NR 603 EXAM 1: ADVANCED PRIMARY
CARE MANAGEMENT QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 68-year-old male with a history of hypertension and CKD Stage 3 presents for follow-up.
His BP is 142/92 mmHg despite being on Lisinopril 20mg daily. According to JNC 8 and
AHA/ACC guidelines, what is the most appropriate next step?
A. Increase Lisinopril to 40mg daily
B. Change Lisinopril to Losartan 50mg daily
C. Add Chlorthalidone 12.5mg daily
D. Add Amlodipine 5mg daily
Answer: D
Conceptual Explanation: In patients with CKD and HTN, ACE inhibitors are first-line. If BP
is not at goal, adding a Calcium Channel Blocker (CCB) or a Thiazide is appropriate. CCBs
are often preferred in CKD when there is concern for electrolyte fluctuations with diuretics,
though both are valid. Increasing the dose is an option, but adding a second class provides
synergistic effects.
,2. Which of the following findings is diagnostic of Type 2 Diabetes Mellitus based on ADA
standards?
A. Random plasma glucose of 210 mg/dL with polyuria and polydipsia
B. Hemoglobin A1C of 6.4%
C. Fast plasma glucose of 118 mg/dL
D. Two-hour plasma glucose of 180 mg/dL during an OGTT
Answer: A
Conceptual Explanation: A random plasma glucose of 200 mg/dL or higher in a patient
with classic symptoms of hyperglycemia (polyuria, polydipsia, weight loss) is diagnostic for
diabetes. Other criteria include A1C >= 6.5% or FPG >= 126 mg/dL.
3. A 72-year-old female presents with a TSH level of 8.2 mIU/L and a normal Free T4. She
complains of mild fatigue but is otherwise asymptomatic. What is the most appropriate
management?
A. Recheck TSH and Free T4 in 3-6 months
B. Start Levothyroxine 25mcg daily
C. Diagnose primary hypothyroidism and start full replacement dose
D. Order a thyroid ultrasound
Answer: A
, Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH with
normal T4). Treatment is generally reserved for TSH > 10, presence of symptoms, or
positive TPO antibodies. In an asymptomatic elderly patient with TSH < 10, monitoring is
appropriate to avoid over-treatment risks like AFib or bone loss.
4. According to the GOLD 2023 guidelines, which medication is recommended as initial
therapy for a patient in Group B (highly symptomatic, low risk of exacerbations)?
A. Short-acting beta-agonist (SABA) PRN
B. Inhaled corticosteroid (ICS) plus LABA
C. Theophylline
D. Long-acting muscarinic antagonist (LAMA) or Long-acting beta-agonist (LABA)
Answer: D
Conceptual Explanation: For GOLD Group B patients, the recommendation is a long-acting
bronchodilator (LAMA or LABA). Combined LAMA/LABA may also be considered if
symptoms are severe.
5. A 75-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Carvedilol and Lisinopril. Their BP is 110/70 and HR is 68. They are NYHA Class II. What
is the next step to improve outcomes based on current guidelines?
A. Add Digoxin 0.125mg daily
B. Switch Lisinopril to Sacubitril/Valsartan (ARNI)
C. Add Amlodipine 5mg daily
CARE MANAGEMENT QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 68-year-old male with a history of hypertension and CKD Stage 3 presents for follow-up.
His BP is 142/92 mmHg despite being on Lisinopril 20mg daily. According to JNC 8 and
AHA/ACC guidelines, what is the most appropriate next step?
A. Increase Lisinopril to 40mg daily
B. Change Lisinopril to Losartan 50mg daily
C. Add Chlorthalidone 12.5mg daily
D. Add Amlodipine 5mg daily
Answer: D
Conceptual Explanation: In patients with CKD and HTN, ACE inhibitors are first-line. If BP
is not at goal, adding a Calcium Channel Blocker (CCB) or a Thiazide is appropriate. CCBs
are often preferred in CKD when there is concern for electrolyte fluctuations with diuretics,
though both are valid. Increasing the dose is an option, but adding a second class provides
synergistic effects.
,2. Which of the following findings is diagnostic of Type 2 Diabetes Mellitus based on ADA
standards?
A. Random plasma glucose of 210 mg/dL with polyuria and polydipsia
B. Hemoglobin A1C of 6.4%
C. Fast plasma glucose of 118 mg/dL
D. Two-hour plasma glucose of 180 mg/dL during an OGTT
Answer: A
Conceptual Explanation: A random plasma glucose of 200 mg/dL or higher in a patient
with classic symptoms of hyperglycemia (polyuria, polydipsia, weight loss) is diagnostic for
diabetes. Other criteria include A1C >= 6.5% or FPG >= 126 mg/dL.
3. A 72-year-old female presents with a TSH level of 8.2 mIU/L and a normal Free T4. She
complains of mild fatigue but is otherwise asymptomatic. What is the most appropriate
management?
A. Recheck TSH and Free T4 in 3-6 months
B. Start Levothyroxine 25mcg daily
C. Diagnose primary hypothyroidism and start full replacement dose
D. Order a thyroid ultrasound
Answer: A
, Conceptual Explanation: This patient has subclinical hypothyroidism (elevated TSH with
normal T4). Treatment is generally reserved for TSH > 10, presence of symptoms, or
positive TPO antibodies. In an asymptomatic elderly patient with TSH < 10, monitoring is
appropriate to avoid over-treatment risks like AFib or bone loss.
4. According to the GOLD 2023 guidelines, which medication is recommended as initial
therapy for a patient in Group B (highly symptomatic, low risk of exacerbations)?
A. Short-acting beta-agonist (SABA) PRN
B. Inhaled corticosteroid (ICS) plus LABA
C. Theophylline
D. Long-acting muscarinic antagonist (LAMA) or Long-acting beta-agonist (LABA)
Answer: D
Conceptual Explanation: For GOLD Group B patients, the recommendation is a long-acting
bronchodilator (LAMA or LABA). Combined LAMA/LABA may also be considered if
symptoms are severe.
5. A 75-year-old patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is currently
taking Carvedilol and Lisinopril. Their BP is 110/70 and HR is 68. They are NYHA Class II. What
is the next step to improve outcomes based on current guidelines?
A. Add Digoxin 0.125mg daily
B. Switch Lisinopril to Sacubitril/Valsartan (ARNI)
C. Add Amlodipine 5mg daily
