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NR601 Week 8 Final Exam

A 72-year-old man presents to the clinic with a history of NSAID use for chronic osteoarthritis and now reports vague epigastric discomfort. He denies heartburn or regurgitation but mentions some nausea and decreased appetite. The NP suspects peptic ulcer disease. Which of the following BEST explains a contributing factor to his condition?

Answers: A – D

1. Stimulation of mucus production by COX-2 inhibition
2. ✅ Inhibition of COX-1, which impairs mucosal integrity
3. Increased bicarbonate secretion due to NSAID use
4. Enhanced gastric blood flow from prostaglandin inhibition

The NP is assessing a patient with suspected rheumatoid arthritis (RA) and finds that the patient is positive for anti-cyclic citrullinated peptide (anti-CCP antibodies) but negative for rheumatoid factor (RF). Based on this result, what is the MOST appropriate interpretation?

Answers: A – D

1. RA is unlikely, and another autoimmune disease should be considered
2. ✅ RA remains a strong possibility, as anti-CCP antibodies are highly specific for the disease
3. RA can be ruled out because RF is necessary for diagnosis
4. RA is diagnosed only when both RF and anti-CCP antibodies are positive

Which of the following BEST defines an uncomplicated urinary tract infection (UTI)?

Answers: A – D

1. An infection involving the kidneys, with systemic symptoms such as fever and flank pain
2. ✅ An infection confined to the bladder, or acute cystitis
3. A catheter-associated infection with positive urine culture but no symptoms
4. A recurrent bladder infection in a postmenopausal woman with diabetes

A 68-year-old male with no significant symptoms presents for a routine check-up. His digital rectal examination (DRE) is normal, but his baseline serum PSA level is 2.5 ng/mL. He is in good health with a life expectancy of over 15 years. Based on current guidelines and best practices, what is the MOST appropriate next step in managing this patient?

Answers: A – D

1. Reassure the patient and repeat PSA testing in 5 years
2. ✅ Engage in shared decision-making about PSA-based screening and monitoring
3. Recommend prostate biopsy due to elevated PSA
4. Prescribe an alpha-reductase inhibitor and reassess PSA in 6 weeks

The NP is evaluating a patient with frequent migraine attacks who prefers to avoid daily medications. The patient has no history of cardiovascular disease. Which of the following is the BEST option for acute treatment?

Answers: A – D

1. Propranolol (Inderal)
2. ✅ Sumatriptan (Imitrex)
3. Naproxen (Naprosyn)
4. Amitriptyline (Elavil)

A 58-year-old woman with a 10-year history of rheumatoid arthritis presents for routine follow-up. She has morning stiffness lasting over an hour and reports increasing shortness of breath on exertion. She is a former smoker and has no history of cardiac disease. Physical examination reveals fine bibasilar crackles, and pulmonary function testing shows a restrictive pattern with reduced diffusing capacity for carbon monoxide (DLCO). Which of the following is the MOST likely pulmonary complication of her underlying disease?

Answers: A – D

1. Chronic obstructive pulmonary disease (COPD)
2. Pulmonary embolism
3. Bronchial asthma
4. ✅ Usual interstitial pneumonia (UIP)

Which of the following is a risk factor for developing urinary tract infections in aging patients?

Answers: A – D

1. Daily physical activity
2. High fluid intake
3. ✅ Urinary retention
4. Increased estrogen levels

A 54-year-old postmenopausal woman with an intact uterus asks about estrogen therapy for fracture prevention. What additional medication is MOST important to include if you prescribe estrogen?

Answers: A – D

1. Alendronate (Fosamax)
2. Raloxifene (Evista)
3. Calcitonin-salmon (Miacalcin)
4. ✅ Progesterone (Prometrium)

An NP is evaluating a hospitalized 62-year-old female and suspects inflammation-related malnutrition. Which of the following findings BEST supports this clinical suspicion?

Answers: A – D

1. The patient has a normal BMI but has lost 4% of body weight over two months
2. The patient has persistent diarrhea and reported poor food intake
3. Micronutrient deficiencies are suspected based on recent medication use
4. ✅ Albumin and prealbumin levels are decreased in the setting of elevated CRP

A patient presents with complaints of dry skin, brittle hair, and fatigue. On physical examination, the NP notes nonpitting pretibial edema, a puffy face, and thinning of the outer third of the eyebrows. Laboratory results show the following:

TSH: 18.6 mIU/L

Free T4: 0.4 ng/dL

Hemoglobin: 11.2 g/dL

Sodium: 135 mEq/L

Based on the clinical presentation and lab findings, which of the following is the MOST appropriate initial intervention to address the underlying condition?

Answers: A – D

1. ✅ Prescribe a starting dose of levothyroxine and follow up in 6 weeks
2. Recommend increased vitamin A intake to manage carotene accumulation
3. Prescribe topical corticosteroids for dry skin and refer to dermatology
4. Order an MRI of the brain to evaluate for pituitary mass

An 80-year-old patient is newly diagnosed with major depressive disorder (MDD). Which of the following is the most appropriate initial pharmacologic treatment strategy in this population?

Answers: A – D

1. ✅ Begin with a low-dose SSRI and titrate slowly based on response and tolerability
2. Prescribe tricyclic antidepressants as first-line treatment due to cost
3. Avoid SSRIs due to risk of sedation and falls
4. Start a full adult dose of an SSRI to achieve a faster response

A 38-year-old patient with a BMI of 28 kg/m² and a family history of type 2 diabetes presents for a routine checkup. The patient has no current symptoms of diabetes. Based on screening recommendations from the American Diabetes Association (ADA), which of the following is the MOST appropriate next step?

Answers: A – D

1. Perform an oral glucose tolerance test (OGTT) as it is the only valid screening method
2. ✅ Order fasting plasma glucose (FPG) or HbA1c testing due to the weight and family history
3. Delay diabetes screening until the patient turns 45, as the patient is asymptomatic
4. Screen for type 1 diabetes immunologic markers, there is a family history of diabetes

The NP is treating a 58-year-old patient with type 2 diabetes mellitus and a history of cardiovascular disease and is considering a medication adjustment. Which class of medication not only improves glycemic control but has also been shown to reduce cardiovascular events and progression of diabetic kidney disease?

Answers: A – D

1. α-glucosidase inhibitors
2. Sulfonylureas
3. ✅ SGLT2 inhibitors
4. DPP-IV inhibitors

A 54-year-old patient presents to the clinic with recurrent episodes of vertigo, a sensation of fullness in the right ear, fluctuating hearing loss, and occasional tinnitus. Based on the clinical presentation, which of the following is the most likely diagnosis?

Answers: A – D

1. Vestibular neuritis
2. Benign paroxysmal positional vertigo (BPPV)
3. ✅ Ménière’s disease
4. Acoustic Neuroma

The NP is treating a patient recently diagnosed with irritable bowel syndrome with diarrhea (IBS-D). The patient reports frequent loose stools, especially during periods of stress. Which of the following is the BEST initial pharmacologic intervention?

Answers: A – D

1. Citalopram (Celexa) 20 mg daily for 4 weeks
2. ✅ Loperamide (Imodium) 2–4 mg every 4–6 hours as needed
3. Dicyclomine (Bentyl) 10 mg before meals as needed
4. Psyllium husk fiber supplement once daily as needed

A 78-year-old patient with type 2 diabetes and reduced kidney function is being evaluated for therapy adjustment. Which of the following medications should be avoided?

Answers: A – D

1. Pioglitazone (Actos)
2. ✅ Metformin (Glucophage)
3. Empagliflozin (Jardiance)
4. Sitagliptin (Januvia)

An 82-year-old patient presents with new-onset anxiety symptoms. Which of the following is the MOST appropriate initial step in the diagnostic workup?

Answers: A – D

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