1. Primary care roles, competencies, and scope of practice for nurse practitioners
2. Health promotion, disease prevention, and screening guidelines across the
lifespan
3. Comprehensive health history taking and advanced physical assessment
techniques
4. Clinical reasoning, differential diagnosis, and diagnostic test interpretation
5. Pharmacotherapeutics: prescribing principles, drug interactions, and patient
education
6. Management of common acute and chronic primary care conditions
7. Patient education, counseling, and behavioral change models
8. Cultural competence, health disparities, and social determinants of health
9. Documentation, billing, coding, and legal/ethical issues in primary care
10. Coordination of care, referral, and interprofessional collaboration
Wilkes University NSG 555 Nurse Practitioners in Primary Care I – Exam 1
,1. A nurse practitioner is assessing a patient with a chief complaint of fatigue and
unintentional weight loss over the past three months. Which of the following
components of the patient history is most important to obtain first?
A. Review of systems focused on the endocrine system
B. Detailed dietary and appetite history
C. Complete medication and supplement history
D. Family history of metabolic disorders
Answer: B
Rationale: In a patient with fatigue and unintentional weight loss, a detailed dietary
and appetite history is the most critical first step to differentiate nutritional
deficiency, malabsorption, or eating disorders before pursuing endocrine or
metabolic workup.
2. During a focused physical examination of an older adult presenting with dizziness
upon standing, which assessment finding would most strongly suggest orthostatic
hypotension requiring further intervention?
A. A drop in systolic blood pressure of 15 mm Hg after standing for one minute
B. A drop in diastolic blood pressure of 5 mm Hg after standing for one minute
C. A drop in systolic blood pressure of 25 mm Hg after standing for three minutes
, D. An increase in heart rate of 10 beats per minute after standing
Answer: C
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure
of at least 20 mm Hg or diastolic of at least 10 mm Hg within three minutes of
standing; a 25 mm Hg systolic drop meets this criterion.
3. A 58-year-old patient with type 2 diabetes presents for routine follow-up and
reports intermittent numbness and tingling in both feet. Which diagnostic test is
most appropriate to evaluate for diabetic peripheral neuropathy?
A. Nerve conduction velocity study of the lower extremities
B. Monofilament testing and vibration sense assessment
C. Magnetic resonance imaging of the lumbar spine
D. Serum vitamin B12 and folate levels
Answer: B
Rationale: Monofilament testing and vibration sense assessment are the
recommended screening tools for diabetic peripheral neuropathy in primary care,
providing rapid and reliable detection of sensory loss.
4. A nurse practitioner is prescribing a new medication to a patient with chronic
kidney disease and must consider renal dose adjustment. Which pharmacokinetic
, parameter is most directly affected by reduced glomerular filtration rate?
A. Volume of distribution of lipophilic drugs
B. Hepatic first-pass metabolism of oral agents
C. Renal clearance of water-soluble drugs
D. Protein binding of highly albumin-bound drugs
Answer: C
Rationale: Reduced glomerular filtration rate directly decreases renal clearance of
water-soluble drugs, necessitating dose adjustment to prevent accumulation and
toxicity.
5. A patient with newly diagnosed hypertension and a history of asthma requires
antihypertensive therapy. Which class of medication should be avoided in this
patient due to the risk of bronchospasm?
A. Angiotensin-converting enzyme inhibitors
B. Thiazide diuretics
C. Non-selective beta-blockers
D. Calcium channel blockers
Answer: C
2. Health promotion, disease prevention, and screening guidelines across the
lifespan
3. Comprehensive health history taking and advanced physical assessment
techniques
4. Clinical reasoning, differential diagnosis, and diagnostic test interpretation
5. Pharmacotherapeutics: prescribing principles, drug interactions, and patient
education
6. Management of common acute and chronic primary care conditions
7. Patient education, counseling, and behavioral change models
8. Cultural competence, health disparities, and social determinants of health
9. Documentation, billing, coding, and legal/ethical issues in primary care
10. Coordination of care, referral, and interprofessional collaboration
Wilkes University NSG 555 Nurse Practitioners in Primary Care I – Exam 1
,1. A nurse practitioner is assessing a patient with a chief complaint of fatigue and
unintentional weight loss over the past three months. Which of the following
components of the patient history is most important to obtain first?
A. Review of systems focused on the endocrine system
B. Detailed dietary and appetite history
C. Complete medication and supplement history
D. Family history of metabolic disorders
Answer: B
Rationale: In a patient with fatigue and unintentional weight loss, a detailed dietary
and appetite history is the most critical first step to differentiate nutritional
deficiency, malabsorption, or eating disorders before pursuing endocrine or
metabolic workup.
2. During a focused physical examination of an older adult presenting with dizziness
upon standing, which assessment finding would most strongly suggest orthostatic
hypotension requiring further intervention?
A. A drop in systolic blood pressure of 15 mm Hg after standing for one minute
B. A drop in diastolic blood pressure of 5 mm Hg after standing for one minute
C. A drop in systolic blood pressure of 25 mm Hg after standing for three minutes
, D. An increase in heart rate of 10 beats per minute after standing
Answer: C
Rationale: Orthostatic hypotension is defined as a drop in systolic blood pressure
of at least 20 mm Hg or diastolic of at least 10 mm Hg within three minutes of
standing; a 25 mm Hg systolic drop meets this criterion.
3. A 58-year-old patient with type 2 diabetes presents for routine follow-up and
reports intermittent numbness and tingling in both feet. Which diagnostic test is
most appropriate to evaluate for diabetic peripheral neuropathy?
A. Nerve conduction velocity study of the lower extremities
B. Monofilament testing and vibration sense assessment
C. Magnetic resonance imaging of the lumbar spine
D. Serum vitamin B12 and folate levels
Answer: B
Rationale: Monofilament testing and vibration sense assessment are the
recommended screening tools for diabetic peripheral neuropathy in primary care,
providing rapid and reliable detection of sensory loss.
4. A nurse practitioner is prescribing a new medication to a patient with chronic
kidney disease and must consider renal dose adjustment. Which pharmacokinetic
, parameter is most directly affected by reduced glomerular filtration rate?
A. Volume of distribution of lipophilic drugs
B. Hepatic first-pass metabolism of oral agents
C. Renal clearance of water-soluble drugs
D. Protein binding of highly albumin-bound drugs
Answer: C
Rationale: Reduced glomerular filtration rate directly decreases renal clearance of
water-soluble drugs, necessitating dose adjustment to prevent accumulation and
toxicity.
5. A patient with newly diagnosed hypertension and a history of asthma requires
antihypertensive therapy. Which class of medication should be avoided in this
patient due to the risk of bronchospasm?
A. Angiotensin-converting enzyme inhibitors
B. Thiazide diuretics
C. Non-selective beta-blockers
D. Calcium channel blockers
Answer: C
