Fitzgerald NP Exam Review Post Test South College -
NSG 5640 | Exam with Verified Rationales Practice
Questions and Answers 2026 with complete solution
Fitzgerald NP Exam Review | NSG 5640 | Practice Exam
with Rationales
Question 1:
A 65-year-old male with a history of hypertension and
type 2 diabetes presents for a routine physical. His blood
pressure today is 142/88 mmHg. His last three readings
over the past 6 months have been in the range of 136-
144/84-90 mmHg. He is currently on lisinopril 10mg daily.
What is the most appropriate next step in management?
A. Increase lisinopril to 20mg daily.
B. Add hydrochlorothiazide 12.5mg daily.
C. Reassure the patient and recheck in 3 months.
D. Order renal artery stenosis workup.
Answer: B. Add hydrochlorothiazide 12.5mg daily.
Rationale: According to JNC 8 guidelines, for patients
over 18 with diabetes, the blood pressure goal is <140/90
mmHg. This patient is not at goal on monotherapy. The
recommended strategy is to initiate a thiazide diuretic (like
HCTZ) as a second-line agent when a patient is already on
an ACE inhibitor (lisinopril) and not at target. Increasing
,the lisinopril dose (A) is an option, but guideline-directed
therapy often favors adding a second agent from a
different class for synergistic effect. Waiting 3 months (C)
is inappropriate as he is above goal. Renal artery stenosis
workup (D) is not indicated without other suggestive signs
(e.g., acute kidney injury after ACEi, abdominal bruit).
Question 2:
A 28-year-old female presents with a 3-day history of
dysuria, frequency, and urgency. She has no fever, flank
pain, or vaginal discharge. Urine dipstick is positive for
leukocyte esterase and nitrites. She has no known drug
allergies. What is the most appropriate first-line
treatment?
A. Nitrofurantoin monohydrate/macrocrystals 100mg BID
for 5 days
B. Ciprofloxacin 250mg BID for 3 days
C. Ceftriaxone 1g IM single dose
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Answer: A. Nitrofurantoin monohydrate/macrocrystals
100mg BID for 5 days.
Rationale: This is an uncomplicated urinary tract infection
(UTI) in a non-pregnant woman. Current IDSA guidelines
recommend nitrofurantoin for 5 days or fosfomycin as
,first-line due to high rates of E. coli resistance to TMP-SMX
(D) and fluoroquinolones (B) in many regions.
Fluoroquinolones are not first-line due to black box
warnings for serious adverse effects. A 3-day course of
TMP-SMX is an alternative only if local resistance is <20%.
Ceftriaxone (C) is reserved for complicated UTIs or
pyelonephritis.
Question 3:
During a well-child visit, the mother of a 6-month-old
infant is concerned about "crossed eyes." You note
intermittent symmetric corneal light reflexes but
occasionally observe the infant's right eye turning inward.
The red reflex is present bilaterally. What is the most
appropriate initial action?
A. Immediate referral to a pediatric ophthalmologist.
B. Reassure the mother that this is normal accommodative
reflex.
C. Schedule a follow-up in 6 months to re-evaluate.
D. Patch the left eye for 2 hours daily.
Answer: B. Reassure the mother that this is normal
accommodative reflex.
Rationale: Infants up to 6 months often have intermittent
strabismus (pseudostrabismus) due to a wide, flat nasal
, bridge and epicanthal folds. The key findings here are
the intermittent nature and the symmetric corneal light
reflex, which rules out true (constant) strabismus. The
presence of a normal red reflex also rules out cataract or
retinoblastoma. Immediate referral (A) is for constant
misalignment, asymmetric light reflex, or absent red reflex.
Patching (D) is treatment for amblyopia, not diagnosis.
Question 4:
A 45-year-old female presents with fatigue, weight gain,
cold intolerance, and dry skin for 6 months. TSH is 8.2
mIU/L (normal 0.4-4.5). Free T4 is 0.7 ng/dL (normal 0.8-
1.8). What is the most appropriate initial
pharmacotherapy?
A. Levothyroxine 25-50 mcg daily.
B. Liothyronine (T3) 5 mcg daily.
C. Methimazole 5mg daily.
D. Observation and repeat labs in 6 months.
Answer: A. Levothyroxine 25-50 mcg daily.
Rationale: The lab results confirm primary hypothyroidism
(elevated TSH, low Free T4). The standard of care is
replacement with levothyroxine, starting at a low dose (1.6
mcg/kg/day, often 25-50 mcg in adults) with recheck of
TSH in 6-8 weeks. Liothyronine (B) is synthetic T3 and is
NSG 5640 | Exam with Verified Rationales Practice
Questions and Answers 2026 with complete solution
Fitzgerald NP Exam Review | NSG 5640 | Practice Exam
with Rationales
Question 1:
A 65-year-old male with a history of hypertension and
type 2 diabetes presents for a routine physical. His blood
pressure today is 142/88 mmHg. His last three readings
over the past 6 months have been in the range of 136-
144/84-90 mmHg. He is currently on lisinopril 10mg daily.
What is the most appropriate next step in management?
A. Increase lisinopril to 20mg daily.
B. Add hydrochlorothiazide 12.5mg daily.
C. Reassure the patient and recheck in 3 months.
D. Order renal artery stenosis workup.
Answer: B. Add hydrochlorothiazide 12.5mg daily.
Rationale: According to JNC 8 guidelines, for patients
over 18 with diabetes, the blood pressure goal is <140/90
mmHg. This patient is not at goal on monotherapy. The
recommended strategy is to initiate a thiazide diuretic (like
HCTZ) as a second-line agent when a patient is already on
an ACE inhibitor (lisinopril) and not at target. Increasing
,the lisinopril dose (A) is an option, but guideline-directed
therapy often favors adding a second agent from a
different class for synergistic effect. Waiting 3 months (C)
is inappropriate as he is above goal. Renal artery stenosis
workup (D) is not indicated without other suggestive signs
(e.g., acute kidney injury after ACEi, abdominal bruit).
Question 2:
A 28-year-old female presents with a 3-day history of
dysuria, frequency, and urgency. She has no fever, flank
pain, or vaginal discharge. Urine dipstick is positive for
leukocyte esterase and nitrites. She has no known drug
allergies. What is the most appropriate first-line
treatment?
A. Nitrofurantoin monohydrate/macrocrystals 100mg BID
for 5 days
B. Ciprofloxacin 250mg BID for 3 days
C. Ceftriaxone 1g IM single dose
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Answer: A. Nitrofurantoin monohydrate/macrocrystals
100mg BID for 5 days.
Rationale: This is an uncomplicated urinary tract infection
(UTI) in a non-pregnant woman. Current IDSA guidelines
recommend nitrofurantoin for 5 days or fosfomycin as
,first-line due to high rates of E. coli resistance to TMP-SMX
(D) and fluoroquinolones (B) in many regions.
Fluoroquinolones are not first-line due to black box
warnings for serious adverse effects. A 3-day course of
TMP-SMX is an alternative only if local resistance is <20%.
Ceftriaxone (C) is reserved for complicated UTIs or
pyelonephritis.
Question 3:
During a well-child visit, the mother of a 6-month-old
infant is concerned about "crossed eyes." You note
intermittent symmetric corneal light reflexes but
occasionally observe the infant's right eye turning inward.
The red reflex is present bilaterally. What is the most
appropriate initial action?
A. Immediate referral to a pediatric ophthalmologist.
B. Reassure the mother that this is normal accommodative
reflex.
C. Schedule a follow-up in 6 months to re-evaluate.
D. Patch the left eye for 2 hours daily.
Answer: B. Reassure the mother that this is normal
accommodative reflex.
Rationale: Infants up to 6 months often have intermittent
strabismus (pseudostrabismus) due to a wide, flat nasal
, bridge and epicanthal folds. The key findings here are
the intermittent nature and the symmetric corneal light
reflex, which rules out true (constant) strabismus. The
presence of a normal red reflex also rules out cataract or
retinoblastoma. Immediate referral (A) is for constant
misalignment, asymmetric light reflex, or absent red reflex.
Patching (D) is treatment for amblyopia, not diagnosis.
Question 4:
A 45-year-old female presents with fatigue, weight gain,
cold intolerance, and dry skin for 6 months. TSH is 8.2
mIU/L (normal 0.4-4.5). Free T4 is 0.7 ng/dL (normal 0.8-
1.8). What is the most appropriate initial
pharmacotherapy?
A. Levothyroxine 25-50 mcg daily.
B. Liothyronine (T3) 5 mcg daily.
C. Methimazole 5mg daily.
D. Observation and repeat labs in 6 months.
Answer: A. Levothyroxine 25-50 mcg daily.
Rationale: The lab results confirm primary hypothyroidism
(elevated TSH, low Free T4). The standard of care is
replacement with levothyroxine, starting at a low dose (1.6
mcg/kg/day, often 25-50 mcg in adults) with recheck of
TSH in 6-8 weeks. Liothyronine (B) is synthetic T3 and is
