1
EXAM 1, EXAM 2, EXAM 3 & EXAM 4: NSG555 / NSG 555
(LATEST UPDATES STUDY BUNDLE WITH
COMPLETE SOLUTIONS) - NURSE PRACTITIONERS IN
PRIMARY CARE II EXAM REVIEWS | COMPLETE GUIDE
WITH QUESTIONS AND VERIFIED ANSWERS | ALL
MODULES COVERED
1.
A 58-year-old patient presents for follow-up after several elevated blood-pressure
measurements obtained at home and in the clinic. The patient has no history of
cardiovascular disease, diabetes, or chronic kidney disease. Blood pressure
readings have consistently remained above the recommended treatment threshold
despite lifestyle modifications involving sodium restriction, increased physical
activity, weight reduction, and limitation of alcohol intake. Which intervention is
most appropriate for the nurse practitioner to initiate as part of evidence-based
primary-care management?
A. Begin appropriate first-line antihypertensive pharmacotherapy and continue
lifestyle modification
B. Delay pharmacologic therapy for another year regardless of blood-pressure
readings
C. Begin a loop diuretic as monotherapy in every patient with uncomplicated
hypertension
D. Recommend aspirin as the primary treatment for elevated blood pressure
Answer: A
2.
A 64-year-old patient with hypertension has been taking lisinopril consistently for
several months. The patient now reports a persistent dry, nonproductive cough that
began after initiation of therapy and has continued despite treatment of possible
environmental causes. Examination is otherwise unremarkable, and there is no
evidence of infection or heart failure. Which medication change is most
appropriate?
A. Add another ACE inhibitor
B. Discontinue the ACE inhibitor and substitute an appropriate angiotensin
,2
receptor blocker
C. Increase the lisinopril dosage
D. Add a short-acting nitrate
Answer: B
3.
A 52-year-old patient with type 2 diabetes has been taking metformin along with
lifestyle therapy, but the most recent HbA1c remains significantly above the
individualized target. The patient has obesity and established cardiovascular risk
factors but no contraindication to additional glucose-lowering therapy. Which
approach should the nurse practitioner consider when intensifying treatment?
A. Add an evidence-based agent that also addresses cardiovascular and/or weight-
related risk
B. Stop all diabetes medication and prescribe dietary therapy alone
C. Begin chronic short-acting insulin in every patient with an elevated HbA1c
D. Discontinue metformin solely because the HbA1c remains elevated
Answer: A
4.
A 71-year-old patient with type 2 diabetes is being evaluated during an annual
primary-care visit. The patient reports no visual symptoms and has never been
diagnosed with diabetic retinopathy. The patient asks whether an eye examination
is still necessary because vision appears normal. Which response reflects
appropriate preventive management?
A. Screening is unnecessary unless visual symptoms develop
B. Retinal evaluation should be performed according to diabetes screening
recommendations
C. Eye screening is required only after insulin is started
D. Screening is necessary only when HbA1c exceeds 10%
Answer: B
5.
,3
A 67-year-old patient with diabetes has decreased sensation to monofilament
testing over several plantar surfaces of both feet. There is no ulceration, cellulitis,
or active wound. Which management strategy is most appropriate?
A. Routine foot surveillance, protective footwear, daily inspection, and risk-based
follow-up
B. Encourage walking barefoot to strengthen the feet
C. Apply topical corticosteroids to all areas of decreased sensation
D. Restrict all physical activity permanently
Answer: A
6.
A 60-year-old patient with type 2 diabetes presents with an HbA1c substantially
above the individualized goal despite adherence to two noninsulin glucose-
lowering medications. The patient reports polyuria and polydipsia and has
experienced unintended weight loss. Which finding would most strongly support
consideration of insulin therapy?
A. Mildly elevated fasting glucose without symptoms
B. Significant symptomatic hyperglycemia with catabolic features
C. HbA1c at the individualized target
D. Normal fasting glucose with occasional postprandial elevation
Answer: B
7.
A 45-year-old patient with obesity and hypertension has laboratory testing showing
elevated LDL cholesterol. The patient has no history of statin intolerance and has
multiple cardiovascular risk factors. Which pharmacologic intervention is
generally appropriate when indicated by the patient's overall ASCVD risk
assessment?
A. Statin therapy at an appropriate intensity
B. Niacin monotherapy for every patient
C. Immediate fibrate monotherapy regardless of triglyceride level
D. Discontinue dietary interventions after starting medication
Answer: A
, 4
8.
A 59-year-old patient taking a statin reports new generalized muscle aching. The
patient denies trauma or strenuous exercise and is concerned that the medication
may be responsible. Which initial clinical approach is most appropriate?
A. Evaluate symptoms and relevant laboratory findings while assessing alternative
causes and medication-related adverse effects
B. Immediately increase the statin dose
C. Tell the patient that statins can never cause muscle symptoms
D. Begin chronic corticosteroid therapy
Answer: A
9.
A 73-year-old patient with chronic kidney disease and hypertension is being
followed in primary care. Laboratory evaluation demonstrates persistent
albuminuria. Which class of medication may provide both blood-pressure control
and kidney-protective benefit when clinically appropriate?
A. ACE inhibitor or ARB
B. Anticholinergic medication
C. Proton-pump inhibitor
D. H2 receptor antagonist
Answer: A
10.
A 55-year-old patient presents with fatigue and laboratory findings consistent with
primary hypothyroidism. The patient has no evidence of acute illness and is not
pregnant. Which medication is generally used as first-line thyroid hormone
replacement?
A. Levothyroxine
B. Methimazole
C. Propylthiouracil
D. Radioactive iodine as immediate replacement therapy
Answer: A
EXAM 1, EXAM 2, EXAM 3 & EXAM 4: NSG555 / NSG 555
(LATEST UPDATES STUDY BUNDLE WITH
COMPLETE SOLUTIONS) - NURSE PRACTITIONERS IN
PRIMARY CARE II EXAM REVIEWS | COMPLETE GUIDE
WITH QUESTIONS AND VERIFIED ANSWERS | ALL
MODULES COVERED
1.
A 58-year-old patient presents for follow-up after several elevated blood-pressure
measurements obtained at home and in the clinic. The patient has no history of
cardiovascular disease, diabetes, or chronic kidney disease. Blood pressure
readings have consistently remained above the recommended treatment threshold
despite lifestyle modifications involving sodium restriction, increased physical
activity, weight reduction, and limitation of alcohol intake. Which intervention is
most appropriate for the nurse practitioner to initiate as part of evidence-based
primary-care management?
A. Begin appropriate first-line antihypertensive pharmacotherapy and continue
lifestyle modification
B. Delay pharmacologic therapy for another year regardless of blood-pressure
readings
C. Begin a loop diuretic as monotherapy in every patient with uncomplicated
hypertension
D. Recommend aspirin as the primary treatment for elevated blood pressure
Answer: A
2.
A 64-year-old patient with hypertension has been taking lisinopril consistently for
several months. The patient now reports a persistent dry, nonproductive cough that
began after initiation of therapy and has continued despite treatment of possible
environmental causes. Examination is otherwise unremarkable, and there is no
evidence of infection or heart failure. Which medication change is most
appropriate?
A. Add another ACE inhibitor
B. Discontinue the ACE inhibitor and substitute an appropriate angiotensin
,2
receptor blocker
C. Increase the lisinopril dosage
D. Add a short-acting nitrate
Answer: B
3.
A 52-year-old patient with type 2 diabetes has been taking metformin along with
lifestyle therapy, but the most recent HbA1c remains significantly above the
individualized target. The patient has obesity and established cardiovascular risk
factors but no contraindication to additional glucose-lowering therapy. Which
approach should the nurse practitioner consider when intensifying treatment?
A. Add an evidence-based agent that also addresses cardiovascular and/or weight-
related risk
B. Stop all diabetes medication and prescribe dietary therapy alone
C. Begin chronic short-acting insulin in every patient with an elevated HbA1c
D. Discontinue metformin solely because the HbA1c remains elevated
Answer: A
4.
A 71-year-old patient with type 2 diabetes is being evaluated during an annual
primary-care visit. The patient reports no visual symptoms and has never been
diagnosed with diabetic retinopathy. The patient asks whether an eye examination
is still necessary because vision appears normal. Which response reflects
appropriate preventive management?
A. Screening is unnecessary unless visual symptoms develop
B. Retinal evaluation should be performed according to diabetes screening
recommendations
C. Eye screening is required only after insulin is started
D. Screening is necessary only when HbA1c exceeds 10%
Answer: B
5.
,3
A 67-year-old patient with diabetes has decreased sensation to monofilament
testing over several plantar surfaces of both feet. There is no ulceration, cellulitis,
or active wound. Which management strategy is most appropriate?
A. Routine foot surveillance, protective footwear, daily inspection, and risk-based
follow-up
B. Encourage walking barefoot to strengthen the feet
C. Apply topical corticosteroids to all areas of decreased sensation
D. Restrict all physical activity permanently
Answer: A
6.
A 60-year-old patient with type 2 diabetes presents with an HbA1c substantially
above the individualized goal despite adherence to two noninsulin glucose-
lowering medications. The patient reports polyuria and polydipsia and has
experienced unintended weight loss. Which finding would most strongly support
consideration of insulin therapy?
A. Mildly elevated fasting glucose without symptoms
B. Significant symptomatic hyperglycemia with catabolic features
C. HbA1c at the individualized target
D. Normal fasting glucose with occasional postprandial elevation
Answer: B
7.
A 45-year-old patient with obesity and hypertension has laboratory testing showing
elevated LDL cholesterol. The patient has no history of statin intolerance and has
multiple cardiovascular risk factors. Which pharmacologic intervention is
generally appropriate when indicated by the patient's overall ASCVD risk
assessment?
A. Statin therapy at an appropriate intensity
B. Niacin monotherapy for every patient
C. Immediate fibrate monotherapy regardless of triglyceride level
D. Discontinue dietary interventions after starting medication
Answer: A
, 4
8.
A 59-year-old patient taking a statin reports new generalized muscle aching. The
patient denies trauma or strenuous exercise and is concerned that the medication
may be responsible. Which initial clinical approach is most appropriate?
A. Evaluate symptoms and relevant laboratory findings while assessing alternative
causes and medication-related adverse effects
B. Immediately increase the statin dose
C. Tell the patient that statins can never cause muscle symptoms
D. Begin chronic corticosteroid therapy
Answer: A
9.
A 73-year-old patient with chronic kidney disease and hypertension is being
followed in primary care. Laboratory evaluation demonstrates persistent
albuminuria. Which class of medication may provide both blood-pressure control
and kidney-protective benefit when clinically appropriate?
A. ACE inhibitor or ARB
B. Anticholinergic medication
C. Proton-pump inhibitor
D. H2 receptor antagonist
Answer: A
10.
A 55-year-old patient presents with fatigue and laboratory findings consistent with
primary hypothyroidism. The patient has no evidence of acute illness and is not
pregnant. Which medication is generally used as first-line thyroid hormone
replacement?
A. Levothyroxine
B. Methimazole
C. Propylthiouracil
D. Radioactive iodine as immediate replacement therapy
Answer: A
