NR 566 Advanced Midterm Practice Exam verified with correct answers
2026/2027 version A+ Graded
1. A 58-year-old man with type 2 diabetes (A1C 8.9%), hypertension, and CKD
stage 3 (eGFR 48 mL/min/1.73 m²) is taking metformin 1,000 mg twice daily.
Which is the most appropriate next step?
A. Increase metformin to 2,500 mg/day
B. Discontinue metformin immediately because of CKD
C. Continue metformin and consider adding an SGLT2 inhibitor if appropriate
D. Start glyburide
Answer: C
Rationale: Metformin is generally safe if eGFR is ≥30 mL/min/1.73 m², though renal function
should be monitored. SGLT2 inhibitors provide renal and cardiovascular benefits in appropriate
patients. Glyburide is avoided in CKD because of prolonged hypoglycemia risk.
2. A 72-year-old woman presents with dysuria and urinary frequency. Urinalysis
is positive for nitrites and leukocyte esterase. She has no fever or flank pain.
Which medication is preferred?
A. Ciprofloxacin
B. Nitrofurantoin
C. Vancomycin
D. Clindamycin
Answer: B
Rationale: Nitrofurantoin is a first-line treatment for uncomplicated cystitis when renal function
is adequate. Fluoroquinolones should generally be reserved for more complicated infections.
3. A patient taking lisinopril develops facial swelling and difficulty breathing.
What should the NP do first?
A. Reduce the dose
B. Switch to another ACE inhibitor
C. Stop lisinopril immediately and treat as angioedema
D. Continue the medication
Answer: C
,Rationale: ACE inhibitor–induced angioedema is a medical emergency. The medication must be
discontinued permanently.
4. Which medication is preferred for hypertension during pregnancy?
A. Lisinopril
B. Losartan
C. Labetalol
D. Aliskiren
Answer: C
Rationale: Labetalol is one of the preferred antihypertensive medications during pregnancy.
ACE inhibitors, ARBs, and direct renin inhibitors are contraindicated.
5. A patient taking warfarin starts trimethoprim-sulfamethoxazole. What should
the NP anticipate?
A. Decreased INR
B. Increased INR and bleeding risk
C. No interaction
D. Reduced anticoagulation
Answer: B
Rationale: TMP-SMX inhibits warfarin metabolism and significantly increases INR and
bleeding risk.
6. Which patient is at greatest risk for digoxin toxicity?
A. Potassium 5.2 mEq/L
B. Potassium 2.9 mEq/L
C. Sodium 145 mEq/L
D. Magnesium 2.0 mg/dL
Answer: B
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and predisposes patients to
toxicity.
, 7. Which adverse effect should be discussed before initiating an SGLT2
inhibitor?
A. Hyperthyroidism
B. Genital fungal infections
C. Hearing loss
D. Bradycardia
Answer: B
Rationale: Increased urinary glucose promotes genital mycotic infections.
8. Which medication is contraindicated in patients taking nitrates?
A. Sildenafil
B. Aspirin
C. Atorvastatin
D. Clopidogrel
Answer: A
Rationale: Concurrent use of nitrates and phosphodiesterase-5 inhibitors can cause profound
hypotension.
9. A patient with asthma requires antihypertensive therapy. Which medication
should generally be avoided?
A. Amlodipine
B. Hydrochlorothiazide
C. Propranolol
D. Losartan
Answer: C
Rationale: Nonselective beta-blockers may trigger bronchospasm in patients with asthma.
10. Which medication should be taken 30–60 minutes before breakfast?
2026/2027 version A+ Graded
1. A 58-year-old man with type 2 diabetes (A1C 8.9%), hypertension, and CKD
stage 3 (eGFR 48 mL/min/1.73 m²) is taking metformin 1,000 mg twice daily.
Which is the most appropriate next step?
A. Increase metformin to 2,500 mg/day
B. Discontinue metformin immediately because of CKD
C. Continue metformin and consider adding an SGLT2 inhibitor if appropriate
D. Start glyburide
Answer: C
Rationale: Metformin is generally safe if eGFR is ≥30 mL/min/1.73 m², though renal function
should be monitored. SGLT2 inhibitors provide renal and cardiovascular benefits in appropriate
patients. Glyburide is avoided in CKD because of prolonged hypoglycemia risk.
2. A 72-year-old woman presents with dysuria and urinary frequency. Urinalysis
is positive for nitrites and leukocyte esterase. She has no fever or flank pain.
Which medication is preferred?
A. Ciprofloxacin
B. Nitrofurantoin
C. Vancomycin
D. Clindamycin
Answer: B
Rationale: Nitrofurantoin is a first-line treatment for uncomplicated cystitis when renal function
is adequate. Fluoroquinolones should generally be reserved for more complicated infections.
3. A patient taking lisinopril develops facial swelling and difficulty breathing.
What should the NP do first?
A. Reduce the dose
B. Switch to another ACE inhibitor
C. Stop lisinopril immediately and treat as angioedema
D. Continue the medication
Answer: C
,Rationale: ACE inhibitor–induced angioedema is a medical emergency. The medication must be
discontinued permanently.
4. Which medication is preferred for hypertension during pregnancy?
A. Lisinopril
B. Losartan
C. Labetalol
D. Aliskiren
Answer: C
Rationale: Labetalol is one of the preferred antihypertensive medications during pregnancy.
ACE inhibitors, ARBs, and direct renin inhibitors are contraindicated.
5. A patient taking warfarin starts trimethoprim-sulfamethoxazole. What should
the NP anticipate?
A. Decreased INR
B. Increased INR and bleeding risk
C. No interaction
D. Reduced anticoagulation
Answer: B
Rationale: TMP-SMX inhibits warfarin metabolism and significantly increases INR and
bleeding risk.
6. Which patient is at greatest risk for digoxin toxicity?
A. Potassium 5.2 mEq/L
B. Potassium 2.9 mEq/L
C. Sodium 145 mEq/L
D. Magnesium 2.0 mg/dL
Answer: B
Rationale: Hypokalemia increases myocardial sensitivity to digoxin and predisposes patients to
toxicity.
, 7. Which adverse effect should be discussed before initiating an SGLT2
inhibitor?
A. Hyperthyroidism
B. Genital fungal infections
C. Hearing loss
D. Bradycardia
Answer: B
Rationale: Increased urinary glucose promotes genital mycotic infections.
8. Which medication is contraindicated in patients taking nitrates?
A. Sildenafil
B. Aspirin
C. Atorvastatin
D. Clopidogrel
Answer: A
Rationale: Concurrent use of nitrates and phosphodiesterase-5 inhibitors can cause profound
hypotension.
9. A patient with asthma requires antihypertensive therapy. Which medication
should generally be avoided?
A. Amlodipine
B. Hydrochlorothiazide
C. Propranolol
D. Losartan
Answer: C
Rationale: Nonselective beta-blockers may trigger bronchospasm in patients with asthma.
10. Which medication should be taken 30–60 minutes before breakfast?
