NR 566| NR 566 FINAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. A 72-year-old patient with Alzheimer's disease has been
taking donepezil 10 mg daily for 18 months. Her family reports
increased confusion, agitation, and urinary incontinence over the
past week. Her vital signs are BP 110/68, HR 48, RR 16. Which
of the following is the most likely cause of her symptoms?
A. Disease progression requiring dose escalation
B. Cholinergic crisis secondary to donepezil accumulation
C. Worsening dementia with behavioral disturbance
D. Urinary tract infection causing delirium
Correct Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that can
cause bradycardia, syncope, and urinary incontinence due to
increased cholinergic effects. The bradycardia (HR 48) and
urinary symptoms suggest cholinergic excess rather than
simple disease progression. A UTI could cause delirium, but
bradycardia points toward medication effect.
2. A 28-year-old female with a history of migraines with aura is
seeking contraception. She has no other medical conditions and
does not smoke. Which contraceptive method is absolutely
contraindicated for this patient?
A. Copper intrauterine device (IUD)
,B. Progestin-only pill
C. Combined oral contraceptive pill
D. Etonogestrel implant
Correct Answer: C
Rationale: Combined oral contraceptives (containing estrogen)
are contraindicated in women with migraine with aura due to
an increased risk of ischemic stroke. Progestin-only methods,
copper IUDs, and implants are considered safe alternatives as
they do not contain estrogen.
3. A 45-year-old male presents with a 3-day history of painful
vesicular rash on the right side of his face involving the
ophthalmic branch of the trigeminal nerve. He reports severe
burning pain and photophobia. What is the most appropriate
management for this patient?
A. Oral acyclovir 400 mg TID for 7 days
B. Oral valacyclovir 1,000 mg TID for 7 days with urgent
ophthalmology referral
C. Topical acyclovir cream applied 5 times daily
D. Oral prednisone 60 mg daily with taper
Correct Answer: B
Rationale: Herpes zoster ophthalmicus is an ophthalmologic
emergency requiring prompt antiviral therapy and immediate
ophthalmology consultation. Valacyclovir 1,000 mg TID for 7
days is the preferred regimen due to better bioavailability.
Topical antivirals are ineffective for herpes zoster, and
corticosteroids alone without antivirals are inappropriate.
4. A 55-year-old female with type 2 diabetes and stage 3 chronic
kidney disease (eGFR 45 mL/min) is started on metformin.
,Which of the following is the most important monitoring
parameter for this patient?
A. Serum creatinine and eGFR every 6–12 months
B. Fasting blood glucose only
C. Serum potassium levels
D. Liver function tests monthly
Correct Answer: A
Rationale: Metformin is contraindicated in patients with eGFR
<30 mL/min and requires dose adjustment and close
monitoring when eGFR is 30–45 mL/min. The FDA
recommends monitoring renal function at least annually in
patients with normal renal function and more frequently in
those at risk of renal impairment. Lactic acidosis risk
increases with declining renal function.
5. A 32-year-old pregnant woman at 28 weeks gestation presents
with a urinary tract infection. Urine culture shows >100,000
CFU/mL of Escherichia coli sensitive to nitrofurantoin,
amoxicillin, and cephalexin. Which antibiotic is the safest and
most appropriate choice for this patient?
A. Nitrofurantoin 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 7 days
C. Doxycycline 100 mg BID for 7 days
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Correct Answer: A
Rationale: Nitrofurantoin is pregnancy category B and is the
first-line agent for asymptomatic bacteriuria and acute cystitis
in pregnancy when susceptible. Fluoroquinolones
(ciprofloxacin) are avoided in pregnancy due to risk of
, arthropathy. Doxycycline is contraindicated in the second and
third trimesters due to dental discoloration and bone growth
inhibition. TMP-SMX should be avoided near term due to risk
of kernicterus.
6. An 8-year-old child is diagnosed with absence seizures.
Which medication is considered first-line treatment for this
seizure type?
A. Phenytoin
B. Valproic acid
C. Ethosuximide
D. Carbamazepine
Correct Answer: C
Rationale: Ethosuximide is the drug of choice for absence
seizures. It is highly effective and has a relatively favorable
side effect profile compared to valproic acid. Phenytoin and
carbamazepine are not effective for absence seizures and may
actually worsen them.
7. A 67-year-old male with benign prostatic hyperplasia (BPH)
is started on tamsulosin. He returns 2 weeks later reporting
dizziness upon standing and lightheadedness. His sitting BP is
138/82, and standing BP is 110/64. What is the most appropriate
next step?
A. Discontinue tamsulosin immediately
B. Add an alpha-blocker
C. Instruct the patient to take tamsulosin at bedtime and rise
slowly
D. Increase the tamsulosin dose to improve symptom control
Correct Answer: C
QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES ALREADY A GRADED WITH
EXPERT FEEDBACK |NEW AND REVISED
1. A 72-year-old patient with Alzheimer's disease has been
taking donepezil 10 mg daily for 18 months. Her family reports
increased confusion, agitation, and urinary incontinence over the
past week. Her vital signs are BP 110/68, HR 48, RR 16. Which
of the following is the most likely cause of her symptoms?
A. Disease progression requiring dose escalation
B. Cholinergic crisis secondary to donepezil accumulation
C. Worsening dementia with behavioral disturbance
D. Urinary tract infection causing delirium
Correct Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that can
cause bradycardia, syncope, and urinary incontinence due to
increased cholinergic effects. The bradycardia (HR 48) and
urinary symptoms suggest cholinergic excess rather than
simple disease progression. A UTI could cause delirium, but
bradycardia points toward medication effect.
2. A 28-year-old female with a history of migraines with aura is
seeking contraception. She has no other medical conditions and
does not smoke. Which contraceptive method is absolutely
contraindicated for this patient?
A. Copper intrauterine device (IUD)
,B. Progestin-only pill
C. Combined oral contraceptive pill
D. Etonogestrel implant
Correct Answer: C
Rationale: Combined oral contraceptives (containing estrogen)
are contraindicated in women with migraine with aura due to
an increased risk of ischemic stroke. Progestin-only methods,
copper IUDs, and implants are considered safe alternatives as
they do not contain estrogen.
3. A 45-year-old male presents with a 3-day history of painful
vesicular rash on the right side of his face involving the
ophthalmic branch of the trigeminal nerve. He reports severe
burning pain and photophobia. What is the most appropriate
management for this patient?
A. Oral acyclovir 400 mg TID for 7 days
B. Oral valacyclovir 1,000 mg TID for 7 days with urgent
ophthalmology referral
C. Topical acyclovir cream applied 5 times daily
D. Oral prednisone 60 mg daily with taper
Correct Answer: B
Rationale: Herpes zoster ophthalmicus is an ophthalmologic
emergency requiring prompt antiviral therapy and immediate
ophthalmology consultation. Valacyclovir 1,000 mg TID for 7
days is the preferred regimen due to better bioavailability.
Topical antivirals are ineffective for herpes zoster, and
corticosteroids alone without antivirals are inappropriate.
4. A 55-year-old female with type 2 diabetes and stage 3 chronic
kidney disease (eGFR 45 mL/min) is started on metformin.
,Which of the following is the most important monitoring
parameter for this patient?
A. Serum creatinine and eGFR every 6–12 months
B. Fasting blood glucose only
C. Serum potassium levels
D. Liver function tests monthly
Correct Answer: A
Rationale: Metformin is contraindicated in patients with eGFR
<30 mL/min and requires dose adjustment and close
monitoring when eGFR is 30–45 mL/min. The FDA
recommends monitoring renal function at least annually in
patients with normal renal function and more frequently in
those at risk of renal impairment. Lactic acidosis risk
increases with declining renal function.
5. A 32-year-old pregnant woman at 28 weeks gestation presents
with a urinary tract infection. Urine culture shows >100,000
CFU/mL of Escherichia coli sensitive to nitrofurantoin,
amoxicillin, and cephalexin. Which antibiotic is the safest and
most appropriate choice for this patient?
A. Nitrofurantoin 100 mg BID for 5 days
B. Ciprofloxacin 500 mg BID for 7 days
C. Doxycycline 100 mg BID for 7 days
D. Trimethoprim-sulfamethoxazole DS BID for 3 days
Correct Answer: A
Rationale: Nitrofurantoin is pregnancy category B and is the
first-line agent for asymptomatic bacteriuria and acute cystitis
in pregnancy when susceptible. Fluoroquinolones
(ciprofloxacin) are avoided in pregnancy due to risk of
, arthropathy. Doxycycline is contraindicated in the second and
third trimesters due to dental discoloration and bone growth
inhibition. TMP-SMX should be avoided near term due to risk
of kernicterus.
6. An 8-year-old child is diagnosed with absence seizures.
Which medication is considered first-line treatment for this
seizure type?
A. Phenytoin
B. Valproic acid
C. Ethosuximide
D. Carbamazepine
Correct Answer: C
Rationale: Ethosuximide is the drug of choice for absence
seizures. It is highly effective and has a relatively favorable
side effect profile compared to valproic acid. Phenytoin and
carbamazepine are not effective for absence seizures and may
actually worsen them.
7. A 67-year-old male with benign prostatic hyperplasia (BPH)
is started on tamsulosin. He returns 2 weeks later reporting
dizziness upon standing and lightheadedness. His sitting BP is
138/82, and standing BP is 110/64. What is the most appropriate
next step?
A. Discontinue tamsulosin immediately
B. Add an alpha-blocker
C. Instruct the patient to take tamsulosin at bedtime and rise
slowly
D. Increase the tamsulosin dose to improve symptom control
Correct Answer: C
