,South College NSG 5544 Exam 2 | Primary Care of Adults & Older
Adults (2026) Q&A
1. A 55-year-old male with a 30-pack-year smoking history presents for a wellness visit.
According to the USPSTF, which screening test is recommended for lung cancer in this
patient?
A) Annual chest X-ray
B) Annual low-dose computed tomography (LDCT)
C) Sputum cytology
D) Pulmonary function testing
Correct Answer: Annual low-dose computed tomography (LDCT)
Rationale: The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography in adults aged 50-80 years who have a 20 pack-year smoking history
and currently smoke or have quit within the past 15 years. LDCT has been shown to reduce
lung cancer mortality. Chest X-ray and sputum cytology are not recommended for screening.
2. A 65-year-old patient with a history of hypertension and hyperlipidemia is being screened
for abdominal aortic aneurysm. According to the USPSTF, which of the following is the
appropriate screening recommendation?
A) One-time ultrasound screening for all adults aged 65-75
B) One-time ultrasound screening for men aged 65-75 who have ever smoked
C) Annual ultrasound screening for all adults aged 65-75
D) No screening is recommended
Correct Answer: One-time ultrasound screening for men aged 65-75 who have ever smoked
Rationale: The USPSTF recommends a one-time screening for abdominal aortic aneurysm
with ultrasound in men aged 65 to 75 years who have ever smoked. This is based on
,evidence that screening reduces AAA-related mortality in this population. Women and non-
smoking men do not benefit from routine screening.
3. Which of the following is the most appropriate initial screening test for type 2 diabetes in
a 50-year-old asymptomatic patient with a BMI of 32 kg/m²?
A) Fasting plasma glucose
B) Hemoglobin A1c
C) Oral glucose tolerance test
D) Random plasma glucose
Correct Answer: Hemoglobin A1c
Rationale: Hemoglobin A1c, fasting plasma glucose, or an oral glucose tolerance test are all
acceptable screening tests. However, hemoglobin A1c is often preferred due to its
convenience (no fasting required) and its ability to reflect chronic hyperglycemia. The
patient's BMI > 25 qualifies for screening.
4. A 68-year-old female presents for a routine physical examination. Her blood pressure is
142/88 mmHg on two separate occasions. According to the Eighth Joint National Committee
(JNC 8) guidelines, what is the recommended blood pressure target for this patient?
A) < 140/90 mmHg
B) < 150/90 mmHg
C) < 130/80 mmHg
D) < 120/80 mmHg
Correct Answer: < 150/90 mmHg
Rationale: The JNC 8 guidelines recommend a blood pressure target of < 150/90 mmHg for
adults aged 60 years and older, based on evidence that this target reduces cardiovascular
events. The target for younger adults is < 140/90 mmHg. The more recent ACC/AHA
guidelines recommend <130/80 mmHg.
, 5. A 45-year-old male with no significant past medical history is found to have a blood
pressure of 138/86 mmHg on two separate visits. Which of the following is the most
appropriate next step in management?
A) Initiate antihypertensive therapy immediately
B) Recommend lifestyle modifications and recheck in 3-6 months
C) Order an echocardiogram
D) Refer to a cardiologist
Correct Answer: Recommend lifestyle modifications and recheck in 3-6 months
Rationale: This patient has prehypertension (120-139/80-89 mmHg). Lifestyle modifications
such as weight loss, dietary changes (DASH diet), and increased physical activity are
recommended. Pharmacologic therapy is generally initiated if blood pressure remains
elevated despite lifestyle changes.
6. A 62-year-old male with a history of COPD presents with worsening dyspnea and a
productive cough. Which of the following findings on pulmonary function testing is most
consistent with a diagnosis of COPD?
A) FEV1/FVC ratio < 70%
B) FEV1/FVC ratio > 80%
C) Normal FEV1 with decreased FVC
D) Increased FEV1 with normal FVC
Correct Answer: FEV1/FVC ratio < 70%
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 70% is the diagnostic criterion
for COPD. This indicates airflow obstruction that is not fully reversible. The severity of COPD
is graded based on the FEV1 percentage of predicted.
Adults (2026) Q&A
1. A 55-year-old male with a 30-pack-year smoking history presents for a wellness visit.
According to the USPSTF, which screening test is recommended for lung cancer in this
patient?
A) Annual chest X-ray
B) Annual low-dose computed tomography (LDCT)
C) Sputum cytology
D) Pulmonary function testing
Correct Answer: Annual low-dose computed tomography (LDCT)
Rationale: The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography in adults aged 50-80 years who have a 20 pack-year smoking history
and currently smoke or have quit within the past 15 years. LDCT has been shown to reduce
lung cancer mortality. Chest X-ray and sputum cytology are not recommended for screening.
2. A 65-year-old patient with a history of hypertension and hyperlipidemia is being screened
for abdominal aortic aneurysm. According to the USPSTF, which of the following is the
appropriate screening recommendation?
A) One-time ultrasound screening for all adults aged 65-75
B) One-time ultrasound screening for men aged 65-75 who have ever smoked
C) Annual ultrasound screening for all adults aged 65-75
D) No screening is recommended
Correct Answer: One-time ultrasound screening for men aged 65-75 who have ever smoked
Rationale: The USPSTF recommends a one-time screening for abdominal aortic aneurysm
with ultrasound in men aged 65 to 75 years who have ever smoked. This is based on
,evidence that screening reduces AAA-related mortality in this population. Women and non-
smoking men do not benefit from routine screening.
3. Which of the following is the most appropriate initial screening test for type 2 diabetes in
a 50-year-old asymptomatic patient with a BMI of 32 kg/m²?
A) Fasting plasma glucose
B) Hemoglobin A1c
C) Oral glucose tolerance test
D) Random plasma glucose
Correct Answer: Hemoglobin A1c
Rationale: Hemoglobin A1c, fasting plasma glucose, or an oral glucose tolerance test are all
acceptable screening tests. However, hemoglobin A1c is often preferred due to its
convenience (no fasting required) and its ability to reflect chronic hyperglycemia. The
patient's BMI > 25 qualifies for screening.
4. A 68-year-old female presents for a routine physical examination. Her blood pressure is
142/88 mmHg on two separate occasions. According to the Eighth Joint National Committee
(JNC 8) guidelines, what is the recommended blood pressure target for this patient?
A) < 140/90 mmHg
B) < 150/90 mmHg
C) < 130/80 mmHg
D) < 120/80 mmHg
Correct Answer: < 150/90 mmHg
Rationale: The JNC 8 guidelines recommend a blood pressure target of < 150/90 mmHg for
adults aged 60 years and older, based on evidence that this target reduces cardiovascular
events. The target for younger adults is < 140/90 mmHg. The more recent ACC/AHA
guidelines recommend <130/80 mmHg.
, 5. A 45-year-old male with no significant past medical history is found to have a blood
pressure of 138/86 mmHg on two separate visits. Which of the following is the most
appropriate next step in management?
A) Initiate antihypertensive therapy immediately
B) Recommend lifestyle modifications and recheck in 3-6 months
C) Order an echocardiogram
D) Refer to a cardiologist
Correct Answer: Recommend lifestyle modifications and recheck in 3-6 months
Rationale: This patient has prehypertension (120-139/80-89 mmHg). Lifestyle modifications
such as weight loss, dietary changes (DASH diet), and increased physical activity are
recommended. Pharmacologic therapy is generally initiated if blood pressure remains
elevated despite lifestyle changes.
6. A 62-year-old male with a history of COPD presents with worsening dyspnea and a
productive cough. Which of the following findings on pulmonary function testing is most
consistent with a diagnosis of COPD?
A) FEV1/FVC ratio < 70%
B) FEV1/FVC ratio > 80%
C) Normal FEV1 with decreased FVC
D) Increased FEV1 with normal FVC
Correct Answer: FEV1/FVC ratio < 70%
Rationale: A post-bronchodilator FEV1/FVC ratio of less than 70% is the diagnostic criterion
for COPD. This indicates airflow obstruction that is not fully reversible. The severity of COPD
is graded based on the FEV1 percentage of predicted.
