EXAM SIMULATION: ADVANCED
PRIMARY CARE NURSING (6TH
EDITION)
COMPREHENSIVE TEST BANK:
PRIMARY CARE
The Art and Science of Advanced Practice
Nursing – An Interprofessional Approach
(6th Edition)
Based on the authoritative text by: Lynne M. Dunphy, Jill E. Winland-Brown, Brian O.
Porter, and Deborah Holtzclaw
Featuring Integrated Updates from 2024-2025 Clinical Practice Guidelines:
● American Diabetes Association (ADA) Standards of Care 2025
● Global Initiative for Asthma (GINA) 2025
● Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025
● ACC/AHA Hypertension and Lipid Guidelines 2024
● American College of Gastroenterology (ACG) Guidelines 2024
● CDC STI Treatment Guidelines and US MEC 2024
● American Academy of Dermatology (AAD) Acne Guidelines 2024
Unit I: Caring-Based Nursing – The Art
Question 1: Theoretical Frameworks in Advanced Practice
Clinical Vignette: A 45-year-old female presents to the primary care clinic reporting vague
symptoms of fatigue, "brain fog," and general dissatisfaction with her current health status
despite normal laboratory results from a previous provider. She states, "I just don't feel like
myself, and nobody seems to listen." The Advanced Practice Nurse (APRN) utilizes the "Circle
of Caring" model described by Dunphy et al. to approach this encounter. Which of the following
provider behaviors best exemplifies the core "Caring" component of this specific framework?
A. Ordering an expansive autoimmune panel and MRI to definitively rule out organic pathology
before addressing the subjective complaints. B. Utilizing active listening to validate the patient’s
lived experience and co-creating a health promotion plan that integrates her values with
evidence-based interventions. C. Prescribing a low-dose selective serotonin reuptake inhibitor
,(SSRI) to manage the somatic manifestations of depression while waiting for test results. D.
Referring the patient to a functional medicine specialist who focuses on fatigue syndromes to
ensure specialized care.
Correct Answer: B
Pathophysiologic and Theoretical Foundation: The foundational philosophy of Primary Care:
The Art and Science of Advanced Practice Nursing is the "Circle of Caring" model. This
framework challenges the purely biomedical reductionist model, positing instead that the central
function of the APRN is the holistic engagement with the patient's lived experience. In the
context of "The Art" (Unit I), caring is defined not merely as a feeling but as a dynamic, mutual
process where the provider bears witness to the patient's reality. The pathophysiology of
"dis-ease" often transcends cellular dysfunction; in this case, the patient's distress is rooted in a
disconnect between her subjective experience and the objective medical data. By utilizing active
listening and co-creating a plan, the APRN validates the patient's autonomy, reducing
cortisol-driven stress responses associated with feeling "unheard," and facilitates a therapeutic
alliance that is, in itself, an intervention.
Distractor Analysis:
● Option A represents a defensive, biomedical approach. While thoroughness is part of the
"Science," prioritizing expensive diagnostics over the patient's narrative violates the
"Circle of Caring" by treating the patient as a puzzle to be solved rather than a person to
be understood. This approach often leads to "medicalization" of normal life stressors.
● Option C constitutes premature pharmacologic intervention. Prescribing psychotropic
medication without a clear diagnosis or therapeutic alliance bypasses the assessment of
the patient's readiness for change and ignores the potential for non-pharmacologic health
promotion strategies emphasized in Chapter 3.
● Option D may be perceived as "dumping" the patient. The primary care provider's role is
to manage undifferentiated problems; immediate referral suggests the patient's concerns
are outside the scope of caring, potentially deepening her feeling of alienation.
Clinical Insight: Effective primary care in the 21st century requires shifting from a paternalistic
model to a partnership model. The "Circle of Caring" encourages the APRN to view the patient
not as a collection of symptoms but as a whole person interacting with their environment.
Question 2: Health Promotion and Lung Cancer Screening
Clinical Vignette: A 53-year-old male presents for an annual wellness exam. He requests
information about "checking his lungs" because his father recently died of lung cancer. He
reports a 25 pack-year smoking history and currently smokes half a pack per day. He has no
symptoms of cough or weight loss. Based on the Health Promotion chapters of the 6th edition
and the most current USPSTF recommendations, what is the appropriate clinical action?
A. Inform the patient that he does not meet the criteria for screening as he has not smoked for
30 pack-years. B. Order a chest x-ray (CXR) as a baseline screening tool given his family
history. C. Initiate annual screening with Low-Dose Computed Tomography (LDCT) and engage
in shared decision-making regarding smoking cessation. D. Advise the patient that screening is
only indicated if he quits smoking first, to prevent false positives from inflammation.
Correct Answer: C
Pathophysiologic and Theoretical Foundation: Lung cancer remains the leading cause of
cancer death, and early detection is critical for survival. The pathophysiology of cigarette
smoke-induced carcinogenesis involves chronic inflammation and DNA mutation in bronchial
epithelial cells. The 6th Edition of Dunphy emphasizes Evidence-Based Practice (Chapter 5),
, necessitating adherence to updated guidelines. The United States Preventive Services Task
Force (USPSTF) updated its recommendation in 2021 (superseding older 30 pack-year
guidelines). The current Class B recommendation advises annual screening with LDCT for
adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or
have quit within the past 15 years. This patient (53 years old, 25 pack-years, current smoker)
squarely meets the criteria.
Distractor Analysis:
● Option A relies on outdated guidelines (the previous threshold was 30 pack-years).
Advanced practice requires currency with evolving evidence; failing to screen this
high-risk patient would be a deviation from the standard of care.
● Option B is clinically inappropriate. Chest x-rays have low sensitivity for early-stage lung
nodules and high rates of false negatives. The National Lung Screening Trial (NLST)
demonstrated that only LDCT significantly reduces lung cancer mortality compared to
CXR.
● Option D is incorrect; screening is most crucial for current smokers, and the guidelines
specifically couple screening with smoking cessation counseling. Requiring cessation as a
prerequisite creates a barrier to care and misses the opportunity to detect cancer in its
treatable stages.
Clinical Insight: Shared decision-making is a required component of the lung cancer screening
reimbursement (CMS). The APRN must discuss the "false positives" (nodules requiring
follow-up) versus the mortality benefit.
Unit II: Caring-Based Nursing – The Science
Section 1: Neurological Problems
Question 3: Headache Differential Diagnosis (SNOOP4 Criteria)
Clinical Vignette: A 56-year-old female presents with a chief complaint of a "new, persistent
headache" that began 3 weeks ago. She describes the pain as a dull, occipital ache that is
present upon waking and worsens when she bends over to tie her shoes or coughs. She has no
prior history of migraines. Her neurological exam is non-focal, but fundoscopic exam reveals
blurring of the optic disc margins. Which component of the SNOOP4 mnemonic is most
concerning, and what is the immediate management?
A. Systemic symptoms; check for Giant Cell Arteritis using ESR/CRP. B. Neurologic symptoms;
initiate triptan therapy for migraine. C. Precipitated by Valsalva/Positional change; refer for
immediate neuroimaging (MRI) to rule out mass/ICP. D. Onset; treat as tension-type headache
due to the "dull" quality.
Correct Answer: C
Pathophysiologic and Theoretical Foundation: The "Science" of neurological diagnosis relies
heavily on pattern recognition to distinguish benign primary headaches (migraine, tension) from
life-threatening secondary headaches. The SNOOP4 mnemonic is the gold standard
assessment tool.
● S: Systemic symptoms/illness (fever, weight loss, cancer).
● N: Neurologic signs/symptoms.
● O: Onset (sudden/thunderclap).
● O: Older age of onset (>50 years).
PRIMARY CARE NURSING (6TH
EDITION)
COMPREHENSIVE TEST BANK:
PRIMARY CARE
The Art and Science of Advanced Practice
Nursing – An Interprofessional Approach
(6th Edition)
Based on the authoritative text by: Lynne M. Dunphy, Jill E. Winland-Brown, Brian O.
Porter, and Deborah Holtzclaw
Featuring Integrated Updates from 2024-2025 Clinical Practice Guidelines:
● American Diabetes Association (ADA) Standards of Care 2025
● Global Initiative for Asthma (GINA) 2025
● Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2025
● ACC/AHA Hypertension and Lipid Guidelines 2024
● American College of Gastroenterology (ACG) Guidelines 2024
● CDC STI Treatment Guidelines and US MEC 2024
● American Academy of Dermatology (AAD) Acne Guidelines 2024
Unit I: Caring-Based Nursing – The Art
Question 1: Theoretical Frameworks in Advanced Practice
Clinical Vignette: A 45-year-old female presents to the primary care clinic reporting vague
symptoms of fatigue, "brain fog," and general dissatisfaction with her current health status
despite normal laboratory results from a previous provider. She states, "I just don't feel like
myself, and nobody seems to listen." The Advanced Practice Nurse (APRN) utilizes the "Circle
of Caring" model described by Dunphy et al. to approach this encounter. Which of the following
provider behaviors best exemplifies the core "Caring" component of this specific framework?
A. Ordering an expansive autoimmune panel and MRI to definitively rule out organic pathology
before addressing the subjective complaints. B. Utilizing active listening to validate the patient’s
lived experience and co-creating a health promotion plan that integrates her values with
evidence-based interventions. C. Prescribing a low-dose selective serotonin reuptake inhibitor
,(SSRI) to manage the somatic manifestations of depression while waiting for test results. D.
Referring the patient to a functional medicine specialist who focuses on fatigue syndromes to
ensure specialized care.
Correct Answer: B
Pathophysiologic and Theoretical Foundation: The foundational philosophy of Primary Care:
The Art and Science of Advanced Practice Nursing is the "Circle of Caring" model. This
framework challenges the purely biomedical reductionist model, positing instead that the central
function of the APRN is the holistic engagement with the patient's lived experience. In the
context of "The Art" (Unit I), caring is defined not merely as a feeling but as a dynamic, mutual
process where the provider bears witness to the patient's reality. The pathophysiology of
"dis-ease" often transcends cellular dysfunction; in this case, the patient's distress is rooted in a
disconnect between her subjective experience and the objective medical data. By utilizing active
listening and co-creating a plan, the APRN validates the patient's autonomy, reducing
cortisol-driven stress responses associated with feeling "unheard," and facilitates a therapeutic
alliance that is, in itself, an intervention.
Distractor Analysis:
● Option A represents a defensive, biomedical approach. While thoroughness is part of the
"Science," prioritizing expensive diagnostics over the patient's narrative violates the
"Circle of Caring" by treating the patient as a puzzle to be solved rather than a person to
be understood. This approach often leads to "medicalization" of normal life stressors.
● Option C constitutes premature pharmacologic intervention. Prescribing psychotropic
medication without a clear diagnosis or therapeutic alliance bypasses the assessment of
the patient's readiness for change and ignores the potential for non-pharmacologic health
promotion strategies emphasized in Chapter 3.
● Option D may be perceived as "dumping" the patient. The primary care provider's role is
to manage undifferentiated problems; immediate referral suggests the patient's concerns
are outside the scope of caring, potentially deepening her feeling of alienation.
Clinical Insight: Effective primary care in the 21st century requires shifting from a paternalistic
model to a partnership model. The "Circle of Caring" encourages the APRN to view the patient
not as a collection of symptoms but as a whole person interacting with their environment.
Question 2: Health Promotion and Lung Cancer Screening
Clinical Vignette: A 53-year-old male presents for an annual wellness exam. He requests
information about "checking his lungs" because his father recently died of lung cancer. He
reports a 25 pack-year smoking history and currently smokes half a pack per day. He has no
symptoms of cough or weight loss. Based on the Health Promotion chapters of the 6th edition
and the most current USPSTF recommendations, what is the appropriate clinical action?
A. Inform the patient that he does not meet the criteria for screening as he has not smoked for
30 pack-years. B. Order a chest x-ray (CXR) as a baseline screening tool given his family
history. C. Initiate annual screening with Low-Dose Computed Tomography (LDCT) and engage
in shared decision-making regarding smoking cessation. D. Advise the patient that screening is
only indicated if he quits smoking first, to prevent false positives from inflammation.
Correct Answer: C
Pathophysiologic and Theoretical Foundation: Lung cancer remains the leading cause of
cancer death, and early detection is critical for survival. The pathophysiology of cigarette
smoke-induced carcinogenesis involves chronic inflammation and DNA mutation in bronchial
epithelial cells. The 6th Edition of Dunphy emphasizes Evidence-Based Practice (Chapter 5),
, necessitating adherence to updated guidelines. The United States Preventive Services Task
Force (USPSTF) updated its recommendation in 2021 (superseding older 30 pack-year
guidelines). The current Class B recommendation advises annual screening with LDCT for
adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or
have quit within the past 15 years. This patient (53 years old, 25 pack-years, current smoker)
squarely meets the criteria.
Distractor Analysis:
● Option A relies on outdated guidelines (the previous threshold was 30 pack-years).
Advanced practice requires currency with evolving evidence; failing to screen this
high-risk patient would be a deviation from the standard of care.
● Option B is clinically inappropriate. Chest x-rays have low sensitivity for early-stage lung
nodules and high rates of false negatives. The National Lung Screening Trial (NLST)
demonstrated that only LDCT significantly reduces lung cancer mortality compared to
CXR.
● Option D is incorrect; screening is most crucial for current smokers, and the guidelines
specifically couple screening with smoking cessation counseling. Requiring cessation as a
prerequisite creates a barrier to care and misses the opportunity to detect cancer in its
treatable stages.
Clinical Insight: Shared decision-making is a required component of the lung cancer screening
reimbursement (CMS). The APRN must discuss the "false positives" (nodules requiring
follow-up) versus the mortality benefit.
Unit II: Caring-Based Nursing – The Science
Section 1: Neurological Problems
Question 3: Headache Differential Diagnosis (SNOOP4 Criteria)
Clinical Vignette: A 56-year-old female presents with a chief complaint of a "new, persistent
headache" that began 3 weeks ago. She describes the pain as a dull, occipital ache that is
present upon waking and worsens when she bends over to tie her shoes or coughs. She has no
prior history of migraines. Her neurological exam is non-focal, but fundoscopic exam reveals
blurring of the optic disc margins. Which component of the SNOOP4 mnemonic is most
concerning, and what is the immediate management?
A. Systemic symptoms; check for Giant Cell Arteritis using ESR/CRP. B. Neurologic symptoms;
initiate triptan therapy for migraine. C. Precipitated by Valsalva/Positional change; refer for
immediate neuroimaging (MRI) to rule out mass/ICP. D. Onset; treat as tension-type headache
due to the "dull" quality.
Correct Answer: C
Pathophysiologic and Theoretical Foundation: The "Science" of neurological diagnosis relies
heavily on pattern recognition to distinguish benign primary headaches (migraine, tension) from
life-threatening secondary headaches. The SNOOP4 mnemonic is the gold standard
assessment tool.
● S: Systemic symptoms/illness (fever, weight loss, cancer).
● N: Neurologic signs/symptoms.
● O: Onset (sudden/thunderclap).
● O: Older age of onset (>50 years).
