NSG554 Assessment 4– Nurse Practitioners in
Primary Care I | Wilkes
Question 1
A 52-year-old patient presents with fatigue, pallor, and glossitis. Lab results show
microcytic anemia. Which is the most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Chronic kidney disease
Rationale: Iron deficiency anemia presents with microcytosis, pallor, and glossitis.
B12 and folate deficiencies cause macrocytic anemia.
Question 2
A patient with type 2 diabetes has an HbA1c of 9.2%. Which is the best initial
management step?
A. Start insulin therapy
B. Increase exercise only
C. Add aspirin therapy
D. Continue current oral medication
Rationale: HbA1c >9% often requires insulin initiation for glycemic control. Lifestyle
changes alone are insufficient.
Question 3
A 7-year-old presents with sore throat, fever, and anterior cervical
lymphadenopathy. Rapid strep test is positive. What is the treatment of choice?
A. Azithromycin
B. Penicillin V
C. Ciprofloxacin
D. Amoxicillin-clavulanate
Rationale: Penicillin V (or amoxicillin) is first-line for group A strep pharyngitis.
Question 4
A 68-year-old smoker presents with chronic cough and sputum production for 3
months each year over the past 2 years. What is the most likely diagnosis?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Tuberculosis
Rationale: Chronic bronchitis is defined clinically by productive cough ≥3
months/year for ≥2 consecutive years.
Question 5
A patient presents with dysuria and frequency. Urinalysis shows positive nitrites
and leukocyte esterase. What is the best treatment?
,A. Nitrofurantoin
B. Ciprofloxacin
C. Metronidazole
D. Amoxicillin
Rationale: Nitrofurantoin is first-line for uncomplicated UTI in women. Ciprofloxacin
is reserved for resistant cases.
Question 6
A 45-year-old woman presents with weight gain, cold intolerance, and dry skin.
Labs show elevated TSH and low free T4. What is the diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Subclinical hyperthyroidism
D. Thyroid storm
Rationale: Elevated TSH with low free T4 confirms hypothyroidism.
Question 7
A patient with hypertension is started on lisinopril. Which lab should be monitored?
A. Hemoglobin
B. Potassium
C. Calcium
D. Platelets
Rationale: ACE inhibitors can cause hyperkalemia; potassium must be monitored.
Question 8
A 60-year-old man presents with exertional chest pain relieved by rest. What is the
most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Rationale: Predictable chest pain with exertion relieved by rest is stable angina.
Question 9
A 25-year-old woman presents with dysuria and suprapubic pain. Urinalysis shows
pyuria. What is the best initial treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Metronidazole
D. Doxycycline
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis.
Question 10
A 70-year-old man with COPD presents with worsening dyspnea. Which medication
improves survival?
A. Albuterol
B. Inhaled corticosteroids
, C. Long-term oxygen therapy
D. Theophylline
Rationale: Long-term oxygen therapy improves survival in COPD patients with
hypoxemia.
Question 11
A 30-year-old woman presents with malar rash, joint pain, and fatigue. What is the
most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Psoriatic arthritis
D. Dermatomyositis
Rationale: Malar rash and systemic symptoms suggest lupus.
Question 12
A patient with atrial fibrillation is at risk for which complication?
A. Pulmonary embolism
B. Ischemic stroke
C. Myocardial infarction
D. Deep vein thrombosis
Rationale: AF increases risk of thromboembolic stroke.
Question 13
A 5-year-old presents with barking cough and inspiratory stridor. What is the
diagnosis?
A. Epiglottitis
B. Croup
C. Asthma
D. Bronchiolitis
Rationale: Barking cough and stridor are classic for croup.
Question 14
A 40-year-old man presents with RUQ pain after fatty meals. Ultrasound shows
gallstones. What is the best management?
A. Cholecystectomy
B. Antibiotics
C. ERCP
D. Observation
Rationale: Symptomatic gallstones require cholecystectomy.
Question 15
A patient with hypertension and diabetes should be started on which
antihypertensive?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Thiazide diuretic
Primary Care I | Wilkes
Question 1
A 52-year-old patient presents with fatigue, pallor, and glossitis. Lab results show
microcytic anemia. Which is the most likely cause?
A. Vitamin B12 deficiency
B. Iron deficiency anemia
C. Folate deficiency
D. Chronic kidney disease
Rationale: Iron deficiency anemia presents with microcytosis, pallor, and glossitis.
B12 and folate deficiencies cause macrocytic anemia.
Question 2
A patient with type 2 diabetes has an HbA1c of 9.2%. Which is the best initial
management step?
A. Start insulin therapy
B. Increase exercise only
C. Add aspirin therapy
D. Continue current oral medication
Rationale: HbA1c >9% often requires insulin initiation for glycemic control. Lifestyle
changes alone are insufficient.
Question 3
A 7-year-old presents with sore throat, fever, and anterior cervical
lymphadenopathy. Rapid strep test is positive. What is the treatment of choice?
A. Azithromycin
B. Penicillin V
C. Ciprofloxacin
D. Amoxicillin-clavulanate
Rationale: Penicillin V (or amoxicillin) is first-line for group A strep pharyngitis.
Question 4
A 68-year-old smoker presents with chronic cough and sputum production for 3
months each year over the past 2 years. What is the most likely diagnosis?
A. Asthma
B. Chronic bronchitis
C. Emphysema
D. Tuberculosis
Rationale: Chronic bronchitis is defined clinically by productive cough ≥3
months/year for ≥2 consecutive years.
Question 5
A patient presents with dysuria and frequency. Urinalysis shows positive nitrites
and leukocyte esterase. What is the best treatment?
,A. Nitrofurantoin
B. Ciprofloxacin
C. Metronidazole
D. Amoxicillin
Rationale: Nitrofurantoin is first-line for uncomplicated UTI in women. Ciprofloxacin
is reserved for resistant cases.
Question 6
A 45-year-old woman presents with weight gain, cold intolerance, and dry skin.
Labs show elevated TSH and low free T4. What is the diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Subclinical hyperthyroidism
D. Thyroid storm
Rationale: Elevated TSH with low free T4 confirms hypothyroidism.
Question 7
A patient with hypertension is started on lisinopril. Which lab should be monitored?
A. Hemoglobin
B. Potassium
C. Calcium
D. Platelets
Rationale: ACE inhibitors can cause hyperkalemia; potassium must be monitored.
Question 8
A 60-year-old man presents with exertional chest pain relieved by rest. What is the
most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Rationale: Predictable chest pain with exertion relieved by rest is stable angina.
Question 9
A 25-year-old woman presents with dysuria and suprapubic pain. Urinalysis shows
pyuria. What is the best initial treatment?
A. Nitrofurantoin
B. Ciprofloxacin
C. Metronidazole
D. Doxycycline
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis.
Question 10
A 70-year-old man with COPD presents with worsening dyspnea. Which medication
improves survival?
A. Albuterol
B. Inhaled corticosteroids
, C. Long-term oxygen therapy
D. Theophylline
Rationale: Long-term oxygen therapy improves survival in COPD patients with
hypoxemia.
Question 11
A 30-year-old woman presents with malar rash, joint pain, and fatigue. What is the
most likely diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Psoriatic arthritis
D. Dermatomyositis
Rationale: Malar rash and systemic symptoms suggest lupus.
Question 12
A patient with atrial fibrillation is at risk for which complication?
A. Pulmonary embolism
B. Ischemic stroke
C. Myocardial infarction
D. Deep vein thrombosis
Rationale: AF increases risk of thromboembolic stroke.
Question 13
A 5-year-old presents with barking cough and inspiratory stridor. What is the
diagnosis?
A. Epiglottitis
B. Croup
C. Asthma
D. Bronchiolitis
Rationale: Barking cough and stridor are classic for croup.
Question 14
A 40-year-old man presents with RUQ pain after fatty meals. Ultrasound shows
gallstones. What is the best management?
A. Cholecystectomy
B. Antibiotics
C. ERCP
D. Observation
Rationale: Symptomatic gallstones require cholecystectomy.
Question 15
A patient with hypertension and diabetes should be started on which
antihypertensive?
A. Beta-blocker
B. ACE inhibitor
C. Calcium channel blocker
D. Thiazide diuretic
