NSG 526 Exam 3 Wilkes University
2026/2027 | Latest Update | Questions &
Answers | Graded A+
1. A 68-year-old male presents with a 3-month history of progressive dyspnea on exertion,
orthopnea, and bilateral pedal edema. Which finding on physical exam is most consistent with
heart failure?
A) Clear lung fields
B) S3 gallop and jugular venous distention
C) Unilateral leg swelling
D) Bradycardia
Answer B: S3 gallop and jugular venous distention
Rationale: S3 gallop indicates volume overload; JVD reflects elevated right heart pressures. Both are
classic heart failure signs.
2. Which medication is first-line for a patient with type 2 diabetes and stage 3 chronic kidney
disease (eGFR 45 mL/min)?
A) Metformin
B) Empagliflozin (SGLT2 inhibitor)
C) Glipizide
D) Pioglitazone
Answer B: Empagliflozin (SGLT2 inhibitor)
Rationale: SGLT2 inhibitors have renal and cardiovascular benefits and can be used with eGFR ≥30.
Metformin is contraindicated with eGFR <30.
3. A 55-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. TSH
is 25 mIU/L, free T4 is 0.6 ng/dL. What is the initial daily dose of levothyroxine for this patient?
,A) 200 mcg
B) 50 mcg
C) 100 mcg
D) 150 mcg
Answer B: 50 mcg
Rationale: Start low in older adults or those with cardiac disease (25-50 mcg) and titrate every 6-8
weeks. Full replacement is 1.6 mcg/kg/day.
4. Which of the following is the most appropriate initial treatment for a patient with
uncomplicated cystitis?
A) Ciprofloxacin for 7 days
B) Nitrofurantoin for 5 days
C) Amoxicillin for 10 days
D) Levofloxacin for 3 days
Answer B: Nitrofurantoin for 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis. Fluoroquinolones are reserved for
complicated infections.
5. A 45-year-old male presents with sudden onset of severe, tearing chest pain radiating to the
back. Blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is
the most appropriate initial diagnostic test?
A) ECG
B) CT angiography of the chest
C) Chest X-ray
D) Troponin level
Answer B: CT angiography of the chest
Rationale: Unequal arm pressures with tearing pain suggest aortic dissection. CT angiography is the
diagnostic study of choice.
,6. Which medication is first-line for a patient with generalized anxiety disorder (GAD)?
A) Alprazolam
B) Escitalopram (SSRI)
C) Diazepam
D) Hydroxyzine
Answer B: Escitalopram (SSRI)
Rationale: SSRIs are first-line for GAD due to efficacy and favorable long-term safety profile.
Benzodiazepines are for short-term use.
7. A 72-year-old female presents with a 2-week history of progressive confusion, unsteady gait,
and urinary incontinence. Head CT shows enlarged ventricles without cortical atrophy. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Normal pressure hydrocephalus
C) Parkinson's disease
D) Subdural hematoma
Answer B: Normal pressure hydrocephalus
Rationale: NPH triad: gait apraxia, cognitive decline, urinary incontinence. Ventriculomegaly out of
proportion to atrophy is characteristic.
8. A 35-year-old female presents with a malar rash, arthralgias, and fatigue. ANA is positive at
1:320. Which antibody is most specific for systemic lupus erythematosus (SLE)?
A) Anti-dsDNA
B) Anti-Smith
C) Anti-Ro
D) Anti-RNP
Answer B: Anti-Smith
, Rationale: Anti-Smith is highly specific for SLE, though not sensitive. Anti-dsDNA correlates with disease
activity.
9. A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis and weight
loss. Chest X-ray shows a right hilar mass. What is the most appropriate next step?
A) Sputum cytology
B) CT chest with biopsy
C) PET scan
D) Bronchoscopy alone
Answer B: CT chest with biopsy
Rationale: Tissue diagnosis is required for suspected lung cancer. CT staging followed by biopsy guides
treatment.
10. Which of the following is a contraindication to metformin?
A) Hypertension
B) eGFR <30 mL/min
C) Obesity
D) Hyperlipidemia
Answer B: eGFR <30 mL/min
Rationale: Metformin is contraindicated in severe renal impairment due to risk of lactic acidosis.
11. A 28-year-old female presents with a 2-day history of dysuria, frequency, and suprapubic pain.
She is 28 weeks pregnant. Which antibiotic is safest?
A) Ciprofloxacin
B) Cephalexin
C) Doxycycline
D) Trimethoprim-sulfamethoxazole
Answer B: Cephalexin
2026/2027 | Latest Update | Questions &
Answers | Graded A+
1. A 68-year-old male presents with a 3-month history of progressive dyspnea on exertion,
orthopnea, and bilateral pedal edema. Which finding on physical exam is most consistent with
heart failure?
A) Clear lung fields
B) S3 gallop and jugular venous distention
C) Unilateral leg swelling
D) Bradycardia
Answer B: S3 gallop and jugular venous distention
Rationale: S3 gallop indicates volume overload; JVD reflects elevated right heart pressures. Both are
classic heart failure signs.
2. Which medication is first-line for a patient with type 2 diabetes and stage 3 chronic kidney
disease (eGFR 45 mL/min)?
A) Metformin
B) Empagliflozin (SGLT2 inhibitor)
C) Glipizide
D) Pioglitazone
Answer B: Empagliflozin (SGLT2 inhibitor)
Rationale: SGLT2 inhibitors have renal and cardiovascular benefits and can be used with eGFR ≥30.
Metformin is contraindicated with eGFR <30.
3. A 55-year-old female presents with fatigue, weight gain, cold intolerance, and constipation. TSH
is 25 mIU/L, free T4 is 0.6 ng/dL. What is the initial daily dose of levothyroxine for this patient?
,A) 200 mcg
B) 50 mcg
C) 100 mcg
D) 150 mcg
Answer B: 50 mcg
Rationale: Start low in older adults or those with cardiac disease (25-50 mcg) and titrate every 6-8
weeks. Full replacement is 1.6 mcg/kg/day.
4. Which of the following is the most appropriate initial treatment for a patient with
uncomplicated cystitis?
A) Ciprofloxacin for 7 days
B) Nitrofurantoin for 5 days
C) Amoxicillin for 10 days
D) Levofloxacin for 3 days
Answer B: Nitrofurantoin for 5 days
Rationale: Nitrofurantoin is first-line for uncomplicated cystitis. Fluoroquinolones are reserved for
complicated infections.
5. A 45-year-old male presents with sudden onset of severe, tearing chest pain radiating to the
back. Blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is
the most appropriate initial diagnostic test?
A) ECG
B) CT angiography of the chest
C) Chest X-ray
D) Troponin level
Answer B: CT angiography of the chest
Rationale: Unequal arm pressures with tearing pain suggest aortic dissection. CT angiography is the
diagnostic study of choice.
,6. Which medication is first-line for a patient with generalized anxiety disorder (GAD)?
A) Alprazolam
B) Escitalopram (SSRI)
C) Diazepam
D) Hydroxyzine
Answer B: Escitalopram (SSRI)
Rationale: SSRIs are first-line for GAD due to efficacy and favorable long-term safety profile.
Benzodiazepines are for short-term use.
7. A 72-year-old female presents with a 2-week history of progressive confusion, unsteady gait,
and urinary incontinence. Head CT shows enlarged ventricles without cortical atrophy. What is the
most likely diagnosis?
A) Alzheimer's disease
B) Normal pressure hydrocephalus
C) Parkinson's disease
D) Subdural hematoma
Answer B: Normal pressure hydrocephalus
Rationale: NPH triad: gait apraxia, cognitive decline, urinary incontinence. Ventriculomegaly out of
proportion to atrophy is characteristic.
8. A 35-year-old female presents with a malar rash, arthralgias, and fatigue. ANA is positive at
1:320. Which antibody is most specific for systemic lupus erythematosus (SLE)?
A) Anti-dsDNA
B) Anti-Smith
C) Anti-Ro
D) Anti-RNP
Answer B: Anti-Smith
, Rationale: Anti-Smith is highly specific for SLE, though not sensitive. Anti-dsDNA correlates with disease
activity.
9. A 55-year-old male with a 40-pack-year smoking history presents with hemoptysis and weight
loss. Chest X-ray shows a right hilar mass. What is the most appropriate next step?
A) Sputum cytology
B) CT chest with biopsy
C) PET scan
D) Bronchoscopy alone
Answer B: CT chest with biopsy
Rationale: Tissue diagnosis is required for suspected lung cancer. CT staging followed by biopsy guides
treatment.
10. Which of the following is a contraindication to metformin?
A) Hypertension
B) eGFR <30 mL/min
C) Obesity
D) Hyperlipidemia
Answer B: eGFR <30 mL/min
Rationale: Metformin is contraindicated in severe renal impairment due to risk of lactic acidosis.
11. A 28-year-old female presents with a 2-day history of dysuria, frequency, and suprapubic pain.
She is 28 weeks pregnant. Which antibiotic is safest?
A) Ciprofloxacin
B) Cephalexin
C) Doxycycline
D) Trimethoprim-sulfamethoxazole
Answer B: Cephalexin
