NSG 554 EXAM 4 V3 - NURSE
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 62-year-old African American male presents with a blood pressure of 155/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril
B. Chlorthalidone
C. Losartan
D. Metoprolol
Answer: B
Conceptual Explanation: For African American patients without CKD, initial therapy
should include a thiazide-type diuretic or a calcium channel blocker (CCB). Chlorthalidone
is a thiazide-like diuretic preferred for its long half-life and proven cardiovascular benefits.
2. A patient with Type 2 Diabetes has a current eGFR of 38 mL/min/1.73m². Which
adjustment is most appropriate for their Metformin therapy?
A. Discontinue Metformin immediately
,B. Increase the dose to compensate for renal decline
C. Reduce the dose by 50% and monitor closely
D. Continue the current dose but monitor GFR every 3 months
Answer: C
Conceptual Explanation: Metformin is contraindicated when eGFR is below 30. For
patients with eGFR between 30-45, the dose should be reduced by 50% (maximum
1000mg/day), and initiation of Metformin is not recommended in this range.
3. Which of the following physical exam findings is most suggestive of Chronic Obstructive
Pulmonary Disease (COPD) rather than Asthma?
A. Wheezing on expiration
B. Increased tactile fremitus
C. Stridor during inhalation
D. Increased anteroposterior (AP) chest diameter
Answer: D
Conceptual Explanation: An increased AP diameter (barrel chest) is a classic sign of
hyperinflation common in chronic obstructive conditions like emphysema/COPD, whereas
asthma is typically characterized by reversible airway obstruction without permanent
structural changes early on.
, 4. A 45-year-old female presents with a TSH of 8.2 mIU/L and a normal free T4 level. She
complains of mild fatigue but has no other symptoms. What is the most appropriate next
step?
A. Start Levothyroxine 25 mcg daily
B. Start Methimazole 5 mg daily
C. Refer to surgery for total thyroidectomy
D. Repeat TSH and check TPO antibodies in 3-6 months
Answer: D
Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally reserved for TSH > 10, pregnancy, or significant
symptoms/positive antibodies. Monitoring and repeating the test is the standard of care for
mild elevations.
5. Which screening tool is most appropriate for assessing a 75-year-old patient for cognitive
impairment during a Medicare Wellness Visit?
A. PHQ-9
B. GAD-7
C. Mini-Cog
D. CAGE questionnaire
Answer: C
PRACTITIONERS IN PRIMARY CARE I
QUESTIONS AND ANSWERS
1. A 62-year-old African American male presents with a blood pressure of 155/94 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate initial
pharmacological treatment?
A. Lisinopril
B. Chlorthalidone
C. Losartan
D. Metoprolol
Answer: B
Conceptual Explanation: For African American patients without CKD, initial therapy
should include a thiazide-type diuretic or a calcium channel blocker (CCB). Chlorthalidone
is a thiazide-like diuretic preferred for its long half-life and proven cardiovascular benefits.
2. A patient with Type 2 Diabetes has a current eGFR of 38 mL/min/1.73m². Which
adjustment is most appropriate for their Metformin therapy?
A. Discontinue Metformin immediately
,B. Increase the dose to compensate for renal decline
C. Reduce the dose by 50% and monitor closely
D. Continue the current dose but monitor GFR every 3 months
Answer: C
Conceptual Explanation: Metformin is contraindicated when eGFR is below 30. For
patients with eGFR between 30-45, the dose should be reduced by 50% (maximum
1000mg/day), and initiation of Metformin is not recommended in this range.
3. Which of the following physical exam findings is most suggestive of Chronic Obstructive
Pulmonary Disease (COPD) rather than Asthma?
A. Wheezing on expiration
B. Increased tactile fremitus
C. Stridor during inhalation
D. Increased anteroposterior (AP) chest diameter
Answer: D
Conceptual Explanation: An increased AP diameter (barrel chest) is a classic sign of
hyperinflation common in chronic obstructive conditions like emphysema/COPD, whereas
asthma is typically characterized by reversible airway obstruction without permanent
structural changes early on.
, 4. A 45-year-old female presents with a TSH of 8.2 mIU/L and a normal free T4 level. She
complains of mild fatigue but has no other symptoms. What is the most appropriate next
step?
A. Start Levothyroxine 25 mcg daily
B. Start Methimazole 5 mg daily
C. Refer to surgery for total thyroidectomy
D. Repeat TSH and check TPO antibodies in 3-6 months
Answer: D
Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally reserved for TSH > 10, pregnancy, or significant
symptoms/positive antibodies. Monitoring and repeating the test is the standard of care for
mild elevations.
5. Which screening tool is most appropriate for assessing a 75-year-old patient for cognitive
impairment during a Medicare Wellness Visit?
A. PHQ-9
B. GAD-7
C. Mini-Cog
D. CAGE questionnaire
Answer: C
