MN 566 NP I – Introduction to Primary Care
for the Nurse Practitioner | Purdue University
Global 2026/2027 Study Guide, Exam Prep,
Practice Questions & Answers, Clinical
Reasoning, Differential Diagnosis, Diagnostic
Testing, Acute & Chronic Conditions, Health
Promotion and Primary Care Review
Question 1: A 45-year-old male with a history of hypertension presents with a
new onset of painful, red, swollen right great toe. He reports consuming a
large steak and several beers two nights prior. Which of the following is the
most appropriate initial diagnostic test to confirm the suspected diagnosis?
A. Serum uric acid level
B. Synovial fluid analysis for monosodium urate crystals
C. 24-hour urine uric acid collection
D. Serum creatinine and BUN
CORRECT ANSWER: B. Synovial fluid analysis for monosodium urate crystals
Rationale: The gold standard for diagnosing acute gouty arthritis is the identification of
negatively birefringent monosodium urate crystals in synovial fluid aspirated from the
affected joint. While serum uric acid may be elevated, it can be normal during an acute
attack and is not diagnostic. A 24-hour urine collection is useful for evaluating
overproduction or underexcretion of uric acid but is not an initial diagnostic test. Renal
function tests are important for treatment planning but not for definitive diagnosis.
Question 2: A 68-year-old female with a history of COPD presents with
increasing dyspnea and a productive cough with purulent sputum for the past
3 days. She is afebrile, but has increased wheezing on auscultation. Which of
the following is the most appropriate initial antibiotic for an acute
exacerbation of COPD in an outpatient with no recent antibiotic use?
A. Azithromycin
B. Levofloxacin
C. Amoxicillin
D. Doxycycline
CORRECT ANSWER: D. Doxycycline
Rationale: For mild to moderate acute exacerbations of COPD without risk factors for
poor outcomes (e.g., frequent exacerbations, severe airflow obstruction, or recent
antibiotic use), a macrolide, tetracycline, or amoxicillin is recommended. Doxycycline is
a cost-effective and guideline-supported choice that covers common pathogens like
Haemophilus influenzae and Streptococcus pneumoniae. Levofloxacin is a respiratory
fluoroquinolone and is generally reserved for patients with more severe disease or risk
,factors for treatment failure due to concerns about resistance and side effects.
Azithromycin is also an option, but doxycycline is often preferred due to lower cost and
comparable efficacy in this setting.
Question 3: A 32-year-old pregnant woman at 28 weeks gestation presents
with a 2-day history of dysuria, frequency, and urgency. Her urine dipstick is
positive for nitrites and leukocyte esterase. Which of the following antibiotics
is the safest and most appropriate for treating a urinary tract infection in the
third trimester of pregnancy?
A. Ciprofloxacin
B. Nitrofurantoin
C. Doxycycline
D. Trimethoprim-sulfamethoxazole
CORRECT ANSWER: B. Nitrofurantoin
Rationale: Nitrofurantoin is a first-line agent for asymptomatic bacteriuria and acute
cystitis in pregnant women, especially in the second and third trimesters, due to its
safety profile and efficacy against common uropathogens. Fluoroquinolones (e.g.,
ciprofloxacin) are contraindicated in pregnancy due to risk of fetal cartilage damage.
Doxycycline is contraindicated due to effects on fetal bone and tooth development.
Trimethoprim-sulfamethoxazole is generally avoided near term due to the risk of
kernicterus.
Question 4: A 55-year-old obese male with a history of type 2 diabetes and
hypertension presents with a 3-month history of bilateral, burning pain and
tingling in his feet. The pain is worse at night. On examination, his lower
extremity reflexes are diminished and there is decreased sensation to light
touch in a "stocking" distribution. What is the most appropriate first-line
pharmacologic treatment for this patient's neuropathic pain?
A. Ibuprofen
B. Duloxetine
C. Oxycodone
D. Topical lidocaine patch
CORRECT ANSWER: B. Duloxetine
Rationale: This patient's presentation is classic for diabetic peripheral neuropathy.
Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is FDA-approved for
diabetic peripheral neuropathy and is a first-line treatment. Gabapentin and pregabalin
are also first-line options. Ibuprofen is an NSAID and is not effective for neuropathic
pain. Oxycodone is an opioid and is generally not recommended as first-line therapy for
chronic neuropathic pain due to the risk of dependence and long-term side effects.
,Topical lidocaine patches may be used for localized pain but are not the first-line
systemic choice for this patient's diffuse, bilateral symptoms.
Question 5: A 72-year-old male presents with a 6-month history of a resting
tremor in his right hand, rigidity in his right arm, and bradykinesia. He has
also noticed a shuffling gait. Which of the following is the most appropriate
initial pharmacologic therapy to improve motor symptoms?
A. Levodopa-carbidopa
B. Selegiline
C. Amantadine
D. Trihexyphenidyl
CORRECT ANSWER: A. Levodopa-carbidopa
Rationale: Levodopa-carbidopa is the most effective and commonly used initial
symptomatic therapy for Parkinson's disease, particularly in older patients with
significant functional impairment. It provides superior motor symptom relief compared
to other agents. Selegiline (a MAO-B inhibitor) and amantadine are generally used as
adjunctive therapy or in early, mild disease, while trihexyphenidyl (anticholinergic) is
typically reserved for younger patients with prominent tremor.
Question 6: A 48-year-old female presents with fatigue, weight gain, cold
intolerance, and dry skin. Laboratory studies reveal an elevated TSH and a low
free T4. Which of the following is the most likely cause of her hypothyroidism?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Subacute granulomatous thyroiditis
D. Pituitary adenoma
CORRECT ANSWER: B. Hashimoto's thyroiditis
Rationale: This patient's presentation is consistent with primary hypothyroidism. The
most common cause of primary hypothyroidism in iodine-sufficient areas is Hashimoto's
thyroiditis, an autoimmune disorder characterized by anti-thyroid peroxidase antibodies.
Graves' disease causes hyperthyroidism. Subacute thyroiditis can cause a transient
hyperthyroid phase followed by hypothyroidism but is often associated with neck pain.
A pituitary adenoma would cause secondary hypothyroidism, presenting with a low
TSH and low free T4.
Question 7: A 58-year-old male with a 30-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest x-ray shows a right
, hilar mass. Which of the following is the most appropriate initial step in the
diagnostic workup?
A. CT-guided biopsy of the mass
B. Bronchoscopy with biopsy
C. PET scan
D. Sputum cytology
CORRECT ANSWER: B. Bronchoscopy with biopsy
Rationale: Bronchoscopy with biopsy is the preferred initial diagnostic procedure for a
central hilar mass suspected of being lung cancer, as it allows direct visualization and
biopsy of the lesion. CT-guided biopsy is an option for peripheral lesions but carries a
higher risk of pneumothorax and may not be appropriate for central lesions near major
vessels. PET scans are useful for staging once a diagnosis is confirmed. Sputum cytology
has low sensitivity for central tumors compared to tissue biopsy.
Question 8: A 29-year-old female presents with palpitations, heat intolerance,
and weight loss despite a good appetite. On examination, she has a fine tremor
and a diffusely enlarged, nontender thyroid gland. Which of the following
laboratory findings would be most consistent with Graves' disease?
A. Elevated TSH and elevated free T4
B. Low TSH and elevated free T4
C. Low TSH and low free T4
D. Elevated TSH and low free T4
CORRECT ANSWER: B. Low TSH and elevated free T4
Rationale: Graves' disease is the most common cause of hyperthyroidism. In primary
hyperthyroidism, negative feedback inhibition leads to a suppressed TSH, while the
thyroid hormones (free T4 and T3) are elevated. Elevated TSH with elevated free T4 is
seen in TSH-secreting pituitary adenomas. Low TSH and low free T4 are consistent with
central hypothyroidism. Elevated TSH and low free T4 are seen in primary
hypothyroidism.
Question 9: A 65-year-old male with a history of atrial fibrillation and chronic
kidney disease stage 3 presents with a sudden onset of severe, sharp chest
pain that is worse with inspiration. On examination, he is tachypneic and has
an elevated jugular venous pressure. An EKG shows sinus tachycardia with
S1Q3T3 findings. What is the most appropriate initial anticoagulant for this
patient if he has a confirmed massive pulmonary embolism?
A. Unfractionated heparin IV
B. Low-molecular-weight heparin SC
for the Nurse Practitioner | Purdue University
Global 2026/2027 Study Guide, Exam Prep,
Practice Questions & Answers, Clinical
Reasoning, Differential Diagnosis, Diagnostic
Testing, Acute & Chronic Conditions, Health
Promotion and Primary Care Review
Question 1: A 45-year-old male with a history of hypertension presents with a
new onset of painful, red, swollen right great toe. He reports consuming a
large steak and several beers two nights prior. Which of the following is the
most appropriate initial diagnostic test to confirm the suspected diagnosis?
A. Serum uric acid level
B. Synovial fluid analysis for monosodium urate crystals
C. 24-hour urine uric acid collection
D. Serum creatinine and BUN
CORRECT ANSWER: B. Synovial fluid analysis for monosodium urate crystals
Rationale: The gold standard for diagnosing acute gouty arthritis is the identification of
negatively birefringent monosodium urate crystals in synovial fluid aspirated from the
affected joint. While serum uric acid may be elevated, it can be normal during an acute
attack and is not diagnostic. A 24-hour urine collection is useful for evaluating
overproduction or underexcretion of uric acid but is not an initial diagnostic test. Renal
function tests are important for treatment planning but not for definitive diagnosis.
Question 2: A 68-year-old female with a history of COPD presents with
increasing dyspnea and a productive cough with purulent sputum for the past
3 days. She is afebrile, but has increased wheezing on auscultation. Which of
the following is the most appropriate initial antibiotic for an acute
exacerbation of COPD in an outpatient with no recent antibiotic use?
A. Azithromycin
B. Levofloxacin
C. Amoxicillin
D. Doxycycline
CORRECT ANSWER: D. Doxycycline
Rationale: For mild to moderate acute exacerbations of COPD without risk factors for
poor outcomes (e.g., frequent exacerbations, severe airflow obstruction, or recent
antibiotic use), a macrolide, tetracycline, or amoxicillin is recommended. Doxycycline is
a cost-effective and guideline-supported choice that covers common pathogens like
Haemophilus influenzae and Streptococcus pneumoniae. Levofloxacin is a respiratory
fluoroquinolone and is generally reserved for patients with more severe disease or risk
,factors for treatment failure due to concerns about resistance and side effects.
Azithromycin is also an option, but doxycycline is often preferred due to lower cost and
comparable efficacy in this setting.
Question 3: A 32-year-old pregnant woman at 28 weeks gestation presents
with a 2-day history of dysuria, frequency, and urgency. Her urine dipstick is
positive for nitrites and leukocyte esterase. Which of the following antibiotics
is the safest and most appropriate for treating a urinary tract infection in the
third trimester of pregnancy?
A. Ciprofloxacin
B. Nitrofurantoin
C. Doxycycline
D. Trimethoprim-sulfamethoxazole
CORRECT ANSWER: B. Nitrofurantoin
Rationale: Nitrofurantoin is a first-line agent for asymptomatic bacteriuria and acute
cystitis in pregnant women, especially in the second and third trimesters, due to its
safety profile and efficacy against common uropathogens. Fluoroquinolones (e.g.,
ciprofloxacin) are contraindicated in pregnancy due to risk of fetal cartilage damage.
Doxycycline is contraindicated due to effects on fetal bone and tooth development.
Trimethoprim-sulfamethoxazole is generally avoided near term due to the risk of
kernicterus.
Question 4: A 55-year-old obese male with a history of type 2 diabetes and
hypertension presents with a 3-month history of bilateral, burning pain and
tingling in his feet. The pain is worse at night. On examination, his lower
extremity reflexes are diminished and there is decreased sensation to light
touch in a "stocking" distribution. What is the most appropriate first-line
pharmacologic treatment for this patient's neuropathic pain?
A. Ibuprofen
B. Duloxetine
C. Oxycodone
D. Topical lidocaine patch
CORRECT ANSWER: B. Duloxetine
Rationale: This patient's presentation is classic for diabetic peripheral neuropathy.
Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is FDA-approved for
diabetic peripheral neuropathy and is a first-line treatment. Gabapentin and pregabalin
are also first-line options. Ibuprofen is an NSAID and is not effective for neuropathic
pain. Oxycodone is an opioid and is generally not recommended as first-line therapy for
chronic neuropathic pain due to the risk of dependence and long-term side effects.
,Topical lidocaine patches may be used for localized pain but are not the first-line
systemic choice for this patient's diffuse, bilateral symptoms.
Question 5: A 72-year-old male presents with a 6-month history of a resting
tremor in his right hand, rigidity in his right arm, and bradykinesia. He has
also noticed a shuffling gait. Which of the following is the most appropriate
initial pharmacologic therapy to improve motor symptoms?
A. Levodopa-carbidopa
B. Selegiline
C. Amantadine
D. Trihexyphenidyl
CORRECT ANSWER: A. Levodopa-carbidopa
Rationale: Levodopa-carbidopa is the most effective and commonly used initial
symptomatic therapy for Parkinson's disease, particularly in older patients with
significant functional impairment. It provides superior motor symptom relief compared
to other agents. Selegiline (a MAO-B inhibitor) and amantadine are generally used as
adjunctive therapy or in early, mild disease, while trihexyphenidyl (anticholinergic) is
typically reserved for younger patients with prominent tremor.
Question 6: A 48-year-old female presents with fatigue, weight gain, cold
intolerance, and dry skin. Laboratory studies reveal an elevated TSH and a low
free T4. Which of the following is the most likely cause of her hypothyroidism?
A. Graves' disease
B. Hashimoto's thyroiditis
C. Subacute granulomatous thyroiditis
D. Pituitary adenoma
CORRECT ANSWER: B. Hashimoto's thyroiditis
Rationale: This patient's presentation is consistent with primary hypothyroidism. The
most common cause of primary hypothyroidism in iodine-sufficient areas is Hashimoto's
thyroiditis, an autoimmune disorder characterized by anti-thyroid peroxidase antibodies.
Graves' disease causes hyperthyroidism. Subacute thyroiditis can cause a transient
hyperthyroid phase followed by hypothyroidism but is often associated with neck pain.
A pituitary adenoma would cause secondary hypothyroidism, presenting with a low
TSH and low free T4.
Question 7: A 58-year-old male with a 30-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. A chest x-ray shows a right
, hilar mass. Which of the following is the most appropriate initial step in the
diagnostic workup?
A. CT-guided biopsy of the mass
B. Bronchoscopy with biopsy
C. PET scan
D. Sputum cytology
CORRECT ANSWER: B. Bronchoscopy with biopsy
Rationale: Bronchoscopy with biopsy is the preferred initial diagnostic procedure for a
central hilar mass suspected of being lung cancer, as it allows direct visualization and
biopsy of the lesion. CT-guided biopsy is an option for peripheral lesions but carries a
higher risk of pneumothorax and may not be appropriate for central lesions near major
vessels. PET scans are useful for staging once a diagnosis is confirmed. Sputum cytology
has low sensitivity for central tumors compared to tissue biopsy.
Question 8: A 29-year-old female presents with palpitations, heat intolerance,
and weight loss despite a good appetite. On examination, she has a fine tremor
and a diffusely enlarged, nontender thyroid gland. Which of the following
laboratory findings would be most consistent with Graves' disease?
A. Elevated TSH and elevated free T4
B. Low TSH and elevated free T4
C. Low TSH and low free T4
D. Elevated TSH and low free T4
CORRECT ANSWER: B. Low TSH and elevated free T4
Rationale: Graves' disease is the most common cause of hyperthyroidism. In primary
hyperthyroidism, negative feedback inhibition leads to a suppressed TSH, while the
thyroid hormones (free T4 and T3) are elevated. Elevated TSH with elevated free T4 is
seen in TSH-secreting pituitary adenomas. Low TSH and low free T4 are consistent with
central hypothyroidism. Elevated TSH and low free T4 are seen in primary
hypothyroidism.
Question 9: A 65-year-old male with a history of atrial fibrillation and chronic
kidney disease stage 3 presents with a sudden onset of severe, sharp chest
pain that is worse with inspiration. On examination, he is tachypneic and has
an elevated jugular venous pressure. An EKG shows sinus tachycardia with
S1Q3T3 findings. What is the most appropriate initial anticoagulant for this
patient if he has a confirmed massive pulmonary embolism?
A. Unfractionated heparin IV
B. Low-molecular-weight heparin SC
