UNMC PPC 1 FINAL EXAM (2026/2027) | QUESTIONS AND VERIFIED ANSWERS |
GRADED A+ | APPROVED PASS
University of Nebraska Medical Center (UNMC) PPC 1: Primary Care 1 Comprehensive Final
Examination | Core Domains: Advanced Health Assessment & Diagnostic Reasoning, Management of
Common Acute & Chronic Conditions in Primary Care, Pharmacotherapeutics & Prescriptive Practice,
Health Promotion & Disease Prevention Across the Lifespan, Professional Role & Ethical Practice,
Interprofessional Collaboration, Evidence-Based Practice & Clinical Guidelines, and Patient Education
& Self-Management Support | Nurse Practitioner Program Focus | Comprehensive Course Final Exam
Format
Exam Structure
The UNMC PPC 1 Final Exam for the 2026/2027 academic cycle is a 120-question, multiple-choice
question (MCQ) examination.
Introduction
This UNMC PPC 1 Final Exam guide for the 2026/2027 cycle prepares nurse practitioner students for the
summative assessment of foundational primary care knowledge and skills. The content integrates
advanced assessment techniques, pathophysiology, and evidence-based management of conditions
commonly encountered in the primary care setting, emphasizing clinical judgment, patient-centered care,
and preparation for the NP role.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green, followed
by detailed rationales that apply evidence-based clinical guidelines (e.g., USPSTF, AAFP), justify
diagnostic and therapeutic decisions, incorporate patient-specific factors (age, comorbidities), and
demonstrate the integration of health promotion and chronic disease management principles.
Questions (120 Total)
1. A 58-year-old male with hypertension and type 2 diabetes presents for an annual wellness visit. His
blood pressure is 148/92 mm Hg. According to the 2023 ACC/AHA guidelines, what is the most
appropriate next step?
A. Continue current regimen and recheck in 6 months
B. Add a thiazide diuretic
C. Initiate or intensify antihypertensive therapy to achieve BP <130/80 mm Hg
D. Refer to cardiology immediately
Rationale: Per ACC/AHA 2023 guidelines, patients with diabetes and hypertension should have a
target BP <130/80 mm Hg due to increased cardiovascular risk. This patient’s BP is above goal, so
therapy should be initiated or intensified (e.g., ACE inhibitor + CCB or thiazide). Lifestyle modifications
alone are insufficient at this level. Referral is not indicated without end-organ damage or resistant
hypertension.
,2. A 65-year-old female asks about colorectal cancer screening. She has no family history and is
asymptomatic. According to USPSTF 2023 recommendations, which option is appropriate?
A. No screening needed after age 60
B. Annual fecal occult blood test only
C. Colonoscopy every 10 years OR FIT annually
D. CT colonography every 2 years
Rationale: USPSTF (2023) recommends colorectal cancer screening from ages 45–75 using one of
several evidence-based options: colonoscopy every 10 years, annual high-sensitivity fecal
immunochemical test (FIT), or stool DNA test (e.g., Cologuard) every 3 years. CT colonography every 5
years is also acceptable, but not every 2 years. Shared decision-making is key.
3. A 42-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is 12.5 mIU/L
(normal 0.4–4.0), and free T4 is low. What is the most appropriate treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 1.6 mcg/kg/day based on ideal body weight
C. Liothyronine (T3) monotherapy
D. Observation and repeat labs in 3 months
Rationale: This patient has primary hypothyroidism. Standard initial dose of levothyroxine is 1.6
mcg/kg/day of ideal body weight (not actual weight if obese). For a 70 kg woman, this is ~112 mcg/day.
Starting low (e.g., 25–50 mcg) is reserved for elderly or cardiac patients. T3 monotherapy is not
recommended. Treatment should begin promptly; delay risks worsening symptoms.
4. A 30-year-old male presents with acute onset of severe right flank pain radiating to the groin, nausea,
and hematuria. What is the most likely diagnosis?
A. Appendicitis
B. Pyelonephritis
C. Nephrolithiasis (kidney stone)
D. Testicular torsion
Rationale: Classic presentation of nephrolithiasis includes colicky flank pain radiating to groin,
hematuria, and nausea. Non-contrast CT is diagnostic. Appendicitis causes RLQ pain; pyelonephritis
presents with fever and CVA tenderness; testicular torsion causes acute scrotal pain. Pain management
(NSAIDs first-line) and hydration are initial steps.
5. According to CDC and AAFP guidelines, which vaccine should be administered annually to all adults?
,A. Pneumococcal conjugate vaccine (PCV20)
B. Influenza vaccine
C. Hepatitis B vaccine
D. MMR vaccine
Rationale: The influenza vaccine is recommended annually for all individuals aged 6 months and
older by CDC and AAFP. PCV20 is given once in adults ≥65 or with risk factors. Hepatitis B is now
recommended for all adults up to age 60 (and older with risk), but not annually. MMR is given as a
one-time adult dose if not immune.
6. A 72-year-old man with heart failure (HFrEF, ejection fraction 30%) is on lisinopril and carvedilol.
Which medication should be added to reduce mortality?
A. Furosemide
B. Digoxin
C. Sacubitril/valsartan (Entresto)
D. Spironolactone
Rationale: Per 2022 AHA/ACC/HFSA guidelines, sacubitril/valsartan is recommended to replace ACE
inhibitors in HFrEF patients with NYHA Class II–III symptoms to reduce mortality and hospitalization.
Spironolactone is also indicated (if eGFR >30 and K+ <5.0), but Entresto provides greater benefit and is
prioritized in the “four pillars” of HFrEF therapy. Furosemide treats volume overload but doesn’t reduce
mortality.
7. A 28-year-old pregnant woman at 28 weeks gestation has a blood pressure of 150/94 mm Hg and 1+
proteinuria on dipstick. What is the most likely diagnosis?
A. Gestational hypertension
B. Preeclampsia
C. Chronic hypertension
D. Eclampsia
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90) after 20 weeks with
proteinuria (≥1+ on dipstick or PCR ≥0.3). Eclampsia includes seizures. Gestational hypertension lacks
proteinuria. Chronic hypertension precedes pregnancy or occurs before 20 weeks. Immediate referral to
OB/GYN is required; delivery is definitive treatment.
8. Which statement best reflects the principle of interprofessional collaboration in primary care?
A. The NP makes all clinical decisions independently
, B. Team members communicate regularly to coordinate patient care based on shared goals
C. Only physicians lead care planning
D. Pharmacists should not discuss medication changes with NPs
Rationale: Interprofessional collaboration involves shared decision-making, clear communication,
and role clarity among providers (NP, MD, pharmacist, social worker, etc.) to improve outcomes. The
IPEC competencies emphasize values/ethics, roles/responsibilities, communication, and teamwork. NPs
function autonomously but collaboratively within team-based care models like PCMH.
9. A 50-year-old male with no cardiac history presents with sudden-onset chest pain radiating to the left
arm and diaphoresis. What is the first diagnostic test?
A. Chest X-ray
B. D-dimer
C. 12-lead ECG within 10 minutes of arrival
D. Troponin I
Rationale: Per AHA/ACC guidelines, any patient with suspected acute coronary syndrome (ACS)
requires a 12-lead ECG within 10 minutes of arrival to assess for STEMI. Troponin is important but
takes time to rise; ECG guides immediate reperfusion decisions. D-dimer is for PE; CXR rules out other
causes but is not first-line for ACS.
10. A patient with type 2 diabetes has an HbA1c of 9.2%. He is on metformin 1000 mg BID. What is the
next best step per ADA 2026 standards?
A. Add insulin glargine
B. Add a GLP-1 receptor agonist (e.g., semaglutide)
C. Switch to sulfonylurea
D. Increase metformin to maximum dose
Rationale: ADA 2026 guidelines recommend adding a GLP-1 RA (e.g., semaglutide) as second-line
therapy for patients with ASCVD, CKD, or obesity—common in T2DM—even if HbA1c is not at goal.
GLP-1 RAs provide glycemic control, weight loss, and cardiovascular/kidney protection. Insulin is
reserved for severe hyperglycemia (HbA1c >10%) or symptoms. Metformin is already at max dose
(2000 mg/day).
11. According to USPSTF, at what age should bone mineral density screening begin for women?
A. Age 50
B. Age 65
GRADED A+ | APPROVED PASS
University of Nebraska Medical Center (UNMC) PPC 1: Primary Care 1 Comprehensive Final
Examination | Core Domains: Advanced Health Assessment & Diagnostic Reasoning, Management of
Common Acute & Chronic Conditions in Primary Care, Pharmacotherapeutics & Prescriptive Practice,
Health Promotion & Disease Prevention Across the Lifespan, Professional Role & Ethical Practice,
Interprofessional Collaboration, Evidence-Based Practice & Clinical Guidelines, and Patient Education
& Self-Management Support | Nurse Practitioner Program Focus | Comprehensive Course Final Exam
Format
Exam Structure
The UNMC PPC 1 Final Exam for the 2026/2027 academic cycle is a 120-question, multiple-choice
question (MCQ) examination.
Introduction
This UNMC PPC 1 Final Exam guide for the 2026/2027 cycle prepares nurse practitioner students for the
summative assessment of foundational primary care knowledge and skills. The content integrates
advanced assessment techniques, pathophysiology, and evidence-based management of conditions
commonly encountered in the primary care setting, emphasizing clinical judgment, patient-centered care,
and preparation for the NP role.
Answer Format
All correct answers and clinical management strategies must be presented in bold and green, followed
by detailed rationales that apply evidence-based clinical guidelines (e.g., USPSTF, AAFP), justify
diagnostic and therapeutic decisions, incorporate patient-specific factors (age, comorbidities), and
demonstrate the integration of health promotion and chronic disease management principles.
Questions (120 Total)
1. A 58-year-old male with hypertension and type 2 diabetes presents for an annual wellness visit. His
blood pressure is 148/92 mm Hg. According to the 2023 ACC/AHA guidelines, what is the most
appropriate next step?
A. Continue current regimen and recheck in 6 months
B. Add a thiazide diuretic
C. Initiate or intensify antihypertensive therapy to achieve BP <130/80 mm Hg
D. Refer to cardiology immediately
Rationale: Per ACC/AHA 2023 guidelines, patients with diabetes and hypertension should have a
target BP <130/80 mm Hg due to increased cardiovascular risk. This patient’s BP is above goal, so
therapy should be initiated or intensified (e.g., ACE inhibitor + CCB or thiazide). Lifestyle modifications
alone are insufficient at this level. Referral is not indicated without end-organ damage or resistant
hypertension.
,2. A 65-year-old female asks about colorectal cancer screening. She has no family history and is
asymptomatic. According to USPSTF 2023 recommendations, which option is appropriate?
A. No screening needed after age 60
B. Annual fecal occult blood test only
C. Colonoscopy every 10 years OR FIT annually
D. CT colonography every 2 years
Rationale: USPSTF (2023) recommends colorectal cancer screening from ages 45–75 using one of
several evidence-based options: colonoscopy every 10 years, annual high-sensitivity fecal
immunochemical test (FIT), or stool DNA test (e.g., Cologuard) every 3 years. CT colonography every 5
years is also acceptable, but not every 2 years. Shared decision-making is key.
3. A 42-year-old woman presents with fatigue, weight gain, and cold intolerance. TSH is 12.5 mIU/L
(normal 0.4–4.0), and free T4 is low. What is the most appropriate treatment?
A. Levothyroxine 25 mcg daily
B. Levothyroxine 1.6 mcg/kg/day based on ideal body weight
C. Liothyronine (T3) monotherapy
D. Observation and repeat labs in 3 months
Rationale: This patient has primary hypothyroidism. Standard initial dose of levothyroxine is 1.6
mcg/kg/day of ideal body weight (not actual weight if obese). For a 70 kg woman, this is ~112 mcg/day.
Starting low (e.g., 25–50 mcg) is reserved for elderly or cardiac patients. T3 monotherapy is not
recommended. Treatment should begin promptly; delay risks worsening symptoms.
4. A 30-year-old male presents with acute onset of severe right flank pain radiating to the groin, nausea,
and hematuria. What is the most likely diagnosis?
A. Appendicitis
B. Pyelonephritis
C. Nephrolithiasis (kidney stone)
D. Testicular torsion
Rationale: Classic presentation of nephrolithiasis includes colicky flank pain radiating to groin,
hematuria, and nausea. Non-contrast CT is diagnostic. Appendicitis causes RLQ pain; pyelonephritis
presents with fever and CVA tenderness; testicular torsion causes acute scrotal pain. Pain management
(NSAIDs first-line) and hydration are initial steps.
5. According to CDC and AAFP guidelines, which vaccine should be administered annually to all adults?
,A. Pneumococcal conjugate vaccine (PCV20)
B. Influenza vaccine
C. Hepatitis B vaccine
D. MMR vaccine
Rationale: The influenza vaccine is recommended annually for all individuals aged 6 months and
older by CDC and AAFP. PCV20 is given once in adults ≥65 or with risk factors. Hepatitis B is now
recommended for all adults up to age 60 (and older with risk), but not annually. MMR is given as a
one-time adult dose if not immune.
6. A 72-year-old man with heart failure (HFrEF, ejection fraction 30%) is on lisinopril and carvedilol.
Which medication should be added to reduce mortality?
A. Furosemide
B. Digoxin
C. Sacubitril/valsartan (Entresto)
D. Spironolactone
Rationale: Per 2022 AHA/ACC/HFSA guidelines, sacubitril/valsartan is recommended to replace ACE
inhibitors in HFrEF patients with NYHA Class II–III symptoms to reduce mortality and hospitalization.
Spironolactone is also indicated (if eGFR >30 and K+ <5.0), but Entresto provides greater benefit and is
prioritized in the “four pillars” of HFrEF therapy. Furosemide treats volume overload but doesn’t reduce
mortality.
7. A 28-year-old pregnant woman at 28 weeks gestation has a blood pressure of 150/94 mm Hg and 1+
proteinuria on dipstick. What is the most likely diagnosis?
A. Gestational hypertension
B. Preeclampsia
C. Chronic hypertension
D. Eclampsia
Rationale: Preeclampsia is defined as new-onset hypertension (≥140/90) after 20 weeks with
proteinuria (≥1+ on dipstick or PCR ≥0.3). Eclampsia includes seizures. Gestational hypertension lacks
proteinuria. Chronic hypertension precedes pregnancy or occurs before 20 weeks. Immediate referral to
OB/GYN is required; delivery is definitive treatment.
8. Which statement best reflects the principle of interprofessional collaboration in primary care?
A. The NP makes all clinical decisions independently
, B. Team members communicate regularly to coordinate patient care based on shared goals
C. Only physicians lead care planning
D. Pharmacists should not discuss medication changes with NPs
Rationale: Interprofessional collaboration involves shared decision-making, clear communication,
and role clarity among providers (NP, MD, pharmacist, social worker, etc.) to improve outcomes. The
IPEC competencies emphasize values/ethics, roles/responsibilities, communication, and teamwork. NPs
function autonomously but collaboratively within team-based care models like PCMH.
9. A 50-year-old male with no cardiac history presents with sudden-onset chest pain radiating to the left
arm and diaphoresis. What is the first diagnostic test?
A. Chest X-ray
B. D-dimer
C. 12-lead ECG within 10 minutes of arrival
D. Troponin I
Rationale: Per AHA/ACC guidelines, any patient with suspected acute coronary syndrome (ACS)
requires a 12-lead ECG within 10 minutes of arrival to assess for STEMI. Troponin is important but
takes time to rise; ECG guides immediate reperfusion decisions. D-dimer is for PE; CXR rules out other
causes but is not first-line for ACS.
10. A patient with type 2 diabetes has an HbA1c of 9.2%. He is on metformin 1000 mg BID. What is the
next best step per ADA 2026 standards?
A. Add insulin glargine
B. Add a GLP-1 receptor agonist (e.g., semaglutide)
C. Switch to sulfonylurea
D. Increase metformin to maximum dose
Rationale: ADA 2026 guidelines recommend adding a GLP-1 RA (e.g., semaglutide) as second-line
therapy for patients with ASCVD, CKD, or obesity—common in T2DM—even if HbA1c is not at goal.
GLP-1 RAs provide glycemic control, weight loss, and cardiovascular/kidney protection. Insulin is
reserved for severe hyperglycemia (HbA1c >10%) or symptoms. Metformin is already at max dose
(2000 mg/day).
11. According to USPSTF, at what age should bone mineral density screening begin for women?
A. Age 50
B. Age 65
