NR603 Adult Primary Care — Original Latest Version Study Set Study Guide

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Sample questions from NR603 Adult Primary Care — Original Latest Version Study Set Study Guide

This material has 24 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old man reports fatigue and reduced exercise tolerance. Hemoglobin is 10.2 g/dL, mean corpuscular volume is 73 fL, and ferritin is 9 ng/mL. He has no visible gastrointestinal bleeding, and a recent fecal immunochemical test was negative. He takes naproxen most days for knee pain. Which plan best addresses the findings?

   • A.Treat with oral iron alone and investigate only if hemoglobin fails to normalize
   • B.Arrange colonoscopy and upper endoscopy, initiate iron replacement, and review naproxen use
   • C.Attribute the anemia to aging and repeat the complete blood count in six months
   • D.Repeat the fecal immunochemical test and refer for endoscopy only if it becomes positive

   Rationale: Low ferritin with microcytic anemia indicates iron deficiency. An older man requires evaluation for gastrointestinal blood loss, including malignancy, generally with upper endoscopy and colonoscopy. Iron replacement and review of NSAID-related bleeding risk are also appropriate. Iron alone may correct the anemia while leaving its cause undiagnosed. Anemia is not a normal consequence of aging. A negative stool test does not exclude a gastrointestinal lesion and should not determine whether this patient receives endoscopic evaluation.

2. 2.A 67-year-old postmenopausal woman has a femoral neck DXA T-score of -2.7. She has no prior fragility fracture. Estimated glomerular filtration rate is 72 mL/min/1.73 m2, calcium is normal, and she has no swallowing disorder or esophageal disease. She wants treatment to reduce fracture risk. Which initial plan is most appropriate?

   • A.Recommend calcium and vitamin D alone and repeat DXA in five years
   • B.Start systemic estrogen solely for fracture prevention
   • C.Start oral alendronate with administration teaching, adequate calcium and vitamin D, and fall-prevention measures
   • D.Recommend avoiding weight-bearing exercise and using a walker regardless of gait assessment

   Rationale: A T-score of -2.5 or lower establishes osteoporosis and supports pharmacologic treatment. Alendronate is an appropriate initial option here; teach taking it with plain water on an empty stomach and remaining upright for at least 30 minutes. Nutrition, resistance and weight-bearing activity, and individualized fall prevention complement medication. Supplements alone are insufficient treatment. Initiating systemic estrogen at this age solely for fracture prevention is generally inappropriate because of its risk profile. Routine activity restriction promotes deconditioning, and assistive devices should reflect functional assessment.

3. 3.A 61-year-old adult with type 2 diabetes, hypertension, and chronic kidney disease takes metformin and maximally tolerated losartan. Blood pressure is 128/76 mm Hg, A1C is 7.1%, estimated glomerular filtration rate is 48 mL/min/1.73 m2, and urine albumin-to-creatinine ratio is persistently 420 mg/g. There is no history of ketoacidosis. Which addition most directly addresses kidney and cardiovascular risk?

   • A.Start an SGLT2 inhibitor with counseling about genital infections, volume depletion, and sick-day precautions
   • B.Add lisinopril to losartan to achieve more complete renin-angiotensin system blockade
   • C.Replace metformin with glyburide because sulfonylureas prevent kidney disease progression
   • D.Make no medication changes because the A1C is near the usual treatment target

   Rationale: An SGLT2 inhibitor with demonstrated benefit is recommended for many adults with type 2 diabetes and CKD at this kidney function, particularly with substantial albuminuria, independent of whether A1C is near target. Teaching includes holding it during significant acute illness or prolonged fasting and before surgery because of ketoacidosis risk. Combining an ACE inhibitor with an ARB increases hyperkalemia and acute kidney injury without sufficient benefit. Glyburide can cause prolonged hypoglycemia in CKD and does not provide comparable kidney protection. A1C alone does not determine the need for organ-protective therapy.

4. 4.A 34-year-old nonsmoker reports episodic wheezing, chest tightness, and cough that worsen with pollen exposure. Spirometry shows airflow obstruction, with FEV1 increasing by 15% and 320 mL after bronchodilator administration. Symptoms occur about twice weekly, with no current exacerbation. Which treatment strategy best reduces future severe exacerbation risk?

   • A.Use albuterol alone whenever symptoms occur
   • B.Begin daily oral prednisone to suppress airway inflammation
   • C.Use a long-acting beta agonist alone every day
   • D.Use an inhaled corticosteroid-containing regimen, such as as-needed low-dose ICS-formoterol when available and appropriate

   Answer and rationale are in the full material.

5. 5.A 29-year-old adult presents with six weeks of depressed mood, anhedonia, and poor concentration. Before prescribing an antidepressant, the nurse practitioner learns that the patient previously had a five-day period of sleeping three hours nightly without fatigue, unusually rapid speech, increased activity, and impulsive spending that others noticed. The patient denies current suicidal intent or psychotic symptoms. What is the best next step?

   • A.Start SSRI monotherapy because the current symptoms are depressive
   • B.Assess for bipolar disorder, clarify episode history and substance exposure, and arrange timely psychiatric collaboration before selecting treatment
   • C.Exclude bipolar disorder because the elevated period lasted less than seven days
   • D.Reassure the patient that brief periods of increased productivity are unrelated to treatment selection

   Answer and rationale are in the full material.