NSG 552 Management of Adults with Acute & Chronic Illness
Exam | Complete Practice Questions & Detailed Rationales
2026/2026
QUESTION 1 Which of the following medication classes is considered
the cornerstone of therapy for reducing morbidity and mortality in a
patient with heart failure with reduced ejection fraction (HFrEF)?
A. Calcium channel blockers
B. Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin
Receptor-Neprilysin Inhibitors (ARNIs)
C. Loop diuretics
D. Phosphodiesterase inhibitors
Correct Answer: B. Angiotensin-converting enzyme (ACE) inhibitors or
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Detailed Rationale: ACE inhibitors, ARBs, and ARNIs (along with beta-
blockers and aldosterone antagonists) are foundational therapies that
prevent detrimental cardiac remodeling and have been proven to
reduce mortality in HFrEF. Loop diuretics manage fluid overload
symptoms but do not directly reduce mortality.
QUESTION 2 A 68-year-old male with a history of COPD presents to the
clinic with increased dyspnea, increased sputum volume, and increased
sputum purulence. What is the most appropriate initial pharmacological
intervention for this acute exacerbation?
A. Initiate long-term oxygen therapy at 4 L/min
,B. Prescribe a 5-to-7-day course of systemic corticosteroids and an
appropriate broad-spectrum oral antibiotic
C. Prescribe daily oral roflumilast
D. Discontinue all inhaled bronchodilators
Correct Answer: B. Prescribe a 5-to-7-day course of systemic
corticosteroids and an appropriate broad-spectrum oral antibiotic
Detailed Rationale: The presence of all three cardinal symptoms
(increased dyspnea, sputum volume, and sputum purulence) indicates a
severe COPD exacerbation. Guidelines recommend a short course of
systemic corticosteroids and an antibiotic (such as a macrolide or
respiratory fluoroquinolone) alongside optimized inhaled
bronchodilator therapy.
QUESTION 3 According to current asthma management guidelines,
what is the preferred first-line controller therapy for an adult patient
with persistent asthma?
A. Short-acting beta-agonists (SABA) as needed
B. Daily low-dose inhaled corticosteroids (ICS)
C. Oral systemic corticosteroids
D. Leukotriene receptor antagonists
Correct Answer: B. Daily low-dose inhaled corticosteroids (ICS)
Detailed Rationale: Inhaled corticosteroids are the most effective long-
term controller medications for asthma. They reduce airway
inflammation, decrease hyperresponsiveness, and prevent asthma
exacerbations in patients with persistent symptoms.
,QUESTION 4 A 55-year-old African American male with no other
comorbidities is diagnosed with primary hypertension. Which of the
following is the recommended initial antihypertensive medication for
this patient?
A. Lisinopril
B. Atenolol
C. Amlodipine or Chlorthalidone
D. Losartan
Correct Answer: C. Amlodipine or Chlorthalidone
Detailed Rationale: Current clinical guidelines recommend that the
initial antihypertensive therapy for Black patients (without heart failure
or chronic kidney disease) should include a thiazide-type diuretic or a
calcium channel blocker, as they have been shown to be more effective
at lowering blood pressure and preventing cardiovascular events in this
population compared to ACE inhibitors or ARBs.
QUESTION 5 What is the primary mechanism of action of metformin,
the first-line oral agent for Type 2 Diabetes Mellitus?
A. Stimulates the pancreas to secrete more insulin
B. Decreases hepatic glucose production and increases peripheral
insulin sensitivity
C. Blocks the reabsorption of glucose in the proximal renal tubule
D. Slows gastric emptying and promotes satiety
Correct Answer: B. Decreases hepatic glucose production and increases
peripheral insulin sensitivity
, Detailed Rationale: Metformin, a biguanide, primarily lowers blood
glucose by reducing hepatic gluconeogenesis and glycogenolysis. It also
improves insulin sensitivity in peripheral tissues (skeletal muscle),
increasing glucose uptake and utilization without directly stimulating
insulin secretion, which minimizes the risk of hypoglycemia.
QUESTION 6 A patient presents to the emergency department with
profound dehydration, altered mental status, a blood glucose of 850
mg/dL, and negative serum ketones. Which acute complication of
diabetes is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Hypoglycemic coma
D. Lactic acidosis
Correct Answer: B. Hyperosmolar Hyperglycemic State (HHS)
Detailed Rationale: HHS is characterized by extreme hyperglycemia
(often >600 mg/dL), profound dehydration, hyperosmolarity, and
altered mental status without significant ketoacidosis. It typically occurs
in older adults with Type 2 Diabetes who have enough residual insulin
to prevent ketogenesis but not enough to prevent severe
hyperglycemia.
QUESTION 7 A 60-year-old female has an estimated Glomerular
Filtration Rate (eGFR) of 40 mL/min/1.73 m². According to KDIGO
guidelines, what stage of Chronic Kidney Disease (CKD) does this
represent?
A. Stage 1
Exam | Complete Practice Questions & Detailed Rationales
2026/2026
QUESTION 1 Which of the following medication classes is considered
the cornerstone of therapy for reducing morbidity and mortality in a
patient with heart failure with reduced ejection fraction (HFrEF)?
A. Calcium channel blockers
B. Angiotensin-converting enzyme (ACE) inhibitors or Angiotensin
Receptor-Neprilysin Inhibitors (ARNIs)
C. Loop diuretics
D. Phosphodiesterase inhibitors
Correct Answer: B. Angiotensin-converting enzyme (ACE) inhibitors or
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Detailed Rationale: ACE inhibitors, ARBs, and ARNIs (along with beta-
blockers and aldosterone antagonists) are foundational therapies that
prevent detrimental cardiac remodeling and have been proven to
reduce mortality in HFrEF. Loop diuretics manage fluid overload
symptoms but do not directly reduce mortality.
QUESTION 2 A 68-year-old male with a history of COPD presents to the
clinic with increased dyspnea, increased sputum volume, and increased
sputum purulence. What is the most appropriate initial pharmacological
intervention for this acute exacerbation?
A. Initiate long-term oxygen therapy at 4 L/min
,B. Prescribe a 5-to-7-day course of systemic corticosteroids and an
appropriate broad-spectrum oral antibiotic
C. Prescribe daily oral roflumilast
D. Discontinue all inhaled bronchodilators
Correct Answer: B. Prescribe a 5-to-7-day course of systemic
corticosteroids and an appropriate broad-spectrum oral antibiotic
Detailed Rationale: The presence of all three cardinal symptoms
(increased dyspnea, sputum volume, and sputum purulence) indicates a
severe COPD exacerbation. Guidelines recommend a short course of
systemic corticosteroids and an antibiotic (such as a macrolide or
respiratory fluoroquinolone) alongside optimized inhaled
bronchodilator therapy.
QUESTION 3 According to current asthma management guidelines,
what is the preferred first-line controller therapy for an adult patient
with persistent asthma?
A. Short-acting beta-agonists (SABA) as needed
B. Daily low-dose inhaled corticosteroids (ICS)
C. Oral systemic corticosteroids
D. Leukotriene receptor antagonists
Correct Answer: B. Daily low-dose inhaled corticosteroids (ICS)
Detailed Rationale: Inhaled corticosteroids are the most effective long-
term controller medications for asthma. They reduce airway
inflammation, decrease hyperresponsiveness, and prevent asthma
exacerbations in patients with persistent symptoms.
,QUESTION 4 A 55-year-old African American male with no other
comorbidities is diagnosed with primary hypertension. Which of the
following is the recommended initial antihypertensive medication for
this patient?
A. Lisinopril
B. Atenolol
C. Amlodipine or Chlorthalidone
D. Losartan
Correct Answer: C. Amlodipine or Chlorthalidone
Detailed Rationale: Current clinical guidelines recommend that the
initial antihypertensive therapy for Black patients (without heart failure
or chronic kidney disease) should include a thiazide-type diuretic or a
calcium channel blocker, as they have been shown to be more effective
at lowering blood pressure and preventing cardiovascular events in this
population compared to ACE inhibitors or ARBs.
QUESTION 5 What is the primary mechanism of action of metformin,
the first-line oral agent for Type 2 Diabetes Mellitus?
A. Stimulates the pancreas to secrete more insulin
B. Decreases hepatic glucose production and increases peripheral
insulin sensitivity
C. Blocks the reabsorption of glucose in the proximal renal tubule
D. Slows gastric emptying and promotes satiety
Correct Answer: B. Decreases hepatic glucose production and increases
peripheral insulin sensitivity
, Detailed Rationale: Metformin, a biguanide, primarily lowers blood
glucose by reducing hepatic gluconeogenesis and glycogenolysis. It also
improves insulin sensitivity in peripheral tissues (skeletal muscle),
increasing glucose uptake and utilization without directly stimulating
insulin secretion, which minimizes the risk of hypoglycemia.
QUESTION 6 A patient presents to the emergency department with
profound dehydration, altered mental status, a blood glucose of 850
mg/dL, and negative serum ketones. Which acute complication of
diabetes is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hyperosmolar Hyperglycemic State (HHS)
C. Hypoglycemic coma
D. Lactic acidosis
Correct Answer: B. Hyperosmolar Hyperglycemic State (HHS)
Detailed Rationale: HHS is characterized by extreme hyperglycemia
(often >600 mg/dL), profound dehydration, hyperosmolarity, and
altered mental status without significant ketoacidosis. It typically occurs
in older adults with Type 2 Diabetes who have enough residual insulin
to prevent ketogenesis but not enough to prevent severe
hyperglycemia.
QUESTION 7 A 60-year-old female has an estimated Glomerular
Filtration Rate (eGFR) of 40 mL/min/1.73 m². According to KDIGO
guidelines, what stage of Chronic Kidney Disease (CKD) does this
represent?
A. Stage 1
