NR 602 FINAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 45-year-old patient presents with fatigue, weight gain, cold intolerance,
and constipation. Labs show elevated TSH and low free T4. What is the most
appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Prednisone
Answer: B
Rationale: Elevated TSH and low free T4 indicate primary hypothyroidism.
Levothyroxine is the treatment of choice.
,2. A patient with type 2 diabetes has an A1c of 9.8% on metformin. What is
the best next step?
A. Add a GLP-1 agonist
B. Discontinue metformin
C. Add levothyroxine
D. Start prednisone
Answer: A
Rationale: A1c >9% requires additional therapy. GLP-1 agonists help with
glycemic control and weight loss.
3. A patient presents with RUQ pain, fever, and jaundice. Which is the most
likely diagnosis?
A. Acute pancreatitis
B. Ascending cholangitis
C. Appendicitis
D. Peptic ulcer disease
Answer: B
Rationale: Charcot triad (RUQ pain, fever, jaundice) indicates ascending
cholangitis.
4. A patient presents with sudden severe headache, nuchal rigidity, and
photophobia. What is the most appropriate initial test?
A. CT scan without contrast
B. MRI
C. Abdominal ultrasound
D. EKG
Answer: A
Rationale: CT without contrast is first-line for suspected subarachnoid
hemorrhage.
,5. A 60-year-old patient with hypertension presents with chest pain radiating
to the left arm. Which is the most appropriate next step?
A. Obtain ECG
B. Prescribe antibiotics
C. Order abdominal ultrasound
D. Start insulin
Answer: A
Rationale: ECG is the first diagnostic test for suspected acute coronary syndrome.
6. A patient presents with fatigue, pallor, and low MCV. Which condition is
most likely?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Aplastic anemia
D. Hemolytic anemia
Answer: A
Rationale: Low MCV indicates microcytic anemia; iron deficiency is most
common cause.
7. A patient has A1c 5.9% and fasting glucose 115 mg/dL. What is the
diagnosis?
A. Diabetes
B. Prediabetes
C. Normal
D. DKA
Answer: B
Rationale: A1c 5.7–6.4% indicates prediabetes.
, 8. A patient presents with sudden unilateral facial droop, arm weakness, and
slurred speech. What is the most appropriate next step?
A. CT scan of head
B. Chest X-ray
C. Abdominal CT
D. ECG
Answer: A
Rationale: CT head is first-line to differentiate ischemic vs hemorrhagic stroke.
9. A patient presents with fever, productive cough, and crackles on lung exam.
CXR shows lobar consolidation. What is the most likely diagnosis?
A. Community-acquired pneumonia
B. Asthma
C. COPD exacerbation
D. Pulmonary embolism
Answer: A
Rationale: Lobar consolidation with fever and productive cough indicates
bacterial pneumonia.
10. A patient with COPD presents with worsening dyspnea and increased
sputum. What is the most appropriate treatment?
A. Antibiotics + bronchodilators
B. Insulin
C. Levothyroxine
D. Statin
Answer: A
Rationale: COPD exacerbation often requires antibiotics and bronchodilators.
CORRECT ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 45-year-old patient presents with fatigue, weight gain, cold intolerance,
and constipation. Labs show elevated TSH and low free T4. What is the most
appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Prednisone
Answer: B
Rationale: Elevated TSH and low free T4 indicate primary hypothyroidism.
Levothyroxine is the treatment of choice.
,2. A patient with type 2 diabetes has an A1c of 9.8% on metformin. What is
the best next step?
A. Add a GLP-1 agonist
B. Discontinue metformin
C. Add levothyroxine
D. Start prednisone
Answer: A
Rationale: A1c >9% requires additional therapy. GLP-1 agonists help with
glycemic control and weight loss.
3. A patient presents with RUQ pain, fever, and jaundice. Which is the most
likely diagnosis?
A. Acute pancreatitis
B. Ascending cholangitis
C. Appendicitis
D. Peptic ulcer disease
Answer: B
Rationale: Charcot triad (RUQ pain, fever, jaundice) indicates ascending
cholangitis.
4. A patient presents with sudden severe headache, nuchal rigidity, and
photophobia. What is the most appropriate initial test?
A. CT scan without contrast
B. MRI
C. Abdominal ultrasound
D. EKG
Answer: A
Rationale: CT without contrast is first-line for suspected subarachnoid
hemorrhage.
,5. A 60-year-old patient with hypertension presents with chest pain radiating
to the left arm. Which is the most appropriate next step?
A. Obtain ECG
B. Prescribe antibiotics
C. Order abdominal ultrasound
D. Start insulin
Answer: A
Rationale: ECG is the first diagnostic test for suspected acute coronary syndrome.
6. A patient presents with fatigue, pallor, and low MCV. Which condition is
most likely?
A. Iron deficiency anemia
B. Vitamin B12 deficiency
C. Aplastic anemia
D. Hemolytic anemia
Answer: A
Rationale: Low MCV indicates microcytic anemia; iron deficiency is most
common cause.
7. A patient has A1c 5.9% and fasting glucose 115 mg/dL. What is the
diagnosis?
A. Diabetes
B. Prediabetes
C. Normal
D. DKA
Answer: B
Rationale: A1c 5.7–6.4% indicates prediabetes.
, 8. A patient presents with sudden unilateral facial droop, arm weakness, and
slurred speech. What is the most appropriate next step?
A. CT scan of head
B. Chest X-ray
C. Abdominal CT
D. ECG
Answer: A
Rationale: CT head is first-line to differentiate ischemic vs hemorrhagic stroke.
9. A patient presents with fever, productive cough, and crackles on lung exam.
CXR shows lobar consolidation. What is the most likely diagnosis?
A. Community-acquired pneumonia
B. Asthma
C. COPD exacerbation
D. Pulmonary embolism
Answer: A
Rationale: Lobar consolidation with fever and productive cough indicates
bacterial pneumonia.
10. A patient with COPD presents with worsening dyspnea and increased
sputum. What is the most appropriate treatment?
A. Antibiotics + bronchodilators
B. Insulin
C. Levothyroxine
D. Statin
Answer: A
Rationale: COPD exacerbation often requires antibiotics and bronchodilators.
