1|Page
NSG 6440 PREDICTOR EXAM
COMPREHENSIVE PRACTICE QUESTION BANK (300+
QUESTIONS)
2026-2027 ACADEMIC YEAR
# SECTION I: CARDIOVASCULAR DISORDERS
## QUESTION 1
A 45-year-old male presents with acute onset of unilateral scrotal pain, swelling,
and erythema. He reports fever and dysuria. On examination, the affected testicle is
tender, and the cremasteric reflex is intact. Which of the following is the most
appropriate initial management?
A. Oral antibiotics and scrotal support
B. Surgical exploration for possible testicular torsion
C. Intravenous antibiotics and urology consultation
D. NSAIDs and rest without antibiotics
**Correct Answer: A**
,2|Page
**Rationale:** The presentation of acute unilateral scrotal pain with fever, dysuria,
and an intact cremasteric reflex is consistent with epididymitis. Epididymitis is
typically caused by sexually transmitted organisms (Chlamydia trachomatis,
Neisseria gonorrhoeae) in younger men or urinary pathogens (E. coli) in older
men. Initial management includes appropriate oral antibiotics based on the
suspected pathogen and supportive care including scrotal elevation, ice packs, and
NSAIDs for pain. Scrotal elevation helps reduce pain by decreasing hydrostatic
pressure and improving venous drainage.
**Why the other options are incorrect:**
- **B. Surgical exploration:** This would be indicated for testicular torsion, which
presents with sudden onset severe pain, an absent cremasteric reflex, and a high-
riding testicle. The presence of fever, dysuria, and an intact cremasteric reflex
points away from torsion.
- **C. Intravenous antibiotics:** IV antibiotics are reserved for severe cases with
systemic signs, sepsis, or abscess formation. Most cases of uncomplicated
epididymitis can be managed with oral antibiotics.
- **D. NSAIDs and rest:** This would be inadequate because it fails to address the
underlying infectious etiology. Antibiotics are essential to treat the causative
organism and prevent complications.
---
## QUESTION 2
A 32-year-old female presents with bilateral jaw pain, clicking sounds when
opening her mouth, and headaches. She reports that symptoms worsen when she
chews gum or eats hard foods. Physical examination reveals tenderness over the
temporomandibular joints. Which medication class is most appropriate for this
patient, and what specific patient education should be provided?
,3|Page
A. Tricyclic antidepressants; advise the patient not to drive until effects are known
B. NSAIDs; advise regular use for optimal pain control
C. Muscle relaxants; advise use only during acute flare-ups
D. Benzodiazepines; advise use as needed for muscle spasm
**Correct Answer: A**
**Rationale:** Temporomandibular disorder (TMD) is commonly treated with
tricyclic antidepressants (TCAs) such as amitriptyline (Elavil) at low doses, which
help modulate pain pathways and improve sleep. TCAs have significant sedative
effects, and patients must be advised not to drive or operate heavy machinery until
they know how the medication affects them. These medications are typically
started at low doses and titrated upward based on response.
**Why the other options are incorrect:**
- **B. NSAIDs:** While NSAIDs can help with acute pain, they are not the
primary pharmacological treatment for chronic TMD. Regular use increases the
risk of GI bleeding and renal impairment.
- **C. Muscle relaxants:** These may provide temporary relief but do not address
the underlying pain pathways and have significant sedative properties. They are
typically used short-term only.
- **D. Benzodiazepines:** While diazepam may be used occasionally for muscle
spasm, they carry a significant risk of dependence and are not first-line therapy for
TMD.
---
, 4|Page
## QUESTION 3
A 58-year-old female with a history of hypothyroidism has been taking
levothyroxine (Synthroid) for 6 months. Her current TSH level is 3.5 mIU/L
(reference range: 0.4-4.0 mIU/L). What is the most appropriate next step?
A. Continue current dose; TSH is within normal limits
B. Increase the dose; target TSH should be <2.5 mIU/L
C. Decrease the dose; TSH is at the upper limit of normal
D. Discontinue medication; patient is euthyroid
**Correct Answer: A**
**Rationale:** In primary hypothyroidism, the goal of levothyroxine therapy is to
achieve a euthyroid state with a TSH level within the normal reference range. A
TSH of 3.5 mIU/L is within the normal range (0.4-4.0 mIU/L), indicating adequate
replacement. Complete clinical response may take several months, and after 6
months of therapy, this TSH level suggests appropriate dosing. The patient should
continue on the current dose with routine monitoring.
**Why the other options are incorrect:**
- **B. Increase the dose:** The target TSH for most patients is within the normal
reference range. There is no evidence supporting a target of <2.5 mIU/L for all
patients. This target may be appropriate for certain populations (e.g., pregnant
women, those with thyroid cancer), but not for this patient.
- **C. Decrease the dose:** Since the TSH is within normal limits, decreasing the
dose would likely result in a subtherapeutic level and return of hypothyroid
symptoms.
NSG 6440 PREDICTOR EXAM
COMPREHENSIVE PRACTICE QUESTION BANK (300+
QUESTIONS)
2026-2027 ACADEMIC YEAR
# SECTION I: CARDIOVASCULAR DISORDERS
## QUESTION 1
A 45-year-old male presents with acute onset of unilateral scrotal pain, swelling,
and erythema. He reports fever and dysuria. On examination, the affected testicle is
tender, and the cremasteric reflex is intact. Which of the following is the most
appropriate initial management?
A. Oral antibiotics and scrotal support
B. Surgical exploration for possible testicular torsion
C. Intravenous antibiotics and urology consultation
D. NSAIDs and rest without antibiotics
**Correct Answer: A**
,2|Page
**Rationale:** The presentation of acute unilateral scrotal pain with fever, dysuria,
and an intact cremasteric reflex is consistent with epididymitis. Epididymitis is
typically caused by sexually transmitted organisms (Chlamydia trachomatis,
Neisseria gonorrhoeae) in younger men or urinary pathogens (E. coli) in older
men. Initial management includes appropriate oral antibiotics based on the
suspected pathogen and supportive care including scrotal elevation, ice packs, and
NSAIDs for pain. Scrotal elevation helps reduce pain by decreasing hydrostatic
pressure and improving venous drainage.
**Why the other options are incorrect:**
- **B. Surgical exploration:** This would be indicated for testicular torsion, which
presents with sudden onset severe pain, an absent cremasteric reflex, and a high-
riding testicle. The presence of fever, dysuria, and an intact cremasteric reflex
points away from torsion.
- **C. Intravenous antibiotics:** IV antibiotics are reserved for severe cases with
systemic signs, sepsis, or abscess formation. Most cases of uncomplicated
epididymitis can be managed with oral antibiotics.
- **D. NSAIDs and rest:** This would be inadequate because it fails to address the
underlying infectious etiology. Antibiotics are essential to treat the causative
organism and prevent complications.
---
## QUESTION 2
A 32-year-old female presents with bilateral jaw pain, clicking sounds when
opening her mouth, and headaches. She reports that symptoms worsen when she
chews gum or eats hard foods. Physical examination reveals tenderness over the
temporomandibular joints. Which medication class is most appropriate for this
patient, and what specific patient education should be provided?
,3|Page
A. Tricyclic antidepressants; advise the patient not to drive until effects are known
B. NSAIDs; advise regular use for optimal pain control
C. Muscle relaxants; advise use only during acute flare-ups
D. Benzodiazepines; advise use as needed for muscle spasm
**Correct Answer: A**
**Rationale:** Temporomandibular disorder (TMD) is commonly treated with
tricyclic antidepressants (TCAs) such as amitriptyline (Elavil) at low doses, which
help modulate pain pathways and improve sleep. TCAs have significant sedative
effects, and patients must be advised not to drive or operate heavy machinery until
they know how the medication affects them. These medications are typically
started at low doses and titrated upward based on response.
**Why the other options are incorrect:**
- **B. NSAIDs:** While NSAIDs can help with acute pain, they are not the
primary pharmacological treatment for chronic TMD. Regular use increases the
risk of GI bleeding and renal impairment.
- **C. Muscle relaxants:** These may provide temporary relief but do not address
the underlying pain pathways and have significant sedative properties. They are
typically used short-term only.
- **D. Benzodiazepines:** While diazepam may be used occasionally for muscle
spasm, they carry a significant risk of dependence and are not first-line therapy for
TMD.
---
, 4|Page
## QUESTION 3
A 58-year-old female with a history of hypothyroidism has been taking
levothyroxine (Synthroid) for 6 months. Her current TSH level is 3.5 mIU/L
(reference range: 0.4-4.0 mIU/L). What is the most appropriate next step?
A. Continue current dose; TSH is within normal limits
B. Increase the dose; target TSH should be <2.5 mIU/L
C. Decrease the dose; TSH is at the upper limit of normal
D. Discontinue medication; patient is euthyroid
**Correct Answer: A**
**Rationale:** In primary hypothyroidism, the goal of levothyroxine therapy is to
achieve a euthyroid state with a TSH level within the normal reference range. A
TSH of 3.5 mIU/L is within the normal range (0.4-4.0 mIU/L), indicating adequate
replacement. Complete clinical response may take several months, and after 6
months of therapy, this TSH level suggests appropriate dosing. The patient should
continue on the current dose with routine monitoring.
**Why the other options are incorrect:**
- **B. Increase the dose:** The target TSH for most patients is within the normal
reference range. There is no evidence supporting a target of <2.5 mIU/L for all
patients. This target may be appropriate for certain populations (e.g., pregnant
women, those with thyroid cancer), but not for this patient.
- **C. Decrease the dose:** Since the TSH is within normal limits, decreasing the
dose would likely result in a subtherapeutic level and return of hypothyroid
symptoms.
