NR 603 ADVANCED PRIMARY CARE
EXAM REVIEW QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 65-year-old male patient with a history of hypertension and chronic kidney disease (CKD)
Stage 3 presents for a follow-up. His blood pressure is 152/94 mmHg. According to current
guidelines, which of the following is the most appropriate initial or add-on antihypertensive
class?
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Calcium channel blocker
D. Beta-blocker
Answer: B
Conceptual Explanation: For patients with CKD, regardless of race or diabetes status, an
ACE inhibitor or ARB should be used to protect renal function and reduce proteinuria.
2. In the management of Chronic Obstructive Pulmonary Disease (COPD), which criterion is
required for the diagnosis of COPD according to the GOLD guidelines?
A. Increase in FEV1 > 12% after bronchodilator inhalation
,B. FEV1/FVC ratio > 0.80 pre-bronchodilator
C. Total Lung Capacity < 80% predicted
D. FEV1/FVC ratio < 0.70 post-bronchodilator
Answer: D
Conceptual Explanation: The GOLD guidelines define the presence of a post-
bronchodilator FEV1/FVC < 0.70 as the requirement for confirming the presence of
persistent airflow limitation (COPD).
3. A 45-year-old female presents with complaints of fatigue, cold intolerance, and weight
gain. Laboratory results show an elevated TSH and a low Free T4. What is the most likely
diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Primary hypothyroidism
D. Hashimoto’s thyroiditis in the thyrotoxic phase
Answer: C
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH (as
the pituitary tries to stimulate the thyroid) and a low Free T4 (low output from the
thyroid).
, 4. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID but their A1c
remains at 8.2%. The patient has established atherosclerotic cardiovascular disease (ASCVD).
Which class of medication should be added next?
A. DPP-4 inhibitor
B. Sulfonylurea
C. Basal insulin
D. GLP-1 receptor agonist with proven CVD benefit
Answer: D
Conceptual Explanation: ADA guidelines recommend adding a GLP-1 receptor agonist or
SGLT2 inhibitor with proven cardiovascular benefit for patients with T2DM and
established ASCVD, regardless of A1c.
5. Which of the following heart murmurs is characterized as a holosystolic murmur heard best
at the apex and radiating to the left axilla?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
Answer: A
EXAM REVIEW QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 65-year-old male patient with a history of hypertension and chronic kidney disease (CKD)
Stage 3 presents for a follow-up. His blood pressure is 152/94 mmHg. According to current
guidelines, which of the following is the most appropriate initial or add-on antihypertensive
class?
A. Thiazide diuretic
B. ACE inhibitor or ARB
C. Calcium channel blocker
D. Beta-blocker
Answer: B
Conceptual Explanation: For patients with CKD, regardless of race or diabetes status, an
ACE inhibitor or ARB should be used to protect renal function and reduce proteinuria.
2. In the management of Chronic Obstructive Pulmonary Disease (COPD), which criterion is
required for the diagnosis of COPD according to the GOLD guidelines?
A. Increase in FEV1 > 12% after bronchodilator inhalation
,B. FEV1/FVC ratio > 0.80 pre-bronchodilator
C. Total Lung Capacity < 80% predicted
D. FEV1/FVC ratio < 0.70 post-bronchodilator
Answer: D
Conceptual Explanation: The GOLD guidelines define the presence of a post-
bronchodilator FEV1/FVC < 0.70 as the requirement for confirming the presence of
persistent airflow limitation (COPD).
3. A 45-year-old female presents with complaints of fatigue, cold intolerance, and weight
gain. Laboratory results show an elevated TSH and a low Free T4. What is the most likely
diagnosis?
A. Subclinical hypothyroidism
B. Secondary hypothyroidism
C. Primary hypothyroidism
D. Hashimoto’s thyroiditis in the thyrotoxic phase
Answer: C
Conceptual Explanation: Primary hypothyroidism is characterized by an elevated TSH (as
the pituitary tries to stimulate the thyroid) and a low Free T4 (low output from the
thyroid).
, 4. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID but their A1c
remains at 8.2%. The patient has established atherosclerotic cardiovascular disease (ASCVD).
Which class of medication should be added next?
A. DPP-4 inhibitor
B. Sulfonylurea
C. Basal insulin
D. GLP-1 receptor agonist with proven CVD benefit
Answer: D
Conceptual Explanation: ADA guidelines recommend adding a GLP-1 receptor agonist or
SGLT2 inhibitor with proven cardiovascular benefit for patients with T2DM and
established ASCVD, regardless of A1c.
5. Which of the following heart murmurs is characterized as a holosystolic murmur heard best
at the apex and radiating to the left axilla?
A. Mitral regurgitation
B. Aortic stenosis
C. Mitral stenosis
D. Aortic regurgitation
Answer: A
