NRNP 6531 Final Exam – Primary Care of Adults Actual Exam
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Differential Diagnosis & Clinical Reasoning
Question 1
A 58-year-old male with hypertension and type 2 diabetes presents with crushing
substernal chest pain radiating to his left arm and jaw. He is diaphoretic and nauseated.
Vital signs show blood pressure 88/60 mmHg, heart rate 112, and oxygen saturation
91% on room air. The ECG reveals ST-segment elevation in leads V1 through V4. What is
the most likely diagnosis?
A) Unstable angina
B) Non-ST elevation myocardial infarction
C) ST-elevation myocardial infarction ✓
D) Acute pericarditis
Correct Answer: C) ST-elevation myocardial infarction
Rationale: ST elevation in contiguous precordial leads with hemodynamic compromise
is diagnostic of STEMI. Unstable angina and NSTEMI do not demonstrate ST elevation
on ECG. Acute pericarditis produces diffuse ST elevation with PR depression rather than
localized changes.
Question 2
A 45-year-old female presents with six months of progressive fatigue, weight gain,
constipation, and dry skin. She reports menorrhagia and feeling cold intolerant.
,Laboratory studies reveal a TSH of 8.5 mIU/L and free T4 at the lower limit of normal.
What is the most likely diagnosis?
A) Hyperthyroidism
B) Subclinical hypothyroidism
C) Hypothyroidism ✓
D) Hashimoto thyroiditis
Correct Answer: C) Hypothyroidism
Rationale: Elevated TSH with low-normal free T4 and classic symptoms of decreased
metabolic function indicates overt hypothyroidism. While Hashimoto thyroiditis is the
likely etiology, the clinical diagnosis is hypothyroidism. Hyperthyroidism would present
with weight loss, heat intolerance, and suppressed TSH.
Question 3
A 62-year-old male with a known history of COPD presents with increased dyspnea,
purulent sputum production, and low-grade fever over the past 48 hours. His FEV1 is
45% predicted. Chest examination reveals diffuse wheezing without focal consolidation.
What is the most likely diagnosis?
A) Acute exacerbation of COPD ✓
B) Community-acquired pneumonia
C) Pulmonary embolism
D) Acute decompensated heart failure
Correct Answer: A) Acute exacerbation of COPD
Rationale: Increased dyspnea with purulent sputum and fever in a patient with known
COPD defines an acute exacerbation. Pneumonia would typically show focal findings on
imaging, pulmonary embolism presents with pleuritic chest pain and tachypnea without
fever, and heart failure causes orthopnea and peripheral edema rather than purulent
sputum.
, Question 4
A 38-year-old female presents with a malar rash, photosensitivity, recurrent oral ulcers,
and symmetric arthritis of the small joints. Laboratory studies show a positive ANA and
elevated anti-dsDNA antibodies. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus ✓
C) Sjogren syndrome
D) Dermatomyositis
Correct Answer: B) Systemic lupus erythematosus
Rationale: Malar rash, photosensitivity, oral ulcers, symmetric arthritis, and positive
anti-dsDNA antibodies are characteristic of SLE. Rheumatoid arthritis lacks these
cutaneous and serologic features, Sjogren syndrome primarily involves sicca
symptoms, and dermatomyositis presents with heliotrope rash and proximal muscle
weakness.
Question 5
A 28-year-old male presents with a sore throat, fever of 101.5°F, tender anterior cervical
lymphadenopathy, and tonsillar exudates. He denies cough or rhinorrhea. What is the
most likely diagnosis?
A) Viral pharyngitis
B) Group A streptococcal pharyngitis ✓
C) Infectious mononucleosis
D) Acute retropharyngeal abscess
Correct Answer: B) Group A streptococcal pharyngitis
Rationale: Fever, tonsillar exudates, tender anterior cervical nodes, and absence of
cough fulfill Centor criteria for streptococcal pharyngitis. Viral pharyngitis typically
presents with cough and rhinorrhea, mononucleosis causes posterior cervical
2026/2027: Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
Differential Diagnosis & Clinical Reasoning
Question 1
A 58-year-old male with hypertension and type 2 diabetes presents with crushing
substernal chest pain radiating to his left arm and jaw. He is diaphoretic and nauseated.
Vital signs show blood pressure 88/60 mmHg, heart rate 112, and oxygen saturation
91% on room air. The ECG reveals ST-segment elevation in leads V1 through V4. What is
the most likely diagnosis?
A) Unstable angina
B) Non-ST elevation myocardial infarction
C) ST-elevation myocardial infarction ✓
D) Acute pericarditis
Correct Answer: C) ST-elevation myocardial infarction
Rationale: ST elevation in contiguous precordial leads with hemodynamic compromise
is diagnostic of STEMI. Unstable angina and NSTEMI do not demonstrate ST elevation
on ECG. Acute pericarditis produces diffuse ST elevation with PR depression rather than
localized changes.
Question 2
A 45-year-old female presents with six months of progressive fatigue, weight gain,
constipation, and dry skin. She reports menorrhagia and feeling cold intolerant.
,Laboratory studies reveal a TSH of 8.5 mIU/L and free T4 at the lower limit of normal.
What is the most likely diagnosis?
A) Hyperthyroidism
B) Subclinical hypothyroidism
C) Hypothyroidism ✓
D) Hashimoto thyroiditis
Correct Answer: C) Hypothyroidism
Rationale: Elevated TSH with low-normal free T4 and classic symptoms of decreased
metabolic function indicates overt hypothyroidism. While Hashimoto thyroiditis is the
likely etiology, the clinical diagnosis is hypothyroidism. Hyperthyroidism would present
with weight loss, heat intolerance, and suppressed TSH.
Question 3
A 62-year-old male with a known history of COPD presents with increased dyspnea,
purulent sputum production, and low-grade fever over the past 48 hours. His FEV1 is
45% predicted. Chest examination reveals diffuse wheezing without focal consolidation.
What is the most likely diagnosis?
A) Acute exacerbation of COPD ✓
B) Community-acquired pneumonia
C) Pulmonary embolism
D) Acute decompensated heart failure
Correct Answer: A) Acute exacerbation of COPD
Rationale: Increased dyspnea with purulent sputum and fever in a patient with known
COPD defines an acute exacerbation. Pneumonia would typically show focal findings on
imaging, pulmonary embolism presents with pleuritic chest pain and tachypnea without
fever, and heart failure causes orthopnea and peripheral edema rather than purulent
sputum.
, Question 4
A 38-year-old female presents with a malar rash, photosensitivity, recurrent oral ulcers,
and symmetric arthritis of the small joints. Laboratory studies show a positive ANA and
elevated anti-dsDNA antibodies. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Systemic lupus erythematosus ✓
C) Sjogren syndrome
D) Dermatomyositis
Correct Answer: B) Systemic lupus erythematosus
Rationale: Malar rash, photosensitivity, oral ulcers, symmetric arthritis, and positive
anti-dsDNA antibodies are characteristic of SLE. Rheumatoid arthritis lacks these
cutaneous and serologic features, Sjogren syndrome primarily involves sicca
symptoms, and dermatomyositis presents with heliotrope rash and proximal muscle
weakness.
Question 5
A 28-year-old male presents with a sore throat, fever of 101.5°F, tender anterior cervical
lymphadenopathy, and tonsillar exudates. He denies cough or rhinorrhea. What is the
most likely diagnosis?
A) Viral pharyngitis
B) Group A streptococcal pharyngitis ✓
C) Infectious mononucleosis
D) Acute retropharyngeal abscess
Correct Answer: B) Group A streptococcal pharyngitis
Rationale: Fever, tonsillar exudates, tender anterior cervical nodes, and absence of
cough fulfill Centor criteria for streptococcal pharyngitis. Viral pharyngitis typically
presents with cough and rhinorrhea, mononucleosis causes posterior cervical
