NSG 554 EXAM 4: NURSE
PRACTITIONERS IN PRIMARY CARE I -
WILKES UNIVERSITY. QUESTIONS AND
ANSWERS
1. A 45-year-old male with Type 2 Diabetes has a serum creatinine of 1.8 mg/dL and a
calculated GFR of 28 mL/min/1.73m². Which of the following is the most appropriate
management regarding his Metformin therapy?
A. Continue current dose but monitor renal function monthly
B. Discontinue Metformin due to the risk of lactic acidosis
C. Reduce the dose by 50% immediately
D. Switch to a Sulfonylurea at a high dose
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the significantly increased risk of lactic acidosis.
2. Which of the following physical exam findings is most suggestive of Grave’s Disease rather
than other causes of hyperthyroidism?
A. Tachycardia and palpitations
,B. Fine tremor of the hands
C. Heat intolerance and weight loss
D. Exophthalmos and pretibial myxedema
Answer: D
Conceptual Explanation: Exophthalmos (bulging eyes) and pretibial myxedema are
specific extrathyroidal manifestations of Grave’s Disease, whereas tachycardia and tremors
occur in general hyperthyroidism.
3. A patient presents with a TSH of 8.5 mIU/L and a normal Free T4 level. The patient is
asymptomatic. What is the most appropriate next step?
A. Start Levothyroxine 50 mcg daily
B. Order a thyroid ultrasound immediately
C. Repeat TSH and Free T4 in 3-6 months
D. Diagnose primary hypothyroidism and treat
Answer: C
Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally not indicated for asymptomatic patients with TSH < 10
unless they are pregnant or have high cardiovascular risk. Monitoring is preferred.
, 4. Which class of medication is considered first-line for a patient with symptomatic Benign
Prostatic Hyperplasia (BPH) who also has hypertension?
A. Alpha-1 adrenergic antagonists
B. PDE-5 inhibitors
C. 5-alpha-reductase inhibitors
D. Loop diuretics
Answer: A
Conceptual Explanation: Alpha-1 antagonists like Tamsulosin or Terazosin provide rapid
relief of BPH symptoms by relaxing smooth muscle in the bladder neck and can also assist
in blood pressure management.
5. When evaluating a patient with microcytic, hypochromic anemia, which lab value best
differentiates iron deficiency anemia from thalassemia?
A. Mean Corpuscular Volume (MCV)
B. Hematocrit
C. Hemoglobin level
D. Red Cell Distribution Width (RDW)
Answer: D
PRACTITIONERS IN PRIMARY CARE I -
WILKES UNIVERSITY. QUESTIONS AND
ANSWERS
1. A 45-year-old male with Type 2 Diabetes has a serum creatinine of 1.8 mg/dL and a
calculated GFR of 28 mL/min/1.73m². Which of the following is the most appropriate
management regarding his Metformin therapy?
A. Continue current dose but monitor renal function monthly
B. Discontinue Metformin due to the risk of lactic acidosis
C. Reduce the dose by 50% immediately
D. Switch to a Sulfonylurea at a high dose
Answer: B
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the significantly increased risk of lactic acidosis.
2. Which of the following physical exam findings is most suggestive of Grave’s Disease rather
than other causes of hyperthyroidism?
A. Tachycardia and palpitations
,B. Fine tremor of the hands
C. Heat intolerance and weight loss
D. Exophthalmos and pretibial myxedema
Answer: D
Conceptual Explanation: Exophthalmos (bulging eyes) and pretibial myxedema are
specific extrathyroidal manifestations of Grave’s Disease, whereas tachycardia and tremors
occur in general hyperthyroidism.
3. A patient presents with a TSH of 8.5 mIU/L and a normal Free T4 level. The patient is
asymptomatic. What is the most appropriate next step?
A. Start Levothyroxine 50 mcg daily
B. Order a thyroid ultrasound immediately
C. Repeat TSH and Free T4 in 3-6 months
D. Diagnose primary hypothyroidism and treat
Answer: C
Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH,
normal T4). Treatment is generally not indicated for asymptomatic patients with TSH < 10
unless they are pregnant or have high cardiovascular risk. Monitoring is preferred.
, 4. Which class of medication is considered first-line for a patient with symptomatic Benign
Prostatic Hyperplasia (BPH) who also has hypertension?
A. Alpha-1 adrenergic antagonists
B. PDE-5 inhibitors
C. 5-alpha-reductase inhibitors
D. Loop diuretics
Answer: A
Conceptual Explanation: Alpha-1 antagonists like Tamsulosin or Terazosin provide rapid
relief of BPH symptoms by relaxing smooth muscle in the bladder neck and can also assist
in blood pressure management.
5. When evaluating a patient with microcytic, hypochromic anemia, which lab value best
differentiates iron deficiency anemia from thalassemia?
A. Mean Corpuscular Volume (MCV)
B. Hematocrit
C. Hemoglobin level
D. Red Cell Distribution Width (RDW)
Answer: D
