NR 603 EXAM 3: ADVANCED PRIMARY
CARE MANAGEMENT QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 62-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril and Carvedilol. His blood pressure is
138/84 mmHg and heart rate is 68 bpm. Which medication class is now considered a
foundational ‘pillar’ of therapy to further reduce mortality in HFrEF regardless of diabetic
status?
A. Loop diuretics
B. Alpha-1 blockers
C. Calcium channel blockers
D. SGLT2 inhibitors
Answer: D
Conceptual Explanation: Current guidelines recognize SGLT2 inhibitors (like
dapagliflozin) as one of the four pillars of HFrEF management, alongside ARNI/ACE/ARB,
Beta-blockers, and MRAs, because they significantly reduce cardiovascular death and heart
failure hospitalizations.
,2. A 45-year-old female presents with palpitations, heat intolerance, and a suppressed TSH
with elevated Free T4. A radioactive iodine uptake (RAIU) scan shows a high, diffuse uptake.
What is the most likely diagnosis?
A. Subacute thyroiditis
B. Toxic multinodular goiter
C. Graves’ disease
D. Factitious hyperthyroidism
Answer: C
Conceptual Explanation: High, diffuse uptake on an RAIU scan is characteristic of Graves’
disease. Subacute thyroiditis would show low uptake, and toxic multinodular goiter would
show patchy/nodular uptake.
3. In the management of a patient with Chronic Obstructive Pulmonary Disease (COPD) who
is categorized as Group E (Gold 2023), which of the following is the preferred initial
pharmacological treatment?
A. LABA + LAMA combination
B. LABA monotherapy
C. SABA as needed only
D. Inhaled corticosteroid (ICS) monotherapy
Answer: A
, Conceptual Explanation: The GOLD 2023 update recommends LABA+LAMA combination
therapy for Group E patients (those with high exacerbation risk), regardless of their
symptom score.
4. A 68-year-old male presents with a sudden onset of ‘the worst headache of his life.’ He is
photophobic and has neck stiffness. A non-contrast CT of the head is negative. What is the
most appropriate next step?
A. Perform a lumbar puncture
B. Discharge home with migraine medications
C. Order an EEG
D. Start high-dose oral steroids
Answer: A
Conceptual Explanation: A ‘thunderclap’ headache requires exclusion of subarachnoid
hemorrhage. If the CT is negative, a lumbar puncture must be performed to look for
xanthochromia or red blood cells.
5. Which of the following laboratory findings is most characteristic of iron deficiency anemia
in its early stages?
A. High Ferritin and High TIBC
B. Low Ferritin and Low TIBC
C. Low Ferritin and High TIBC
CARE MANAGEMENT QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A 62-year-old male with a history of heart failure with reduced ejection fraction (HFrEF)
presents for a follow-up. He is currently taking Lisinopril and Carvedilol. His blood pressure is
138/84 mmHg and heart rate is 68 bpm. Which medication class is now considered a
foundational ‘pillar’ of therapy to further reduce mortality in HFrEF regardless of diabetic
status?
A. Loop diuretics
B. Alpha-1 blockers
C. Calcium channel blockers
D. SGLT2 inhibitors
Answer: D
Conceptual Explanation: Current guidelines recognize SGLT2 inhibitors (like
dapagliflozin) as one of the four pillars of HFrEF management, alongside ARNI/ACE/ARB,
Beta-blockers, and MRAs, because they significantly reduce cardiovascular death and heart
failure hospitalizations.
,2. A 45-year-old female presents with palpitations, heat intolerance, and a suppressed TSH
with elevated Free T4. A radioactive iodine uptake (RAIU) scan shows a high, diffuse uptake.
What is the most likely diagnosis?
A. Subacute thyroiditis
B. Toxic multinodular goiter
C. Graves’ disease
D. Factitious hyperthyroidism
Answer: C
Conceptual Explanation: High, diffuse uptake on an RAIU scan is characteristic of Graves’
disease. Subacute thyroiditis would show low uptake, and toxic multinodular goiter would
show patchy/nodular uptake.
3. In the management of a patient with Chronic Obstructive Pulmonary Disease (COPD) who
is categorized as Group E (Gold 2023), which of the following is the preferred initial
pharmacological treatment?
A. LABA + LAMA combination
B. LABA monotherapy
C. SABA as needed only
D. Inhaled corticosteroid (ICS) monotherapy
Answer: A
, Conceptual Explanation: The GOLD 2023 update recommends LABA+LAMA combination
therapy for Group E patients (those with high exacerbation risk), regardless of their
symptom score.
4. A 68-year-old male presents with a sudden onset of ‘the worst headache of his life.’ He is
photophobic and has neck stiffness. A non-contrast CT of the head is negative. What is the
most appropriate next step?
A. Perform a lumbar puncture
B. Discharge home with migraine medications
C. Order an EEG
D. Start high-dose oral steroids
Answer: A
Conceptual Explanation: A ‘thunderclap’ headache requires exclusion of subarachnoid
hemorrhage. If the CT is negative, a lumbar puncture must be performed to look for
xanthochromia or red blood cells.
5. Which of the following laboratory findings is most characteristic of iron deficiency anemia
in its early stages?
A. High Ferritin and High TIBC
B. Low Ferritin and Low TIBC
C. Low Ferritin and High TIBC
