“NRNP 6531 / PRAC 6531 – Primary Care of Adults Across the
Lifespan | 100-Question Comprehensive Practice Exam with
Answers & Rationales (Chronic, Acute, Preventive, Geriatric,
and Pharmacology Review)”
1
A 55-year-old man with hypertension is started on lisinopril. Which monitoring is most
important after initiation?
A. Fasting glucose
B. Serum potassium and creatinine
C. Liver function tests
D. TSH
Answer: B — ACE inhibitors can cause hyperkalemia and reduce glomerular filtration; check K⁺
and creatinine after starting.
2
A 45-year-old woman with new primary dysmenorrhea asks about first-line therapy for pain.
Best initial recommendation:
A. Ibuprofen or naproxen PRN around menses
B. Acetaminophen only
C. Oral contraceptive patch only after failure of NSAIDs
D. Opioid analgesic PRN
Answer: A — NSAIDs are first-line for primary dysmenorrhea by inhibiting prostaglandin
synthesis.
3
Which lipid abnormality is most strongly associated with increased ASCVD risk?
A. Elevated HDL
B. Elevated LDL cholesterol
C. Elevated triglycerides only
,D. Low total cholesterol
Answer: B — LDL cholesterol is the primary causal lipid for atherosclerotic cardiovascular
disease.
4
A 68-year-old with stage 3 CKD (eGFR 45) and diabetes — which diabetes med should be
avoided or used cautiously?
A. Metformin — continue without adjustment
B. Metformin — dose reduction or hold depending on eGFR
C. Insulin only in all CKD
D. SGLT2 inhibitors contraindicated at any eGFR
Answer: B — Metformin requires dose adjustment and may be contraindicated below certain
eGFR thresholds; assess renal function and follow guidelines.
5
A patient presents with sudden-onset, crushing chest pain radiating to jaw and diaphoresis.
Immediate priority in primary care:
A. Obtain lipid panel
B. Administer aspirin 325 mg (chewable) and call emergency services
C. Give sublingual nitroglycerin and discharge if pain improves
D. Schedule urgent cardiac stress test tomorrow
Answer: B — Suspected acute coronary syndrome: give aspirin and activate EMS immediately.
6
For primary prevention, which adult should start low-dose daily aspirin?
A. 40-year-old with no risk factors
B. 52-year-old with diabetes and 10-yr ASCVD risk 8%
C. 65-year-old with high bleeding risk
D. 50-year-old with high ASCVD risk and low bleeding risk (individualized decision)
Answer: D — Aspirin for primary prevention is individualized; recent guidance favors selective
use in specific older adults with high ASCVD and low bleeding risk.
7
, A 28-year-old on combined oral contraceptives develops severe calf pain and swelling. Next
step:
A. Reassure and follow up in a week
B. Order D-dimer only
C. Evaluate for DVT (duplex ultrasound) and stop estrogen-containing OCPs
D. Switch to progesterone-only pill without further testing
Answer: C — Suspect DVT: stop estrogen OCPs and evaluate urgently with duplex ultrasound
(and anticoagulate if confirmed).
8
Which vaccine is recommended yearly for adults with chronic lung disease?
A. Live attenuated influenza vaccine only
B. Inactivated influenza vaccine annually
C. Varicella vaccine annually
D. No vaccine recommended
Answer: B — Annual inactivated influenza vaccine is recommended for adults with chronic lung
disease.
9
A 62-year-old with newly diagnosed type 2 diabetes — which initial A1c target is reasonable for
most nonfrail adults?
A. <5.7%
B. <6.5%
C. <7.0% to 7.5%
D. <9.0%
Answer: C — Many guidelines recommend an individualized A1c target around <7–7.5% for
most nonfrail adults.
10
Which physical finding suggests congestive heart failure rather than COPD?
A. Barrel chest
B. Bilateral lower-extremity pitting edema and elevated JVD
C. Wheezing improved by bronchodilator
Lifespan | 100-Question Comprehensive Practice Exam with
Answers & Rationales (Chronic, Acute, Preventive, Geriatric,
and Pharmacology Review)”
1
A 55-year-old man with hypertension is started on lisinopril. Which monitoring is most
important after initiation?
A. Fasting glucose
B. Serum potassium and creatinine
C. Liver function tests
D. TSH
Answer: B — ACE inhibitors can cause hyperkalemia and reduce glomerular filtration; check K⁺
and creatinine after starting.
2
A 45-year-old woman with new primary dysmenorrhea asks about first-line therapy for pain.
Best initial recommendation:
A. Ibuprofen or naproxen PRN around menses
B. Acetaminophen only
C. Oral contraceptive patch only after failure of NSAIDs
D. Opioid analgesic PRN
Answer: A — NSAIDs are first-line for primary dysmenorrhea by inhibiting prostaglandin
synthesis.
3
Which lipid abnormality is most strongly associated with increased ASCVD risk?
A. Elevated HDL
B. Elevated LDL cholesterol
C. Elevated triglycerides only
,D. Low total cholesterol
Answer: B — LDL cholesterol is the primary causal lipid for atherosclerotic cardiovascular
disease.
4
A 68-year-old with stage 3 CKD (eGFR 45) and diabetes — which diabetes med should be
avoided or used cautiously?
A. Metformin — continue without adjustment
B. Metformin — dose reduction or hold depending on eGFR
C. Insulin only in all CKD
D. SGLT2 inhibitors contraindicated at any eGFR
Answer: B — Metformin requires dose adjustment and may be contraindicated below certain
eGFR thresholds; assess renal function and follow guidelines.
5
A patient presents with sudden-onset, crushing chest pain radiating to jaw and diaphoresis.
Immediate priority in primary care:
A. Obtain lipid panel
B. Administer aspirin 325 mg (chewable) and call emergency services
C. Give sublingual nitroglycerin and discharge if pain improves
D. Schedule urgent cardiac stress test tomorrow
Answer: B — Suspected acute coronary syndrome: give aspirin and activate EMS immediately.
6
For primary prevention, which adult should start low-dose daily aspirin?
A. 40-year-old with no risk factors
B. 52-year-old with diabetes and 10-yr ASCVD risk 8%
C. 65-year-old with high bleeding risk
D. 50-year-old with high ASCVD risk and low bleeding risk (individualized decision)
Answer: D — Aspirin for primary prevention is individualized; recent guidance favors selective
use in specific older adults with high ASCVD and low bleeding risk.
7
, A 28-year-old on combined oral contraceptives develops severe calf pain and swelling. Next
step:
A. Reassure and follow up in a week
B. Order D-dimer only
C. Evaluate for DVT (duplex ultrasound) and stop estrogen-containing OCPs
D. Switch to progesterone-only pill without further testing
Answer: C — Suspect DVT: stop estrogen OCPs and evaluate urgently with duplex ultrasound
(and anticoagulate if confirmed).
8
Which vaccine is recommended yearly for adults with chronic lung disease?
A. Live attenuated influenza vaccine only
B. Inactivated influenza vaccine annually
C. Varicella vaccine annually
D. No vaccine recommended
Answer: B — Annual inactivated influenza vaccine is recommended for adults with chronic lung
disease.
9
A 62-year-old with newly diagnosed type 2 diabetes — which initial A1c target is reasonable for
most nonfrail adults?
A. <5.7%
B. <6.5%
C. <7.0% to 7.5%
D. <9.0%
Answer: C — Many guidelines recommend an individualized A1c target around <7–7.5% for
most nonfrail adults.
10
Which physical finding suggests congestive heart failure rather than COPD?
A. Barrel chest
B. Bilateral lower-extremity pitting edema and elevated JVD
C. Wheezing improved by bronchodilator
