1
NSG 555 EXAM 3 (WILKES) NEWEST 2026 ACTUAL EXAM
TEST BANK| NURSE PRACTITIONERS IN PRIMARY CARE I
EXAM 3 REVIEW WITH COMPLETE 250 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
GRADED A+ (MOST RECENT!!)
SECTION 1: ENDOCRINE DISORDERS (Questions 1-50)
1. A 45-year-old female presents with fatigue, weight gain, constipation, and dry skin. Her
TSH is 8.5 mIU/mL (high). What is the first-line treatment?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine ablation
D) Levothyroxine and Liothyronine combination
Answer: B Rationale: Levothyroxine (T4) is the standard of care for hypothyroidism.
2. A patient with type 2 diabetes mellitus (T2DM) has an eGFR of 35 mL/min. Which oral
anti-diabetic agent requires the most significant dose adjustment or avoidance due to
the risk of lactic acidosis?
A) Metformin
B) Glipizide
C) Sitagliptin
D) Pioglitazone
Answer: A Rationale: Metformin is contraindicated in eGFR <30 and used with caution
if <45 due to lactic acidosis risk.
3. A 28-year-old male presents with acute onset of severe testicular pain, nausea, and
vomiting. The testis is elevated and tender. Cremasteric reflex is absent. What is the
most appropriate next step?
A) Urinalysis and antibiotics
B) Ultrasound with Doppler
C) Immediate surgical consultation
D) NSAIDs and scrotal elevation
Answer: C Rationale: These symptoms are classic for testicular torsion. Time is critical;
surgical exploration is needed immediately. Doppler ultrasound should not delay
surgical consult if torsion is highly suspected.
4. Which medication used for diabetes mellitus has been shown to provide the most
significant cardiovascular and renal protective benefits (reducing MACE and CKD
progression) independent of glycemic control?
A) DPP-4 inhibitors
B) SGLT2 inhibitors
C) Sulfonylureas
D) Thiazolidinediones
Answer: B Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have strong
evidence for cardiovascular and renal protection.
5. A patient with hyperthyroidism is prescribed methimazole. What serious adverse
effect should the patient be educated to report immediately?
A) Weight gain
, 2
B) Constipation
C) Fever and sore throat
D) Tremors
Answer: C Rationale: Fever and sore throat can indicate agranulocytosis, a rare but
life-threatening side effect of methimazole and PTU.
6. The American Diabetes Association (ADA) recommends screening for T2DM in
asymptomatic adults starting at what age, regardless of risk factors?
A) 25 years
B) 35 years
C) 45 years
D) 50 years
Answer: B Rationale: The ADA lowered the screening age to 35 years for all adults.
7. A 60-year-old with T2DM has a blood pressure of 145/88 mmHg. What is the
recommended BP target for most adults with diabetes?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B Rationale: The current ADA guideline recommends a BP target of <130/80
mmHg for patients with diabetes.
8. A patient presents with polyuria, polydipsia, and a random plasma glucose of 400
mg/dL. Labs show a pH of 7.25 and positive serum ketones. What is the priority
intervention?
A) IV insulin bolus
B) Oral hypoglycemic agents
C) IV fluids and insulin drip
D) Sodium bicarbonate infusion
Answer: C Rationale: This is diabetic ketoacidosis (DKA). Priority is IV fluid resuscitation
followed by insulin infusion.
9. A 55-year-old male with a history of HTN and T2DM is found to have a TSH of 0.1
mIU/mL (low) and a normal Free T4. He is asymptomatic. What is the most appropriate
management?
A) Levothyroxine 50 mcg daily
B) Methimazole 10 mg daily
C) Repeat TSH in 3-6 months
D) Radioactive iodine uptake scan
Answer: C Rationale: This is subclinical hyperthyroidism. In an asymptomatic patient,
monitoring is appropriate unless TSH is persistently <0.1 with risk factors.
10. Which laboratory finding is consistent with primary hyperparathyroidism?
A) Low serum calcium, high PTH
B) High serum calcium, high PTH
C) Low serum calcium, low PTH
D) High serum calcium, low PTH
Answer: B Rationale: Primary hyperparathyroidism is characterized by hypercalcemia
and an inappropriately elevated PTH.
11. A 32-year-old woman presents with palpitations, weight loss despite increased
appetite, heat intolerance, and a fine tremor. On exam, she has a diffusely enlarged,
non-tender thyroid. What is the most likely diagnosis?
A) Hashimoto’s thyroiditis
, 3
B) Subacute thyroiditis
C) Graves’ disease
D) Toxic multinodular goiter
Answer: C Rationale: Diffuse goiter with hyperthyroid symptoms in a young woman is
classic for Graves’ disease.
12. What is the first-line injectable medication for weight loss management in patients
with obesity or T2DM that acts as a GLP-1 and GIP agonist?
A) Liraglutide (Victoza)
B) Semaglutide (Ozempic)
C) Tirzepatide (Mounjaro)
D) Dulaglutide (Trulicity)
Answer: C Rationale: Tirzepatide is a dual GIP/GLP-1 receptor agonist.
13. A patient taking levothyroxine has a persistently elevated TSH despite reported
adherence. She takes her calcium carbonate with her levothyroxine every morning.
What is the likely issue?
A) The levothyroxine dose is too high
B) The calcium is interfering with absorption
C) She likely has central hypothyroidism
D) She needs liothyronine added
Answer: B Rationale: Calcium, iron, and antacids significantly interfere with
levothyroxine absorption. It should be taken on an empty stomach 60 minutes before
food or other medications.
14. A patient presents with a tender, erythematous, warm, swollen great toe. He reports a
similar episode last year. What is the most appropriate initial treatment?
A) Allopurinol
B) Colchicine
C) Probenecid
D) Acetaminophen
Answer: B Rationale: This is acute gout. First-line treatment options are NSAIDs,
colchicine, or corticosteroids.
15. What is the target hemoglobin A1c for most non-pregnant adults with diabetes,
according to the ADA?
A) <6.0%
B) <6.5%
C) <7.0%
D) <8.0%
Answer: C Rationale: A general goal is <7.0%, though goals should be individualized.
16. A patient with diabetes has a urine albumin-to-creatinine ratio (UACR) of 80 mg/g.
How should this be classified?
A) Normoalbuminuria
B) Microalbuminuria
C) Macroalbuminuria
D) Nephrotic syndrome
Answer: B Rationale: Microalbuminuria is defined as UACR 30-300 mg/g.
17. A 70-year-old with T2DM has an A1c of 8.5%. She has a history of multiple falls and
cognitive impairment. What is the most appropriate A1c goal?
A) <6.5%
B) <7.0%
C) <7.5%
, 4
D) <8.5%
Answer: D Rationale: In frail elderly patients with limited life expectancy or significant
comorbidities, a less stringent A1c goal (e.g., <8.0-8.5%) is appropriate to avoid
hypoglycemia.
18. A patient with a history of obesity and acanthosis nigricans presents with signs of
hyperandrogenism and oligomenorrhea. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Polycystic ovary syndrome (PCOS)
C) Congenital adrenal hyperplasia
D) Premature ovarian failure
Answer: B Rationale: PCOS is characterized by hyperandrogenism, ovulatory
dysfunction, and polycystic ovaries, often associated with insulin resistance (acanthosis
nigricans).
19. A patient with type 1 diabetes mellitus (T1DM) checks their blood glucose before
lunch. It is 55 mg/dL. They are conscious but feel shaky and sweaty. What should they
ingest?
A) 4 oz of orange juice
B) 2 tbsp of peanut butter
C) A slice of whole wheat bread
D) Insulin bolus
Answer: A Rationale: Hypoglycemia (<70) is treated with the "Rule of 15": 15g of fast-
acting carbohydrate (4 oz juice, 3-4 glucose tabs), recheck in 15 minutes.
20. Which of the following is a major risk factor for osteoporosis in postmenopausal
women?
A) African American race
B) Obesity
C) Long-term corticosteroid use
D) High calcium intake
Answer: C Rationale: Long-term corticosteroid use is a significant risk factor for
secondary osteoporosis. Other risks include Caucasian/Asian race, low body weight,
smoking, and family history.
21. A 45-year-old male presents with gradual onset of erectile dysfunction, decreased
libido, and fatigue. Labs show a low morning testosterone. What is the next
appropriate step?
A) Start testosterone replacement therapy immediately
B) Measure LH, FSH, and prolactin
C) Refer to urology for penile implant
D) Prescribe sildenafil
Answer: B Rationale: To differentiate between primary and secondary hypogonadism,
LH and FSH levels must be checked before initiating therapy.
22. A patient with T2DM is started on a GLP-1 receptor agonist. What common side effect
should they be counseled on?
A) Hypoglycemia
B) Weight gain
C) Nausea and vomiting
D) Edema
Answer: C Rationale: Gastrointestinal side effects, particularly nausea, are the most
common adverse effects of GLP-1 agonists.
NSG 555 EXAM 3 (WILKES) NEWEST 2026 ACTUAL EXAM
TEST BANK| NURSE PRACTITIONERS IN PRIMARY CARE I
EXAM 3 REVIEW WITH COMPLETE 250 REAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
GRADED A+ (MOST RECENT!!)
SECTION 1: ENDOCRINE DISORDERS (Questions 1-50)
1. A 45-year-old female presents with fatigue, weight gain, constipation, and dry skin. Her
TSH is 8.5 mIU/mL (high). What is the first-line treatment?
A) Methimazole
B) Levothyroxine
C) Radioactive iodine ablation
D) Levothyroxine and Liothyronine combination
Answer: B Rationale: Levothyroxine (T4) is the standard of care for hypothyroidism.
2. A patient with type 2 diabetes mellitus (T2DM) has an eGFR of 35 mL/min. Which oral
anti-diabetic agent requires the most significant dose adjustment or avoidance due to
the risk of lactic acidosis?
A) Metformin
B) Glipizide
C) Sitagliptin
D) Pioglitazone
Answer: A Rationale: Metformin is contraindicated in eGFR <30 and used with caution
if <45 due to lactic acidosis risk.
3. A 28-year-old male presents with acute onset of severe testicular pain, nausea, and
vomiting. The testis is elevated and tender. Cremasteric reflex is absent. What is the
most appropriate next step?
A) Urinalysis and antibiotics
B) Ultrasound with Doppler
C) Immediate surgical consultation
D) NSAIDs and scrotal elevation
Answer: C Rationale: These symptoms are classic for testicular torsion. Time is critical;
surgical exploration is needed immediately. Doppler ultrasound should not delay
surgical consult if torsion is highly suspected.
4. Which medication used for diabetes mellitus has been shown to provide the most
significant cardiovascular and renal protective benefits (reducing MACE and CKD
progression) independent of glycemic control?
A) DPP-4 inhibitors
B) SGLT2 inhibitors
C) Sulfonylureas
D) Thiazolidinediones
Answer: B Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have strong
evidence for cardiovascular and renal protection.
5. A patient with hyperthyroidism is prescribed methimazole. What serious adverse
effect should the patient be educated to report immediately?
A) Weight gain
, 2
B) Constipation
C) Fever and sore throat
D) Tremors
Answer: C Rationale: Fever and sore throat can indicate agranulocytosis, a rare but
life-threatening side effect of methimazole and PTU.
6. The American Diabetes Association (ADA) recommends screening for T2DM in
asymptomatic adults starting at what age, regardless of risk factors?
A) 25 years
B) 35 years
C) 45 years
D) 50 years
Answer: B Rationale: The ADA lowered the screening age to 35 years for all adults.
7. A 60-year-old with T2DM has a blood pressure of 145/88 mmHg. What is the
recommended BP target for most adults with diabetes?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B Rationale: The current ADA guideline recommends a BP target of <130/80
mmHg for patients with diabetes.
8. A patient presents with polyuria, polydipsia, and a random plasma glucose of 400
mg/dL. Labs show a pH of 7.25 and positive serum ketones. What is the priority
intervention?
A) IV insulin bolus
B) Oral hypoglycemic agents
C) IV fluids and insulin drip
D) Sodium bicarbonate infusion
Answer: C Rationale: This is diabetic ketoacidosis (DKA). Priority is IV fluid resuscitation
followed by insulin infusion.
9. A 55-year-old male with a history of HTN and T2DM is found to have a TSH of 0.1
mIU/mL (low) and a normal Free T4. He is asymptomatic. What is the most appropriate
management?
A) Levothyroxine 50 mcg daily
B) Methimazole 10 mg daily
C) Repeat TSH in 3-6 months
D) Radioactive iodine uptake scan
Answer: C Rationale: This is subclinical hyperthyroidism. In an asymptomatic patient,
monitoring is appropriate unless TSH is persistently <0.1 with risk factors.
10. Which laboratory finding is consistent with primary hyperparathyroidism?
A) Low serum calcium, high PTH
B) High serum calcium, high PTH
C) Low serum calcium, low PTH
D) High serum calcium, low PTH
Answer: B Rationale: Primary hyperparathyroidism is characterized by hypercalcemia
and an inappropriately elevated PTH.
11. A 32-year-old woman presents with palpitations, weight loss despite increased
appetite, heat intolerance, and a fine tremor. On exam, she has a diffusely enlarged,
non-tender thyroid. What is the most likely diagnosis?
A) Hashimoto’s thyroiditis
, 3
B) Subacute thyroiditis
C) Graves’ disease
D) Toxic multinodular goiter
Answer: C Rationale: Diffuse goiter with hyperthyroid symptoms in a young woman is
classic for Graves’ disease.
12. What is the first-line injectable medication for weight loss management in patients
with obesity or T2DM that acts as a GLP-1 and GIP agonist?
A) Liraglutide (Victoza)
B) Semaglutide (Ozempic)
C) Tirzepatide (Mounjaro)
D) Dulaglutide (Trulicity)
Answer: C Rationale: Tirzepatide is a dual GIP/GLP-1 receptor agonist.
13. A patient taking levothyroxine has a persistently elevated TSH despite reported
adherence. She takes her calcium carbonate with her levothyroxine every morning.
What is the likely issue?
A) The levothyroxine dose is too high
B) The calcium is interfering with absorption
C) She likely has central hypothyroidism
D) She needs liothyronine added
Answer: B Rationale: Calcium, iron, and antacids significantly interfere with
levothyroxine absorption. It should be taken on an empty stomach 60 minutes before
food or other medications.
14. A patient presents with a tender, erythematous, warm, swollen great toe. He reports a
similar episode last year. What is the most appropriate initial treatment?
A) Allopurinol
B) Colchicine
C) Probenecid
D) Acetaminophen
Answer: B Rationale: This is acute gout. First-line treatment options are NSAIDs,
colchicine, or corticosteroids.
15. What is the target hemoglobin A1c for most non-pregnant adults with diabetes,
according to the ADA?
A) <6.0%
B) <6.5%
C) <7.0%
D) <8.0%
Answer: C Rationale: A general goal is <7.0%, though goals should be individualized.
16. A patient with diabetes has a urine albumin-to-creatinine ratio (UACR) of 80 mg/g.
How should this be classified?
A) Normoalbuminuria
B) Microalbuminuria
C) Macroalbuminuria
D) Nephrotic syndrome
Answer: B Rationale: Microalbuminuria is defined as UACR 30-300 mg/g.
17. A 70-year-old with T2DM has an A1c of 8.5%. She has a history of multiple falls and
cognitive impairment. What is the most appropriate A1c goal?
A) <6.5%
B) <7.0%
C) <7.5%
, 4
D) <8.5%
Answer: D Rationale: In frail elderly patients with limited life expectancy or significant
comorbidities, a less stringent A1c goal (e.g., <8.0-8.5%) is appropriate to avoid
hypoglycemia.
18. A patient with a history of obesity and acanthosis nigricans presents with signs of
hyperandrogenism and oligomenorrhea. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Polycystic ovary syndrome (PCOS)
C) Congenital adrenal hyperplasia
D) Premature ovarian failure
Answer: B Rationale: PCOS is characterized by hyperandrogenism, ovulatory
dysfunction, and polycystic ovaries, often associated with insulin resistance (acanthosis
nigricans).
19. A patient with type 1 diabetes mellitus (T1DM) checks their blood glucose before
lunch. It is 55 mg/dL. They are conscious but feel shaky and sweaty. What should they
ingest?
A) 4 oz of orange juice
B) 2 tbsp of peanut butter
C) A slice of whole wheat bread
D) Insulin bolus
Answer: A Rationale: Hypoglycemia (<70) is treated with the "Rule of 15": 15g of fast-
acting carbohydrate (4 oz juice, 3-4 glucose tabs), recheck in 15 minutes.
20. Which of the following is a major risk factor for osteoporosis in postmenopausal
women?
A) African American race
B) Obesity
C) Long-term corticosteroid use
D) High calcium intake
Answer: C Rationale: Long-term corticosteroid use is a significant risk factor for
secondary osteoporosis. Other risks include Caucasian/Asian race, low body weight,
smoking, and family history.
21. A 45-year-old male presents with gradual onset of erectile dysfunction, decreased
libido, and fatigue. Labs show a low morning testosterone. What is the next
appropriate step?
A) Start testosterone replacement therapy immediately
B) Measure LH, FSH, and prolactin
C) Refer to urology for penile implant
D) Prescribe sildenafil
Answer: B Rationale: To differentiate between primary and secondary hypogonadism,
LH and FSH levels must be checked before initiating therapy.
22. A patient with T2DM is started on a GLP-1 receptor agonist. What common side effect
should they be counseled on?
A) Hypoglycemia
B) Weight gain
C) Nausea and vomiting
D) Edema
Answer: C Rationale: Gastrointestinal side effects, particularly nausea, are the most
common adverse effects of GLP-1 agonists.
