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EXAMS
(2026) Primary Care Questions | Nursing Exam (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam (2026) Primary Care Questions | Nursing
Exam (PDF) - 2026/2027 Update
Page 1
,Question 1
A 45-year-old previously healthy individual presents with acute onset of severe, colicky right flank
pain radiating to the groin, associated with nausea and hematuria. Urinalysis shows pH 6.5,
specific gravity 1.020, and numerous red blood cells. Noncontrast CT reveals a 5 mm radiopaque
calculus at the ureterovesical junction. Which of the following management strategies is most
appropriate as first-line therapy?
A) Initiate tamsulosin 0.4 mg daily and encourage vigorous oral hydration; schedule urology follow-up
in 2 weeks.
B) Prescribe hydrocodone/acetaminophen for pain and arrange for extracorporeal shock wave
lithotripsy (ESWL) within 48 hours.
C) Administer intravenous ketorolac and fluids, then refer for urgent ureteroscopic stone extraction.
D) Start oral antibiotics for presumed urinary tract infection and order a 24-hour urine collection for
metabolic analysis.
Answer: A) Initiate tamsulosin 0.4 mg daily and encourage vigorous oral hydration; schedule
urology follow-up in 2 weeks.
Explanation: A 5 mm distal ureteral stone has a high likelihood of spontaneous passage (up to 75%).
Medical expulsive therapy with an alpha-blocker like tamsulosin facilitates passage, and
hydration promotes urine flow. ESWL or ureteroscopy is reserved for stones >10 mm or
those failing conservative management. Antibiotics are not indicated without evidence
of infection.
Question 2
A patient with a history of hypertension and type 2 diabetes mellitus has a blood pressure reading
of 148/92 mm Hg on two separate visits. Current medications include metformin 1000 mg twice
daily and lisinopril 10 mg daily. Estimated glomerular filtration rate (eGFR) is 55 mL/min/1.73 m²
and urine albumin-to-creatinine ratio is 120 mg/g. According to current guidelines, which
antihypertensive agent should be added next?
A) Amlodipine 5 mg daily
B) Chlorthalidone 12.5 mg daily
C) Spironolactone 25 mg daily
D) Atenolol 50 mg daily
Answer: A) Amlodipine 5 mg daily
Explanation: In patients with CKD and albuminuria, an ACE inhibitor or ARB is first-line. With BP
still above goal, adding a calcium channel blocker (amlodipine) is recommended.
Thiazide diuretics become less effective when eGFR <30 mL/min; chlorthalidone is less
preferred at eGFR 55. Spironolactone may cause hyperkalemia with ACEi and CKD.
Beta-blockers are not first-line add-on therapy without compelling indications.
Page 2
,Question 3
A 30-year-old presents with a 2-week history of dry cough, low-grade fevers, and dyspnea on
exertion. Chest X-ray shows bilateral interstitial infiltrates and hilar lymphadenopathy. Serum
angiotensin-converting enzyme (ACE) level is elevated. Which of the following is the most likely
diagnosis?
A) Sarcoidosis
B) Tuberculosis
C) Hypersensitivity pneumonitis
D) Lymphoma
Answer: A) Sarcoidosis
Explanation: The combination of bilateral interstitial infiltrates, hilar lymphadenopathy, and elevated
ACE is classic for sarcoidosis. Tuberculosis typically presents with apical infiltrates and
cavitation. Hypersensitivity pneumonitis is associated with antigen exposure and often
normal ACE. Lymphoma may cause mediastinal adenopathy but not typically bilateral
hilar with elevated ACE.
Question 4
Which of the following best describes the mechanism of action of metformin in the management of
type 2 diabetes mellitus?
A) Increases insulin secretion from pancreatic beta cells by binding to sulfonylurea receptors.
B) Activates peroxisome proliferator-activated receptor-gamma (PPAR-³) to improve insulin
sensitivity.
C) Suppresses hepatic gluconeogenesis and increases peripheral glucose uptake via AMPK activation.
D) Slows carbohydrate absorption in the gut by inhibiting alpha-glucosidase enzymes.
Answer: C) Suppresses hepatic gluconeogenesis and increases peripheral glucose uptake via AMPK
activation.
Explanation: Metformin primarily activates AMP-activated protein kinase (AMPK), leading to
reduced hepatic glucose production and improved insulin sensitivity in muscle and
adipose tissue. Option A describes sulfonylureas, B describes thiazolidinediones, and D
describes alpha-glucosidase inhibitors.
Page 3
, Question 5
A patient with a history of recurrent calcium oxalate kidney stones is found to have hypercalciuria
on 24-hour urine collection. Serum calcium and parathyroid hormone levels are normal. Which
dietary modification is most likely to reduce stone recurrence?
A) Increase dietary calcium intake to 1200 mg daily
B) Restrict dietary calcium intake to less than 800 mg daily
C) Increase oxalate-rich foods such as spinach and nuts
D) Supplement with vitamin C 1000 mg daily
Answer: A) Increase dietary calcium intake to 1200 mg daily
Explanation: In idiopathic hypercalciuria, dietary calcium restriction paradoxically increases oxalate
absorption and stone risk. Normal or higher calcium intake (with meals) binds oxalate in
the gut, reducing urinary oxalate. Oxalate-rich foods should be limited, and vitamin C
can increase oxalate production. Thus, increasing dietary calcium is recommended.
Question 6
A 60-year-old with a 30-pack-year smoking history presents with hemoptysis and weight loss.
Chest CT reveals a 3 cm spiculated mass in the right upper lobe. Biopsy shows non-small cell lung
cancer, adenocarcinoma subtype. Molecular testing reveals an EGFR exon 19 deletion. Which of
the following targeted therapies is most appropriate as first-line treatment?
A) Osimertinib
B) Crizotinib
C) Pembrolizumab
D) Bevacizumab
Answer: A) Osimertinib
Explanation: EGFR exon 19 deletions are sensitive to first-generation EGFR TKIs (erlotinib,
gefitinib) and the third-generation TKI osimertinib, which is now preferred due to
superior CNS penetration and efficacy. Crizotinib targets ALK rearrangements.
Pembrolizumab is an immune checkpoint inhibitor; bevacizumab is anti-angiogenic.
Osimertinib is the recommended first-line therapy for EGFR-mutant NSCLC.
Page 4
Download Download
EXAMS
(2026) Primary Care Questions | Nursing Exam (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam (2026) Primary Care Questions | Nursing
Exam (PDF) - 2026/2027 Update
Page 1
,Question 1
A 45-year-old previously healthy individual presents with acute onset of severe, colicky right flank
pain radiating to the groin, associated with nausea and hematuria. Urinalysis shows pH 6.5,
specific gravity 1.020, and numerous red blood cells. Noncontrast CT reveals a 5 mm radiopaque
calculus at the ureterovesical junction. Which of the following management strategies is most
appropriate as first-line therapy?
A) Initiate tamsulosin 0.4 mg daily and encourage vigorous oral hydration; schedule urology follow-up
in 2 weeks.
B) Prescribe hydrocodone/acetaminophen for pain and arrange for extracorporeal shock wave
lithotripsy (ESWL) within 48 hours.
C) Administer intravenous ketorolac and fluids, then refer for urgent ureteroscopic stone extraction.
D) Start oral antibiotics for presumed urinary tract infection and order a 24-hour urine collection for
metabolic analysis.
Answer: A) Initiate tamsulosin 0.4 mg daily and encourage vigorous oral hydration; schedule
urology follow-up in 2 weeks.
Explanation: A 5 mm distal ureteral stone has a high likelihood of spontaneous passage (up to 75%).
Medical expulsive therapy with an alpha-blocker like tamsulosin facilitates passage, and
hydration promotes urine flow. ESWL or ureteroscopy is reserved for stones >10 mm or
those failing conservative management. Antibiotics are not indicated without evidence
of infection.
Question 2
A patient with a history of hypertension and type 2 diabetes mellitus has a blood pressure reading
of 148/92 mm Hg on two separate visits. Current medications include metformin 1000 mg twice
daily and lisinopril 10 mg daily. Estimated glomerular filtration rate (eGFR) is 55 mL/min/1.73 m²
and urine albumin-to-creatinine ratio is 120 mg/g. According to current guidelines, which
antihypertensive agent should be added next?
A) Amlodipine 5 mg daily
B) Chlorthalidone 12.5 mg daily
C) Spironolactone 25 mg daily
D) Atenolol 50 mg daily
Answer: A) Amlodipine 5 mg daily
Explanation: In patients with CKD and albuminuria, an ACE inhibitor or ARB is first-line. With BP
still above goal, adding a calcium channel blocker (amlodipine) is recommended.
Thiazide diuretics become less effective when eGFR <30 mL/min; chlorthalidone is less
preferred at eGFR 55. Spironolactone may cause hyperkalemia with ACEi and CKD.
Beta-blockers are not first-line add-on therapy without compelling indications.
Page 2
,Question 3
A 30-year-old presents with a 2-week history of dry cough, low-grade fevers, and dyspnea on
exertion. Chest X-ray shows bilateral interstitial infiltrates and hilar lymphadenopathy. Serum
angiotensin-converting enzyme (ACE) level is elevated. Which of the following is the most likely
diagnosis?
A) Sarcoidosis
B) Tuberculosis
C) Hypersensitivity pneumonitis
D) Lymphoma
Answer: A) Sarcoidosis
Explanation: The combination of bilateral interstitial infiltrates, hilar lymphadenopathy, and elevated
ACE is classic for sarcoidosis. Tuberculosis typically presents with apical infiltrates and
cavitation. Hypersensitivity pneumonitis is associated with antigen exposure and often
normal ACE. Lymphoma may cause mediastinal adenopathy but not typically bilateral
hilar with elevated ACE.
Question 4
Which of the following best describes the mechanism of action of metformin in the management of
type 2 diabetes mellitus?
A) Increases insulin secretion from pancreatic beta cells by binding to sulfonylurea receptors.
B) Activates peroxisome proliferator-activated receptor-gamma (PPAR-³) to improve insulin
sensitivity.
C) Suppresses hepatic gluconeogenesis and increases peripheral glucose uptake via AMPK activation.
D) Slows carbohydrate absorption in the gut by inhibiting alpha-glucosidase enzymes.
Answer: C) Suppresses hepatic gluconeogenesis and increases peripheral glucose uptake via AMPK
activation.
Explanation: Metformin primarily activates AMP-activated protein kinase (AMPK), leading to
reduced hepatic glucose production and improved insulin sensitivity in muscle and
adipose tissue. Option A describes sulfonylureas, B describes thiazolidinediones, and D
describes alpha-glucosidase inhibitors.
Page 3
, Question 5
A patient with a history of recurrent calcium oxalate kidney stones is found to have hypercalciuria
on 24-hour urine collection. Serum calcium and parathyroid hormone levels are normal. Which
dietary modification is most likely to reduce stone recurrence?
A) Increase dietary calcium intake to 1200 mg daily
B) Restrict dietary calcium intake to less than 800 mg daily
C) Increase oxalate-rich foods such as spinach and nuts
D) Supplement with vitamin C 1000 mg daily
Answer: A) Increase dietary calcium intake to 1200 mg daily
Explanation: In idiopathic hypercalciuria, dietary calcium restriction paradoxically increases oxalate
absorption and stone risk. Normal or higher calcium intake (with meals) binds oxalate in
the gut, reducing urinary oxalate. Oxalate-rich foods should be limited, and vitamin C
can increase oxalate production. Thus, increasing dietary calcium is recommended.
Question 6
A 60-year-old with a 30-pack-year smoking history presents with hemoptysis and weight loss.
Chest CT reveals a 3 cm spiculated mass in the right upper lobe. Biopsy shows non-small cell lung
cancer, adenocarcinoma subtype. Molecular testing reveals an EGFR exon 19 deletion. Which of
the following targeted therapies is most appropriate as first-line treatment?
A) Osimertinib
B) Crizotinib
C) Pembrolizumab
D) Bevacizumab
Answer: A) Osimertinib
Explanation: EGFR exon 19 deletions are sensitive to first-generation EGFR TKIs (erlotinib,
gefitinib) and the third-generation TKI osimertinib, which is now preferred due to
superior CNS penetration and efficacy. Crizotinib targets ALK rearrangements.
Pembrolizumab is an immune checkpoint inhibitor; bevacizumab is anti-angiogenic.
Osimertinib is the recommended first-line therapy for EGFR-mutant NSCLC.
Page 4
