COMPREHENSIVE CLINICAL
REASONING EXAMINATION
Advanced Primary Care:
Multisystem and Complex
Patient Management
### Question 1
,Jamie Feldman, a 67-year-old male, presents with stable angina and shortness of breath. He reports
chest pressure with exertion that resolves with rest. His blood pressure is 148/88 mmHg and heart rate
is 86 beats per minute. Which medication should be initiated for long-term management?
A. Sublingual nitroglycerin
B. Aspirin 81 mg daily
C. Metoprolol succinate 25 mg daily
D. Atorvastatin 40 mg daily
💫RATIONALE✔️✔️: Metoprolol (a beta-blocker) is indicated for long-term management of stable
angina to reduce myocardial oxygen demand by decreasing heart rate and contractility. Aspirin and
statins are also important but beta-blockers are specifically indicated for angina symptom control.
Sublingual nitroglycerin is for acute symptom relief only.
💫ANSWER✔️✔️: C. Metoprolol succinate 25 mg daily
---
### Question 2
Jamie Feldman reports that his chest pain now occurs with minimal exertion and sometimes at rest. He
is diaphoretic and nauseated. Which action should the nurse take first?
A. Administer sublingual nitroglycerin
B. Activate emergency medical services (call 911)
C. Obtain a 12-lead ECG
D. Administer aspirin 324 mg chewed
,💫RATIONALE✔️✔️: The patient is experiencing unstable angina or possibly an acute myocardial
infarction. This is a medical emergency requiring immediate activation of emergency medical services.
While aspirin, nitroglycerin, and ECG are important, the priority is to get the patient to emergency care.
💫ANSWER✔️✔️: B. Activate emergency medical services (call 911)
---
### Question 3
Anselmo Lopez, a 57-year-old male, presents for evaluation of high blood pressure. His blood pressure
today is 158/94 mmHg. He reports no prior diagnosis of hypertension. Which initial diagnostic study is
most appropriate?
A. Complete blood count
B. Basic metabolic panel (serum creatinine, electrolytes)
C. Lipid panel
D. Thyroid function tests
💫RATIONALE✔️✔️: The initial evaluation of hypertension should include a basic metabolic panel to
assess renal function and electrolytes. Renal function is important because hypertension can cause or be
caused by kidney disease. A lipid panel is also important but not the priority for initial evaluation.
💫ANSWER✔️✔️: B. Basic metabolic panel (serum creatinine, electrolytes)
---
### Question 4
, Anselmo Lopez is started on hydrochlorothiazide 25 mg daily. Which teaching is most important?
A. "Take this medication at bedtime to prevent daytime urination."
B. "You may experience increased urination and should take it in the morning."
C. "You should avoid potassium-rich foods while taking this medication."
D. "This medication will work immediately to lower your blood pressure."
💫RATIONALE✔️✔️: Hydrochlorothiazide is a thiazide diuretic that increases urine output. Patients
should take it in the morning to avoid nighttime urination. It does not work immediately and may take
several weeks to achieve full effect. Potassium supplementation may be needed as thiazides can cause
hypokalemia.
💫ANSWER✔️✔️: B. "You may experience increased urination and should take it in the morning."
---
### Question 5
Samantha Graves, an 18-month-old female, presents with vomiting and diarrhea for 36 hours. Her
mother reports decreased urine output and dry diapers. Which finding indicates severe dehydration?
A. Sunken fontanel
B. Dry mucous membranes
C. Capillary refill of 3 seconds
D. Lethargy
REASONING EXAMINATION
Advanced Primary Care:
Multisystem and Complex
Patient Management
### Question 1
,Jamie Feldman, a 67-year-old male, presents with stable angina and shortness of breath. He reports
chest pressure with exertion that resolves with rest. His blood pressure is 148/88 mmHg and heart rate
is 86 beats per minute. Which medication should be initiated for long-term management?
A. Sublingual nitroglycerin
B. Aspirin 81 mg daily
C. Metoprolol succinate 25 mg daily
D. Atorvastatin 40 mg daily
💫RATIONALE✔️✔️: Metoprolol (a beta-blocker) is indicated for long-term management of stable
angina to reduce myocardial oxygen demand by decreasing heart rate and contractility. Aspirin and
statins are also important but beta-blockers are specifically indicated for angina symptom control.
Sublingual nitroglycerin is for acute symptom relief only.
💫ANSWER✔️✔️: C. Metoprolol succinate 25 mg daily
---
### Question 2
Jamie Feldman reports that his chest pain now occurs with minimal exertion and sometimes at rest. He
is diaphoretic and nauseated. Which action should the nurse take first?
A. Administer sublingual nitroglycerin
B. Activate emergency medical services (call 911)
C. Obtain a 12-lead ECG
D. Administer aspirin 324 mg chewed
,💫RATIONALE✔️✔️: The patient is experiencing unstable angina or possibly an acute myocardial
infarction. This is a medical emergency requiring immediate activation of emergency medical services.
While aspirin, nitroglycerin, and ECG are important, the priority is to get the patient to emergency care.
💫ANSWER✔️✔️: B. Activate emergency medical services (call 911)
---
### Question 3
Anselmo Lopez, a 57-year-old male, presents for evaluation of high blood pressure. His blood pressure
today is 158/94 mmHg. He reports no prior diagnosis of hypertension. Which initial diagnostic study is
most appropriate?
A. Complete blood count
B. Basic metabolic panel (serum creatinine, electrolytes)
C. Lipid panel
D. Thyroid function tests
💫RATIONALE✔️✔️: The initial evaluation of hypertension should include a basic metabolic panel to
assess renal function and electrolytes. Renal function is important because hypertension can cause or be
caused by kidney disease. A lipid panel is also important but not the priority for initial evaluation.
💫ANSWER✔️✔️: B. Basic metabolic panel (serum creatinine, electrolytes)
---
### Question 4
, Anselmo Lopez is started on hydrochlorothiazide 25 mg daily. Which teaching is most important?
A. "Take this medication at bedtime to prevent daytime urination."
B. "You may experience increased urination and should take it in the morning."
C. "You should avoid potassium-rich foods while taking this medication."
D. "This medication will work immediately to lower your blood pressure."
💫RATIONALE✔️✔️: Hydrochlorothiazide is a thiazide diuretic that increases urine output. Patients
should take it in the morning to avoid nighttime urination. It does not work immediately and may take
several weeks to achieve full effect. Potassium supplementation may be needed as thiazides can cause
hypokalemia.
💫ANSWER✔️✔️: B. "You may experience increased urination and should take it in the morning."
---
### Question 5
Samantha Graves, an 18-month-old female, presents with vomiting and diarrhea for 36 hours. Her
mother reports decreased urine output and dry diapers. Which finding indicates severe dehydration?
A. Sunken fontanel
B. Dry mucous membranes
C. Capillary refill of 3 seconds
D. Lethargy
