NSG 554 EXAM 4 V3: ADVANCED
PRIMARY CARE PRACTICE QUESTIONS
AND ANSWERS
1. A 55-year-old African American male presents with a blood pressure of 155/95 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate first-line
treatment?
A. Lisinopril
B. Amlodipine
C. Losartan
D. Metoprolol
Answer: B
Conceptual Explanation: For the general African American population, including those
with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or
calcium channel blocker (CCB) like Amlodipine.
2. A patient with Type 2 Diabetes has an A1c of 8.2% despite maximal Metformin therapy.
The patient has established atherosclerotic cardiovascular disease (ASCVD). Which agent
should be added next?
A. Empagliflozin
,B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Conceptual Explanation: ADA guidelines recommend SGLT2 inhibitors (like
Empagliflozin) or GLP-1 receptor agonists with proven CVD benefit for patients with
established ASCVD.
3. Which of the following is a contraindication for initiating Metformin therapy in a patient
with chronic kidney disease?
A. Serum Creatinine > 1.2 mg/dL
B. eGFR < 45 mL/min/1.73m²
C. eGFR < 30 mL/min/1.73m²
D. Microalbuminuria
Answer: C
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the increased risk of lactic acidosis.
4. A 68-year-old female presents with fatigue and cold intolerance. Her TSH is 12.4 mIU/L
(High) and Free T4 is 0.6 ng/dL (Low). What is the most likely diagnosis?
A. Subclinical hypothyroidism
, B. Secondary hypothyroidism
C. Hashimoto’s thyroiditis
D. Primary hypothyroidism
Answer: D
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4. While Hashimoto’s is a common cause, the physiological diagnosis is
primary hypothyroidism.
5. When starting Levothyroxine in an elderly patient with underlying coronary artery disease,
the initial dose should be:
A. 1.6 mcg/kg/day
B. 50 to 75 mcg daily
C. 12.5 to 25 mcg daily
D. 100 mcg daily
Answer: C
Conceptual Explanation: In elderly patients or those with cardiac disease, ‘start low and
go slow’ is the rule to avoid precipitating angina or arrhythmias; 12.5-25 mcg is the
recommended starting dose.
PRIMARY CARE PRACTICE QUESTIONS
AND ANSWERS
1. A 55-year-old African American male presents with a blood pressure of 155/95 mmHg.
According to JNC 8 guidelines, which of the following is the most appropriate first-line
treatment?
A. Lisinopril
B. Amlodipine
C. Losartan
D. Metoprolol
Answer: B
Conceptual Explanation: For the general African American population, including those
with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or
calcium channel blocker (CCB) like Amlodipine.
2. A patient with Type 2 Diabetes has an A1c of 8.2% despite maximal Metformin therapy.
The patient has established atherosclerotic cardiovascular disease (ASCVD). Which agent
should be added next?
A. Empagliflozin
,B. Pioglitazone
C. Glipizide
D. Sitagliptin
Answer: A
Conceptual Explanation: ADA guidelines recommend SGLT2 inhibitors (like
Empagliflozin) or GLP-1 receptor agonists with proven CVD benefit for patients with
established ASCVD.
3. Which of the following is a contraindication for initiating Metformin therapy in a patient
with chronic kidney disease?
A. Serum Creatinine > 1.2 mg/dL
B. eGFR < 45 mL/min/1.73m²
C. eGFR < 30 mL/min/1.73m²
D. Microalbuminuria
Answer: C
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the increased risk of lactic acidosis.
4. A 68-year-old female presents with fatigue and cold intolerance. Her TSH is 12.4 mIU/L
(High) and Free T4 is 0.6 ng/dL (Low). What is the most likely diagnosis?
A. Subclinical hypothyroidism
, B. Secondary hypothyroidism
C. Hashimoto’s thyroiditis
D. Primary hypothyroidism
Answer: D
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH
and a low Free T4. While Hashimoto’s is a common cause, the physiological diagnosis is
primary hypothyroidism.
5. When starting Levothyroxine in an elderly patient with underlying coronary artery disease,
the initial dose should be:
A. 1.6 mcg/kg/day
B. 50 to 75 mcg daily
C. 12.5 to 25 mcg daily
D. 100 mcg daily
Answer: C
Conceptual Explanation: In elderly patients or those with cardiac disease, ‘start low and
go slow’ is the rule to avoid precipitating angina or arrhythmias; 12.5-25 mcg is the
recommended starting dose.
