NRNP 6531 Final Exam ACTUAL
EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 45-year-old male presents with acute onset chest pain described as "tearing" and
radiating to his back. He has a history of hypertension and Marfan syndrome. Blood pressure is
180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is the most appropriate
initial diagnostic test?
A. Chest X-ray
B. D-dimer assay
C. CT angiography of the chest
D. Echocardiogram
Correct Answer: C
Rationale: CT angiography is the gold standard for diagnosing aortic dissection, showing the
intimal flap and extent of dissection. The presentation with tearing chest pain, blood pressure
differential, and Marfan syndrome history is classic for aortic dissection.
Question 2: A 28-year-old female presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She is afebrile. Urinalysis shows positive leukocyte esterase, negative nitrites,
and 15-20 WBCs/HPF. What is the most appropriate initial management?
A. Oral trimethoprim-sulfamethoxazole for 3 days
B. Oral nitrofurantoin for 5 days
C. IV ceftriaxone followed by oral antibiotics
D. Urine culture and wait for results before treatment
Correct Answer: B
Rationale: This presentation is consistent with uncomplicated cystitis. Nitrofurantoin for 5 days is
first-line therapy according to IDSA guidelines, with excellent coverage for common uropathogens
and low resistance rates.
,Question 3: A 55-year-old diabetic patient presents with a 2-week history of persistent dry cough,
low-grade fever, and malaise. Chest X-ray shows bilateral interstitial infiltrates. Complete blood
count shows normal WBC count. What is the most likely pathogen and appropriate treatment?
A. Streptococcus pneumoniae - amoxicillin
B. Mycoplasma pneumoniae - azithromycin
C. Legionella pneumophila - levofloxacin
D. Influenza virus - oseltamivir
Correct Answer: B
Rationale: The presentation with persistent dry cough, low-grade fever, bilateral interstitial
infiltrates, and normal WBC count is classic for atypical pneumonia caused by Mycoplasma
pneumoniae, which responds well to macrolides like azithromycin.
Question 4: A 35-year-old female presents with a 6-week history of fatigue, weight gain, cold
intolerance, and constipation. TSH is 12.5 mIU/L (normal 0.4-4.0), free T4 is 0.8 ng/dL (normal
0.8-1.8). What is the most appropriate initial treatment and monitoring plan?
A. Start levothyroxine 25 mcg daily, recheck TSH in 6 weeks
B. Start levothyroxine 50 mcg daily, recheck TSH in 3 months
C. Start levothyroxine 100 mcg daily, recheck TSH in 4 weeks
D. Order thyroid ultrasound before starting treatment
Correct Answer: A
Rationale: This patient has subclinical hypothyroidism (elevated TSH, normal free T4). Starting with
low-dose levothyroxine (1.6 mcg/kg/day) and monitoring TSH in 6 weeks is appropriate to avoid
over-treatment and allow for dose adjustment.
Question 5: A 42-year-old male presents with acute onset severe right great toe pain, swelling, and
erythema that began last night. He has a history of hypertension and takes hydrochlorothiazide.
Serum uric acid is 8.2 mg/dL. What is the most appropriate acute treatment?
A. Allopurinol 300 mg daily
B. Indomethacin 50 mg TID
C. Colchicine 0.6 mg BID
D. Prednisone 40 mg daily
Correct Answer: B
Rationale: This is classic acute gouty arthritis. NSAIDs like indomethacin are first-line treatment for
acute gout attacks, providing rapid anti-inflammatory relief. Allopurinol is for chronic urate-lowering
therapy, not acute attacks.
,Question 6: A 68-year-old patient with COPD presents with increased dyspnea, increased sputum
production, and change in sputum color from clear to yellow-green. Oxygen saturation is 89% on
room air. What is the most appropriate initial management?
A. Oral prednisone 40 mg daily for 5 days
B. Nebulized albuterol only
C. Home oxygen therapy
D. Immediate intubation
Correct Answer: A
Rationale: This patient has acute COPD exacerbation with increased dyspnea, sputum volume, and
purulence. Systemic corticosteroids reduce inflammation and improve lung function. Guidelines
recommend 40 mg prednisone daily for 5 days for moderate exacerbations.
Question 7: A 25-year-old female presents with a 3-day history of sore throat, fever of 101.5°F, and
difficulty swallowing. Exam reveals tonsillar exudates, tender anterior cervical lymphadenopathy,
and absence of cough. Rapid strep test is positive. What is the most appropriate treatment?
A. Supportive care only
B. Penicillin V 500 mg BID for 10 days
C. Azithromycin 500 mg daily for 3 days
D. Amoxicillin-clavulanate for 5 days
Correct Answer: B
Rationale: This patient has streptococcal pharyngitis based on clinical criteria (Centor score 4) and
positive rapid strep test. Penicillin V remains first-line treatment, with 10-day course providing
optimal bacterial eradication and rheumatic fever prevention.
Question 8: A 50-year-old patient presents with new-onset type 2 diabetes. HbA1c is 8.8%. BMI is
32 kg/m². Fasting glucose is 185 mg/dL. What is the most appropriate initial pharmacologic
management?
A. Metformin 500 mg BID
B. Glipizide 5 mg daily
C. Sitagliptin 100 mg daily
D. Insulin glargine 20 units daily
Correct Answer: A
Rationale: Metformin remains first-line therapy for type 2 diabetes unless contraindicated. It
effectively lowers HbA1c, promotes weight neutrality/loss, and has cardiovascular benefits. Starting
dose of 500 mg BID minimizes GI side effects.
, Question 9: A 35-year-old presents with a 2-week history of low back pain radiating down the left
leg. Straight leg raise test is positive at 45 degrees. Neurological exam is normal. What is the most
appropriate initial management?
A. Immediate MRI of lumbar spine
B. Bed rest for 1 week
C. NSAIDs and physical therapy
D. Epidural steroid injection
Correct Answer: C
Rationale: This presentation suggests lumbar radiculopathy without red flags. Conservative
management with NSAIDs and physical therapy is appropriate for 4-6 weeks before considering
imaging, as most cases improve with conservative care.
Question 10: A 45-year-old female presents with irregular menses, hot flashes, mood swings, and
sleep disturbances. FSH is 35 mIU/mL (normal <20). What is the most appropriate initial
management for symptom relief?
A. Combined oral contraceptives
B. Estrogen-only hormone therapy
C. SSRI antidepressant
D. Gabapentin for hot flashes
Correct Answer: A
Rationale: This patient is in perimenopause with elevated FSH. Combined oral contraceptives
effectively regulate cycles, reduce hot flashes, and provide contraception during the transition to
menopause while symptoms are managed.
Question 11: A 60-year-old patient with hypertension presents for follow-up. BP is 148/92 mmHg on
lisinopril 10 mg daily. Potassium is 4.2 mEq/L, creatinine is 1.0 mg/dL. What is the most appropriate
next step?
A. Increase lisinopril to 20 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add amlodipine 5 mg daily
D. Switch to losartan 100 mg daily
Correct Answer: B
Rationale: Current guidelines recommend combination therapy when BP is >20/10 mmHg above
target. Adding a thiazide diuretic to an ACE inhibitor provides synergistic BP reduction and is
well-tolerated with preserved kidney function.
EXAM 2026/2027: 100% Verified
Questions & Correct Answers
Question 1: A 45-year-old male presents with acute onset chest pain described as "tearing" and
radiating to his back. He has a history of hypertension and Marfan syndrome. Blood pressure is
180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is the most appropriate
initial diagnostic test?
A. Chest X-ray
B. D-dimer assay
C. CT angiography of the chest
D. Echocardiogram
Correct Answer: C
Rationale: CT angiography is the gold standard for diagnosing aortic dissection, showing the
intimal flap and extent of dissection. The presentation with tearing chest pain, blood pressure
differential, and Marfan syndrome history is classic for aortic dissection.
Question 2: A 28-year-old female presents with a 3-day history of dysuria, urinary frequency, and
suprapubic pain. She is afebrile. Urinalysis shows positive leukocyte esterase, negative nitrites,
and 15-20 WBCs/HPF. What is the most appropriate initial management?
A. Oral trimethoprim-sulfamethoxazole for 3 days
B. Oral nitrofurantoin for 5 days
C. IV ceftriaxone followed by oral antibiotics
D. Urine culture and wait for results before treatment
Correct Answer: B
Rationale: This presentation is consistent with uncomplicated cystitis. Nitrofurantoin for 5 days is
first-line therapy according to IDSA guidelines, with excellent coverage for common uropathogens
and low resistance rates.
,Question 3: A 55-year-old diabetic patient presents with a 2-week history of persistent dry cough,
low-grade fever, and malaise. Chest X-ray shows bilateral interstitial infiltrates. Complete blood
count shows normal WBC count. What is the most likely pathogen and appropriate treatment?
A. Streptococcus pneumoniae - amoxicillin
B. Mycoplasma pneumoniae - azithromycin
C. Legionella pneumophila - levofloxacin
D. Influenza virus - oseltamivir
Correct Answer: B
Rationale: The presentation with persistent dry cough, low-grade fever, bilateral interstitial
infiltrates, and normal WBC count is classic for atypical pneumonia caused by Mycoplasma
pneumoniae, which responds well to macrolides like azithromycin.
Question 4: A 35-year-old female presents with a 6-week history of fatigue, weight gain, cold
intolerance, and constipation. TSH is 12.5 mIU/L (normal 0.4-4.0), free T4 is 0.8 ng/dL (normal
0.8-1.8). What is the most appropriate initial treatment and monitoring plan?
A. Start levothyroxine 25 mcg daily, recheck TSH in 6 weeks
B. Start levothyroxine 50 mcg daily, recheck TSH in 3 months
C. Start levothyroxine 100 mcg daily, recheck TSH in 4 weeks
D. Order thyroid ultrasound before starting treatment
Correct Answer: A
Rationale: This patient has subclinical hypothyroidism (elevated TSH, normal free T4). Starting with
low-dose levothyroxine (1.6 mcg/kg/day) and monitoring TSH in 6 weeks is appropriate to avoid
over-treatment and allow for dose adjustment.
Question 5: A 42-year-old male presents with acute onset severe right great toe pain, swelling, and
erythema that began last night. He has a history of hypertension and takes hydrochlorothiazide.
Serum uric acid is 8.2 mg/dL. What is the most appropriate acute treatment?
A. Allopurinol 300 mg daily
B. Indomethacin 50 mg TID
C. Colchicine 0.6 mg BID
D. Prednisone 40 mg daily
Correct Answer: B
Rationale: This is classic acute gouty arthritis. NSAIDs like indomethacin are first-line treatment for
acute gout attacks, providing rapid anti-inflammatory relief. Allopurinol is for chronic urate-lowering
therapy, not acute attacks.
,Question 6: A 68-year-old patient with COPD presents with increased dyspnea, increased sputum
production, and change in sputum color from clear to yellow-green. Oxygen saturation is 89% on
room air. What is the most appropriate initial management?
A. Oral prednisone 40 mg daily for 5 days
B. Nebulized albuterol only
C. Home oxygen therapy
D. Immediate intubation
Correct Answer: A
Rationale: This patient has acute COPD exacerbation with increased dyspnea, sputum volume, and
purulence. Systemic corticosteroids reduce inflammation and improve lung function. Guidelines
recommend 40 mg prednisone daily for 5 days for moderate exacerbations.
Question 7: A 25-year-old female presents with a 3-day history of sore throat, fever of 101.5°F, and
difficulty swallowing. Exam reveals tonsillar exudates, tender anterior cervical lymphadenopathy,
and absence of cough. Rapid strep test is positive. What is the most appropriate treatment?
A. Supportive care only
B. Penicillin V 500 mg BID for 10 days
C. Azithromycin 500 mg daily for 3 days
D. Amoxicillin-clavulanate for 5 days
Correct Answer: B
Rationale: This patient has streptococcal pharyngitis based on clinical criteria (Centor score 4) and
positive rapid strep test. Penicillin V remains first-line treatment, with 10-day course providing
optimal bacterial eradication and rheumatic fever prevention.
Question 8: A 50-year-old patient presents with new-onset type 2 diabetes. HbA1c is 8.8%. BMI is
32 kg/m². Fasting glucose is 185 mg/dL. What is the most appropriate initial pharmacologic
management?
A. Metformin 500 mg BID
B. Glipizide 5 mg daily
C. Sitagliptin 100 mg daily
D. Insulin glargine 20 units daily
Correct Answer: A
Rationale: Metformin remains first-line therapy for type 2 diabetes unless contraindicated. It
effectively lowers HbA1c, promotes weight neutrality/loss, and has cardiovascular benefits. Starting
dose of 500 mg BID minimizes GI side effects.
, Question 9: A 35-year-old presents with a 2-week history of low back pain radiating down the left
leg. Straight leg raise test is positive at 45 degrees. Neurological exam is normal. What is the most
appropriate initial management?
A. Immediate MRI of lumbar spine
B. Bed rest for 1 week
C. NSAIDs and physical therapy
D. Epidural steroid injection
Correct Answer: C
Rationale: This presentation suggests lumbar radiculopathy without red flags. Conservative
management with NSAIDs and physical therapy is appropriate for 4-6 weeks before considering
imaging, as most cases improve with conservative care.
Question 10: A 45-year-old female presents with irregular menses, hot flashes, mood swings, and
sleep disturbances. FSH is 35 mIU/mL (normal <20). What is the most appropriate initial
management for symptom relief?
A. Combined oral contraceptives
B. Estrogen-only hormone therapy
C. SSRI antidepressant
D. Gabapentin for hot flashes
Correct Answer: A
Rationale: This patient is in perimenopause with elevated FSH. Combined oral contraceptives
effectively regulate cycles, reduce hot flashes, and provide contraception during the transition to
menopause while symptoms are managed.
Question 11: A 60-year-old patient with hypertension presents for follow-up. BP is 148/92 mmHg on
lisinopril 10 mg daily. Potassium is 4.2 mEq/L, creatinine is 1.0 mg/dL. What is the most appropriate
next step?
A. Increase lisinopril to 20 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add amlodipine 5 mg daily
D. Switch to losartan 100 mg daily
Correct Answer: B
Rationale: Current guidelines recommend combination therapy when BP is >20/10 mmHg above
target. Adding a thiazide diuretic to an ACE inhibitor provides synergistic BP reduction and is
well-tolerated with preserved kidney function.
