NSG 6440 EXAM WEEK 9 PREDICTOR
TEST | SOUTH UNIVERSITY
SECTION I: INFECTIOUS DISEASE & DIAGNOSTIC REASONING (Questions 1-5)
Q1. A 15-year-old high school student with a mild sore throat and low-grade fever has persisted
for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects
mononucleosis. Which of the following is the LEAST appropriate intervention?
A) Palpate the lymph nodes and spleen
B) Examine the posterior oropharynx for petechiae
C) Obtain a CBC, throat culture, and heterophil antibody test
D) Obtain urinalysis and serum for LFTs and amylase
Correct Answer: D
Rationale: Mononucleosis is a symptomatic infection caused by the Epstein-Barr virus, common
in people 15-24 years of age . Common signs and symptoms following the incubation period
(1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates, and
lymphadenopathy of the posterior cervical region. Splenomegaly can be present. A diagnosis is
usually made using the Monospot test. CBC may reveal neutropenia and lymphocytosis.
Urinalysis and LFTs/amylase are not standard for diagnosing mononucleosis.
Q2. A 32-year-old male patient complains of urinary frequency and burning on urination for 3
days. Urinalysis reveals bacteriuria and positive nitrites. He denies any past history of urinary
tract infections. The initial treatment should be:
A) Trimethoprim-sulfamethoxazole (Bactrim) for 7-10 days
B) Ciprofloxacin (Cipro) for 3-5 days
C) Trimethoprim-sulfamethoxazole for 3 days
D) 750 mg ciprofloxacin as a one-time dose
Correct Answer: A
Rationale: For men with UTIs, current guidelines recommend a longer course of antibiotics due
to the higher risk of prostatic involvement and complications . Trimethoprim-sulfamethoxazole
for 7-10 days is considered appropriate. Short courses (3 days) and single-dose regimens are
not recommended for male patients. While fluoroquinolones may be used, they are not first-line
and would require longer duration than 3-5 days when used.
,Q3. Which agent is most effective for the treatment of nodulocystic acne?
A) Benzoyl peroxide (Benzac)
B) Retinoic acid (Retin-A)
C) Topical tetracycline
D) Isotretinoin
Correct Answer: D
Rationale: Isotretinoin (Accutane) is a systemic agent indicated for treatment of severe
inflammatory acne . Guidelines for its use must be clearly understood by the patient. A woman
of childbearing age must use an effective method of contraception because isotretinoin is
teratogenic. There are many restrictions in prescribing this medication due to its teratogenic
effects. It is a Pregnancy Category X medication.
Q4. An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy if:
A) Throughout the week of placebo pills
B) If prescribed topiramate (Topamax) for migraines
C) If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
D) If she forgets to take a single dose of the contraceptive
Correct Answer: B
Rationale: Anticonvulsants including phenytoin (Dilantin), carbamazepine (Tegretol), primidone
(Mysoline), topiramate (Topamax), and oxcarbazepine (Trileptal) reduce the effectiveness of
hormonal contraceptives . Most commonly used antibiotics have not been proven to reduce the
effectiveness of contraceptives, with rifampin being a notable exception. No additional protection
is needed during the week of placebo pills. Missing a single dose of contraceptive does not
require additional protection; missing more than one dose does.
Q5. A 32-year-old male presents with sudden onset of severe right testicular pain and absent
cremasteric reflex. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Hydrocele
, D) Varicocele
Correct Answer: B
Rationale: Testicular torsion presents with acute, severe testicular pain and loss of the
cremasteric reflex . This is a urologic emergency requiring immediate referral for surgical
exploration. Epididymitis typically presents with gradual onset, fever, and preserved cremasteric
reflex.
SECTION II: CARDIOVASCULAR & ENDOCRINE MANAGEMENT (Questions 6-12)
Q6. A 44-year-old female patient with diabetes has total cholesterol (TC) of 250 mg/dL,
LDL=190 mg/dL, HDL=25 mg/dL, and triglycerides=344 mg/dL. Which agent has the greatest
effect on improving her lipid profile and reducing morbidity and mortality associated with
dyslipidemia?
A) Niacin (Niaspan)
B) Atorvastatin
C) Omega-3 fatty acids
D) Fenofibrates
Correct Answer: B
Rationale: Statin therapy, particularly atorvastatin, is strongly recommended for diabetic patients
because it effectively lowers LDL cholesterol levels and provides additional cardiovascular
protective benefits . Guidelines strongly recommend statin therapy because they primarily lower
LDL-C levels, but they also have secondary effects of lowering triglycerides and increasing
HDL-C levels. Other options assist with triglyceride management but do not provide the same
degree of overall risk reduction as statins.
Q7. A patient is started on lisinopril for hypertension. Which finding is a common side effect that
should be discussed with the patient?
A) Hyperkalemia
B) Dry, persistent cough
C) Acute renal failure
D) Angioedema
Correct Answer: B
TEST | SOUTH UNIVERSITY
SECTION I: INFECTIOUS DISEASE & DIAGNOSTIC REASONING (Questions 1-5)
Q1. A 15-year-old high school student with a mild sore throat and low-grade fever has persisted
for about 3 weeks. She reports general malaise, fatigue, and loss of appetite. The NP suspects
mononucleosis. Which of the following is the LEAST appropriate intervention?
A) Palpate the lymph nodes and spleen
B) Examine the posterior oropharynx for petechiae
C) Obtain a CBC, throat culture, and heterophil antibody test
D) Obtain urinalysis and serum for LFTs and amylase
Correct Answer: D
Rationale: Mononucleosis is a symptomatic infection caused by the Epstein-Barr virus, common
in people 15-24 years of age . Common signs and symptoms following the incubation period
(1-2 months) include fatigue, chills, malaise, anorexia, white tonsillar exudates, and
lymphadenopathy of the posterior cervical region. Splenomegaly can be present. A diagnosis is
usually made using the Monospot test. CBC may reveal neutropenia and lymphocytosis.
Urinalysis and LFTs/amylase are not standard for diagnosing mononucleosis.
Q2. A 32-year-old male patient complains of urinary frequency and burning on urination for 3
days. Urinalysis reveals bacteriuria and positive nitrites. He denies any past history of urinary
tract infections. The initial treatment should be:
A) Trimethoprim-sulfamethoxazole (Bactrim) for 7-10 days
B) Ciprofloxacin (Cipro) for 3-5 days
C) Trimethoprim-sulfamethoxazole for 3 days
D) 750 mg ciprofloxacin as a one-time dose
Correct Answer: A
Rationale: For men with UTIs, current guidelines recommend a longer course of antibiotics due
to the higher risk of prostatic involvement and complications . Trimethoprim-sulfamethoxazole
for 7-10 days is considered appropriate. Short courses (3 days) and single-dose regimens are
not recommended for male patients. While fluoroquinolones may be used, they are not first-line
and would require longer duration than 3-5 days when used.
,Q3. Which agent is most effective for the treatment of nodulocystic acne?
A) Benzoyl peroxide (Benzac)
B) Retinoic acid (Retin-A)
C) Topical tetracycline
D) Isotretinoin
Correct Answer: D
Rationale: Isotretinoin (Accutane) is a systemic agent indicated for treatment of severe
inflammatory acne . Guidelines for its use must be clearly understood by the patient. A woman
of childbearing age must use an effective method of contraception because isotretinoin is
teratogenic. There are many restrictions in prescribing this medication due to its teratogenic
effects. It is a Pregnancy Category X medication.
Q4. An 18-year-old woman is taking a combined hormonal oral contraceptive. She should be
instructed to use a backup method for the prevention of pregnancy if:
A) Throughout the week of placebo pills
B) If prescribed topiramate (Topamax) for migraines
C) If prescribed amoxicillin/clavulanate (Augmentin) for a sinus infection
D) If she forgets to take a single dose of the contraceptive
Correct Answer: B
Rationale: Anticonvulsants including phenytoin (Dilantin), carbamazepine (Tegretol), primidone
(Mysoline), topiramate (Topamax), and oxcarbazepine (Trileptal) reduce the effectiveness of
hormonal contraceptives . Most commonly used antibiotics have not been proven to reduce the
effectiveness of contraceptives, with rifampin being a notable exception. No additional protection
is needed during the week of placebo pills. Missing a single dose of contraceptive does not
require additional protection; missing more than one dose does.
Q5. A 32-year-old male presents with sudden onset of severe right testicular pain and absent
cremasteric reflex. What is the most likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Hydrocele
, D) Varicocele
Correct Answer: B
Rationale: Testicular torsion presents with acute, severe testicular pain and loss of the
cremasteric reflex . This is a urologic emergency requiring immediate referral for surgical
exploration. Epididymitis typically presents with gradual onset, fever, and preserved cremasteric
reflex.
SECTION II: CARDIOVASCULAR & ENDOCRINE MANAGEMENT (Questions 6-12)
Q6. A 44-year-old female patient with diabetes has total cholesterol (TC) of 250 mg/dL,
LDL=190 mg/dL, HDL=25 mg/dL, and triglycerides=344 mg/dL. Which agent has the greatest
effect on improving her lipid profile and reducing morbidity and mortality associated with
dyslipidemia?
A) Niacin (Niaspan)
B) Atorvastatin
C) Omega-3 fatty acids
D) Fenofibrates
Correct Answer: B
Rationale: Statin therapy, particularly atorvastatin, is strongly recommended for diabetic patients
because it effectively lowers LDL cholesterol levels and provides additional cardiovascular
protective benefits . Guidelines strongly recommend statin therapy because they primarily lower
LDL-C levels, but they also have secondary effects of lowering triglycerides and increasing
HDL-C levels. Other options assist with triglyceride management but do not provide the same
degree of overall risk reduction as statins.
Q7. A patient is started on lisinopril for hypertension. Which finding is a common side effect that
should be discussed with the patient?
A) Hyperkalemia
B) Dry, persistent cough
C) Acute renal failure
D) Angioedema
Correct Answer: B
