NSG554 EXAM 3 – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Advanced Pathophysiology
Pharmacology & Pharmacotherapeutics
Health Promotion & Disease Prevention
Clinical Assessment & Differential Diagnosis
Management of Acute & Chronic Conditions
Patient Education & Shared Decision-Making
Ethical & Legal Considerations in Primary Care
Interprofessional Collaboration & Systems-Based Practice
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, clinical reasoning, and decision-
making skills essential for advanced practice nursing in primary care. The content spans foundational
pathophysiological concepts, pharmacotherapeutic principles, and evidence-based guidelines for managing a wide
array of patient presentations across the lifespan. Through a series of multiple-choice questions and clinical scenarios,
the exam evaluates the ability to synthesize complex information, prioritize interventions, and formulate safe, patient-
centered care plans. Emphasis is placed on the practical application of theoretical knowledge to real-world situations,
testing the critical thinking required for autonomous practice and effective interprofessional collaboration.
,SECTION ONE: QUESTIONS 1-100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a two-day history of
progressive, severe, sharp chest pain that radiates to his back. His blood pressure is 145/90 mmHg in the right
arm and 100/68 mmHg in the left arm. His heart rate is 110 bpm. What is the most appropriate initial diagnostic
study?
A. Electrocardiogram (ECG)
B. Chest X-ray
C. Computed tomography (CT) angiography of the chest
D. Cardiac troponin panel
🟢 C. Computed tomography (CT) angiography of the chest
🔴 Explanation: The patient's presentation of severe chest pain radiating to the back, combined with a significant
blood pressure differential between arms, is highly suspicious for an acute aortic dissection. CT angiography of the
chest is the gold standard for rapid diagnosis of this life-threatening condition.
2. A 45-year-old female presents with complaints of fatigue, weight gain, constipation, and feeling cold all the
time. Her vital signs are stable. Laboratory results reveal a TSH of 8.5 mIU/L (normal 0.4-4.0) and a free T4 of 0.6
ng/dL (normal 0.8-1.8). What is the most appropriate next step in management?
A. Initiate levothyroxine 25 mcg daily
B. Initiate levothyroxine 100 mcg daily
C. Start a trial of liothyronine (T3)
D. Repeat TSH in 6 weeks
🟢 A. Initiate levothyroxine 25 mcg daily
,🔴 Explanation: The patient has overt primary hypothyroidism based on elevated TSH and low free T4. For an older
adult, starting with a low dose of levothyroxine (25-50 mcg) is recommended to avoid the risk of precipitating
cardiac events. This is a patient-centered, safe approach.
3. A 68-year-old male with a history of COPD and a 50-pack-year smoking history is being evaluated for a chronic
cough that has changed in character. He now reports coughing up blood-streaked sputum. He has lost 15 pounds
unintentionally over the last 4 months. What is the most important initial diagnostic step?
A. Sputum culture and sensitivity
B. Complete blood count (CBC)
C. Chest X-ray
D. Computed tomography (CT) of the chest
🟢 C. Chest X-ray
🔴 Explanation: A chest X-ray is the standard initial imaging study for evaluating a patient with a new or changing
cough, hemoptysis, and constitutional symptoms like weight loss, especially in a high-risk patient with a significant
smoking history.
4. A 55-year-old woman comes to the clinic for a routine check-up. She has a history of osteoarthritis and takes
ibuprofen as needed. She has no other medical history. Her blood pressure is 148/92 mmHg on two separate
occasions. What is the most appropriate initial treatment for her hypertension?
A. Hydrochlorothiazide 12.5 mg daily
B. Lisinopril 10 mg daily
C. Lifestyle modifications only for 3-6 months
D. Amlodipine 5 mg daily
🟢 C. Lifestyle modifications only for 3-6 months
, 🔴 Explanation: According to JNC 8 guidelines, for patients with stage 1 hypertension without other compelling
indications, lifestyle modifications should be initiated for 3-6 months before starting pharmacotherapy. This patient
is in that category.
5. A 32-year-old female presents with a three-day history of dysuria, frequency, and urgency. She has no fever or
flank pain. A urine dipstick reveals positive leukocyte esterase and nitrites. What is the most appropriate
treatment?
A. Nitrofurantoin 100 mg BID for 5 days
B. Trimethoprim-sulfamethoxazole BID for 3 days
C. Ciprofloxacin 250 mg BID for 3 days
D. Encourage increased fluid intake and cranberry juice
🟢 A. Nitrofurantoin 100 mg BID for 5 days
🔴 Explanation: This is an uncomplicated cystitis. Nitrofurantoin is a first-line antibiotic for this indication due to its
high efficacy and low resistance rates. A 5-day course is recommended.
6. A 70-year-old male with a history of benign prostatic hyperplasia presents with a sudden inability to void. He
is in significant distress and has a palpable, distended bladder. What is the most appropriate initial intervention?
A. Prescribe tamsulosin 0.4 mg daily
B. Schedule an appointment for urology consultation
C. Perform a bladder scan and then straight catheterization
D. Administer IV fluids to promote diuresis
🟢 C. Perform a bladder scan and then straight catheterization
GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains
Advanced Pathophysiology
Pharmacology & Pharmacotherapeutics
Health Promotion & Disease Prevention
Clinical Assessment & Differential Diagnosis
Management of Acute & Chronic Conditions
Patient Education & Shared Decision-Making
Ethical & Legal Considerations in Primary Care
Interprofessional Collaboration & Systems-Based Practice
Introduction
This comprehensive examination is designed to rigorously assess the knowledge, clinical reasoning, and decision-
making skills essential for advanced practice nursing in primary care. The content spans foundational
pathophysiological concepts, pharmacotherapeutic principles, and evidence-based guidelines for managing a wide
array of patient presentations across the lifespan. Through a series of multiple-choice questions and clinical scenarios,
the exam evaluates the ability to synthesize complex information, prioritize interventions, and formulate safe, patient-
centered care plans. Emphasis is placed on the practical application of theoretical knowledge to real-world situations,
testing the critical thinking required for autonomous practice and effective interprofessional collaboration.
,SECTION ONE: QUESTIONS 1-100
1. A 72-year-old male with a history of hypertension and type 2 diabetes presents with a two-day history of
progressive, severe, sharp chest pain that radiates to his back. His blood pressure is 145/90 mmHg in the right
arm and 100/68 mmHg in the left arm. His heart rate is 110 bpm. What is the most appropriate initial diagnostic
study?
A. Electrocardiogram (ECG)
B. Chest X-ray
C. Computed tomography (CT) angiography of the chest
D. Cardiac troponin panel
🟢 C. Computed tomography (CT) angiography of the chest
🔴 Explanation: The patient's presentation of severe chest pain radiating to the back, combined with a significant
blood pressure differential between arms, is highly suspicious for an acute aortic dissection. CT angiography of the
chest is the gold standard for rapid diagnosis of this life-threatening condition.
2. A 45-year-old female presents with complaints of fatigue, weight gain, constipation, and feeling cold all the
time. Her vital signs are stable. Laboratory results reveal a TSH of 8.5 mIU/L (normal 0.4-4.0) and a free T4 of 0.6
ng/dL (normal 0.8-1.8). What is the most appropriate next step in management?
A. Initiate levothyroxine 25 mcg daily
B. Initiate levothyroxine 100 mcg daily
C. Start a trial of liothyronine (T3)
D. Repeat TSH in 6 weeks
🟢 A. Initiate levothyroxine 25 mcg daily
,🔴 Explanation: The patient has overt primary hypothyroidism based on elevated TSH and low free T4. For an older
adult, starting with a low dose of levothyroxine (25-50 mcg) is recommended to avoid the risk of precipitating
cardiac events. This is a patient-centered, safe approach.
3. A 68-year-old male with a history of COPD and a 50-pack-year smoking history is being evaluated for a chronic
cough that has changed in character. He now reports coughing up blood-streaked sputum. He has lost 15 pounds
unintentionally over the last 4 months. What is the most important initial diagnostic step?
A. Sputum culture and sensitivity
B. Complete blood count (CBC)
C. Chest X-ray
D. Computed tomography (CT) of the chest
🟢 C. Chest X-ray
🔴 Explanation: A chest X-ray is the standard initial imaging study for evaluating a patient with a new or changing
cough, hemoptysis, and constitutional symptoms like weight loss, especially in a high-risk patient with a significant
smoking history.
4. A 55-year-old woman comes to the clinic for a routine check-up. She has a history of osteoarthritis and takes
ibuprofen as needed. She has no other medical history. Her blood pressure is 148/92 mmHg on two separate
occasions. What is the most appropriate initial treatment for her hypertension?
A. Hydrochlorothiazide 12.5 mg daily
B. Lisinopril 10 mg daily
C. Lifestyle modifications only for 3-6 months
D. Amlodipine 5 mg daily
🟢 C. Lifestyle modifications only for 3-6 months
, 🔴 Explanation: According to JNC 8 guidelines, for patients with stage 1 hypertension without other compelling
indications, lifestyle modifications should be initiated for 3-6 months before starting pharmacotherapy. This patient
is in that category.
5. A 32-year-old female presents with a three-day history of dysuria, frequency, and urgency. She has no fever or
flank pain. A urine dipstick reveals positive leukocyte esterase and nitrites. What is the most appropriate
treatment?
A. Nitrofurantoin 100 mg BID for 5 days
B. Trimethoprim-sulfamethoxazole BID for 3 days
C. Ciprofloxacin 250 mg BID for 3 days
D. Encourage increased fluid intake and cranberry juice
🟢 A. Nitrofurantoin 100 mg BID for 5 days
🔴 Explanation: This is an uncomplicated cystitis. Nitrofurantoin is a first-line antibiotic for this indication due to its
high efficacy and low resistance rates. A 5-day course is recommended.
6. A 70-year-old male with a history of benign prostatic hyperplasia presents with a sudden inability to void. He
is in significant distress and has a palpable, distended bladder. What is the most appropriate initial intervention?
A. Prescribe tamsulosin 0.4 mg daily
B. Schedule an appointment for urology consultation
C. Perform a bladder scan and then straight catheterization
D. Administer IV fluids to promote diuresis
🟢 C. Perform a bladder scan and then straight catheterization
