NSG554 Exam 3 – Nurse Practitioners in
Primary Care I Assessment| Wilkes
Content
Cardiovascular disorders
Hypertension management, lipid disorders, heart failure, atrial fibrillation.
Respiratory conditions
Asthma, COPD, pneumonia, tuberculosis screening.
Endocrine disorders
Diabetes mellitus, thyroid disease, metabolic syndrome.
Women’s health
Contraception, prenatal care, menopause, cervical cancer screening.
Men’s health
Prostate screening, erectile dysfunction, testosterone deficiency.
Gastrointestinal issues
GERD, peptic ulcer disease, IBS, hepatitis.
Musculoskeletal problems
Osteoarthritis, osteoporosis, gout, back pain.
Mental health
Depression, anxiety, substance use disorders.
Question 1
A 52-year-old patient presents with blood pressure readings averaging 150/95
mmHg over the past month. Which initial intervention should the nurse practitioner
prioritize?
A. Begin antihypertensive medication immediately
B. Recommend lifestyle modifications including diet and exercise
C. Schedule a cardiology referral
D. Order a chest X-ray
Rationale: Lifestyle modifications are the first-line intervention for stage 1
hypertension unless the patient has compelling indications for medication.
Question 2
A 45-year-old overweight patient with a family history of type 2 diabetes asks
about screening. Which test is most appropriate?
A. Random blood glucose
B. Hemoglobin A1c
C. Urinalysis
D. Oral glucose tolerance test
Rationale: Hemoglobin A1c is a standard screening tool for diabetes and provides a
long-term view of glucose control.
Question 3
,A patient with mild intermittent asthma reports symptoms twice per week. What is
the recommended treatment?
A. Daily inhaled corticosteroid
B. Short-acting beta-agonist inhaler as needed
C. Leukotriene receptor antagonist daily
D. Oral prednisone taper
Rationale: Mild intermittent asthma is managed with a short-acting beta-agonist
inhaler used only when symptoms occur.
Question 4
Which preventive screening is recommended for a 55-year-old woman with no
significant medical history?
A. Colonoscopy
B. Pap smear
C. Chest CT
D. Bone density scan
Rationale: Colonoscopy is recommended starting at age 50 for average-risk adults.
Question 5
A 60-year-old patient with no history of cardiovascular disease has an LDL
cholesterol of 190 mg/dL. What is the most appropriate management?
A. Lifestyle modification only
B. Initiate high-intensity statin therapy
C. Refer to cardiology
D. Repeat lipid panel in 6 months
Rationale: An LDL ≥190 mg/dL warrants immediate initiation of high-intensity
statin therapy regardless of other risk factors.
Question 6
A patient presents with fatigue, weight gain, and cold intolerance. Lab results show
TSH 8.5 mIU/L and free T4 is low. What is the best treatment?
A. Radioactive iodine therapy
B. Levothyroxine replacement
C. Beta-blocker therapy
D. Observation only
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism, treated
with levothyroxine.
Question 7
A 68-year-old patient with COPD reports daily symptoms and two exacerbations in
the past year. What is the recommended next step in therapy?
A. Short-acting bronchodilator only
B. Long-acting bronchodilator (LABA or LAMA)
C. Oral corticosteroids daily
D. Antibiotics prophylactically
Rationale: Patients with frequent exacerbations and persistent symptoms benefit
from long-acting bronchodilators.
, Question 8
Which vaccine is recommended for a 65-year-old patient with no prior
pneumococcal vaccination?
A. PCV20
B. HPV vaccine
C. MMR booster
D. Varicella vaccine
Rationale: Adults ≥65 should receive pneumococcal vaccination, with PCV20 being
the current recommendation.
Question 9
During a routine visit, a 40-year-old patient reports persistent sadness and loss of
interest in activities. What is the most appropriate initial screening tool?
A. PHQ-9
B. Mini-Mental State Exam
C. GAD-7
D. Beck Anxiety Inventory
Rationale: PHQ-9 is the standard screening tool for depression in primary care.
Question 10
A 35-year-old patient with BMI 32 and no comorbidities asks about treatment. What
is the first-line recommendation?
A. Bariatric surgery
B. Lifestyle modification
C. Metformin therapy
D. Appetite suppressant medication
Rationale: Lifestyle modification is the first-line treatment for obesity without
comorbidities.
Question 11
A 24-year-old woman presents with dysuria and frequency. Urinalysis shows
positive nitrites and leukocyte esterase. What is the best initial treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. IV ceftriaxone
D. No treatment needed
Rationale: Nitrofurantoin is a first-line agent for uncomplicated UTI in young
women.
Question 12
Which finding is most concerning for acute stroke in primary care?
A. Headache
B. Sudden unilateral weakness
C. Dizziness
D. Fatigue
Rationale: Sudden unilateral weakness is a hallmark sign of stroke and requires
Primary Care I Assessment| Wilkes
Content
Cardiovascular disorders
Hypertension management, lipid disorders, heart failure, atrial fibrillation.
Respiratory conditions
Asthma, COPD, pneumonia, tuberculosis screening.
Endocrine disorders
Diabetes mellitus, thyroid disease, metabolic syndrome.
Women’s health
Contraception, prenatal care, menopause, cervical cancer screening.
Men’s health
Prostate screening, erectile dysfunction, testosterone deficiency.
Gastrointestinal issues
GERD, peptic ulcer disease, IBS, hepatitis.
Musculoskeletal problems
Osteoarthritis, osteoporosis, gout, back pain.
Mental health
Depression, anxiety, substance use disorders.
Question 1
A 52-year-old patient presents with blood pressure readings averaging 150/95
mmHg over the past month. Which initial intervention should the nurse practitioner
prioritize?
A. Begin antihypertensive medication immediately
B. Recommend lifestyle modifications including diet and exercise
C. Schedule a cardiology referral
D. Order a chest X-ray
Rationale: Lifestyle modifications are the first-line intervention for stage 1
hypertension unless the patient has compelling indications for medication.
Question 2
A 45-year-old overweight patient with a family history of type 2 diabetes asks
about screening. Which test is most appropriate?
A. Random blood glucose
B. Hemoglobin A1c
C. Urinalysis
D. Oral glucose tolerance test
Rationale: Hemoglobin A1c is a standard screening tool for diabetes and provides a
long-term view of glucose control.
Question 3
,A patient with mild intermittent asthma reports symptoms twice per week. What is
the recommended treatment?
A. Daily inhaled corticosteroid
B. Short-acting beta-agonist inhaler as needed
C. Leukotriene receptor antagonist daily
D. Oral prednisone taper
Rationale: Mild intermittent asthma is managed with a short-acting beta-agonist
inhaler used only when symptoms occur.
Question 4
Which preventive screening is recommended for a 55-year-old woman with no
significant medical history?
A. Colonoscopy
B. Pap smear
C. Chest CT
D. Bone density scan
Rationale: Colonoscopy is recommended starting at age 50 for average-risk adults.
Question 5
A 60-year-old patient with no history of cardiovascular disease has an LDL
cholesterol of 190 mg/dL. What is the most appropriate management?
A. Lifestyle modification only
B. Initiate high-intensity statin therapy
C. Refer to cardiology
D. Repeat lipid panel in 6 months
Rationale: An LDL ≥190 mg/dL warrants immediate initiation of high-intensity
statin therapy regardless of other risk factors.
Question 6
A patient presents with fatigue, weight gain, and cold intolerance. Lab results show
TSH 8.5 mIU/L and free T4 is low. What is the best treatment?
A. Radioactive iodine therapy
B. Levothyroxine replacement
C. Beta-blocker therapy
D. Observation only
Rationale: Elevated TSH with low free T4 indicates primary hypothyroidism, treated
with levothyroxine.
Question 7
A 68-year-old patient with COPD reports daily symptoms and two exacerbations in
the past year. What is the recommended next step in therapy?
A. Short-acting bronchodilator only
B. Long-acting bronchodilator (LABA or LAMA)
C. Oral corticosteroids daily
D. Antibiotics prophylactically
Rationale: Patients with frequent exacerbations and persistent symptoms benefit
from long-acting bronchodilators.
, Question 8
Which vaccine is recommended for a 65-year-old patient with no prior
pneumococcal vaccination?
A. PCV20
B. HPV vaccine
C. MMR booster
D. Varicella vaccine
Rationale: Adults ≥65 should receive pneumococcal vaccination, with PCV20 being
the current recommendation.
Question 9
During a routine visit, a 40-year-old patient reports persistent sadness and loss of
interest in activities. What is the most appropriate initial screening tool?
A. PHQ-9
B. Mini-Mental State Exam
C. GAD-7
D. Beck Anxiety Inventory
Rationale: PHQ-9 is the standard screening tool for depression in primary care.
Question 10
A 35-year-old patient with BMI 32 and no comorbidities asks about treatment. What
is the first-line recommendation?
A. Bariatric surgery
B. Lifestyle modification
C. Metformin therapy
D. Appetite suppressant medication
Rationale: Lifestyle modification is the first-line treatment for obesity without
comorbidities.
Question 11
A 24-year-old woman presents with dysuria and frequency. Urinalysis shows
positive nitrites and leukocyte esterase. What is the best initial treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. IV ceftriaxone
D. No treatment needed
Rationale: Nitrofurantoin is a first-line agent for uncomplicated UTI in young
women.
Question 12
Which finding is most concerning for acute stroke in primary care?
A. Headache
B. Sudden unilateral weakness
C. Dizziness
D. Fatigue
Rationale: Sudden unilateral weakness is a hallmark sign of stroke and requires
