NRNP 6531 PRIMARY CARE OF ADULTS FINAL EXAM –
COMPLETE STUDY GUIDE | PRACTICE QUESTIONS AND
ANSWERS-RATIONALES | EXAM PREP | DOWNLOAD INSTANT
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1. A 58-year-old male with a ten-year history of poorly controlled hypertension presents for
a routine primary care evaluation. His current blood pressure is 148/92 mmHg, and his
estimated glomerular filtration rate is 58 mL/min/1.73m² with persistent
microalbuminuria. Which of the following is the most appropriate first-line
antihypertensive agent to initiate for renal protection in this adult patient?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol tartrate
Answer: B
Angiotensin-converting enzyme inhibitors, such as lisinopril, or angiotensin receptor blockers
are the first-line antihypertensive agents of choice for adult patients with hypertension and
chronic kidney disease or albuminuria because they reduce intraglomerular pressure and slow
the progression of renal disease.
2. A 45-year-old female presents with complaints of fatigue, cold intolerance, dry skin, and
mild weight gain over the past six months. Laboratory evaluation reveals a serum thyroid-
stimulating hormone level of 8.4 mIU/L (elevated) and a free thyroxine level below the
normal reference range. What is the most appropriate initial management step?
A. Initiate levothyroxine replacement therapy at a low starting dose and recheck thyroid-
stimulating hormone in 6 weeks
B. Prescribe high-dose liothyronine and repeat labs in 3 months
C. Reassure the patient and repeat thyroid function tests in 2 years
D. Refer immediately for total thyroidectomy
Answer: A
Primary hypothyroidism is characterized by an elevated thyroid-stimulating hormone and a
low free thyroxine level. Initiating levothyroxine at a low dose (typically 25 to 50 mcg daily in
,otherwise healthy adults) and rechecking levels in 6 weeks allows for safe titration toward
euthyroidism.
3. A 62-year-old male with a 40-pack-year smoking history presents with chronic
productive cough and progressive dyspnea on exertion. Spirometry confirms post-
bronchodilator forced expiratory volume in one second to forced vital capacity ratio of 0.65
and forced expiratory volume in one second of 55% of predicted. What is the most
appropriate initial pharmacotherapeutic class for long-term maintenance treatment of his
condition?
A. Inhaled short-acting beta-2 agonist as needed
B. Long-acting muscarinic antagonist or long-acting beta-2 agonist
C. Chronic oral systemic corticosteroids
D. High-dose antitussive monotherapy
Answer: B
For adult patients with moderate chronic obstructive pulmonary disease, long-acting
bronchodilators such as a long-acting muscarinic antagonist or long-acting beta-2 agonist
represent the foundational first-line maintenance therapy to reduce exacerbations and
improve functional capacity.
4. A 34-year-old female presents with acute onset of right upper quadrant abdominal pain
radiating to her right scapula, accompanied by nausea and vomiting following a fatty meal.
Murphy’s sign is positive on physical examination. Which diagnostic imaging modality is
considered the gold standard for confirming this diagnosis in primary care?
A. Abdominal magnetic resonance cholangiopancreatography
B. Right upper quadrant ultrasonography
C. Plain abdominal radiography
D. Barium swallow study
Answer: B
Right upper quadrant ultrasonography is the preferred, highly sensitive, and specific initial
imaging modality for evaluating acute cholecystitis and cholelithiasis, readily identifying
gallbladder wall thickening, pericholecystic fluid, and gallstones.
5. A 50-year-old male presents for a routine health maintenance exam. He has no personal
history of cardiovascular disease, but his calculated 10-year atherosclerotic cardiovascular
,disease risk score is 11.5%, and his low-density lipoprotein cholesterol is 150 mg/dL. He
has a normal fasting blood glucose. According to current guidelines, what is the most
appropriate recommendation regarding statin therapy?
A. Initiate moderate-intensity statin therapy for primary prevention
B. Recommend strict dietary modifications alone for 5 years without medication consideration
C. Initiate high-intensity statin therapy regardless of risk score
D. Order immediate coronary artery bypass grafting evaluation
Answer: A
For adult patients aged 40 to 75 years with a low-density lipoprotein cholesterol between 70
and 189 mg/dL and a calculated 10-year atherosclerotic cardiovascular disease risk of 7.5% or
higher, initiating moderate-intensity statin therapy is recommended for primary prevention.
6. A 68-year-old female presents with insidious onset of deep, aching pain in both knees
that worsens with activity and improves with rest, accompanied by morning stiffness
lasting less than 15 minutes. Radiographs reveal joint space narrowing, subchondral
sclerosis, and osteophytes. What is the primary pathophysiological mechanism underlying
this clinical condition?
A. Systemic autoimmune destruction of the synovial membrane
B. Progressive mechanical wear and tear leading to articular cartilage degradation and bone
remodeling
C. Urate crystal deposition within the intra-articular space
D. Infectious purulent infiltration of the joint capsule
Answer: B
Osteoarthritis is characterized by non-inflammatory mechanical wear and tear of articular
cartilage, leading to cartilage loss, subchondral bone sclerosis, and osteophyte formation, most
commonly affecting weight-bearing joints in older adults.
7. A 24-year-old female presents with dysuria, increased urinary frequency, and
suprapubic discomfort for two days. Urinalysis reveals positive leukocyte esterase, positive
nitrites, and numerous white blood cells. Urine culture confirms Escherichia coli. She has
no fever, flank pain, or systemic symptoms. What is the most appropriate first-line
outpatient antibiotic regimen?
A. Nitrofurantoin 100 mg orally twice daily for 5 days
, B. Ciprofloxacin 500 mg orally twice daily for 14 days
C. Intravenous vancomycin 1 gram every 12 hours
D. Azithromycin 500 mg orally as a single dose
Answer: A
Uncomplicated acute bacterial cystitis in non-pregnant adult females is effectively treated with
first-line agents such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days,
or fosfomycin as a single dose, avoiding broad-spectrum fluoroquinolones whenever possible.
8. A 52-year-old male presents with sudden, excruciating pain, swelling, and erythema of
the first metatarsophalangeal joint of his right foot, starting overnight. He has a history of
hypertension managed with hydrochlorothiazide. Arthrocentesis reveals negatively
birefringent needle-shaped crystals. What is the most appropriate acute treatment?
A. Oral colchicine, nonsteroidal anti-inflammatory drugs, or oral corticosteroids
B. Allopurinol initiation at a high daily dose immediately
C. Immediate surgical debridement of the joint capsule
D. Application of high-intensity heat packs continuously
Answer: A
Acute gout flares are managed with anti-inflammatory agents such as nonsteroidal anti-
inflammatory drugs, oral colchicine, or corticosteroids to suppress inflammation. Allopurinol
is reserved for long-term urate-lowering therapy and should not be initiated during an acute
flare unless already established.
9. A 70-year-old male presents for evaluation of progressive urinary hesitancy, weak
stream, nocturia, and sensation of incomplete bladder emptying. Digital rectal examination
reveals a moderately enlarged, smooth, non-nodular prostate gland. What is the most
appropriate initial medication class to relieve his dynamic urinary obstruction?
A. Phosphodiesterase-5 inhibitor
B. Alpha-1 adrenergic receptor antagonist
C. 5-alpha-reductase inhibitor
D. Anticholinergic agent
COMPLETE STUDY GUIDE | PRACTICE QUESTIONS AND
ANSWERS-RATIONALES | EXAM PREP | DOWNLOAD INSTANT
PDF | GUARANTEED PASS || LATEST EXAM 2026-2027
1. A 58-year-old male with a ten-year history of poorly controlled hypertension presents for
a routine primary care evaluation. His current blood pressure is 148/92 mmHg, and his
estimated glomerular filtration rate is 58 mL/min/1.73m² with persistent
microalbuminuria. Which of the following is the most appropriate first-line
antihypertensive agent to initiate for renal protection in this adult patient?
A. Amlodipine
B. Lisinopril
C. Hydrochlorothiazide
D. Metoprolol tartrate
Answer: B
Angiotensin-converting enzyme inhibitors, such as lisinopril, or angiotensin receptor blockers
are the first-line antihypertensive agents of choice for adult patients with hypertension and
chronic kidney disease or albuminuria because they reduce intraglomerular pressure and slow
the progression of renal disease.
2. A 45-year-old female presents with complaints of fatigue, cold intolerance, dry skin, and
mild weight gain over the past six months. Laboratory evaluation reveals a serum thyroid-
stimulating hormone level of 8.4 mIU/L (elevated) and a free thyroxine level below the
normal reference range. What is the most appropriate initial management step?
A. Initiate levothyroxine replacement therapy at a low starting dose and recheck thyroid-
stimulating hormone in 6 weeks
B. Prescribe high-dose liothyronine and repeat labs in 3 months
C. Reassure the patient and repeat thyroid function tests in 2 years
D. Refer immediately for total thyroidectomy
Answer: A
Primary hypothyroidism is characterized by an elevated thyroid-stimulating hormone and a
low free thyroxine level. Initiating levothyroxine at a low dose (typically 25 to 50 mcg daily in
,otherwise healthy adults) and rechecking levels in 6 weeks allows for safe titration toward
euthyroidism.
3. A 62-year-old male with a 40-pack-year smoking history presents with chronic
productive cough and progressive dyspnea on exertion. Spirometry confirms post-
bronchodilator forced expiratory volume in one second to forced vital capacity ratio of 0.65
and forced expiratory volume in one second of 55% of predicted. What is the most
appropriate initial pharmacotherapeutic class for long-term maintenance treatment of his
condition?
A. Inhaled short-acting beta-2 agonist as needed
B. Long-acting muscarinic antagonist or long-acting beta-2 agonist
C. Chronic oral systemic corticosteroids
D. High-dose antitussive monotherapy
Answer: B
For adult patients with moderate chronic obstructive pulmonary disease, long-acting
bronchodilators such as a long-acting muscarinic antagonist or long-acting beta-2 agonist
represent the foundational first-line maintenance therapy to reduce exacerbations and
improve functional capacity.
4. A 34-year-old female presents with acute onset of right upper quadrant abdominal pain
radiating to her right scapula, accompanied by nausea and vomiting following a fatty meal.
Murphy’s sign is positive on physical examination. Which diagnostic imaging modality is
considered the gold standard for confirming this diagnosis in primary care?
A. Abdominal magnetic resonance cholangiopancreatography
B. Right upper quadrant ultrasonography
C. Plain abdominal radiography
D. Barium swallow study
Answer: B
Right upper quadrant ultrasonography is the preferred, highly sensitive, and specific initial
imaging modality for evaluating acute cholecystitis and cholelithiasis, readily identifying
gallbladder wall thickening, pericholecystic fluid, and gallstones.
5. A 50-year-old male presents for a routine health maintenance exam. He has no personal
history of cardiovascular disease, but his calculated 10-year atherosclerotic cardiovascular
,disease risk score is 11.5%, and his low-density lipoprotein cholesterol is 150 mg/dL. He
has a normal fasting blood glucose. According to current guidelines, what is the most
appropriate recommendation regarding statin therapy?
A. Initiate moderate-intensity statin therapy for primary prevention
B. Recommend strict dietary modifications alone for 5 years without medication consideration
C. Initiate high-intensity statin therapy regardless of risk score
D. Order immediate coronary artery bypass grafting evaluation
Answer: A
For adult patients aged 40 to 75 years with a low-density lipoprotein cholesterol between 70
and 189 mg/dL and a calculated 10-year atherosclerotic cardiovascular disease risk of 7.5% or
higher, initiating moderate-intensity statin therapy is recommended for primary prevention.
6. A 68-year-old female presents with insidious onset of deep, aching pain in both knees
that worsens with activity and improves with rest, accompanied by morning stiffness
lasting less than 15 minutes. Radiographs reveal joint space narrowing, subchondral
sclerosis, and osteophytes. What is the primary pathophysiological mechanism underlying
this clinical condition?
A. Systemic autoimmune destruction of the synovial membrane
B. Progressive mechanical wear and tear leading to articular cartilage degradation and bone
remodeling
C. Urate crystal deposition within the intra-articular space
D. Infectious purulent infiltration of the joint capsule
Answer: B
Osteoarthritis is characterized by non-inflammatory mechanical wear and tear of articular
cartilage, leading to cartilage loss, subchondral bone sclerosis, and osteophyte formation, most
commonly affecting weight-bearing joints in older adults.
7. A 24-year-old female presents with dysuria, increased urinary frequency, and
suprapubic discomfort for two days. Urinalysis reveals positive leukocyte esterase, positive
nitrites, and numerous white blood cells. Urine culture confirms Escherichia coli. She has
no fever, flank pain, or systemic symptoms. What is the most appropriate first-line
outpatient antibiotic regimen?
A. Nitrofurantoin 100 mg orally twice daily for 5 days
, B. Ciprofloxacin 500 mg orally twice daily for 14 days
C. Intravenous vancomycin 1 gram every 12 hours
D. Azithromycin 500 mg orally as a single dose
Answer: A
Uncomplicated acute bacterial cystitis in non-pregnant adult females is effectively treated with
first-line agents such as nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days,
or fosfomycin as a single dose, avoiding broad-spectrum fluoroquinolones whenever possible.
8. A 52-year-old male presents with sudden, excruciating pain, swelling, and erythema of
the first metatarsophalangeal joint of his right foot, starting overnight. He has a history of
hypertension managed with hydrochlorothiazide. Arthrocentesis reveals negatively
birefringent needle-shaped crystals. What is the most appropriate acute treatment?
A. Oral colchicine, nonsteroidal anti-inflammatory drugs, or oral corticosteroids
B. Allopurinol initiation at a high daily dose immediately
C. Immediate surgical debridement of the joint capsule
D. Application of high-intensity heat packs continuously
Answer: A
Acute gout flares are managed with anti-inflammatory agents such as nonsteroidal anti-
inflammatory drugs, oral colchicine, or corticosteroids to suppress inflammation. Allopurinol
is reserved for long-term urate-lowering therapy and should not be initiated during an acute
flare unless already established.
9. A 70-year-old male presents for evaluation of progressive urinary hesitancy, weak
stream, nocturia, and sensation of incomplete bladder emptying. Digital rectal examination
reveals a moderately enlarged, smooth, non-nodular prostate gland. What is the most
appropriate initial medication class to relieve his dynamic urinary obstruction?
A. Phosphodiesterase-5 inhibitor
B. Alpha-1 adrenergic receptor antagonist
C. 5-alpha-reductase inhibitor
D. Anticholinergic agent
