NRNP 6531 FINAL EXAM 2026 LATEST (250 QUESTIONS AND
CORRECT ANSWERS) GRADED A+
A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider
notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these
symptoms?
a. Bacterial infection
b. Candida albicans
c. Herpes simplex virus (HSV)
d. Human papilloma virus (HPV) - CORRECT ANSWER-ANS: C
HSV infections generally start with a prodrome of tingling, pain, and burning followed by vesicular
and ulcerative lesions. Bacterial infection presents with inflammation of the gingiva, bleeding, and
ulceration with or without purulent discharge. Candida albicans appear as white, cottage cheese-like
lesions that may be removed, but may cause bleeding when removed. HPV manifests as white,
verrucous lesions individually or in clusters.
A patient diagnosed with gingival inflammation presents with several areas of ulceration and a small
amount of purulent discharge. What is required to diagnose this condition?
a. Culture and sensitivity
b. Microscopic exam of oral scrapings
c. Physical examination
d. Tzanck smear - CORRECT ANSWER-ANS: C
This patient has symptoms consistent with gingivitis, which may be diagnosed by physical
examination alone. Cultures are not necessary unless systemic disease is present. A microscopic
exam of oral scrapings to look for hyphae may be performed to diagnose candida infections. A
Tzanck smear is performed to confirm a diagnosis of herpes simplex.
A patient reports painful oral lesions and the provider notes several white, verrucous lesions in
clusters throughout the mouth. What is the recommended treatment for this patient?
a. Nystatin oral suspension
b. Oral acyclovir
c. Oral hygiene measures
d. Surgical excision - CORRECT ANSWER-ANS: D
White, verrucous lesions in clusters are diagnostic for human papilloma virus (HPV) infection
which is treated with surgical excision. Nystatin suspension is given for candida infection. Oral
acyclovir is used for herpes simplex virus (HSV) infection. Oral hygiene measures are used for
gingivitis.
,Which physical examination finding suggests viral rather than bacterial parotitis?
a. Clear discharge from Stensen's duct
b. Enlargement and pain of affected glands
c. Gradual reduction in saliva production
d. Unilateral edema of parotid glands - CORRECT ANSWER-ANS: A
Viral parotitis generally produces clear discharge. Enlargement and pain of affected glands may be
nonspecific or is associated with tuberculosis (TB) infection. A gradual reduction in saliva, resulting in
xerostomia, is characteristic of human immunodeficiency virus (HIV) infection. Unilateral edema is
more often bacterial.
A patient diagnosed with acute suppurative parotitis has been taking amoxicillin-clavulanate for 4
days without improvement in symptoms. The provider will order an antibiotic for Methicillin-
resistant S. aureus. Which other measure may be helpful?
a. Cool compresses
b. Discouraging chewing gum
c. Surgical drainage
d. Topical corticosteroids - CORRECT ANSWER-ANS: C
If improvement does not occur after 3 to 4 days of antibiotics, surgical drainage is appropriate.
Warm compresses are recommended for comfort. Chewing gum and other methods to stimulate
the production of saliva are recommended. Steroids are questionable and topical steroids will have
little effect.
What are factors associated with acute suppurative parotitis? (Select all that apply.)
a. Allergies
b. Anticholinergic medications
c. Diabetes mellitus
d. Hypervolemia
e. Radiotherapy - CORRECT ANSWER-ANS: B, C, E
Anticholinergic medications decrease salivary flow and increase the risk for parotitis. Chronic
diseases, including diabetes mellitus, can increase the risk. Radiotherapy and other procedures may
increase the risk. Allergies and hypervolemia do not increase the risk.
,An adolescent presents with fever, chills, and a severe sore throat. On exam, the provider notes foul-
smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue.
What will the primary care provider do?
a. Evaluate for possible epiglottitis.
b. Perform a rapid strep and throat culture.
c. Prescribe empirical oral antibiotics.
d. Refer the patient to an otolaryngologist. - CORRECT ANSWER-ANS: D
This patient has clinical signs of peritonsillar abscess, which may be diagnosed on clinical signs alone.
Patients with peritonsillar abscess should be referred to an otolaryngologist for possible I&D of the
abscess and hospitalization for IV antibiotics. A rapid strep and culture are not indicated. Oral
antibiotics generally do not work.
A patient is diagnoses with peritonsillar abscess and will be hospitalized for intravenous antibiotics.
What additional treatment will be required?
a. Intubation to protect the airway
b. Needle aspiration of the abscess
c. Systemic corticosteroid administration
d. Tonsillectomy and adenoidectomy - CORRECT ANSWER-ANS: B
Needle aspiration, antibiotics, pain medication, and hydration can effectively treat peritonsillar
abscess. Intubation is not performed unless the airway is compromised. Systemic corticosteroid
administration is useful, but not required in all cases. Tonsillectomy alone is sometimes performed if
recurrent tonsillitis or peritonsillar abscess is present
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild
erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the
most likely cause of these symptoms?
a. Allergic pharyngitis
b. Group A streptococcus
c. Infectious mononucleosis
d. Viral pharyngitis - CORRECT ANSWER-ANS: D
Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by URI
symptoms of cough and runny nose. Allergic pharyngitis usually also causes dryness. GAS causes high
fever, cervical adenopathy, and marked erythema with exudate. Infectious mononucleosis will cause
an exudate along with cervical adenopathy.
, A patient presents with sore throat, a temperature of 38.5°C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient's symptoms?
a. Order an anti-streptolysin O (ASO) titer.
b. Perform a rapid antigen detection test (RADT).
c. Prescribe empirical penicillin.
d. Refer to an otolaryngologist. - CORRECT ANSWER-ANS: B
The RADT is performed initially to determine whether Group A -hemolytic Streptococcus
(GAS) is present. The ASO titer is not used during initial diagnostic screening. Penicillin
should not be given empirically. A referral to a specialist is not required for GAS infection.
A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year.
The child's parent asks the provider if the child needs a tonsillectomy. What will the provider tell
this parent?
a. Current recommendations do not support tonsillectomy for this child.
b. If there is one more episode in the next 6 months, a tonsillectomy is necessary.
c. The child should have radiographic studies to evaluate the need for tonsillectomy.
d. Tonsillectomy is recommended based on this child's history. - CORRECT ANSWER-ANS: A
Management of chronic pharyngitis or tonsillitis with GAS infection may require tonsillectomy.
Tonsillectomy is not performed as often as in the past due to retrospective studies that suggest
there is little benefit and a chance of significant postsurgical complications. Radiographic studies are
not indicated.
A patient prescribed a beta blocker medication is in the emergency department with reports of
syncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35
beats per minute. Which medication may be used to stabilize this patient?
a. Adenosine
b. Amiodarone
c. Atropine
d. Epinephrine - CORRECT ANSWER-ANS: D
Epinephrine is indicated if unstable bradycardia is caused by beta blockers. This patient is
symptomatic and unstable and should be treated. Adenosine and amiodarone are used to treat
tachycardia. Atropine is used for some types of bradycardia, but not when induced by beta blockers.
CORRECT ANSWERS) GRADED A+
A patient reports painful oral lesions 3 days after feeling pain and tingling in the mouth. The provider
notes vesicles and ulcerative lesions on the buccal mucosa. What is the most likely cause of these
symptoms?
a. Bacterial infection
b. Candida albicans
c. Herpes simplex virus (HSV)
d. Human papilloma virus (HPV) - CORRECT ANSWER-ANS: C
HSV infections generally start with a prodrome of tingling, pain, and burning followed by vesicular
and ulcerative lesions. Bacterial infection presents with inflammation of the gingiva, bleeding, and
ulceration with or without purulent discharge. Candida albicans appear as white, cottage cheese-like
lesions that may be removed, but may cause bleeding when removed. HPV manifests as white,
verrucous lesions individually or in clusters.
A patient diagnosed with gingival inflammation presents with several areas of ulceration and a small
amount of purulent discharge. What is required to diagnose this condition?
a. Culture and sensitivity
b. Microscopic exam of oral scrapings
c. Physical examination
d. Tzanck smear - CORRECT ANSWER-ANS: C
This patient has symptoms consistent with gingivitis, which may be diagnosed by physical
examination alone. Cultures are not necessary unless systemic disease is present. A microscopic
exam of oral scrapings to look for hyphae may be performed to diagnose candida infections. A
Tzanck smear is performed to confirm a diagnosis of herpes simplex.
A patient reports painful oral lesions and the provider notes several white, verrucous lesions in
clusters throughout the mouth. What is the recommended treatment for this patient?
a. Nystatin oral suspension
b. Oral acyclovir
c. Oral hygiene measures
d. Surgical excision - CORRECT ANSWER-ANS: D
White, verrucous lesions in clusters are diagnostic for human papilloma virus (HPV) infection
which is treated with surgical excision. Nystatin suspension is given for candida infection. Oral
acyclovir is used for herpes simplex virus (HSV) infection. Oral hygiene measures are used for
gingivitis.
,Which physical examination finding suggests viral rather than bacterial parotitis?
a. Clear discharge from Stensen's duct
b. Enlargement and pain of affected glands
c. Gradual reduction in saliva production
d. Unilateral edema of parotid glands - CORRECT ANSWER-ANS: A
Viral parotitis generally produces clear discharge. Enlargement and pain of affected glands may be
nonspecific or is associated with tuberculosis (TB) infection. A gradual reduction in saliva, resulting in
xerostomia, is characteristic of human immunodeficiency virus (HIV) infection. Unilateral edema is
more often bacterial.
A patient diagnosed with acute suppurative parotitis has been taking amoxicillin-clavulanate for 4
days without improvement in symptoms. The provider will order an antibiotic for Methicillin-
resistant S. aureus. Which other measure may be helpful?
a. Cool compresses
b. Discouraging chewing gum
c. Surgical drainage
d. Topical corticosteroids - CORRECT ANSWER-ANS: C
If improvement does not occur after 3 to 4 days of antibiotics, surgical drainage is appropriate.
Warm compresses are recommended for comfort. Chewing gum and other methods to stimulate
the production of saliva are recommended. Steroids are questionable and topical steroids will have
little effect.
What are factors associated with acute suppurative parotitis? (Select all that apply.)
a. Allergies
b. Anticholinergic medications
c. Diabetes mellitus
d. Hypervolemia
e. Radiotherapy - CORRECT ANSWER-ANS: B, C, E
Anticholinergic medications decrease salivary flow and increase the risk for parotitis. Chronic
diseases, including diabetes mellitus, can increase the risk. Radiotherapy and other procedures may
increase the risk. Allergies and hypervolemia do not increase the risk.
,An adolescent presents with fever, chills, and a severe sore throat. On exam, the provider notes foul-
smelling breath and a muffled voice with marked edema and erythema of the peritonsillar tissue.
What will the primary care provider do?
a. Evaluate for possible epiglottitis.
b. Perform a rapid strep and throat culture.
c. Prescribe empirical oral antibiotics.
d. Refer the patient to an otolaryngologist. - CORRECT ANSWER-ANS: D
This patient has clinical signs of peritonsillar abscess, which may be diagnosed on clinical signs alone.
Patients with peritonsillar abscess should be referred to an otolaryngologist for possible I&D of the
abscess and hospitalization for IV antibiotics. A rapid strep and culture are not indicated. Oral
antibiotics generally do not work.
A patient is diagnoses with peritonsillar abscess and will be hospitalized for intravenous antibiotics.
What additional treatment will be required?
a. Intubation to protect the airway
b. Needle aspiration of the abscess
c. Systemic corticosteroid administration
d. Tonsillectomy and adenoidectomy - CORRECT ANSWER-ANS: B
Needle aspiration, antibiotics, pain medication, and hydration can effectively treat peritonsillar
abscess. Intubation is not performed unless the airway is compromised. Systemic corticosteroid
administration is useful, but not required in all cases. Tonsillectomy alone is sometimes performed if
recurrent tonsillitis or peritonsillar abscess is present
A patient reports a sudden onset of sore throat, fever, malaise, and cough. The provider notes mild
erythema of the pharynx and clear rhinorrhea without cervical lymphadenopathy. What is the
most likely cause of these symptoms?
a. Allergic pharyngitis
b. Group A streptococcus
c. Infectious mononucleosis
d. Viral pharyngitis - CORRECT ANSWER-ANS: D
Viral pharyngitis will cause sore throat, fever, and malaise and is often accompanied by URI
symptoms of cough and runny nose. Allergic pharyngitis usually also causes dryness. GAS causes high
fever, cervical adenopathy, and marked erythema with exudate. Infectious mononucleosis will cause
an exudate along with cervical adenopathy.
, A patient presents with sore throat, a temperature of 38.5°C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient's symptoms?
a. Order an anti-streptolysin O (ASO) titer.
b. Perform a rapid antigen detection test (RADT).
c. Prescribe empirical penicillin.
d. Refer to an otolaryngologist. - CORRECT ANSWER-ANS: B
The RADT is performed initially to determine whether Group A -hemolytic Streptococcus
(GAS) is present. The ASO titer is not used during initial diagnostic screening. Penicillin
should not be given empirically. A referral to a specialist is not required for GAS infection.
A school-age child has had 5 episodes of tonsillitis in the past year and 2 episodes the previous year.
The child's parent asks the provider if the child needs a tonsillectomy. What will the provider tell
this parent?
a. Current recommendations do not support tonsillectomy for this child.
b. If there is one more episode in the next 6 months, a tonsillectomy is necessary.
c. The child should have radiographic studies to evaluate the need for tonsillectomy.
d. Tonsillectomy is recommended based on this child's history. - CORRECT ANSWER-ANS: A
Management of chronic pharyngitis or tonsillitis with GAS infection may require tonsillectomy.
Tonsillectomy is not performed as often as in the past due to retrospective studies that suggest
there is little benefit and a chance of significant postsurgical complications. Radiographic studies are
not indicated.
A patient prescribed a beta blocker medication is in the emergency department with reports of
syncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35
beats per minute. Which medication may be used to stabilize this patient?
a. Adenosine
b. Amiodarone
c. Atropine
d. Epinephrine - CORRECT ANSWER-ANS: D
Epinephrine is indicated if unstable bradycardia is caused by beta blockers. This patient is
symptomatic and unstable and should be treated. Adenosine and amiodarone are used to treat
tachycardia. Atropine is used for some types of bradycardia, but not when induced by beta blockers.
