NSG 555 – Nurse Practitioners in Primary Care
I Practice Exam 2026/2027 Questions with
Correct Detailed Answers & Rationales
(Reliable Answers)
Question 1
A 52-year-old patient presents for a routine primary-care visit.
The blood pressure is 146/92 mmHg. The patient reports that
previous readings at home have generally been around 138–
144/86–90 mmHg. Which approach is most appropriate before
labeling the patient with persistent hypertension?
A. Diagnose hypertension solely from today's office
measurement
B. Begin two antihypertensive medications immediately
C. Confirm the diagnosis with repeated standardized
measurements and, when appropriate, out-of-office blood-
pressure monitoring
D. Reassure the patient that the readings are normal for this
age
Answer: C. Confirm the diagnosis with repeated standardized
measurements and, when appropriate, out-of-office blood-
pressure monitoring
,Rationale: A single elevated office blood-pressure measurement
is not sufficient to establish persistent hypertension in most
patients. Proper diagnosis requires accurate measurement
technique and confirmation over time. Home blood-pressure
monitoring or ambulatory blood-pressure monitoring can help
distinguish sustained hypertension from white-coat
hypertension and provides a more representative assessment of
the patient's usual blood pressure. The patient's readings are
concerning and warrant evaluation, but immediately assigning
a chronic diagnosis from one office measurement is
inappropriate. Starting two medications without confirming the
diagnosis and considering the patient's overall cardiovascular
risk, comorbidities, and average blood pressure would also be
premature.
Question 2
A 47-year-old patient reports intermittent substernal burning
after large meals. Symptoms are worse when lying down and
improve with an over-the-counter antacid. Which additional
finding should most strongly prompt evaluation for a
potentially serious alternative diagnosis rather than empiric
treatment for uncomplicated gastroesophageal reflux?
A. Symptoms occurring after spicy foods
B. Occasional sour taste in the mouth
,C. Symptoms improving after antacid use
D. Progressive dysphagia and unintentional weight loss
Answer: D. Progressive dysphagia and unintentional weight
loss
Rationale: Progressive dysphagia and unexplained weight loss
are alarm features in a patient with upper gastrointestinal
symptoms. They raise concern for structural disease, including
malignancy or significant esophageal pathology, and warrant
further diagnostic evaluation rather than simply assuming
uncomplicated gastroesophageal reflux disease. Postprandial
burning, regurgitation, and relief with antacids are compatible
with reflux, but those findings do not exclude more serious
disease. Alarm symptoms change the diagnostic approach
because delaying evaluation could postpone recognition of a
significant underlying disorder.
Question 3
A 29-year-old adult presents with cough for 8 days following an
upper-respiratory infection. The patient is afebrile, oxygen
saturation is normal, lung examination reveals scattered
rhonchi that partially clear with coughing, and there is no focal
consolidation. Which management is most appropriate?
, A. Routine antibacterial therapy
B. Chest CT immediately
C. Supportive treatment with patient education regarding the
expected course
D. Long-term inhaled corticosteroid therapy
Answer: C. Supportive treatment with patient education
regarding the expected course
Rationale: Acute bronchitis in otherwise healthy adults is most
commonly viral, and antibiotics generally provide little clinical
benefit while contributing to adverse effects and antimicrobial
resistance. Cough may persist for several weeks after the initial
infection even when the patient is otherwise improving. Normal
oxygenation, absence of significant fever, and lack of focal
consolidation reduce concern for pneumonia. Supportive care,
symptom management, and clear return precautions are
appropriate unless new findings suggest a different diagnosis.
Question 4
A patient presents with acute low-back pain after lifting a heavy
object. Which finding requires the most urgent evaluation for
possible cauda equina syndrome?
A. Paraspinal muscle tenderness
B. Pain that increases with bending
I Practice Exam 2026/2027 Questions with
Correct Detailed Answers & Rationales
(Reliable Answers)
Question 1
A 52-year-old patient presents for a routine primary-care visit.
The blood pressure is 146/92 mmHg. The patient reports that
previous readings at home have generally been around 138–
144/86–90 mmHg. Which approach is most appropriate before
labeling the patient with persistent hypertension?
A. Diagnose hypertension solely from today's office
measurement
B. Begin two antihypertensive medications immediately
C. Confirm the diagnosis with repeated standardized
measurements and, when appropriate, out-of-office blood-
pressure monitoring
D. Reassure the patient that the readings are normal for this
age
Answer: C. Confirm the diagnosis with repeated standardized
measurements and, when appropriate, out-of-office blood-
pressure monitoring
,Rationale: A single elevated office blood-pressure measurement
is not sufficient to establish persistent hypertension in most
patients. Proper diagnosis requires accurate measurement
technique and confirmation over time. Home blood-pressure
monitoring or ambulatory blood-pressure monitoring can help
distinguish sustained hypertension from white-coat
hypertension and provides a more representative assessment of
the patient's usual blood pressure. The patient's readings are
concerning and warrant evaluation, but immediately assigning
a chronic diagnosis from one office measurement is
inappropriate. Starting two medications without confirming the
diagnosis and considering the patient's overall cardiovascular
risk, comorbidities, and average blood pressure would also be
premature.
Question 2
A 47-year-old patient reports intermittent substernal burning
after large meals. Symptoms are worse when lying down and
improve with an over-the-counter antacid. Which additional
finding should most strongly prompt evaluation for a
potentially serious alternative diagnosis rather than empiric
treatment for uncomplicated gastroesophageal reflux?
A. Symptoms occurring after spicy foods
B. Occasional sour taste in the mouth
,C. Symptoms improving after antacid use
D. Progressive dysphagia and unintentional weight loss
Answer: D. Progressive dysphagia and unintentional weight
loss
Rationale: Progressive dysphagia and unexplained weight loss
are alarm features in a patient with upper gastrointestinal
symptoms. They raise concern for structural disease, including
malignancy or significant esophageal pathology, and warrant
further diagnostic evaluation rather than simply assuming
uncomplicated gastroesophageal reflux disease. Postprandial
burning, regurgitation, and relief with antacids are compatible
with reflux, but those findings do not exclude more serious
disease. Alarm symptoms change the diagnostic approach
because delaying evaluation could postpone recognition of a
significant underlying disorder.
Question 3
A 29-year-old adult presents with cough for 8 days following an
upper-respiratory infection. The patient is afebrile, oxygen
saturation is normal, lung examination reveals scattered
rhonchi that partially clear with coughing, and there is no focal
consolidation. Which management is most appropriate?
, A. Routine antibacterial therapy
B. Chest CT immediately
C. Supportive treatment with patient education regarding the
expected course
D. Long-term inhaled corticosteroid therapy
Answer: C. Supportive treatment with patient education
regarding the expected course
Rationale: Acute bronchitis in otherwise healthy adults is most
commonly viral, and antibiotics generally provide little clinical
benefit while contributing to adverse effects and antimicrobial
resistance. Cough may persist for several weeks after the initial
infection even when the patient is otherwise improving. Normal
oxygenation, absence of significant fever, and lack of focal
consolidation reduce concern for pneumonia. Supportive care,
symptom management, and clear return precautions are
appropriate unless new findings suggest a different diagnosis.
Question 4
A patient presents with acute low-back pain after lifting a heavy
object. Which finding requires the most urgent evaluation for
possible cauda equina syndrome?
A. Paraspinal muscle tenderness
B. Pain that increases with bending
