NRNP 6531 Midterm Exam | Questions And Answers
with Rationales | Latest 2026/2027 | Digital Download
Pdf | Graded A
Section 1: Health Screening & Prevention (1–10)
1. According to USPSTF, at what age should routine screening for colorectal
cancer begin in average-risk adults?
a) 40 years
b) 45 years
c) 50 years
d) 55 years
*Rationale: USPSTF updated guidelines (2021) recommend starting colorectal
cancer screening at age 45 for average-risk individuals.*
2. Which screening test is recommended annually for adults aged 55–80 years
with a 30 pack-year smoking history who currently smoke or quit within 15
years?
a) Chest X-ray
b) Sputum cytology
c) Low-dose CT chest
d) Serum tumor markers
Rationale: Low-dose CT reduces lung cancer mortality in high-risk smokers per
USPSTF; chest X-ray is not recommended for screening.
3. A 65-year-old woman with no prior fractures has a T-score of -2.8 on DXA
scan. What is the most appropriate initial pharmacotherapy?
a) Calcium and vitamin D alone
b) Raloxifene
,c) Alendronate
d) Teriparatide
*Rationale: T-score ≤ -2.5 = osteoporosis. Bisphosphonates (alendronate) are
first-line; calcium/vitamin D adjuvant, not monotherapy.*
4. USPSTF recommends one-time screening for abdominal aortic aneurysm
(AAA) by ultrasound in which population?
a) All women aged 65–75 years
b) Men aged 65–75 years who ever smoked
c) All adults >80 years
d) Women with hypertension
*Rationale: One-time screening for AAA is recommended for men 65–75 with
smoking history; insufficient evidence for women without family history.*
5. A 50-year-old asymptomatic man with hypertension asks about prostate
cancer screening. What should the NP advise?
a) Annual PSA is mandatory after age 50
b) Shared decision-making discussing benefits and harms of PSA screening
c) DRE alone is sufficient
d) No screening ever
*Rationale: USPSTF recommends shared decision-making for PSA screening in
men 55–69 years; routine screening not recommended ≥70.*
6. Which immunization is recommended for all adults aged ≥65 years
regardless of prior vaccination status?
a) Pneumococcal conjugate vaccine (PCV20) or PCV15 followed by PPSV23
b) Influenza only
c) Tdap every 5 years
d) Shingles vaccine only if history of chickenpox
,*Rationale: ACIP recommends PCV20 alone or PCV15 + PPSV23 for all adults
≥65; plus annual flu, Td/Tdap q10y, shingles (RZV) ≥50.*
7. A 48-year-old woman with BMI 32, no comorbidities, asks about diabetes
screening. What does USPSTF recommend?
a) Screen at age 35 for overweight/obese adults
b) Screen at age 35 for overweight/obese adults
c) Screen only if hypertensive
d) Screen at age 45
*Rationale: USPSTF (2021) recommends screening for prediabetes/diabetes in
adults aged 35–70 who are overweight or obese.*
8. How often should a healthy 55-year-old woman have cervical cancer
screening if prior co-testing (Pap + HPV) was negative?
a) Annually
b) Every 3 years
c) Every 5 years
d) No further screening needed
*Rationale: For ages 30–65, co-testing every 5 years is preferred; Pap alone
every 3 years is acceptable.*
9. A 70-year-old asymptomatic man has BP 142/88. What is the recommended
screening interval for hypertension?
a) Annually
b) Every year per USPSTF
c) Every 2 years
d) Every 5 years
Rationale: USPSTF recommends annual screening for hypertension in adults ≥40
or those at increased risk.
, 10. Which vitamin supplementation is recommended for all adults aged ≥65 to
reduce fall risk?
a) Vitamin A
b) Vitamin C
c) Vitamin D with calcium
d) Vitamin E
*Rationale: Vitamin D (800 IU/day) + calcium reduces fall and fracture risk in
older adults; not vitamin A, C, or E.*
Section 2: Hypertension & Cardiovascular Disease (11–20)
11. A 55-year-old African American with BP 148/92, no diabetes or CKD. What
is the first-line antihypertensive?
a) Lisinopril
b) Metoprolol
c) Hydrochlorothiazide
d) Amlodipine or chlorthalidone
Rationale: For non-black patients, first-line: thiazide, ACEi, ARB, CCB. For black
patients: thiazide or CCB (ACEi less effective as monotherapy).
12. A patient with hypertension and stage 3 CKD (eGFR 45) has BP 142/90.
What is the target BP per KDIGO?
a) <150/90
b) <130/80
c) <140/90
d) <120/80
*Rationale: KDIGO (2021) recommends BP target <130/80 for patients with
CKD regardless of proteinuria.*
with Rationales | Latest 2026/2027 | Digital Download
Pdf | Graded A
Section 1: Health Screening & Prevention (1–10)
1. According to USPSTF, at what age should routine screening for colorectal
cancer begin in average-risk adults?
a) 40 years
b) 45 years
c) 50 years
d) 55 years
*Rationale: USPSTF updated guidelines (2021) recommend starting colorectal
cancer screening at age 45 for average-risk individuals.*
2. Which screening test is recommended annually for adults aged 55–80 years
with a 30 pack-year smoking history who currently smoke or quit within 15
years?
a) Chest X-ray
b) Sputum cytology
c) Low-dose CT chest
d) Serum tumor markers
Rationale: Low-dose CT reduces lung cancer mortality in high-risk smokers per
USPSTF; chest X-ray is not recommended for screening.
3. A 65-year-old woman with no prior fractures has a T-score of -2.8 on DXA
scan. What is the most appropriate initial pharmacotherapy?
a) Calcium and vitamin D alone
b) Raloxifene
,c) Alendronate
d) Teriparatide
*Rationale: T-score ≤ -2.5 = osteoporosis. Bisphosphonates (alendronate) are
first-line; calcium/vitamin D adjuvant, not monotherapy.*
4. USPSTF recommends one-time screening for abdominal aortic aneurysm
(AAA) by ultrasound in which population?
a) All women aged 65–75 years
b) Men aged 65–75 years who ever smoked
c) All adults >80 years
d) Women with hypertension
*Rationale: One-time screening for AAA is recommended for men 65–75 with
smoking history; insufficient evidence for women without family history.*
5. A 50-year-old asymptomatic man with hypertension asks about prostate
cancer screening. What should the NP advise?
a) Annual PSA is mandatory after age 50
b) Shared decision-making discussing benefits and harms of PSA screening
c) DRE alone is sufficient
d) No screening ever
*Rationale: USPSTF recommends shared decision-making for PSA screening in
men 55–69 years; routine screening not recommended ≥70.*
6. Which immunization is recommended for all adults aged ≥65 years
regardless of prior vaccination status?
a) Pneumococcal conjugate vaccine (PCV20) or PCV15 followed by PPSV23
b) Influenza only
c) Tdap every 5 years
d) Shingles vaccine only if history of chickenpox
,*Rationale: ACIP recommends PCV20 alone or PCV15 + PPSV23 for all adults
≥65; plus annual flu, Td/Tdap q10y, shingles (RZV) ≥50.*
7. A 48-year-old woman with BMI 32, no comorbidities, asks about diabetes
screening. What does USPSTF recommend?
a) Screen at age 35 for overweight/obese adults
b) Screen at age 35 for overweight/obese adults
c) Screen only if hypertensive
d) Screen at age 45
*Rationale: USPSTF (2021) recommends screening for prediabetes/diabetes in
adults aged 35–70 who are overweight or obese.*
8. How often should a healthy 55-year-old woman have cervical cancer
screening if prior co-testing (Pap + HPV) was negative?
a) Annually
b) Every 3 years
c) Every 5 years
d) No further screening needed
*Rationale: For ages 30–65, co-testing every 5 years is preferred; Pap alone
every 3 years is acceptable.*
9. A 70-year-old asymptomatic man has BP 142/88. What is the recommended
screening interval for hypertension?
a) Annually
b) Every year per USPSTF
c) Every 2 years
d) Every 5 years
Rationale: USPSTF recommends annual screening for hypertension in adults ≥40
or those at increased risk.
, 10. Which vitamin supplementation is recommended for all adults aged ≥65 to
reduce fall risk?
a) Vitamin A
b) Vitamin C
c) Vitamin D with calcium
d) Vitamin E
*Rationale: Vitamin D (800 IU/day) + calcium reduces fall and fracture risk in
older adults; not vitamin A, C, or E.*
Section 2: Hypertension & Cardiovascular Disease (11–20)
11. A 55-year-old African American with BP 148/92, no diabetes or CKD. What
is the first-line antihypertensive?
a) Lisinopril
b) Metoprolol
c) Hydrochlorothiazide
d) Amlodipine or chlorthalidone
Rationale: For non-black patients, first-line: thiazide, ACEi, ARB, CCB. For black
patients: thiazide or CCB (ACEi less effective as monotherapy).
12. A patient with hypertension and stage 3 CKD (eGFR 45) has BP 142/90.
What is the target BP per KDIGO?
a) <150/90
b) <130/80
c) <140/90
d) <120/80
*Rationale: KDIGO (2021) recommends BP target <130/80 for patients with
CKD regardless of proteinuria.*
