NR 601 Final Exam – Primary Care of the Maturing
& Aged Family Practicum- Chamberlain
100 Multiple-Choice Questions with Rationales
WEEK 5 – ENDOCRINE (25 questions)
1. A 62-year-old patient presents with polyuria, polydipsia, and a fasting glucose of
140 mg/dL. Which test confirms the diagnosis of diabetes mellitus?
A. Random glucose 180 mg/dL with symptoms
B. A1C 6.5% or higher
C. 2-hour OGTT 180 mg/dL
D. Urine glucose positive
Answer: B
Rationale: A1C ≥6.5% is diagnostic. Fasting glucose ≥126 mg/dL, 2-hour OGTT ≥200
mg/dL, or random glucose ≥200 mg/dL with symptoms also confirm. A random glucose
of 180 mg/dL is not diagnostic.
2. A 70-year-old patient with new-onset type 2 diabetes has an eGFR of 45 mL/min
and heart failure with reduced ejection fraction. Which medication class offers
cardiorenal benefit?
A. Sulfonylurea
B. Thiazolidinedione
C. SGLT2 inhibitor
D. DPP-4 inhibitor
Answer: C
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) reduce cardiovascular
death and slow CKD progression in patients with HF and CKD.
3. A patient with type 2 diabetes is started on metformin. Which lab value requires
monitoring before initiation?
A. A1C
B. eGFR
C. ALT
D. TSH
,Answer: B
Rationale: Metformin is contraindicated when eGFR <30 mL/min and should be used
with caution when eGFR 30–45. Renal function must be assessed before starting.
4. A 58-year-old patient with diabetes has an A1C of 7.8% on metformin. He has no
ASCVD, HF, or CKD. Which is the next best step?
A. Add insulin glargine
B. Add a GLP-1 receptor agonist
C. Add a sulfonylurea
D. Continue metformin alone; lifestyle only
Answer: B
Rationale: GLP-1 receptor agonists (e.g., semaglutide) are preferred add-on agents due
to low hypoglycemia risk and weight loss benefits, especially when A1C is above target.
5. A 72-year-old woman with diabetes reports bilateral burning and numbness in
her feet. Which test should the nurse practitioner perform?
A. Monofilament test
B. Tinel sign
C. Phalen maneuver
D. Straight leg raise
Answer: A
Rationale: Monofilament testing assesses for loss of protective sensation in diabetic
peripheral neuropathy.
6. A 68-year-old patient with hypothyroidism is started on levothyroxine. TSH level
on treatment is 8.0 mIU/L. What should the nurse practitioner do?
A. Decrease the dose
B. Increase the dose
C. Maintain current dose
D. Switch to liothyronine
Answer: B
Rationale: Elevated TSH indicates inadequate thyroid hormone replacement. The dose
should be increased and TSH rechecked in 6–8 weeks.
, 7. A 75-year-old woman with hypothyroidism and coronary artery disease is started
on levothyroxine. Which starting dose is most appropriate?
A. 25 mcg daily
B. 75 mcg daily
C. 100 mcg daily
D. 150 mcg daily
Answer: A
Rationale: Older adults and patients with cardiac disease should start with a low dose
(12.5–25 mcg) and titrate slowly to avoid precipitating angina or arrhythmias.
8. A patient presents with weight loss, heat intolerance, palpitations, and a fine
tremor. TSH is <0.01 mIU/L, free T4 is elevated. What is the most likely diagnosis?
A. Secondary hypothyroidism
B. Primary hyperthyroidism
C. Euthyroid sick syndrome
D. Subclinical hypothyroidism
Answer: B
Rationale: Suppressed TSH with elevated free T4 confirms primary hyperthyroidism.
9. A 66-year-old patient with Graves disease has a resting heart rate of 110 bpm and
mild tremor. Which medication should be started first?
A. Methimazole
B. Propranolol
C. Radioactive iodine
D. Prednisone
Answer: B
Rationale: Beta blockers (e.g., propranolol) rapidly control adrenergic symptoms
(tachycardia, tremor) while antithyroid medications take weeks to lower hormone
levels.
10. A patient with hyperthyroidism develops fever (104°F), severe tachycardia,
delirium, and vomiting. What is the priority intervention?
A. Administer acetaminophen
B. Start propranolol and methimazole
C. Prepare for emergency thyroidectomy
D. Administer IV fluids only
Answer: B
& Aged Family Practicum- Chamberlain
100 Multiple-Choice Questions with Rationales
WEEK 5 – ENDOCRINE (25 questions)
1. A 62-year-old patient presents with polyuria, polydipsia, and a fasting glucose of
140 mg/dL. Which test confirms the diagnosis of diabetes mellitus?
A. Random glucose 180 mg/dL with symptoms
B. A1C 6.5% or higher
C. 2-hour OGTT 180 mg/dL
D. Urine glucose positive
Answer: B
Rationale: A1C ≥6.5% is diagnostic. Fasting glucose ≥126 mg/dL, 2-hour OGTT ≥200
mg/dL, or random glucose ≥200 mg/dL with symptoms also confirm. A random glucose
of 180 mg/dL is not diagnostic.
2. A 70-year-old patient with new-onset type 2 diabetes has an eGFR of 45 mL/min
and heart failure with reduced ejection fraction. Which medication class offers
cardiorenal benefit?
A. Sulfonylurea
B. Thiazolidinedione
C. SGLT2 inhibitor
D. DPP-4 inhibitor
Answer: C
Rationale: SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) reduce cardiovascular
death and slow CKD progression in patients with HF and CKD.
3. A patient with type 2 diabetes is started on metformin. Which lab value requires
monitoring before initiation?
A. A1C
B. eGFR
C. ALT
D. TSH
,Answer: B
Rationale: Metformin is contraindicated when eGFR <30 mL/min and should be used
with caution when eGFR 30–45. Renal function must be assessed before starting.
4. A 58-year-old patient with diabetes has an A1C of 7.8% on metformin. He has no
ASCVD, HF, or CKD. Which is the next best step?
A. Add insulin glargine
B. Add a GLP-1 receptor agonist
C. Add a sulfonylurea
D. Continue metformin alone; lifestyle only
Answer: B
Rationale: GLP-1 receptor agonists (e.g., semaglutide) are preferred add-on agents due
to low hypoglycemia risk and weight loss benefits, especially when A1C is above target.
5. A 72-year-old woman with diabetes reports bilateral burning and numbness in
her feet. Which test should the nurse practitioner perform?
A. Monofilament test
B. Tinel sign
C. Phalen maneuver
D. Straight leg raise
Answer: A
Rationale: Monofilament testing assesses for loss of protective sensation in diabetic
peripheral neuropathy.
6. A 68-year-old patient with hypothyroidism is started on levothyroxine. TSH level
on treatment is 8.0 mIU/L. What should the nurse practitioner do?
A. Decrease the dose
B. Increase the dose
C. Maintain current dose
D. Switch to liothyronine
Answer: B
Rationale: Elevated TSH indicates inadequate thyroid hormone replacement. The dose
should be increased and TSH rechecked in 6–8 weeks.
, 7. A 75-year-old woman with hypothyroidism and coronary artery disease is started
on levothyroxine. Which starting dose is most appropriate?
A. 25 mcg daily
B. 75 mcg daily
C. 100 mcg daily
D. 150 mcg daily
Answer: A
Rationale: Older adults and patients with cardiac disease should start with a low dose
(12.5–25 mcg) and titrate slowly to avoid precipitating angina or arrhythmias.
8. A patient presents with weight loss, heat intolerance, palpitations, and a fine
tremor. TSH is <0.01 mIU/L, free T4 is elevated. What is the most likely diagnosis?
A. Secondary hypothyroidism
B. Primary hyperthyroidism
C. Euthyroid sick syndrome
D. Subclinical hypothyroidism
Answer: B
Rationale: Suppressed TSH with elevated free T4 confirms primary hyperthyroidism.
9. A 66-year-old patient with Graves disease has a resting heart rate of 110 bpm and
mild tremor. Which medication should be started first?
A. Methimazole
B. Propranolol
C. Radioactive iodine
D. Prednisone
Answer: B
Rationale: Beta blockers (e.g., propranolol) rapidly control adrenergic symptoms
(tachycardia, tremor) while antithyroid medications take weeks to lower hormone
levels.
10. A patient with hyperthyroidism develops fever (104°F), severe tachycardia,
delirium, and vomiting. What is the priority intervention?
A. Administer acetaminophen
B. Start propranolol and methimazole
C. Prepare for emergency thyroidectomy
D. Administer IV fluids only
Answer: B
