NSG 554 Exam 3 Nurse Practitioners in Primary Care I
Questions and Answers with Rationales - 100 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing / Nurse Practitioner Primary Care
Description This exam assesses advanced knowledge in primary care management across the
lifespan, covering evidence-based guidelines for common acute and chronic
conditions, health promotion, and disease prevention in the primary care setting.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Apply evidence-based guidelines to diagnose and manage common primary
care conditions.
2. Interpret diagnostic tests and clinical data to formulate differential diagnoses
and treatment plans.
3. Integrate pharmacological and non-pharmacological interventions considering
patient preferences, comorbidities, and safety.
4. Evaluate health promotion and disease prevention strategies across diverse
populations.
Accreditation This examination adheres to the standards set by the American Association of
Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner
Faculties (NONPF) for graduate-level nurse practitioner education in the United
States.
Page 1
,1. A patient with chronic kidney disease stage 3a and hypertension is currently on
lisinopril 10 mg daily. Blood pressure is 138/86 mm Hg. Urine albumin-to-creatinine
ratio is 45 mg/g. Which antihypertensive agent should be added to optimize
renoprotection?
A. Amlodipine
B. Chlorthalidone
C. Spironolactone
D. Metoprolol
Answer: A. Amlodipine
In CKD with albuminuria, a non-dihydropyridine calcium channel blocker (e.g.,
verapamil) or amlodipine can be added to ACEi/ARB for additional BP control without
worsening albuminuria. Chlorthalidone may be less effective for renoprotection;
spironolactone increases hyperkalemia risk; metoprolol is not first-line for
renoprotection.
2. Which of the following best explains why the USPSTF recommends against
screening for thyroid cancer in asymptomatic adults?
A. High false-positive rates lead to unnecessary biopsies and surgeries with low mortality
benefit.
B. Screening reduces overall mortality but increases morbidity from overtreatment.
C. There is insufficient evidence that treatment of screen-detected cancers improves
outcomes.
D. Thyroid cancer is too rare to justify population screening.
Answer: C. There is insufficient evidence that treatment of screen-detected cancers
improves outcomes.
The USPSTF D recommendation is based on moderate certainty that screening has no
net benefit because most screen-detected cancers are indolent and treatment does not
improve mortality, while harms from overdiagnosis and overtreatment are significant.
Option A is partially true but the primary reason is lack of mortality benefit.
Page 2
,3. A patient on warfarin for atrial fibrillation develops an INR of 5.2 without
bleeding. After holding warfarin, which intervention is most appropriate?
A. Administer vitamin K 1 mg orally
B. Administer vitamin K 10 mg intravenously
C. Administer fresh frozen plasma
D. Administer prothrombin complex concentrate
Answer: A. Administer vitamin K 1 mg orally
For INR 4.5-10 without bleeding, guidelines recommend holding warfarin and
optionally giving low-dose oral vitamin K (1-2.5 mg). Higher doses or IV vitamin K are
reserved for serious bleeding or very high INR. FFP or PCC are for life-threatening
bleeding.
4. A patient with type 2 diabetes has eGFR 55 mL/min/1.73 m² and
microalbuminuria. Current medications: metformin 1000 mg BID, liraglutide 1.8 mg
daily, and atorvastatin 20 mg daily. Which medication adjustment is indicated?
A. Discontinue metformin
B. Reduce metformin dose
C. Continue current metformin dose
D. Switch metformin to insulin
Answer: B. Reduce metformin dose
Metformin is contraindicated when eGFR <30, but dose reduction (max 1000 mg/day)
is recommended when eGFR falls below 45. With eGFR 55, the current dose of 2000
mg/day exceeds the recommended maximum; thus, dose reduction is indicated.
5. A 50-year-old patient with no prior colonoscopy has a positive fecal
immunochemical test (FIT). What is the next best step?
A. Repeat FIT in one year
B. Colonoscopy
C. CT colonography
D. Fecal DNA test
Answer: B. Colonoscopy
A positive FIT requires follow-up colonoscopy to visualize the entire colon. Repeat FIT
is inappropriate; CT colonography or fecal DNA are not first-line after a positive FIT.
Colonoscopy allows both diagnosis and polypectomy.
Page 3
, 6. Which of the following is a key difference between the CDC and WHO growth
charts for children aged 2-20 years?
A. CDC charts are based on breastfed infants, WHO on formula-fed
B. WHO charts include BMI-for-age, CDC charts do not
C. CDC charts are derived from a more nationally representative sample of US children
D. WHO charts use a different reference population that reflects optimal growth
Answer: C. CDC charts are derived from a more nationally representative sample
of US children
CDC growth charts are based on data from US children, while WHO charts are based
on an international sample of children raised in optimal conditions. For ages 2-20, both
include BMI-for-age. The CDC charts are more representative of the US population.
7. A patient with acute sinusitis has purulent nasal discharge, facial pain, and
symptoms lasting 12 days. Which finding would most strongly indicate the need for
antibiotic therapy?
A. Fever of 100.4°F
B. Double sickening (worsening after initial improvement)
C. C-reactive protein >10 mg/L
D. Erythrocyte sedimentation rate >20 mm/hr
Answer: B. Double sickening (worsening after initial improvement)
Double sickening is a specific sign of bacterial sinusitis. While fever and elevated
inflammatory markers increase suspicion, the strongest predictor of bacterial etiology
is the pattern of worsening after initial viral illness. Antibiotics are indicated when
symptoms persist >10 days or have a biphasic course.
8. A patient with hypertension and gout is prescribed hydrochlorothiazide. Which
mechanism explains the increased risk of gout flares?
A. Thiazides decrease uric acid excretion
B. Thiazides increase uric acid production
C. Thiazides inhibit xanthine oxidase
D. Thiazides alkalinize urine
Answer: A. Thiazides decrease uric acid excretion
Thiazide diuretics reduce renal clearance of uric acid by competing for tubular
secretion, leading to hyperuricemia and increased gout risk. They do not increase
production or inhibit xanthine oxidase; urine alkalinization would increase uric acid
solubility.
Page 4
Questions and Answers with Rationales - 100 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing / Nurse Practitioner Primary Care
Description This exam assesses advanced knowledge in primary care management across the
lifespan, covering evidence-based guidelines for common acute and chronic
conditions, health promotion, and disease prevention in the primary care setting.
Expected Grade A+
Total Questions 100
Duration 3 hours
Learning Outcomes 1. Apply evidence-based guidelines to diagnose and manage common primary
care conditions.
2. Interpret diagnostic tests and clinical data to formulate differential diagnoses
and treatment plans.
3. Integrate pharmacological and non-pharmacological interventions considering
patient preferences, comorbidities, and safety.
4. Evaluate health promotion and disease prevention strategies across diverse
populations.
Accreditation This examination adheres to the standards set by the American Association of
Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner
Faculties (NONPF) for graduate-level nurse practitioner education in the United
States.
Page 1
,1. A patient with chronic kidney disease stage 3a and hypertension is currently on
lisinopril 10 mg daily. Blood pressure is 138/86 mm Hg. Urine albumin-to-creatinine
ratio is 45 mg/g. Which antihypertensive agent should be added to optimize
renoprotection?
A. Amlodipine
B. Chlorthalidone
C. Spironolactone
D. Metoprolol
Answer: A. Amlodipine
In CKD with albuminuria, a non-dihydropyridine calcium channel blocker (e.g.,
verapamil) or amlodipine can be added to ACEi/ARB for additional BP control without
worsening albuminuria. Chlorthalidone may be less effective for renoprotection;
spironolactone increases hyperkalemia risk; metoprolol is not first-line for
renoprotection.
2. Which of the following best explains why the USPSTF recommends against
screening for thyroid cancer in asymptomatic adults?
A. High false-positive rates lead to unnecessary biopsies and surgeries with low mortality
benefit.
B. Screening reduces overall mortality but increases morbidity from overtreatment.
C. There is insufficient evidence that treatment of screen-detected cancers improves
outcomes.
D. Thyroid cancer is too rare to justify population screening.
Answer: C. There is insufficient evidence that treatment of screen-detected cancers
improves outcomes.
The USPSTF D recommendation is based on moderate certainty that screening has no
net benefit because most screen-detected cancers are indolent and treatment does not
improve mortality, while harms from overdiagnosis and overtreatment are significant.
Option A is partially true but the primary reason is lack of mortality benefit.
Page 2
,3. A patient on warfarin for atrial fibrillation develops an INR of 5.2 without
bleeding. After holding warfarin, which intervention is most appropriate?
A. Administer vitamin K 1 mg orally
B. Administer vitamin K 10 mg intravenously
C. Administer fresh frozen plasma
D. Administer prothrombin complex concentrate
Answer: A. Administer vitamin K 1 mg orally
For INR 4.5-10 without bleeding, guidelines recommend holding warfarin and
optionally giving low-dose oral vitamin K (1-2.5 mg). Higher doses or IV vitamin K are
reserved for serious bleeding or very high INR. FFP or PCC are for life-threatening
bleeding.
4. A patient with type 2 diabetes has eGFR 55 mL/min/1.73 m² and
microalbuminuria. Current medications: metformin 1000 mg BID, liraglutide 1.8 mg
daily, and atorvastatin 20 mg daily. Which medication adjustment is indicated?
A. Discontinue metformin
B. Reduce metformin dose
C. Continue current metformin dose
D. Switch metformin to insulin
Answer: B. Reduce metformin dose
Metformin is contraindicated when eGFR <30, but dose reduction (max 1000 mg/day)
is recommended when eGFR falls below 45. With eGFR 55, the current dose of 2000
mg/day exceeds the recommended maximum; thus, dose reduction is indicated.
5. A 50-year-old patient with no prior colonoscopy has a positive fecal
immunochemical test (FIT). What is the next best step?
A. Repeat FIT in one year
B. Colonoscopy
C. CT colonography
D. Fecal DNA test
Answer: B. Colonoscopy
A positive FIT requires follow-up colonoscopy to visualize the entire colon. Repeat FIT
is inappropriate; CT colonography or fecal DNA are not first-line after a positive FIT.
Colonoscopy allows both diagnosis and polypectomy.
Page 3
, 6. Which of the following is a key difference between the CDC and WHO growth
charts for children aged 2-20 years?
A. CDC charts are based on breastfed infants, WHO on formula-fed
B. WHO charts include BMI-for-age, CDC charts do not
C. CDC charts are derived from a more nationally representative sample of US children
D. WHO charts use a different reference population that reflects optimal growth
Answer: C. CDC charts are derived from a more nationally representative sample
of US children
CDC growth charts are based on data from US children, while WHO charts are based
on an international sample of children raised in optimal conditions. For ages 2-20, both
include BMI-for-age. The CDC charts are more representative of the US population.
7. A patient with acute sinusitis has purulent nasal discharge, facial pain, and
symptoms lasting 12 days. Which finding would most strongly indicate the need for
antibiotic therapy?
A. Fever of 100.4°F
B. Double sickening (worsening after initial improvement)
C. C-reactive protein >10 mg/L
D. Erythrocyte sedimentation rate >20 mm/hr
Answer: B. Double sickening (worsening after initial improvement)
Double sickening is a specific sign of bacterial sinusitis. While fever and elevated
inflammatory markers increase suspicion, the strongest predictor of bacterial etiology
is the pattern of worsening after initial viral illness. Antibiotics are indicated when
symptoms persist >10 days or have a biphasic course.
8. A patient with hypertension and gout is prescribed hydrochlorothiazide. Which
mechanism explains the increased risk of gout flares?
A. Thiazides decrease uric acid excretion
B. Thiazides increase uric acid production
C. Thiazides inhibit xanthine oxidase
D. Thiazides alkalinize urine
Answer: A. Thiazides decrease uric acid excretion
Thiazide diuretics reduce renal clearance of uric acid by competing for tubular
secretion, leading to hyperuricemia and increased gout risk. They do not increase
production or inhibit xanthine oxidase; urine alkalinization would increase uric acid
solubility.
Page 4
