NSG 554 PRIMARY CARE EXAM 3 – SOUTH
UNIVERSITY COLLEGE OF NURSING AND
HEALTH SCIENCES – 2026/2027
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
| INSTANT DOWNLOAD PDF
Core Domains:
1. Women's Health (Reproductive, Breast, Gynecologic Conditions)
2. Men's Health (Prostate, Testicular, Urologic Conditions)
3. Geriatric Primary Care (Common Conditions, Polypharmacy, Functional
Decline)
4. Musculoskeletal Disorders and Pain Management
5. Dermatologic Conditions and Skin Cancer Screening
6. Neurologic and Psychiatric Presentations in Primary Care
7. Infectious Disease Management and Antimicrobial Stewardship
8. Preventive Health, Screening Guidelines, and Health Promotion
9. End-of-Life and Palliative Care Principles
10. Evidence-Based Clinical Decision-Making and Referral Criteria
Introduction
This comprehensive examination is designed to evaluate the advanced
practice nursing student's competency in primary care management
across the lifespan. It assesses the integration of evidence-based
guidelines, diagnostic reasoning, and patient-centered care for common
acute and chronic conditions presenting in the outpatient setting. The
exam utilizes a multiple-choice format with clinical scenario-based
questions that reflect real-world primary care encounters. Emphasis is
placed on the application of screening guidelines, pharmacologic and
non-pharmacologic management strategies, and the identification of
,conditions requiring specialty referral. This assessment aligns with
national NP competencies and prepares students for clinical practice.
SECTION ONE: QUESTIONS 1 - 100
1. A 28-year-old woman presents with a 3-month history of irregular
menstrual cycles, hirsutism, and acne. She has a BMI of 32.
Laboratory studies reveal an elevated free testosterone level. Which
of the following is the MOST likely diagnosis?
A. Polycystic ovary syndrome
B. Cushing's syndrome
C. Adrenal tumor
D. Ovarian tumor
A. Polycystic ovary syndrome
RATIONALE: PCOS is the most common cause of hyperandrogenism
in reproductive-aged women. The combination of irregular menses,
hirsutism, acne, obesity, and elevated testosterone is classic. Diagnosis
requires exclusion of other causes and meeting Rotterdam criteria.
2. A 45-year-old woman with a history of breast cancer presents with
hot flashes, night sweats, and vaginal dryness. She is concerned
about managing her menopausal symptoms. Which of the following
is the MOST appropriate recommendation for this patient?
A. Hormone replacement therapy (estrogen plus progestin)
B. Estrogen-only therapy
C. Non-hormonal options such as SSRIs, gabapentin, or venlafaxine
D. Testosterone replacement therapy
C. Non-hormonal options such as SSRIs, gabapentin, or venlafaxine
RATIONALE: Women with a history of breast cancer should not use
systemic hormone therapy due to the risk of recurrence. Non-hormonal
options are preferred. SSRIs (paroxetine, venlafaxine) and gabapentin
are effective for vasomotor symptoms.
,3. A 55-year-old man presents with a 6-month history of difficulty
starting urination, weak stream, and nocturia (3-4 times/night).
Digital rectal examination reveals a smooth, symmetrically
enlarged prostate. What is the MOST likely diagnosis?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Acute bacterial prostatitis
D. Urethral stricture
B. Benign prostatic hyperplasia
RATIONALE: BPH commonly presents with obstructive voiding
symptoms (hesitancy, weak stream) and irritative symptoms (nocturia,
frequency) in men over 50. A smooth, symmetrical prostate on DRE is
consistent with BPH rather than cancer (which is often hard, nodular,
asymmetrical).
4. A 35-year-old woman with no significant medical history presents
with a 3-day history of vaginal discharge with a fishy odor and mild
vulvar itching. On examination, there is a thin, homogeneous white
discharge. A wet mount shows clue cells. What is the MOST
appropriate treatment?
A. Oral metronidazole for 7 days
B. Topical fluconazole
C. Oral fluconazole 150 mg once
D. Oral acyclovir
A. Oral metronidazole for 7 days
RATIONALE: The presentation is classic for bacterial vaginosis. CDC
recommends metronidazole 500 mg twice daily for 7 days or
metronidazole gel or clindamycin cream. Metronidazole is preferred for
its efficacy and convenience.
5. A 68-year-old woman presents with a 2-week history of low back
pain. She has no history of trauma. She reports that the pain is worse
with standing and relieved by lying down. She also has a history of
, osteoporosis. What is the MOST appropriate initial imaging study?
A. X-ray of the lumbar spine
B. MRI of the lumbar spine
C. CT scan of the lumbar spine
D. Bone scan
A. X-ray of the lumbar spine
RATIONALE: In a patient with known osteoporosis and new back
pain, a vertebral compression fracture should be suspected. X-ray is the
initial imaging study of choice to evaluate for compression fractures.
MRI is indicated if there are neurologic deficits or suspected
malignancy.
6. A 25-year-old woman with a history of migraine headaches
presents with a sudden onset of "worst headache of my life"
associated with nausea, vomiting, and photophobia. She has no
history of trauma. What is the MOST appropriate next step?
A. Lumbar puncture
B. Non-contrast head CT
C. MRI of the brain
D. Treat with sumatriptan
B. Non-contrast head CT
RATIONALE: The acute onset of a severe headache ("worst of life")
requires urgent evaluation to rule out subarachnoid hemorrhage. Non-
contrast head CT is the initial imaging study of choice. If CT is negative
but suspicion remains high, lumbar puncture should be performed.
7. A 45-year-old man presents with a 2-week history of cough, fever,
and night sweats. He has a history of heavy alcohol use and
smoking. Chest X-ray shows a cavitary lesion in the right upper
lobe. Sputum culture grows acid-fast bacilli. What is the MOST
appropriate treatment regimen?
A. Azithromycin, ceftriaxone, and vancomycin
B. Isoniazid, rifampin, pyrazinamide, and ethambutol
UNIVERSITY COLLEGE OF NURSING AND
HEALTH SCIENCES – 2026/2027
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS RATIONALES
| INSTANT DOWNLOAD PDF
Core Domains:
1. Women's Health (Reproductive, Breast, Gynecologic Conditions)
2. Men's Health (Prostate, Testicular, Urologic Conditions)
3. Geriatric Primary Care (Common Conditions, Polypharmacy, Functional
Decline)
4. Musculoskeletal Disorders and Pain Management
5. Dermatologic Conditions and Skin Cancer Screening
6. Neurologic and Psychiatric Presentations in Primary Care
7. Infectious Disease Management and Antimicrobial Stewardship
8. Preventive Health, Screening Guidelines, and Health Promotion
9. End-of-Life and Palliative Care Principles
10. Evidence-Based Clinical Decision-Making and Referral Criteria
Introduction
This comprehensive examination is designed to evaluate the advanced
practice nursing student's competency in primary care management
across the lifespan. It assesses the integration of evidence-based
guidelines, diagnostic reasoning, and patient-centered care for common
acute and chronic conditions presenting in the outpatient setting. The
exam utilizes a multiple-choice format with clinical scenario-based
questions that reflect real-world primary care encounters. Emphasis is
placed on the application of screening guidelines, pharmacologic and
non-pharmacologic management strategies, and the identification of
,conditions requiring specialty referral. This assessment aligns with
national NP competencies and prepares students for clinical practice.
SECTION ONE: QUESTIONS 1 - 100
1. A 28-year-old woman presents with a 3-month history of irregular
menstrual cycles, hirsutism, and acne. She has a BMI of 32.
Laboratory studies reveal an elevated free testosterone level. Which
of the following is the MOST likely diagnosis?
A. Polycystic ovary syndrome
B. Cushing's syndrome
C. Adrenal tumor
D. Ovarian tumor
A. Polycystic ovary syndrome
RATIONALE: PCOS is the most common cause of hyperandrogenism
in reproductive-aged women. The combination of irregular menses,
hirsutism, acne, obesity, and elevated testosterone is classic. Diagnosis
requires exclusion of other causes and meeting Rotterdam criteria.
2. A 45-year-old woman with a history of breast cancer presents with
hot flashes, night sweats, and vaginal dryness. She is concerned
about managing her menopausal symptoms. Which of the following
is the MOST appropriate recommendation for this patient?
A. Hormone replacement therapy (estrogen plus progestin)
B. Estrogen-only therapy
C. Non-hormonal options such as SSRIs, gabapentin, or venlafaxine
D. Testosterone replacement therapy
C. Non-hormonal options such as SSRIs, gabapentin, or venlafaxine
RATIONALE: Women with a history of breast cancer should not use
systemic hormone therapy due to the risk of recurrence. Non-hormonal
options are preferred. SSRIs (paroxetine, venlafaxine) and gabapentin
are effective for vasomotor symptoms.
,3. A 55-year-old man presents with a 6-month history of difficulty
starting urination, weak stream, and nocturia (3-4 times/night).
Digital rectal examination reveals a smooth, symmetrically
enlarged prostate. What is the MOST likely diagnosis?
A. Prostate cancer
B. Benign prostatic hyperplasia
C. Acute bacterial prostatitis
D. Urethral stricture
B. Benign prostatic hyperplasia
RATIONALE: BPH commonly presents with obstructive voiding
symptoms (hesitancy, weak stream) and irritative symptoms (nocturia,
frequency) in men over 50. A smooth, symmetrical prostate on DRE is
consistent with BPH rather than cancer (which is often hard, nodular,
asymmetrical).
4. A 35-year-old woman with no significant medical history presents
with a 3-day history of vaginal discharge with a fishy odor and mild
vulvar itching. On examination, there is a thin, homogeneous white
discharge. A wet mount shows clue cells. What is the MOST
appropriate treatment?
A. Oral metronidazole for 7 days
B. Topical fluconazole
C. Oral fluconazole 150 mg once
D. Oral acyclovir
A. Oral metronidazole for 7 days
RATIONALE: The presentation is classic for bacterial vaginosis. CDC
recommends metronidazole 500 mg twice daily for 7 days or
metronidazole gel or clindamycin cream. Metronidazole is preferred for
its efficacy and convenience.
5. A 68-year-old woman presents with a 2-week history of low back
pain. She has no history of trauma. She reports that the pain is worse
with standing and relieved by lying down. She also has a history of
, osteoporosis. What is the MOST appropriate initial imaging study?
A. X-ray of the lumbar spine
B. MRI of the lumbar spine
C. CT scan of the lumbar spine
D. Bone scan
A. X-ray of the lumbar spine
RATIONALE: In a patient with known osteoporosis and new back
pain, a vertebral compression fracture should be suspected. X-ray is the
initial imaging study of choice to evaluate for compression fractures.
MRI is indicated if there are neurologic deficits or suspected
malignancy.
6. A 25-year-old woman with a history of migraine headaches
presents with a sudden onset of "worst headache of my life"
associated with nausea, vomiting, and photophobia. She has no
history of trauma. What is the MOST appropriate next step?
A. Lumbar puncture
B. Non-contrast head CT
C. MRI of the brain
D. Treat with sumatriptan
B. Non-contrast head CT
RATIONALE: The acute onset of a severe headache ("worst of life")
requires urgent evaluation to rule out subarachnoid hemorrhage. Non-
contrast head CT is the initial imaging study of choice. If CT is negative
but suspicion remains high, lumbar puncture should be performed.
7. A 45-year-old man presents with a 2-week history of cough, fever,
and night sweats. He has a history of heavy alcohol use and
smoking. Chest X-ray shows a cavitary lesion in the right upper
lobe. Sputum culture grows acid-fast bacilli. What is the MOST
appropriate treatment regimen?
A. Azithromycin, ceftriaxone, and vancomycin
B. Isoniazid, rifampin, pyrazinamide, and ethambutol
