Disease (GERD): Can cause chest pain but is less likely to
be acute.
Initial tests to narrow down the diagnosis might include:
● Electrocardiogram (ECG): To assess for signs of ischemia or infarction.
● Cardiac Biomarkers (e.g., Troponin): Elevated levels indicate myocardial injury.
● Chest X-ray: To check for signs of PE or aortic dissection.
● Basic Metabolic Panel (BMP): To evaluate electrolyte imbalances and renal function.
Question 2: Management of Diabetes
Question: A 60-year-old patient with type 2 diabetes has an HbA1c of 8.2%. The patient is
currently on metformin but reports frequent hypoglycemic episodes. What changes in
management should be considered?
Answer: For a patient with type 2 diabetes who is experiencing hypoglycemic episodes,
consider the following:
1. Evaluate Metformin Dose: While metformin is generally well-tolerated, it is important to
assess if the dose is appropriate and if the hypoglycemia might be due to other factors.
2. Review Other Medications: Check if the patient is on other medications that might
contribute to hypoglycemia (e.g., insulin or sulfonylureas).
3. Adjust Diabetes Management Plan:
, ○ Reassess Medication Regimen: Consider adding or adjusting medications to
achieve better glucose control while reducing the risk of hypoglycemia. For
example, a GLP-1 receptor agonist or SGLT2 inhibitor might be appropriate.
○ Patient Education: Ensure the patient understands how to manage their blood
glucose levels and recognize signs of hypoglycemia.
○ Lifestyle Modifications: Emphasize the importance of diet, exercise, and
regular monitoring of blood glucose levels.
Question 3: Chronic Disease Management
Question: A patient with chronic kidney disease (CKD) stage 3 presents with fatigue and
swelling in the lower extremities. What are the key management strategies for this patient, and
what complications should be monitored?
Answer: Key management strategies for CKD stage 3 include:
1. Blood Pressure Control: Aim for a target BP of less than 130/80 mmHg to slow
progression of CKD.
2. Glycemic Control: Maintain good control of blood glucose levels if the patient has
diabetes.
3. Dietary Modifications: Advise a diet low in sodium, protein, and potassium, as
recommended for CKD patients.
4. Medications:
○ ACE Inhibitors or ARBs: These can help manage blood pressure and have
renal protective effects.
○ Diuretics: May be used to manage fluid retention and swelling.
5. Monitor Complications:
○ Electrolyte Imbalances: Regular monitoring of potassium, phosphate, and
calcium levels.
○ Anemia: Check hemoglobin levels and consider iron or
erythropoiesis-stimulating agents if needed.
○ Bone Health: Monitor for signs of renal osteodystrophy and consider phosphate
binders if necessary.
Question 4: Pediatric Assessment
Question: A 5-year-old child presents with a high fever, cough, and difficulty breathing. On
examination, you note decreased breath sounds and crackles in the right lower lung field. What
are the likely diagnoses, and what are the appropriate next steps in management?
Answer: Likely diagnoses for a child with these symptoms include:
, 1. Pneumonia: This can present with fever, cough, and localized findings on physical
exam.
2. Bronchitis: May present with cough and wheezing, though fever and localized crackles
are more indicative of pneumonia.
3. Asthma Exacerbation: Less likely in this age group unless there is a history of asthma.
Appropriate next steps in management include:
1. Order a Chest X-ray: To confirm the presence of pneumonia and assess for any
complications (e.g., effusion or abscess).
2. Initiate Empirical Antibiotic Therapy: Based on local guidelines, typically targeting
common pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.
3. Supportive Care: Ensure the child stays hydrated and monitor for signs of respiratory
distress.
4. Follow-Up: Arrange for follow-up to reassess the child’s condition and response to
treatment.
Question 5: Hypertension Management
Question: A 45-year-old patient with newly diagnosed hypertension presents with a blood
pressure of 150/95 mmHg. The patient has no other significant health issues or symptoms.
What is the initial management plan for this patient?
Answer: Initial management for a patient with newly diagnosed hypertension includes:
1. Lifestyle Modifications:
○ Diet: Encourage a diet low in sodium and rich in fruits and vegetables (e.g.,
DASH diet).
○ Exercise: Recommend regular physical activity, such as 150 minutes of
moderate exercise per week.
○ Weight Management: If overweight, advise weight loss strategies.
○ Limit Alcohol and Quit Smoking: If applicable.
2. Medication: Start antihypertensive therapy, typically with:
○ ACE Inhibitors (e.g., lisinopril): Especially if the patient has any signs of organ
damage or is at high risk.
○ Thiazide Diuretics (e.g., hydrochlorothiazide): Can be used alone or in
combination with other antihypertensives.
○ Calcium Channel Blockers (e.g., amlodipine): Can be used as an alternative.
3. Monitor Blood Pressure: Regular follow-up to ensure that the patient’s blood pressure
is controlled and to adjust medication as needed.
Question 6: Geriatric Care
, Question: An 80-year-old patient presents with unintentional weight loss, decreased appetite,
and confusion. What are the possible underlying causes, and what initial investigations should
be undertaken?
Answer: Possible underlying causes for these symptoms in an elderly patient include:
1. Malnutrition or Dehydration: Often due to decreased appetite or difficulty eating.
2. Chronic Diseases: Such as cancer, chronic infections, or heart failure.
3. Medications: Side effects or drug interactions.
4. Cognitive Decline: Conditions such as dementia or delirium.
Initial investigations should include:
1. Complete Blood Count (CBC): To check for anemia or infection.
2. Basic Metabolic Panel (BMP): To assess electrolyte imbalances, renal function, and
glucose levels.
3. Thyroid Function Tests: To rule out thyroid disorders that could contribute to weight
loss and confusion.
4. Urinalysis: To check for signs of infection or other abnormalities.
5. Chest X-ray: If there are concerns about underlying infections or cardiac issues.
Question 7: Depression Screening
Question: A 35-year-old patient presents with persistent sadness, fatigue, and loss of interest
in activities they previously enjoyed. What steps should you take to assess and manage
possible depression?
Answer: Steps to assess and manage possible depression include:
1. Screening Tools: Use validated tools such as the Patient Health Questionnaire-9
(PHQ-9) to assess the severity of depression.
2. Clinical Assessment: Conduct a thorough history and mental status examination to
evaluate the patient's symptoms and any potential triggers or stressors.
3. Assess Risk: Evaluate for any risk of self-harm or suicidal ideation.
4. Management Plan:
○ Counseling and Psychotherapy: Cognitive-behavioral therapy (CBT) or other
forms of psychotherapy can be effective.
○ Pharmacotherapy: Consider prescribing antidepressants such as selective
serotonin reuptake inhibitors (SSRIs) if appropriate.
○ Follow-Up: Arrange for regular follow-up to monitor the patient's response to
treatment and make adjustments as needed.
Cardiovascular
UPDATE
Question: A 52-year-old patient presents with a new onset of chest pain. The pain is described
as a pressure sensation that radiates to the left arm. The patient has a history of hypertension
and diabetes. What are the key differential diagnoses you should consider, and what initial tests
would you order to narrow down the diagnosis?
Answer: Key differential diagnoses for chest pain include:
1. Acute Myocardial Infarction (AMI): Given the patient's history of hypertension and
diabetes, AMI is a significant concern.
2. Angina Pectoris: This can also present with chest pain and is related to coronary artery
disease.
3. Pulmonary Embolism (PE): Can cause chest pain and may be associated with
shortness of breath.
4. Aortic Dissection: Severe chest pain that may radiate to the back; requires immediate
attention.
5. Gastroesophageal Reflux Disease (GERD): Can cause chest pain but is less likely to
be acute.
Initial tests to narrow down the diagnosis might include:
● Electrocardiogram (ECG): To assess for signs of ischemia or infarction.
● Cardiac Biomarkers (e.g., Troponin): Elevated levels indicate myocardial injury.
● Chest X-ray: To check for signs of PE or aortic dissection.
● Basic Metabolic Panel (BMP): To evaluate electrolyte imbalances and renal function.
Question 2: Management of Diabetes
Question: A 60-year-old patient with type 2 diabetes has an HbA1c of 8.2%. The patient is
currently on metformin but reports frequent hypoglycemic episodes. What changes in
management should be considered?
Answer: For a patient with type 2 diabetes who is experiencing hypoglycemic episodes,
consider the following:
1. Evaluate Metformin Dose: While metformin is generally well-tolerated, it is important to
assess if the dose is appropriate and if the hypoglycemia might be due to other factors.
2. Review Other Medications: Check if the patient is on other medications that might
contribute to hypoglycemia (e.g., insulin or sulfonylureas).
3. Adjust Diabetes Management Plan:
, ○ Reassess Medication Regimen: Consider adding or adjusting medications to
achieve better glucose control while reducing the risk of hypoglycemia. For
example, a GLP-1 receptor agonist or SGLT2 inhibitor might be appropriate.
○ Patient Education: Ensure the patient understands how to manage their blood
glucose levels and recognize signs of hypoglycemia.
○ Lifestyle Modifications: Emphasize the importance of diet, exercise, and
regular monitoring of blood glucose levels.
Question 3: Chronic Disease Management
Question: A patient with chronic kidney disease (CKD) stage 3 presents with fatigue and
swelling in the lower extremities. What are the key management strategies for this patient, and
what complications should be monitored?
Answer: Key management strategies for CKD stage 3 include:
1. Blood Pressure Control: Aim for a target BP of less than 130/80 mmHg to slow
progression of CKD.
2. Glycemic Control: Maintain good control of blood glucose levels if the patient has
diabetes.
3. Dietary Modifications: Advise a diet low in sodium, protein, and potassium, as
recommended for CKD patients.
4. Medications:
○ ACE Inhibitors or ARBs: These can help manage blood pressure and have
renal protective effects.
○ Diuretics: May be used to manage fluid retention and swelling.
5. Monitor Complications:
○ Electrolyte Imbalances: Regular monitoring of potassium, phosphate, and
calcium levels.
○ Anemia: Check hemoglobin levels and consider iron or
erythropoiesis-stimulating agents if needed.
○ Bone Health: Monitor for signs of renal osteodystrophy and consider phosphate
binders if necessary.
Question 4: Pediatric Assessment
Question: A 5-year-old child presents with a high fever, cough, and difficulty breathing. On
examination, you note decreased breath sounds and crackles in the right lower lung field. What
are the likely diagnoses, and what are the appropriate next steps in management?
Answer: Likely diagnoses for a child with these symptoms include:
, 1. Pneumonia: This can present with fever, cough, and localized findings on physical
exam.
2. Bronchitis: May present with cough and wheezing, though fever and localized crackles
are more indicative of pneumonia.
3. Asthma Exacerbation: Less likely in this age group unless there is a history of asthma.
Appropriate next steps in management include:
1. Order a Chest X-ray: To confirm the presence of pneumonia and assess for any
complications (e.g., effusion or abscess).
2. Initiate Empirical Antibiotic Therapy: Based on local guidelines, typically targeting
common pathogens such as Streptococcus pneumoniae and Haemophilus influenzae.
3. Supportive Care: Ensure the child stays hydrated and monitor for signs of respiratory
distress.
4. Follow-Up: Arrange for follow-up to reassess the child’s condition and response to
treatment.
Question 5: Hypertension Management
Question: A 45-year-old patient with newly diagnosed hypertension presents with a blood
pressure of 150/95 mmHg. The patient has no other significant health issues or symptoms.
What is the initial management plan for this patient?
Answer: Initial management for a patient with newly diagnosed hypertension includes:
1. Lifestyle Modifications:
○ Diet: Encourage a diet low in sodium and rich in fruits and vegetables (e.g.,
DASH diet).
○ Exercise: Recommend regular physical activity, such as 150 minutes of
moderate exercise per week.
○ Weight Management: If overweight, advise weight loss strategies.
○ Limit Alcohol and Quit Smoking: If applicable.
2. Medication: Start antihypertensive therapy, typically with:
○ ACE Inhibitors (e.g., lisinopril): Especially if the patient has any signs of organ
damage or is at high risk.
○ Thiazide Diuretics (e.g., hydrochlorothiazide): Can be used alone or in
combination with other antihypertensives.
○ Calcium Channel Blockers (e.g., amlodipine): Can be used as an alternative.
3. Monitor Blood Pressure: Regular follow-up to ensure that the patient’s blood pressure
is controlled and to adjust medication as needed.
Question 6: Geriatric Care
, Question: An 80-year-old patient presents with unintentional weight loss, decreased appetite,
and confusion. What are the possible underlying causes, and what initial investigations should
be undertaken?
Answer: Possible underlying causes for these symptoms in an elderly patient include:
1. Malnutrition or Dehydration: Often due to decreased appetite or difficulty eating.
2. Chronic Diseases: Such as cancer, chronic infections, or heart failure.
3. Medications: Side effects or drug interactions.
4. Cognitive Decline: Conditions such as dementia or delirium.
Initial investigations should include:
1. Complete Blood Count (CBC): To check for anemia or infection.
2. Basic Metabolic Panel (BMP): To assess electrolyte imbalances, renal function, and
glucose levels.
3. Thyroid Function Tests: To rule out thyroid disorders that could contribute to weight
loss and confusion.
4. Urinalysis: To check for signs of infection or other abnormalities.
5. Chest X-ray: If there are concerns about underlying infections or cardiac issues.
Question 7: Depression Screening
Question: A 35-year-old patient presents with persistent sadness, fatigue, and loss of interest
in activities they previously enjoyed. What steps should you take to assess and manage
possible depression?
Answer: Steps to assess and manage possible depression include:
1. Screening Tools: Use validated tools such as the Patient Health Questionnaire-9
(PHQ-9) to assess the severity of depression.
2. Clinical Assessment: Conduct a thorough history and mental status examination to
evaluate the patient's symptoms and any potential triggers or stressors.
3. Assess Risk: Evaluate for any risk of self-harm or suicidal ideation.
4. Management Plan:
○ Counseling and Psychotherapy: Cognitive-behavioral therapy (CBT) or other
forms of psychotherapy can be effective.
○ Pharmacotherapy: Consider prescribing antidepressants such as selective
serotonin reuptake inhibitors (SSRIs) if appropriate.
○ Follow-Up: Arrange for regular follow-up to monitor the patient's response to
treatment and make adjustments as needed.
Cardiovascular
