NRNP 6540 Midterm Exam Guide: 200 Practice Questions & Answers for Adult Gerontology & Primary Care (2025/2026)

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NRNP 6540 MIDTERM EXAM LATEST/NRNP6540 MIDTERM EXAM
PREPARATION/ NRNP 6540 MIDTERM EXAM 200 PRACTICE
QUESTIONS AND ANSWERS 2025/2026 (VERIFIED ANSWERS)
Rheumatoid arthritis: what, who - ......ANSWER........chronic, systemic autoimmune
disease that causes inflammation of connective tissue, first that of joints them other soft
tissues (renal, cardiovascular, pulm). TNF-alpha plays a big role



- more women than men

- unknown cause

- Epstein Barr virus



Rheumatoid arthritis: Findings and diagnostics - ......ANSWER........- symmetric joint/
muscle pain, worse in the morning then gets better

- weakness, fatigue

- anorexia, weight loss

- generalized malaise

- swollen joints/ boggy feeling of joints with deformity of joints

- warm, red skin on affected joints

later:

- pleural effusions and pulmonary nodules

- inflammation of sclerae (scleritis)

- pericarditis, myocarditis

- splenomegaly (Felty's syndrome)



- anemia (hypochromic, microcytic) with low ferritin

- possibly: positive rheumatoid factor

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- XR: joint swelling, later cortical and space thinning

- synovial fluid: yellow, thick with elevated WBC up to 100.000



Felty's syndrome - ......ANSWER........rheumatoid arthritis, splenomegaly, neutropenia



Rheumatoid arthritis treatment - ......ANSWER........- early treatment better than stepwise

- early referral rheumatologist

- disease-modifying anti-rheumatic drugs (DMARDs):

- methotrexate (no alcohol, monitor renal and liver, give with folic acid)

- cyclosporine

- Gold preparations (can cause thrombocytopenia)

- Hydroxychloroquine: antimalarial drug (may cause visual changes, monitor)

- sulfasalazine, moderate RA

- Leflunomide, moderate to severe RA

- Etanercept

- monitor liver function with DMARDs

- screen for TB (skin test) and Hep B

- surgery: joint debridement, joint replacement



Gout: what, who - ......ANSWER........Inflammatory disorder in response to high uric acid
production/ levels in blood and synovial fluid causing crystallization which causes
inflammation (Type A and Mediterranean)



- impaired renal function which causes excess uric acid

- foods high in purine, such as dairy, red meat, shellfish, beer

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Gout findings, diagnostics - ......ANSWER........- acute painful joint, often great toe (warm,
swollen)

- pain at night

- flank pain because of renal calculi

- fever

- leukocytosis

- elevated erythrocyte sedimentation rate

- tophi (bump under skin) on ear

- limited joint motion



- elevated serum uric acid (greater than 7mg/dl)

- urate crystals seen with joint aspiration

- xr: joint erosion and renal stones



Gout treatment - ......ANSWER........- NSAIDS: naproxen, indomethacin, sulindac

- Colchicine for those who do not tolerate NSAIDS (caution with renal impairment). Also,
for prophylaxis

- Corticosteroids, if NSAIDS and colchicine not tolerated

- 24hr urine for uric acid

- Allopurinol after flare is over (100mg PO daily)

- Biological modifiers of disease (BMD): Pegloticase. Not for asymptomatic. Treat with
prophylaxis first. Monitor serum uric acid



ANA. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Antinuclear antibody (ANA).

Normal: Titer 1.32

Positive with: Sjogren's (SS), SLE (lupus),

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C4 Complement. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Determines hemolytic activity which speaks to level of inflammatory
response

Normal: men: 12-72. Women: 13-75 mg/dl

Increased with inflammatory disease

Decreased with: RA, lupus, SS



The radioallergosorbent test (RAST). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........measures presence/ increase antigen IgE

normal: 0.01 - 0.04 mg/dl

Increased with allergic reaction



Erythrocyte sedimentation rate (ESR). Tests in rheumatic disease: what, normal level,
abnormal with. - ......ANSWER........rate at which RBC settle out of unclotted blood in 1 hr.

Normal: men: 0-7mm/hr., women: 0 - 25 mm/hr.

Increased with inflammation



CRP. Tests in rheumatic disease: what, normal level, abnormal with. - ......ANSWER........C-
reactive protein, a non-specific antigen antibody

Normal: trace to 6mg/ml

Increased with infection and inflammation, RA. Decreased with successful RA treatment



RF. Tests in rheumatic disease: what, normal level, abnormal with.
- ......ANSWER........Rheumatoid factor. antibody against IgG.

Positive RF in most people with RA