1
NRNP 6531 Primary Care of Adults Across the
Lifespan Midterm Exam \ 100 Adult Health
Questions and Rationales
1. A 55-year-old asymptomatic woman with no significant medical history asks if
she should take a daily aspirin to prevent heart disease. According to the U.S.
Preventive Services Task Force (USPSTF), what is the recommendation?
A. Initiate low-dose aspirin for all adults aged 50–59 years.
B. The decision should be individualized for adults aged 40–59 years with a 10-
year ASCVD risk ≥10%; not recommended routinely for those ≥60 years.
C. Aspirin is contraindicated for primary prevention in all women.
D. Start aspirin 325 mg daily for primary prevention.
Answer: B
Rationale: The USPSTF recommends that the decision to initiate low-dose aspirin
for primary prevention of cardiovascular disease in adults aged 40–59 years with
a 10-year ASCVD risk ≥10% should be an individual one (Grade C). For adults ≥60
years, initiating aspirin for primary prevention is not recommended (Grade D) due
to increased bleeding risk. Option A is too broad; C is incorrect (aspirin can be
considered in selected women); D is wrong dose and not routine.
2. A 68-year-old male former smoker with hypertension and a 50-pack-year
history asks about lung cancer screening. Which of the following meets USPSTF
criteria for annual low-dose CT screening?
A. Age 55–80 years, ≥30 pack-year smoking history, currently smoking or quit
within the past 15 years.
B. Age 50–80 years, ≥20 pack-year smoking history, currently smoking or quit
within the past 15 years.
C. Any age with any smoking history.
D. Only current smokers over age 65.
pg. 1
,2
Answer: B
Rationale: In 2021, the USPSTF expanded lung cancer screening criteria to adults
aged 50–80 years who have a 20 pack-year smoking history and currently smoke
or have quit within the past 15 years (Grade B). Option A reflects older guidelines.
C and D are too broad or restrictive.
3. A 72-year-old woman with osteoporosis is started on alendronate. Which
instruction is most important to prevent adverse effects?
A. Take with a full glass of orange juice.
B. Take on an empty stomach first thing in the morning with 8 oz of plain water,
remain upright for at least 30 minutes.
C. Take at bedtime with milk to enhance absorption.
D. Chew the tablet for faster action.
Answer: B
Rationale: Bisphosphonates like alendronate are poorly absorbed and can cause
esophageal irritation. They must be taken with plain water only, on an empty
stomach, and the patient must remain upright for ≥30 minutes to prevent
esophagitis. Orange juice (A), milk (C), and lying down all interfere with
absorption or increase esophageal injury risk. Chewing (D) is contraindicated.
4. A 29-year-old woman with a history of deep vein thrombosis on warfarin is
diagnosed with strep throat. Which antibiotic would cause the least interaction
with warfarin?
A. Azithromycin
B. Trimethoprim-sulfamethoxazole
C. Penicillin VK
D. Ciprofloxacin
Answer: C
Rationale: Penicillin VK has minimal interaction with warfarin. Azithromycin (A)
may slightly increase INR, TMP-SMX (B) significantly potentiates warfarin via
CYP2C9 inhibition and protein displacement, and ciprofloxacin (D) can also
increase INR. Penicillin is the safest choice here.
pg. 2
,3
5. A 60-year-old man with hypertension, diabetes, and chronic kidney disease
(eGFR 35 mL/min/1.73 m²) has an ACE inhibitor on his medication list. Which lab
value requires the closest monitoring?
A. Serum sodium
B. Serum potassium and creatinine
C. Fasting blood glucose
D. Serum calcium
Answer: B
Rationale: ACE inhibitors reduce aldosterone, predisposing to hyperkalemia,
especially in CKD. They can also cause an initial rise in creatinine due to efferent
arteriole dilation. Potassium and renal function must be monitored within 1–2
weeks of starting or dose change. Sodium (A) may be affected but is not the
primary concern; glucose (C) and calcium (D) are not directly impacted.
6. A 45-year-old woman with major depressive disorder has failed two SSRIs.
Which augmentation agent is FDA-approved for treatment-resistant depression?
A. Bupropion
B. Aripiprazole
C. Buspirone
D. Propranolol
Answer: B
Rationale: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjunctive therapy for major depressive disorder when antidepressants alone are
insufficient. Bupropion (A) is often used as combination therapy but is not
specifically FDA-approved for augmentation. Buspirone (C) is for anxiety, not
approved for depression augmentation. Propranolol (D) is not indicated.
7. A 58-year-old postmenopausal woman with a BMI of 22 and no personal or
family history of breast cancer asks when to stop mammography screening.
According to USPSTF, what is the recommendation?
A. Stop at age 65.
B. Stop at age 75, or when life expectancy is less than 10 years.
C. Continue annually until death.
pg. 3
, 4
D. No mammography needed if no family history.
Answer: B
Rationale: USPSTF recommends biennial screening mammography for women
aged 50–74 years (Grade B). For women ≥75 years, the evidence is insufficient to
assess the balance of benefits and harms (Grade I). Decisions should consider
patient health and life expectancy; many guidelines suggest stopping when life
expectancy <10 years. A is too early, C is not evidence-based, D is false.
8. A patient with type 2 diabetes has an A1c of 8.5% on metformin monotherapy.
Which add-on medication is preferred in the setting of established atherosclerotic
cardiovascular disease (ASCVD)?
A. Glipizide
B. Empagliflozin or liraglutide
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: ADA guidelines recommend SGLT2 inhibitors (e.g., empagliflozin) or
GLP-1 receptor agonists (e.g., liraglutide) with proven cardiovascular benefit in
patients with type 2 diabetes and ASCVD, regardless of A1c. Glipizide (A) and
sitagliptin (C) are CV-neutral. Pioglitazone (D) may reduce stroke but increases HF
risk.
9. A 65-year-old man with BPH complains of difficulty urinating. He is currently on
tamsulosin. Which adverse effect is most specific to this medication?
A. Orthostatic hypotension
B. Retrograde ejaculation
C. Dry mouth
D. Constipation
Answer: B
Rationale: Tamsulosin is an alpha-1A selective blocker that relaxes the bladder
neck, which can cause retrograde ejaculation. Orthostatic hypotension (A) is more
pronounced with non-selective alpha blockers like doxazosin. Dry mouth (C) and
constipation (D) are anticholinergic effects of other BPH drugs.
pg. 4
NRNP 6531 Primary Care of Adults Across the
Lifespan Midterm Exam \ 100 Adult Health
Questions and Rationales
1. A 55-year-old asymptomatic woman with no significant medical history asks if
she should take a daily aspirin to prevent heart disease. According to the U.S.
Preventive Services Task Force (USPSTF), what is the recommendation?
A. Initiate low-dose aspirin for all adults aged 50–59 years.
B. The decision should be individualized for adults aged 40–59 years with a 10-
year ASCVD risk ≥10%; not recommended routinely for those ≥60 years.
C. Aspirin is contraindicated for primary prevention in all women.
D. Start aspirin 325 mg daily for primary prevention.
Answer: B
Rationale: The USPSTF recommends that the decision to initiate low-dose aspirin
for primary prevention of cardiovascular disease in adults aged 40–59 years with
a 10-year ASCVD risk ≥10% should be an individual one (Grade C). For adults ≥60
years, initiating aspirin for primary prevention is not recommended (Grade D) due
to increased bleeding risk. Option A is too broad; C is incorrect (aspirin can be
considered in selected women); D is wrong dose and not routine.
2. A 68-year-old male former smoker with hypertension and a 50-pack-year
history asks about lung cancer screening. Which of the following meets USPSTF
criteria for annual low-dose CT screening?
A. Age 55–80 years, ≥30 pack-year smoking history, currently smoking or quit
within the past 15 years.
B. Age 50–80 years, ≥20 pack-year smoking history, currently smoking or quit
within the past 15 years.
C. Any age with any smoking history.
D. Only current smokers over age 65.
pg. 1
,2
Answer: B
Rationale: In 2021, the USPSTF expanded lung cancer screening criteria to adults
aged 50–80 years who have a 20 pack-year smoking history and currently smoke
or have quit within the past 15 years (Grade B). Option A reflects older guidelines.
C and D are too broad or restrictive.
3. A 72-year-old woman with osteoporosis is started on alendronate. Which
instruction is most important to prevent adverse effects?
A. Take with a full glass of orange juice.
B. Take on an empty stomach first thing in the morning with 8 oz of plain water,
remain upright for at least 30 minutes.
C. Take at bedtime with milk to enhance absorption.
D. Chew the tablet for faster action.
Answer: B
Rationale: Bisphosphonates like alendronate are poorly absorbed and can cause
esophageal irritation. They must be taken with plain water only, on an empty
stomach, and the patient must remain upright for ≥30 minutes to prevent
esophagitis. Orange juice (A), milk (C), and lying down all interfere with
absorption or increase esophageal injury risk. Chewing (D) is contraindicated.
4. A 29-year-old woman with a history of deep vein thrombosis on warfarin is
diagnosed with strep throat. Which antibiotic would cause the least interaction
with warfarin?
A. Azithromycin
B. Trimethoprim-sulfamethoxazole
C. Penicillin VK
D. Ciprofloxacin
Answer: C
Rationale: Penicillin VK has minimal interaction with warfarin. Azithromycin (A)
may slightly increase INR, TMP-SMX (B) significantly potentiates warfarin via
CYP2C9 inhibition and protein displacement, and ciprofloxacin (D) can also
increase INR. Penicillin is the safest choice here.
pg. 2
,3
5. A 60-year-old man with hypertension, diabetes, and chronic kidney disease
(eGFR 35 mL/min/1.73 m²) has an ACE inhibitor on his medication list. Which lab
value requires the closest monitoring?
A. Serum sodium
B. Serum potassium and creatinine
C. Fasting blood glucose
D. Serum calcium
Answer: B
Rationale: ACE inhibitors reduce aldosterone, predisposing to hyperkalemia,
especially in CKD. They can also cause an initial rise in creatinine due to efferent
arteriole dilation. Potassium and renal function must be monitored within 1–2
weeks of starting or dose change. Sodium (A) may be affected but is not the
primary concern; glucose (C) and calcium (D) are not directly impacted.
6. A 45-year-old woman with major depressive disorder has failed two SSRIs.
Which augmentation agent is FDA-approved for treatment-resistant depression?
A. Bupropion
B. Aripiprazole
C. Buspirone
D. Propranolol
Answer: B
Rationale: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjunctive therapy for major depressive disorder when antidepressants alone are
insufficient. Bupropion (A) is often used as combination therapy but is not
specifically FDA-approved for augmentation. Buspirone (C) is for anxiety, not
approved for depression augmentation. Propranolol (D) is not indicated.
7. A 58-year-old postmenopausal woman with a BMI of 22 and no personal or
family history of breast cancer asks when to stop mammography screening.
According to USPSTF, what is the recommendation?
A. Stop at age 65.
B. Stop at age 75, or when life expectancy is less than 10 years.
C. Continue annually until death.
pg. 3
, 4
D. No mammography needed if no family history.
Answer: B
Rationale: USPSTF recommends biennial screening mammography for women
aged 50–74 years (Grade B). For women ≥75 years, the evidence is insufficient to
assess the balance of benefits and harms (Grade I). Decisions should consider
patient health and life expectancy; many guidelines suggest stopping when life
expectancy <10 years. A is too early, C is not evidence-based, D is false.
8. A patient with type 2 diabetes has an A1c of 8.5% on metformin monotherapy.
Which add-on medication is preferred in the setting of established atherosclerotic
cardiovascular disease (ASCVD)?
A. Glipizide
B. Empagliflozin or liraglutide
C. Sitagliptin
D. Pioglitazone
Answer: B
Rationale: ADA guidelines recommend SGLT2 inhibitors (e.g., empagliflozin) or
GLP-1 receptor agonists (e.g., liraglutide) with proven cardiovascular benefit in
patients with type 2 diabetes and ASCVD, regardless of A1c. Glipizide (A) and
sitagliptin (C) are CV-neutral. Pioglitazone (D) may reduce stroke but increases HF
risk.
9. A 65-year-old man with BPH complains of difficulty urinating. He is currently on
tamsulosin. Which adverse effect is most specific to this medication?
A. Orthostatic hypotension
B. Retrograde ejaculation
C. Dry mouth
D. Constipation
Answer: B
Rationale: Tamsulosin is an alpha-1A selective blocker that relaxes the bladder
neck, which can cause retrograde ejaculation. Orthostatic hypotension (A) is more
pronounced with non-selective alpha blockers like doxazosin. Dry mouth (C) and
constipation (D) are anticholinergic effects of other BPH drugs.
pg. 4
