NRNP 6568 Week 5 Comprehensive Practice Questions and Answers 2026 (100% Correct).

NRNP 6568 Week 5 Comprehensive
Practice Questions and Answers 2026
(100% Correct).




NRNP 6568: ADVANCED PRACTICE NURSING
Week 5 Comprehensive Practice Exam
Questions 1-25


Question 1:
A 28-year-old female presents to the clinic with complaints of fatigue, weight
gain, constipation, and feeling cold all the time. She reports that her skin has
become dry and her hair is thinning. Vital signs are BP 110/70, HR 58, RR 12,
temperature 36.2°C. Physical exam reveals dry skin, thinning hair, and delayed
relaxation phase of deep tendon reflexes. Which of the following laboratory
findings is most likely?
A) Elevated TSH, decreased free T4
B) Decreased TSH, elevated free T4
C) Elevated TSH, elevated free T4
D) Decreased TSH, decreased free T4
Answer: A) Elevated TSH, decreased free T4
Detailed Clinical Explanation:
• Pathophysiology: This presentation is classic for primary hypothyroidism.
The thyroid gland fails to produce sufficient thyroid hormone (T3/T4),

, leading to loss of negative feedback on the pituitary, which increases TSH
secretion.
• Clinical Manifestations:
o Subjective: Fatigue, weight gain, constipation, cold intolerance, dry
skin, hair thinning.
o Objective: Bradycardia (HR 58), hypothermia, delayed relaxation
phase of DTRs ("hung-up" reflexes).
• Differential Diagnosis: Subclinical hypothyroidism (elevated TSH, normal
T4), secondary hypothyroidism (pituitary failure), euthyroid sick syndrome.
• Diagnostic Testing: TSH, free T4, TPO antibodies (for Hashimoto's
thyroiditis, the most common cause).
• Management: Levothyroxine replacement, starting at a low dose (25-50
mcg daily) and titrating based on TSH every 6-8 weeks. Monitor for
symptoms of overtreatment (tachycardia, anxiety, insomnia).
• Patient Education: Take on an empty stomach 30-60 minutes before
breakfast; do not stop medication; lifelong therapy required.


Question 2:
A 55-year-old male with a history of hypertension and type 2 diabetes presents
for a routine physical. He is asymptomatic. His blood pressure today is 148/92
mmHg, confirmed on repeat measurement. His most recent HbA1c was 7.2%. He
is currently taking lisinopril 10 mg daily and metformin 1000 mg twice daily.
According to current hypertension guidelines, what is the most appropriate next
step?
A) Continue current therapy and recheck in 6 months
B) Increase lisinopril to 20 mg daily and schedule follow-up in 4 weeks
C) Add a thiazide diuretic
D) Refer to cardiology for further evaluation
Answer: B) Increase lisinopril to 20 mg daily and schedule follow-up in 4 weeks
Detailed Clinical Explanation:

, • Guideline-Based Care (ACC/AHA): For patients with diabetes and
hypertension, the target BP is generally <130/80 mmHg. This patient's BP is
above target.
• Medication Management:
o Lisinopril (ACE inhibitor) is a first-line agent for patients with diabetes
due to renal protective effects.
o The current dose (10 mg) is suboptimal. The next step is to titrate the
existing medication to a therapeutic dose before adding another
agent.
• Follow-Up: Patients started on or with dose changes of antihypertensive
medication should be re-evaluated within 2-4 weeks to assess response and
side effects.
• Distractors:
o A) 6 months is too long; uncontrolled BP requires earlier follow-up.
o C) Adding a second agent is appropriate after maximizing the first,
not before.
o D) Not necessary at this stage; management is within primary care
scope.


Question 3:
A 45-year-old female presents with episodic right upper quadrant pain that occurs
30-60 minutes after meals, especially after fatty foods. The pain lasts 1-2 hours
and then resolves. She is afebrile, and her abdominal exam today is benign. Which
of the following is the most likely diagnosis?
A) Acute cholecystitis
B) Biliary colic (cholelithiasis)
C) Peptic ulcer disease
D) Acute pancreatitis
Answer: B) Biliary colic (cholelithiasis)

, Detailed Clinical Explanation:
• Pathophysiology: Gallstones (cholelithiasis) temporarily obstruct the cystic
duct, causing pain when the gallbladder contracts against the obstruction,
typically after a fatty meal. The pain resolves when the stone falls back or
the gallbladder relaxes.
• Clinical Presentation:
o Timing: 30-60 minutes postprandial.
o Duration: Self-limiting, usually <4-6 hours.
o Location: RUQ, may radiate to right shoulder or back.
o Associated Symptoms: Nausea, bloating, indigestion.
• Distractors:
o A) Acute cholecystitis: Persistent pain (>6 hours), fever, positive
Murphy's sign, leukocytosis.
o C) Peptic ulcer disease: Epigastric pain related to meals (may be
relieved or worsened), not specifically post-fatty meal.
o D) Acute pancreatitis: Severe epigastric pain radiating to back,
associated with nausea/vomiting, elevated lipase/amylase.
• Diagnostic Testing: Right upper quadrant ultrasound is the test of choice to
visualize gallstones.
• Management: Elective laparoscopic cholecystectomy for symptomatic
cholelithiasis. Dietary modification (low-fat diet) while awaiting surgery.


Question 4:
A 32-year-old female presents with several months of fatigue, joint pain, and a
facial rash that worsens with sun exposure. On examination, she has an
erythematous malar rash sparing the nasolabial folds, oral ulcers, and alopecia.
Which of the following laboratory findings is most specific for her suspected
diagnosis?