NR601 WEEK 8 FINAL EXAM & PRACTICE BANK
2026/2027 – Complete 100 Q&A with Detailed
Rationales | Primary Care of the Maturing & Aged
Family
,Question
A 65-year-old male presents to the clinic with a 6-month history of frequent heartburn, and reports partial relief with
over-the-counter antacids. With a initial diagnosis of gastroesophageal reflux disease (GERD), which of the following
is the MOST initial pharmacologic treatment to promote healing of esophagitis and control symptoms?
Options
A. Mucosal protectant
B. Histamine-2 receptor antagonist (H2RA)
C. Antacid
D. Proton pump inhibitor (PPI)
Correct Answer
D. Proton pump inhibitor (PPI)
Rationale
Proton Pump Inhibitors (PPIs): PPIs (e.g., omeprazole, lansoprazole, pantoprazole) are the first-line
initial therapy for managing moderate-to-severe GERD and promoting the healing of erosive esophagitis.
They provide superior acid suppression and significantly higher rates of mucosal healing and symptom relief
compared to H2RAs or antacids.
Why others are incorrect:
o A (Mucosal protectant): Sucralfate or mucosal protectants are generally reserved for specific
indications (such as pregnancy) and are far less effective than PPIs for healing esophagitis.
o B (H2RA): Histamine-2 receptor antagonists (e.g., famotidine) are useful for mild or intermittent
symptoms, or for managing breakthrough nocturnal symptoms, but they are less effective for
healing esophagitis due to incomplete acid suppression and tachyphylaxis.
o C (Antacid): Antacids provide only immediate, temporary symptom relief and do not suppress acid
production sufficiently to promote mucosal healing.
, o
Question
A 58-year-old patient with long-standing type 2 diabetes presents with complaints of dizziness when standing,
bloating after meals, and occasional episodes of urinary incontinence. He also reports mild numbness in both feet.
Which of the following complications of diabetes is the MOST likely explanation for his symptoms?
Options
A. Diabetic distal symmetric sensorimotor polyneuropathy with lower extremity involvement
B. Diabetic autonomic neuropathy affecting multiple organ systems
C. Diabetic peripheral artery disease causing impaired autonomic regulation
D. Diabetic amyotrophy causing systemic and gastrointestinal dysfunction
Correct Answer
B. Diabetic autonomic neuropathy affecting multiple organ systems
Rationale
Diabetic Autonomic Neuropathy (DAN): DAN is a major complication of chronic diabetes that affects the
involuntary (autonomic) nervous system controlling multiple organ systems:
o Cardiovascular System: Manifests as orthostatic hypotension (dizziness upon standing due to
impaired baroreceptor reflex and vascular tone control).
o Gastrointestinal System: Manifests as diabetic gastroparesis (delayed gastric emptying
causing postprandial bloating, nausea, and early satiety).
o Genitourinary System: Manifests as neurogenic bladder (impaired detrusor contractility or
bladder sensation leading to overflow or urinary incontinence).
Why others are incorrect:
o A: Distal symmetric sensorimotor polyneuropathy accounts for sensory symptoms in the feet
(glove-and-stocking distribution), but it does not explain the multisystem autonomic dysfunction
(orthostasis, gastroparesis, bladder incontinence).
o C: Peripheral artery disease (PAD) causes macrovascular arterial insufficiency (claudication,
absent pulses, delayed wound healing), not widespread autonomic dysfunction.
o D: Diabetic amyotrophy (diabetic lumbosacral radiculoplexus neuropathy) presents primarily with
acute asymmetric proximal muscle weakness and severe pain (usually in the thigh/hip), not
visceral autonomic symptoms.
2026/2027 – Complete 100 Q&A with Detailed
Rationales | Primary Care of the Maturing & Aged
Family
,Question
A 65-year-old male presents to the clinic with a 6-month history of frequent heartburn, and reports partial relief with
over-the-counter antacids. With a initial diagnosis of gastroesophageal reflux disease (GERD), which of the following
is the MOST initial pharmacologic treatment to promote healing of esophagitis and control symptoms?
Options
A. Mucosal protectant
B. Histamine-2 receptor antagonist (H2RA)
C. Antacid
D. Proton pump inhibitor (PPI)
Correct Answer
D. Proton pump inhibitor (PPI)
Rationale
Proton Pump Inhibitors (PPIs): PPIs (e.g., omeprazole, lansoprazole, pantoprazole) are the first-line
initial therapy for managing moderate-to-severe GERD and promoting the healing of erosive esophagitis.
They provide superior acid suppression and significantly higher rates of mucosal healing and symptom relief
compared to H2RAs or antacids.
Why others are incorrect:
o A (Mucosal protectant): Sucralfate or mucosal protectants are generally reserved for specific
indications (such as pregnancy) and are far less effective than PPIs for healing esophagitis.
o B (H2RA): Histamine-2 receptor antagonists (e.g., famotidine) are useful for mild or intermittent
symptoms, or for managing breakthrough nocturnal symptoms, but they are less effective for
healing esophagitis due to incomplete acid suppression and tachyphylaxis.
o C (Antacid): Antacids provide only immediate, temporary symptom relief and do not suppress acid
production sufficiently to promote mucosal healing.
, o
Question
A 58-year-old patient with long-standing type 2 diabetes presents with complaints of dizziness when standing,
bloating after meals, and occasional episodes of urinary incontinence. He also reports mild numbness in both feet.
Which of the following complications of diabetes is the MOST likely explanation for his symptoms?
Options
A. Diabetic distal symmetric sensorimotor polyneuropathy with lower extremity involvement
B. Diabetic autonomic neuropathy affecting multiple organ systems
C. Diabetic peripheral artery disease causing impaired autonomic regulation
D. Diabetic amyotrophy causing systemic and gastrointestinal dysfunction
Correct Answer
B. Diabetic autonomic neuropathy affecting multiple organ systems
Rationale
Diabetic Autonomic Neuropathy (DAN): DAN is a major complication of chronic diabetes that affects the
involuntary (autonomic) nervous system controlling multiple organ systems:
o Cardiovascular System: Manifests as orthostatic hypotension (dizziness upon standing due to
impaired baroreceptor reflex and vascular tone control).
o Gastrointestinal System: Manifests as diabetic gastroparesis (delayed gastric emptying
causing postprandial bloating, nausea, and early satiety).
o Genitourinary System: Manifests as neurogenic bladder (impaired detrusor contractility or
bladder sensation leading to overflow or urinary incontinence).
Why others are incorrect:
o A: Distal symmetric sensorimotor polyneuropathy accounts for sensory symptoms in the feet
(glove-and-stocking distribution), but it does not explain the multisystem autonomic dysfunction
(orthostasis, gastroparesis, bladder incontinence).
o C: Peripheral artery disease (PAD) causes macrovascular arterial insufficiency (claudication,
absent pulses, delayed wound healing), not widespread autonomic dysfunction.
o D: Diabetic amyotrophy (diabetic lumbosacral radiculoplexus neuropathy) presents primarily with
acute asymmetric proximal muscle weakness and severe pain (usually in the thigh/hip), not
visceral autonomic symptoms.
