Nurse Practitioners in Primary
Care II
Wilkes University
NSG555/NSG 555 Exam 3
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Endocrinology (Questions 1-15)
Question 1
A 45-year-old female presents with fatigue, weight gain,
constipation, and dry skin. Her TSH is 8.5 mIU/mL (normal 0.4-
4.0 mIU/mL). What is the first-line treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine ablation
D. Levothyroxine and liothyronine combination
Answer: B. Levothyroxine
Rationale: Levothyroxine (T4) is the standard of care for
hypothyroidism. It is a synthetic thyroid hormone that replaces
the deficient hormone. Methimazole and radioactive iodine are
used for hyperthyroidism. Combination T4/T3 therapy is not
routinely recommended as first-line treatment. The starting dose
of levothyroxine is weight-based (1.6 mcg/kg/day) and should be
titrated based on TSH levels.
Question 2
A patient with type 2 diabetes mellitus has an eGFR of 35
mL/min/1.73m². Which oral anti-diabetic agent requires the
most significant dose adjustment or avoidance due to the risk of
lactic acidosis?
,A. Metformin
B. Glipizide
C. Sitagliptin
D. Pioglitazone
Answer: A. Metformin
Rationale: Metformin is contraindicated in patients with an
eGFR < 30 mL/min/1.73m² and should be used with caution with
dose adjustment if eGFR is < 45 mL/min/1.73m² due to the risk of
lactic acidosis. The FDA recommends assessing renal function
before starting metformin and at least annually thereafter.
Glipizide (sulfonylurea) is primarily metabolized by the liver and
can be used with caution in renal impairment. Sitagliptin (DPP-4
inhibitor) requires dose adjustment for renal function but does
not carry the same risk of lactic acidosis. Pioglitazone
(thiazolidinedione) is not renally excreted but has other concerns
such as fluid retention.
Question 3
Which medication used for diabetes mellitus has been shown to
provide the most significant cardiovascular and renal protective
benefits (reducing MACE and CKD progression) independent of
glycemic control?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
C. Sulfonylureas
D. Thiazolidinediones
Answer: B. SGLT2 inhibitors
, Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin,
canagliflozin) have strong evidence for cardiovascular and renal
protection in patients with type 2 diabetes, regardless of baseline
glycemic control. The EMPA-REG OUTCOME trial demonstrated
reduction in cardiovascular mortality, and subsequent trials have
shown benefits in heart failure and chronic kidney disease. These
agents are now recommended as part of comprehensive diabetes
management for patients with established cardiovascular disease,
heart failure, or CKD. DPP-4 inhibitors have neutral
cardiovascular effects. Sulfonylureas and thiazolidinediones do
not have the same level of cardiovascular and renal protective
evidence.
Question 4
A 28-year-old male presents with acute onset of severe testicular
pain, nausea, and vomiting. The testis is elevated and tender.
Cremasteric reflex is absent. What is the most appropriate next
step?
A. Urinalysis and antibiotics
B. Ultrasound with Doppler
C. Immediate surgical consultation
D. NSAIDs and scrotal elevation
Answer: C. Immediate surgical consultation
Rationale: These symptoms are classic for testicular torsion, a
urologic emergency. Time is critical; surgical exploration is
needed immediately to salvage the testis. While Doppler
ultrasound can confirm the diagnosis, it should not delay surgical
consultation if torsion is highly suspected. Testicular viability
Care II
Wilkes University
NSG555/NSG 555 Exam 3
Questions & Answers Plus
Detailed Rationales
Latest 2026 | PDF
THIS EXAM CONTAINS:
✓100% Pass
✓Multiple Choice ( A-D)
✓Detailed Rationales For Each Question
✓Correct Answers For Each Question
✓100 Qs & Answers
,SECTION 1: Endocrinology (Questions 1-15)
Question 1
A 45-year-old female presents with fatigue, weight gain,
constipation, and dry skin. Her TSH is 8.5 mIU/mL (normal 0.4-
4.0 mIU/mL). What is the first-line treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine ablation
D. Levothyroxine and liothyronine combination
Answer: B. Levothyroxine
Rationale: Levothyroxine (T4) is the standard of care for
hypothyroidism. It is a synthetic thyroid hormone that replaces
the deficient hormone. Methimazole and radioactive iodine are
used for hyperthyroidism. Combination T4/T3 therapy is not
routinely recommended as first-line treatment. The starting dose
of levothyroxine is weight-based (1.6 mcg/kg/day) and should be
titrated based on TSH levels.
Question 2
A patient with type 2 diabetes mellitus has an eGFR of 35
mL/min/1.73m². Which oral anti-diabetic agent requires the
most significant dose adjustment or avoidance due to the risk of
lactic acidosis?
,A. Metformin
B. Glipizide
C. Sitagliptin
D. Pioglitazone
Answer: A. Metformin
Rationale: Metformin is contraindicated in patients with an
eGFR < 30 mL/min/1.73m² and should be used with caution with
dose adjustment if eGFR is < 45 mL/min/1.73m² due to the risk of
lactic acidosis. The FDA recommends assessing renal function
before starting metformin and at least annually thereafter.
Glipizide (sulfonylurea) is primarily metabolized by the liver and
can be used with caution in renal impairment. Sitagliptin (DPP-4
inhibitor) requires dose adjustment for renal function but does
not carry the same risk of lactic acidosis. Pioglitazone
(thiazolidinedione) is not renally excreted but has other concerns
such as fluid retention.
Question 3
Which medication used for diabetes mellitus has been shown to
provide the most significant cardiovascular and renal protective
benefits (reducing MACE and CKD progression) independent of
glycemic control?
A. DPP-4 inhibitors
B. SGLT2 inhibitors
C. Sulfonylureas
D. Thiazolidinediones
Answer: B. SGLT2 inhibitors
, Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin,
canagliflozin) have strong evidence for cardiovascular and renal
protection in patients with type 2 diabetes, regardless of baseline
glycemic control. The EMPA-REG OUTCOME trial demonstrated
reduction in cardiovascular mortality, and subsequent trials have
shown benefits in heart failure and chronic kidney disease. These
agents are now recommended as part of comprehensive diabetes
management for patients with established cardiovascular disease,
heart failure, or CKD. DPP-4 inhibitors have neutral
cardiovascular effects. Sulfonylureas and thiazolidinediones do
not have the same level of cardiovascular and renal protective
evidence.
Question 4
A 28-year-old male presents with acute onset of severe testicular
pain, nausea, and vomiting. The testis is elevated and tender.
Cremasteric reflex is absent. What is the most appropriate next
step?
A. Urinalysis and antibiotics
B. Ultrasound with Doppler
C. Immediate surgical consultation
D. NSAIDs and scrotal elevation
Answer: C. Immediate surgical consultation
Rationale: These symptoms are classic for testicular torsion, a
urologic emergency. Time is critical; surgical exploration is
needed immediately to salvage the testis. While Doppler
ultrasound can confirm the diagnosis, it should not delay surgical
consultation if torsion is highly suspected. Testicular viability
