NUR 623 Exam Predictor with Rationale
Answers| 2024–2025| A+ Grade Level – Herzing
University
Exam Questions with Rationales
1. A 17-year-old female presents with profound fatigue, posterior cervical lymphadenopathy, and
low-grade fever. CBC shows lymphocytosis with 15% atypical lymphocytes. Rapid strep is
negative. Which diagnostic test is most appropriate at this time?
a. Monospot (heterophile antibody test)
b. EBV PCR
c. ASO titer
d. Throat culture
Correct Answer: a
Rationale: The Monospot is the most appropriate first-line test for adolescents with symptoms
consistent with EBV infection. Sensitivity is highest after about one week of symptoms,
matching this patient’s timeline. EBV PCR is typically reserved for immunocompromised or
atypical presentations. ASO evaluates recent streptococcal exposure and is not indicated here.
Throat culture is unnecessary when clinical features align with EBV and rapid strep is negative.
Early identification guides counseling on activity restrictions to prevent splenic rupture.
2. A 19-year-old male collegiate athlete recently diagnosed with mononucleosis has
splenomegaly. He asks when he can return to practice. What is the most appropriate
recommendation?
a. Prescribe amoxicillin to help with throat pain
b. Return to contact sports in one week
c. Avoid contact sports for at least 3–4 weeks
d. Begin oral corticosteroids
Correct Answer: c
Rationale: Splenic rupture is a serious complication of EBV infection due to lymphocytic
infiltration and organ enlargement. Evidence supports restricting contact sports for at least 3–4
weeks. Amoxicillin is contraindicated because it frequently causes a rash in patients with EBV.
Steroids are indicated only for complications such as airway obstruction or severe
thrombocytopenia. Early return to sports is unsafe and a legal/ethical liability for the NP.
3. A 45-year-old male presents with dysuria and frequency. UA reveals positive nitrites and
bacteriuria. He is afebrile and has no flank pain. Which treatment is most appropriate?
a. Nitrofurantoin for 3 days
, b. Trimethoprim-sulfamethoxazole (TMP-SMX) for 7–14 days
c. Ciprofloxacin single dose
d. Cephalexin for 3 days
Correct Answer: b
Rationale: All male UTIs are considered complicated and require longer antibiotic therapy.
TMP-SMX for 7–14 days is supported by IDSA recommendations when local resistance patterns
allow. Nitrofurantoin is ineffective for prostatic penetration. Single-dose fluoroquinolones are
inadequate for complicated infections. Short-course cephalexin is also insufficient. Appropriate
therapy prevents progression to prostatitis or pyelonephritis.
4. A 22-year-old male with painful nodules on the face and back has failed treatment with topical
retinoids and doxycycline. What is the next best step?
a. Topical clindamycin
b. Spironolactone
c. High-potency topical steroids
d. Oral isotretinoin
Correct Answer: d
Rationale: Severe nodulocystic acne requires isotretinoin, which reduces sebaceous gland
size, normalizes keratinization, and decreases Cutibacterium acnes. Spironolactone is effective
only in females. Steroids may worsen acne. Topical clindamycin alone is insufficient for this
severity. Isotretinoin requires monitoring for hepatotoxicity, lipid elevation, and mood changes.
5. A 30-year-old woman on combined oral contraceptives is prescribed topiramate 200 mg/day
for migraine prevention. What counseling is essential?
a. No action is needed
b. Use an additional contraceptive method
c. Reduce topiramate dose
d. Switch to an IUD with higher estrogen levels
Correct Answer: b
Rationale: Topiramate at doses ≥200 mg/day induces CYP3A4 and decreases estrogen
concentrations, reducing oral contraceptive efficacy. Backup contraception prevents unintended
pregnancy. Lowering the dose may compromise migraine control. Estrogen dose increases are
not recommended due to clotting risk. An IUD is an option but not required unless the patient
desires it.
6. A 62-year-old male with type 2 diabetes has LDL 155 mg/dL and triglycerides 300 mg/dL.
Which is the most appropriate lipid therapy?
a. Moderate-intensity statin
b. High-intensity statin
c. Fenofibrate monotherapy
d. Niacin monotherapy
Correct Answer: b
Rationale: Diabetic patients aged 40–75 with LDL >70 mg/dL and additional risk factors benefit
from high-intensity statin therapy (per ACC/AHA). Elevated triglycerides should first be managed
by statins, which reduce ASCVD risk. Fibrates are indicated only if triglycerides exceed 500
, mg/dL due to pancreatitis risk. Niacin is no longer recommended due to limited cardiovascular
benefit and adverse effects.
7. A 50-year-old man presents with difficulty initiating urination. He is diagnosed with BPH and
started on tamsulosin. Which condition represents a contraindication to adding a
5-alpha-reductase inhibitor?
a. Mild hypertension
b. Elevated PSA
c. Active liver disease
d. Erectile dysfunction
Correct Answer: c
Rationale: 5-alpha-reductase inhibitors such as finasteride are metabolized hepatically and
should be avoided in patients with active liver impairment. Elevated PSA is an indication to
evaluate for cancer, not a contraindication. Erectile dysfunction is a side effect but not a
contraindication. Hypertension does not restrict therapy.
8. A 34-year-old woman abruptly stops sertraline after 2 years of therapy. She reports dizziness,
irritability, and “electric shock” sensations. What is the best management?
a. Begin an MAOI
b. Restart sertraline and taper gradually
c. Increase fluid intake
d. Start benzodiazepines
Correct Answer: b
Rationale: SSRI discontinuation syndrome occurs when medications with shorter half-lives are
stopped abruptly. Symptoms occur due to transient serotonergic dysregulation. Restarting the
SSRI and tapering over weeks minimizes symptoms. MAOIs and benzodiazepines are
inappropriate. Hydration has no effect on neurotransmitter adjustments.
9. A 29-year-old male presents with scaling plaques on elbows and knees. Which initial
treatment is most appropriate?
a. Oral steroids
b. High-potency topical corticosteroids
c. Oral methotrexate
d. UVB phototherapy
Correct Answer: b
Rationale: Plaque psoriasis localized to limited body areas should begin with high-potency
topical steroids. Systemic therapies such as methotrexate are reserved for severe or
widespread disease. Oral steroids risk rebound flares upon withdrawal. Phototherapy is an
option if topical agents fail.
10. A 38-year-old woman presents with urinary urgency and dysuria. UA shows leukocyte
esterase but negative nitrites. She is afebrile. Which organism is most likely?
a. E. coli
b. Klebsiella
c. Staphylococcus saprophyticus
Answers| 2024–2025| A+ Grade Level – Herzing
University
Exam Questions with Rationales
1. A 17-year-old female presents with profound fatigue, posterior cervical lymphadenopathy, and
low-grade fever. CBC shows lymphocytosis with 15% atypical lymphocytes. Rapid strep is
negative. Which diagnostic test is most appropriate at this time?
a. Monospot (heterophile antibody test)
b. EBV PCR
c. ASO titer
d. Throat culture
Correct Answer: a
Rationale: The Monospot is the most appropriate first-line test for adolescents with symptoms
consistent with EBV infection. Sensitivity is highest after about one week of symptoms,
matching this patient’s timeline. EBV PCR is typically reserved for immunocompromised or
atypical presentations. ASO evaluates recent streptococcal exposure and is not indicated here.
Throat culture is unnecessary when clinical features align with EBV and rapid strep is negative.
Early identification guides counseling on activity restrictions to prevent splenic rupture.
2. A 19-year-old male collegiate athlete recently diagnosed with mononucleosis has
splenomegaly. He asks when he can return to practice. What is the most appropriate
recommendation?
a. Prescribe amoxicillin to help with throat pain
b. Return to contact sports in one week
c. Avoid contact sports for at least 3–4 weeks
d. Begin oral corticosteroids
Correct Answer: c
Rationale: Splenic rupture is a serious complication of EBV infection due to lymphocytic
infiltration and organ enlargement. Evidence supports restricting contact sports for at least 3–4
weeks. Amoxicillin is contraindicated because it frequently causes a rash in patients with EBV.
Steroids are indicated only for complications such as airway obstruction or severe
thrombocytopenia. Early return to sports is unsafe and a legal/ethical liability for the NP.
3. A 45-year-old male presents with dysuria and frequency. UA reveals positive nitrites and
bacteriuria. He is afebrile and has no flank pain. Which treatment is most appropriate?
a. Nitrofurantoin for 3 days
, b. Trimethoprim-sulfamethoxazole (TMP-SMX) for 7–14 days
c. Ciprofloxacin single dose
d. Cephalexin for 3 days
Correct Answer: b
Rationale: All male UTIs are considered complicated and require longer antibiotic therapy.
TMP-SMX for 7–14 days is supported by IDSA recommendations when local resistance patterns
allow. Nitrofurantoin is ineffective for prostatic penetration. Single-dose fluoroquinolones are
inadequate for complicated infections. Short-course cephalexin is also insufficient. Appropriate
therapy prevents progression to prostatitis or pyelonephritis.
4. A 22-year-old male with painful nodules on the face and back has failed treatment with topical
retinoids and doxycycline. What is the next best step?
a. Topical clindamycin
b. Spironolactone
c. High-potency topical steroids
d. Oral isotretinoin
Correct Answer: d
Rationale: Severe nodulocystic acne requires isotretinoin, which reduces sebaceous gland
size, normalizes keratinization, and decreases Cutibacterium acnes. Spironolactone is effective
only in females. Steroids may worsen acne. Topical clindamycin alone is insufficient for this
severity. Isotretinoin requires monitoring for hepatotoxicity, lipid elevation, and mood changes.
5. A 30-year-old woman on combined oral contraceptives is prescribed topiramate 200 mg/day
for migraine prevention. What counseling is essential?
a. No action is needed
b. Use an additional contraceptive method
c. Reduce topiramate dose
d. Switch to an IUD with higher estrogen levels
Correct Answer: b
Rationale: Topiramate at doses ≥200 mg/day induces CYP3A4 and decreases estrogen
concentrations, reducing oral contraceptive efficacy. Backup contraception prevents unintended
pregnancy. Lowering the dose may compromise migraine control. Estrogen dose increases are
not recommended due to clotting risk. An IUD is an option but not required unless the patient
desires it.
6. A 62-year-old male with type 2 diabetes has LDL 155 mg/dL and triglycerides 300 mg/dL.
Which is the most appropriate lipid therapy?
a. Moderate-intensity statin
b. High-intensity statin
c. Fenofibrate monotherapy
d. Niacin monotherapy
Correct Answer: b
Rationale: Diabetic patients aged 40–75 with LDL >70 mg/dL and additional risk factors benefit
from high-intensity statin therapy (per ACC/AHA). Elevated triglycerides should first be managed
by statins, which reduce ASCVD risk. Fibrates are indicated only if triglycerides exceed 500
, mg/dL due to pancreatitis risk. Niacin is no longer recommended due to limited cardiovascular
benefit and adverse effects.
7. A 50-year-old man presents with difficulty initiating urination. He is diagnosed with BPH and
started on tamsulosin. Which condition represents a contraindication to adding a
5-alpha-reductase inhibitor?
a. Mild hypertension
b. Elevated PSA
c. Active liver disease
d. Erectile dysfunction
Correct Answer: c
Rationale: 5-alpha-reductase inhibitors such as finasteride are metabolized hepatically and
should be avoided in patients with active liver impairment. Elevated PSA is an indication to
evaluate for cancer, not a contraindication. Erectile dysfunction is a side effect but not a
contraindication. Hypertension does not restrict therapy.
8. A 34-year-old woman abruptly stops sertraline after 2 years of therapy. She reports dizziness,
irritability, and “electric shock” sensations. What is the best management?
a. Begin an MAOI
b. Restart sertraline and taper gradually
c. Increase fluid intake
d. Start benzodiazepines
Correct Answer: b
Rationale: SSRI discontinuation syndrome occurs when medications with shorter half-lives are
stopped abruptly. Symptoms occur due to transient serotonergic dysregulation. Restarting the
SSRI and tapering over weeks minimizes symptoms. MAOIs and benzodiazepines are
inappropriate. Hydration has no effect on neurotransmitter adjustments.
9. A 29-year-old male presents with scaling plaques on elbows and knees. Which initial
treatment is most appropriate?
a. Oral steroids
b. High-potency topical corticosteroids
c. Oral methotrexate
d. UVB phototherapy
Correct Answer: b
Rationale: Plaque psoriasis localized to limited body areas should begin with high-potency
topical steroids. Systemic therapies such as methotrexate are reserved for severe or
widespread disease. Oral steroids risk rebound flares upon withdrawal. Phototherapy is an
option if topical agents fail.
10. A 38-year-old woman presents with urinary urgency and dysuria. UA shows leukocyte
esterase but negative nitrites. She is afebrile. Which organism is most likely?
a. E. coli
b. Klebsiella
c. Staphylococcus saprophyticus
