LATEST UPDATED NR 511 FINAL EXAM -
PRIMARY CARE PRACTICUM | COMPLETE
EXAM WITH CORRECT ANSWERS AND
RATIONALES. A+ GUARANTEED SUCCESS
1. A 45-year-old male presents with a blood
pressure of 148/92 mm Hg on two separate
office visits. He has no other medical
problems. According to the Eighth Joint
National Committee (JNC 8) guidelines, what is
the initial treatment recommendation for this
patient?
A) Lifestyle modification only, recheck in 6
months
B) Thiazide diuretic, calcium channel blocker,
or ACE inhibitor/ARB
C) Start with two antihypertensive medications
simultaneously
D) Hospital admission for hypertensive
emergency
Correct answer: B
Rationale: For a patient with hypertension (BP
≥140/90) and no comorbidities (diabetes, CKD),
,JNC 8 recommends initiating a thiazide
diuretic, calcium channel blocker, or ACE
inhibitor/ARB. Lifestyle modification is also
recommended but not as monotherapy for
confirmed hypertension with BP above goal.
2. A 55-year-old female with type 2 diabetes
mellitus has a blood pressure of 142/88 mm Hg
at two visits. Her A1c is 7.2%. She is taking
metformin 1000 mg twice daily. According to
ADA guidelines, what is the recommended
blood pressure target for this patient?
A) <150/90 mm Hg
B) <140/90 mm Hg
C) <130/80 mm Hg
D) <120/80 mm Hg
Correct answer: C
Rationale: The American Diabetes Association
(ADA) recommends a blood pressure target of
<130/80 mm Hg for most patients with diabetes
to reduce cardiovascular risk and slow
progression of diabetic kidney disease.
Lifestyle modification and antihypertensive
medication (ACE inhibitor or ARB preferred)
are indicated.
,3. A 68-year-old male presents for a routine
health maintenance visit. He has never been
screened for abdominal aortic aneurysm
(AAA). He has a 40-pack-year smoking history.
Which screening recommendation is most
appropriate?
A) One-time abdominal ultrasound
B) No screening because of his age
C) CT angiography of the abdomen
D) Annual abdominal auscultation for bruits
Correct answer: A
Rationale: The USPSTF recommends one-time
screening for abdominal aortic aneurysm with
abdominal ultrasound in men aged 65-75 who
have ever smoked. This patient meets criteria
(age 68, smoking history). Screening reduces
AAA-related mortality.
4. A 30-year-old female presents with
symptoms of gastroesophageal reflux disease
(GERD) for the past 3 months. She has no
alarm symptoms (dysphagia, weight loss,
anemia, vomiting, hematemesis). What is the
most appropriate initial management?
, A) Esophagogastroduodenoscopy (EGD)
immediately
B) Empiric trial of a proton pump inhibitor (PPI)
once daily for 8 weeks
C) H. pylori testing and treatment
D) Surgical referral for fundoplication
Correct answer: B
Rationale: In patients younger than 60 with
typical GERD symptoms and no alarm features,
an empiric trial of a PPI for 8 weeks is
recommended. EGD is reserved for patients
with alarm symptoms, refractory symptoms, or
long-standing GERD with risk factors for
Barrett esophagus.
5. A 25-year-old female presents with dysuria,
frequency, and urgency. She has no fever,
flank pain, or vaginal discharge. Urinalysis
shows positive nitrites and leukocyte esterase.
Which medication is first-line for
uncomplicated cystitis in a non-pregnant
female?
A) Ciprofloxacin 500 mg twice daily for 7 days
PRIMARY CARE PRACTICUM | COMPLETE
EXAM WITH CORRECT ANSWERS AND
RATIONALES. A+ GUARANTEED SUCCESS
1. A 45-year-old male presents with a blood
pressure of 148/92 mm Hg on two separate
office visits. He has no other medical
problems. According to the Eighth Joint
National Committee (JNC 8) guidelines, what is
the initial treatment recommendation for this
patient?
A) Lifestyle modification only, recheck in 6
months
B) Thiazide diuretic, calcium channel blocker,
or ACE inhibitor/ARB
C) Start with two antihypertensive medications
simultaneously
D) Hospital admission for hypertensive
emergency
Correct answer: B
Rationale: For a patient with hypertension (BP
≥140/90) and no comorbidities (diabetes, CKD),
,JNC 8 recommends initiating a thiazide
diuretic, calcium channel blocker, or ACE
inhibitor/ARB. Lifestyle modification is also
recommended but not as monotherapy for
confirmed hypertension with BP above goal.
2. A 55-year-old female with type 2 diabetes
mellitus has a blood pressure of 142/88 mm Hg
at two visits. Her A1c is 7.2%. She is taking
metformin 1000 mg twice daily. According to
ADA guidelines, what is the recommended
blood pressure target for this patient?
A) <150/90 mm Hg
B) <140/90 mm Hg
C) <130/80 mm Hg
D) <120/80 mm Hg
Correct answer: C
Rationale: The American Diabetes Association
(ADA) recommends a blood pressure target of
<130/80 mm Hg for most patients with diabetes
to reduce cardiovascular risk and slow
progression of diabetic kidney disease.
Lifestyle modification and antihypertensive
medication (ACE inhibitor or ARB preferred)
are indicated.
,3. A 68-year-old male presents for a routine
health maintenance visit. He has never been
screened for abdominal aortic aneurysm
(AAA). He has a 40-pack-year smoking history.
Which screening recommendation is most
appropriate?
A) One-time abdominal ultrasound
B) No screening because of his age
C) CT angiography of the abdomen
D) Annual abdominal auscultation for bruits
Correct answer: A
Rationale: The USPSTF recommends one-time
screening for abdominal aortic aneurysm with
abdominal ultrasound in men aged 65-75 who
have ever smoked. This patient meets criteria
(age 68, smoking history). Screening reduces
AAA-related mortality.
4. A 30-year-old female presents with
symptoms of gastroesophageal reflux disease
(GERD) for the past 3 months. She has no
alarm symptoms (dysphagia, weight loss,
anemia, vomiting, hematemesis). What is the
most appropriate initial management?
, A) Esophagogastroduodenoscopy (EGD)
immediately
B) Empiric trial of a proton pump inhibitor (PPI)
once daily for 8 weeks
C) H. pylori testing and treatment
D) Surgical referral for fundoplication
Correct answer: B
Rationale: In patients younger than 60 with
typical GERD symptoms and no alarm features,
an empiric trial of a PPI for 8 weeks is
recommended. EGD is reserved for patients
with alarm symptoms, refractory symptoms, or
long-standing GERD with risk factors for
Barrett esophagus.
5. A 25-year-old female presents with dysuria,
frequency, and urgency. She has no fever,
flank pain, or vaginal discharge. Urinalysis
shows positive nitrites and leukocyte esterase.
Which medication is first-line for
uncomplicated cystitis in a non-pregnant
female?
A) Ciprofloxacin 500 mg twice daily for 7 days
