NSG 554 Exam 3 – Nurse Practitioners in Primary Care I | 65 Actual Questions and Answers + Expert Rationales | 2026/27 Updates | 100% correct

NSG 554 Exam 3 – Nurse Practitioners in
Primary Care I | 65 Actual Questions and
Answers + Expert Rationales | 2026/27
Updates | 100% correct

NSG 554 Exam 3 – Nurse Practitioners in Primary Care
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Instructions: Choose the single best answer for each question. Each question is worth 2 points.
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Section I: Cardiovascular & Hematology
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1. A 68-year-
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old male with a history of hypertension and type 2 DM presents for a routine physical. H
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is blood pressure is 138/86 mmHg. His home BP log shows an average of 135/82 mmHg.
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According to the JNC 8 (Eighth Joint National Committee) guidelines, which of the follo
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wing is the most appropriate initial pharmacologic treatment goal for this patient?
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• A) BP < 140/90 mmHg, start a thiazide diuretic.
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• B) BP < 130/80 mmHg, start an ACE inhibitor.
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• C) BP < 150/90 mmHg, start a calcium channel blocker.
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• D) BP < 130/80 mmHg, start a beta-blocker.
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Correct Answer: A (For patients >60 with DM, JNC 8 target is <140/90. ACEi or ARB is often p
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referred for DM, but the question asks for the goal. While ACEi is a good choice, Thiazides are
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also first-line. The goal of <140/90 makes A the most correct.)
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2. A 55-year-old female presents with acute onset of severe right-
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sided chest pain that is pleuritic in nature. She is tachypneic and hypoxic. Her D-
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dimer is elevated. Which of the following findings on an ECG is most classically associate
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d with her most likely diagnosis?
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• A) Diffuse ST-segment elevation.
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• B) Deep Q waves in leads II, III, and aVF.
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• C) Sinus tachycardia with an S1Q3T3 pattern.
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• D) Prolonged PR interval.
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,Correct Answer: C (This describes a pulmonary embolism. The classic ECG finding is sinus tach
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ycardia with an S1Q3T3 pattern, though it is not highly sensitive.)
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3. A 72-year-
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old patient with stage 3 Chronic Kidney Disease (CKD) presents with fatigue and pallor. L
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abs show Hb 9.2 g/dL, MCV 78 fL, and ferritin 800 ng/mL. What is the most likely cause
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of this anemia?
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• A) Iron deficiency anemia.
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• B) Anemia of chronic disease (ACD).
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• C) Vitamin B12 deficiency.
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• D) Folic acid deficiency.
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Correct Answer: B (In CKD, erythropoietin production drops. The low Hb, normal/low MCV, an
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d high ferritin (indicating adequate iron stores) point to ACD/renal anemia.)
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Section II: Pulmonology nb nb




4. A 45-year-old with a 30-pack-
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year smoking history presents with a chronic cough producing mucoid sputum. Spiromet
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ry shows FEV1/FVC of 65% (predicted 78%). Which of the following is the most appropri
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ate initial maintenance therapy for this patient's confirmed diagnosis?
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• A) Inhaled corticosteroids alone.
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• B) Long-acting beta-agonist (LABA) alone.
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• C) Long-acting muscarinic antagonist (LAMA) or LABA.
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• D) Oral theophylline.
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Correct Answer: C (This is COPD. The GOLD guidelines recommend LAMA or LABA as initial m
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aintenance therapy for Group B patients.) nb nb nb nb nb




5. A 24-year-
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old with a history of asthma presents with wheezing and shortness of breath. She uses h
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er albuterol inhaler 5 times a week. Which of the following is the most appropriate next
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step in her asthma management?
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• A) Increase the dose of albuterol.
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• B) Start a low-dose inhaled corticosteroid (ICS).
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• C) Start oral montelukast.
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, • D) Refer for allergy testing.
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Correct Answer: B (Using a SABA >2 times a week indicates poor control. The next step is to a
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dd a low-dose ICS.)
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6. A 60-year-
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old male presents with fever, productive cough with purulent sputum, and crackles in th
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e right lower lobe on auscultation. A chest X-
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ray confirms infiltrates. He has no significant medical history. What is the first-
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line treatment for community-acquired pneumonia (CAP) in an outpatient setting?
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• A) Azithromycin.
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• B) Levofloxacin.
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• C) Doxycycline.
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• D) Amoxicillin.
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Correct Answer: D (For a healthy outpatient without comorbidities, Amoxicillin (or a macrolide
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) is appropriate. Macrolide resistance is increasing, making Amoxicillin or Doxycycline good cho
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ices. D is the most universally acceptable first-line.)
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7. A patient with suspected tuberculosis has a positive QuantiFERON-
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TB Gold test. A chest X-
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ray shows a cavitary lesion in the left upper lobe. What is the next best step?
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• A) Start Isoniazid (INH) and Rifampin immediately.
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• B) Obtain three sputum samples for acid-fast bacilli (AFB) smear and culture.
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• C) Order a CT scan of the chest.
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• D) Start prophylactic INH therapy.
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Correct Answer: B (Cavitary lesion + positive IGRA suggests active TB. You must confirm with
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culture before starting 4-drug therapy to ensure sensitivity.)
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Section III: Endocrinology nb nb




8. A 52-year-
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old obese female presents with acanthosis nigricans. Her fasting blood glucose is 132 m
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g/dL and HbA1c is 7.2%. What is the initial pharmacologic therapy of choice for this pati
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ent?

• A) Insulin glargine.
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, • B) Metformin.
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• C) Sulfonylurea (Glipizide).
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• D) DPP-4 inhibitor (Sitagliptin).
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Correct Answer: B (Metformin is the first-
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line agent for type 2 diabetes, especially in patients who are overweight/obese.)
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9. A 48-year-
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old male on Metformin and Glipizide for type 2 DM presents with a random glucose of 2
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80 mg/dL. His HbA1c is 9.5%. He is adherent to his medications. Which of the following
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is the most appropriate next step?
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• A) Increase Metformin dose.
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• B) Add a GLP-1 agonist.
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• C) Start basal insulin (e.g., Lantus) at 0.2 units/kg.
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• D) Switch Glipizide to Pioglitazone.
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Correct Answer: C (When A1C is >9% and the patient is already on two oral agents, insulin is i
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ndicated. Starting basal insulin is the standard of care.)
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10. A 35-year-
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old female presents with heat intolerance, palpitations, and a fine tremor. Labs show TS
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H <0.01 uIU/mL and free T4 of 3.5 ng/dL. Which medication is the first-
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line treatment for her likely diagnosis?
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• A) Levothyroxine.
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• B) Methimazole.
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• C) Propylthiouracil (PTU).
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• D) Propranolol.
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Correct Answer: B (This is hyperthyroidism/Graves disease. Methimazole is the preferred thioa
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mide in non-pregnant patients.)
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11. A 65-year-
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old male presents with fatigue, constipation, and weight gain. Labs show TSH 12.0 uIU/
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mL. He is started on Levothyroxine 25 mcg daily. When should his TSH be rechecked to
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assess adequate dosing? nb nb




• A) 1 week nb nb




• B) 2 weeksnb nb