NSG 554 NURSE PRACTITIONERS IN
PRIMARY CARE I - EXAM 4 PREP
QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with a well-demarcated, erythematous plaque with silvery
scales on the elbows. Which is the first-line treatment for this patient with mild to moderate
disease?
A. High-potency topical corticosteroids
B. Oral Methotrexate
C. Systemic Prednisone
D. Topical Antifungals
Answer: A
Conceptual Explanation: Psoriasis localized to small areas is best treated with high-
potency topical steroids. Systemic steroids should be avoided due to the risk of pustular
rebound.
2. Which of the following is the hallmark clinical finding in a patient presenting with an acute
exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?
A. Inspiratory crackles at the bases
,B. Increased sputum volume and purulence
C. Hemoptysis and weight loss
D. Pleuritic chest pain
Answer: B
Conceptual Explanation: Increased dyspnea, sputum volume, and sputum purulence are
the cardinal symptoms of a COPD exacerbation.
3. A 62-year-old male with a history of hypertension presents with new-onset atrial
fibrillation. His CHA2DS2-VASc score is 3. What is the most appropriate management for
stroke prevention?
A. Aspirin 81 mg daily
B. Aspirin 325 mg plus Clopidogrel
C. Observation only as the patient is stable
D. Oral anticoagulation with a DOAC or Warfarin
Answer: D
Conceptual Explanation: A CHA2DS2-VASc score of 2 or greater in men (3 or greater in
women) warrants oral anticoagulation to reduce the risk of thromboembolic stroke.
4. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Tinea Corporis
, B. Secondary Syphilis
C. Eczema
D. Pityriasis Rosea
Answer: D
Conceptual Explanation: Pityriasis rosea typically begins with a herald patch followed by
a generalized eruption in a Christmas tree pattern along skin cleavage lines.
5. According to the JNC 8 guidelines, what is the goal blood pressure for a 65-year-old patient
without diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: C
Conceptual Explanation: JNC 8 suggests a goal of < 150/90 mmHg for patients aged 65
and older, though many other guidelines (like ACC/AHA) now favor < 130/80.
6. A patient presents with sudden onset of severe eye pain, blurred vision, and seeing ‘halos’
around lights. On exam, the pupil is mid-dilated and non-reactive. What is the priority
intervention?
A. Prescribe topical antibiotics
PRIMARY CARE I - EXAM 4 PREP
QUESTIONS AND ANSWERS
1. A 45-year-old patient presents with a well-demarcated, erythematous plaque with silvery
scales on the elbows. Which is the first-line treatment for this patient with mild to moderate
disease?
A. High-potency topical corticosteroids
B. Oral Methotrexate
C. Systemic Prednisone
D. Topical Antifungals
Answer: A
Conceptual Explanation: Psoriasis localized to small areas is best treated with high-
potency topical steroids. Systemic steroids should be avoided due to the risk of pustular
rebound.
2. Which of the following is the hallmark clinical finding in a patient presenting with an acute
exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?
A. Inspiratory crackles at the bases
,B. Increased sputum volume and purulence
C. Hemoptysis and weight loss
D. Pleuritic chest pain
Answer: B
Conceptual Explanation: Increased dyspnea, sputum volume, and sputum purulence are
the cardinal symptoms of a COPD exacerbation.
3. A 62-year-old male with a history of hypertension presents with new-onset atrial
fibrillation. His CHA2DS2-VASc score is 3. What is the most appropriate management for
stroke prevention?
A. Aspirin 81 mg daily
B. Aspirin 325 mg plus Clopidogrel
C. Observation only as the patient is stable
D. Oral anticoagulation with a DOAC or Warfarin
Answer: D
Conceptual Explanation: A CHA2DS2-VASc score of 2 or greater in men (3 or greater in
women) warrants oral anticoagulation to reduce the risk of thromboembolic stroke.
4. A patient presents with a ‘herald patch’ followed by a ‘Christmas tree’ distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Tinea Corporis
, B. Secondary Syphilis
C. Eczema
D. Pityriasis Rosea
Answer: D
Conceptual Explanation: Pityriasis rosea typically begins with a herald patch followed by
a generalized eruption in a Christmas tree pattern along skin cleavage lines.
5. According to the JNC 8 guidelines, what is the goal blood pressure for a 65-year-old patient
without diabetes or chronic kidney disease?
A. < 120/80 mmHg
B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: C
Conceptual Explanation: JNC 8 suggests a goal of < 150/90 mmHg for patients aged 65
and older, though many other guidelines (like ACC/AHA) now favor < 130/80.
6. A patient presents with sudden onset of severe eye pain, blurred vision, and seeing ‘halos’
around lights. On exam, the pupil is mid-dilated and non-reactive. What is the priority
intervention?
A. Prescribe topical antibiotics
