NSG 5544 EXAM 2 (SOUTH COLLEGE)
NEWEST 2026 EXAM TEST BANK|
NSG5544 PRIMARY CARE FOR ADULTS
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A 68-year-old male with HFrEF (EF 35%) presents with worsening dyspnea over 3 days.
Current medications: lisinopril 20 mg daily, metoprolol succinate 100 mg daily, furosemide 40
mg daily. Vital signs: BP 98/62 mmHg, HR 58 bpm, RR 24/min, SpO₂ 88% on room air. Labs: K⁺
5.4 mEq/L, BUN 38 mg/dL, Cr 1.8 mg/dL (baseline 1.1). Which is the priority action?
A. Increase furosemide to 80 mg IV and add spironolactone
B. Discontinue metoprolol and start dobutamine infusion
C. Hold lisinopril, administer IV furosemide, and monitor potassium closely
D. Start nesiritide and add hydralazine-isosorbide dinitrate
Correct Answer: C
Rationale: Hyperkalemia (K⁺ 5.4) with hypotension and acute kidney injury in the setting of
ACE inhibitor use requires immediate discontinuation of the ACE inhibitor; IV diuresis addresses
volume overload while close potassium monitoring prevents life-threatening arrhythmias.
Always verify potassium and renal function before continuing or escalating RAAS blockade in
decompensated heart failure.
2. A 54-year-old female with type 2 diabetes presents with chest pressure radiating to the jaw,
diaphoresis, and nausea for 45 minutes. ECG shows ST-segment elevation in leads V1–V4. BP
156/94, HR 92. Which medication should be administered first?
A. Metoprolol 25 mg PO
B. Aspirin 325 mg chewable (if not already given) and sublingual nitroglycerin
C. Clopidogrel 600 mg loading dose
D. Heparin 60 units/kg IV bolus
Correct Answer: B
Rationale: Immediate aspirin administration (if not already given by EMS) and sublingual
nitroglycerin for ongoing chest pain are the priority interventions while preparing for emergent
,PCI; antiplatelet and anticoagulant loading follow but do not supersede initial anti-ischemic
therapy. In STEMI, aspirin and nitrates remain the first-line pharmacologic interventions before
definitive reperfusion therapy.
3. A 72-year-old with atrial fibrillation on warfarin (INR 2.5) presents with acute-onset left-sided
weakness and aphasia. CT head shows no hemorrhage. NIHSS score is 14. Time from last known
well is 2.5 hours. Which is the next best step?
A. Administer IV tPA 0.9 mg/kg immediately
B. Hold warfarin, check INR, and if ≤1.7, administer IV tPA
C. Perform emergent CTA of head and neck before any intervention
D. Start aspirin 325 mg and admit for observation
Correct Answer: B
Rationale: IV tPA is contraindicated if INR >1.7 on warfarin; verifying the INR is critical
before thrombolysis, and if acceptable, tPA remains the standard of care within the 4.5-hour
window for eligible patients. Anticoagulation status must be verified before thrombolytic
administration in acute ischemic stroke.
4. A 45-year-old male with HTN presents for follow-up. BP averages 148/92 on home monitoring
despite lisinopril 20 mg daily. Labs: K⁺ 3.2 mEq/L, aldosterone elevated, renin low. CT abdomen
shows a 1.2 cm adrenal nodule. Which is the most likely diagnosis?
A. Pheochromocytoma
B. Primary hyperaldosteronism (Conn syndrome)
C. Cushing syndrome
D. Renal artery stenosis
Correct Answer: B
Rationale: Hypertension with hypokalemia, elevated aldosterone, suppressed renin, and an
adrenal nodule is classic for primary hyperaldosteronism. This is the most common cause of
secondary hypertension. Pheochromocytoma presents with paroxysmal symptoms; Cushing
syndrome has cortisol excess features; renal artery stenosis would show elevated renin.
5. A 50-year-old with hypertension and hyperlipidemia presents with sudden onset of severe
tearing chest pain radiating to the back. BP is 200/110 mmHg in the right arm and 140/80
,mmHg in the left arm. Chest X-ray shows widened mediastinum. What is the most appropriate
diagnostic test to confirm the diagnosis?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Coronary angiography
D. Ventilation-perfusion scan
Correct Answer: B
Rationale: This presentation is classic for aortic dissection. CT angiography is the gold
standard for diagnosis, providing rapid, high-resolution images of the aorta. Transthoracic echo
may miss some dissections, especially Type B. Coronary angiography is not diagnostic for
dissection. V/Q scan is for pulmonary embolism.
6. A 60-year-old with chronic kidney disease stage 3 (eGFR 45 mL/min) has hypertension. Which
antihypertensive medication is most likely to slow progression of kidney disease?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. Hydralazine
Correct Answer: C
Rationale: ACE inhibitors (lisinopril) and ARBs have renoprotective effects independent of
blood pressure lowering, reducing proteinuria and slowing CKD progression. They are first-line
for hypertension with CKD and proteinuria. Amlodipine, metoprolol, and hydralazine do not
have the same evidence for renoprotection.
7. Which of the following ECG findings is most specific for acute pericarditis?
A. ST-segment depression in leads V1–V3
B. PR segment depression in leads II, III, and aVF
C. Pathologic Q waves in leads II, III, and aVF
D. T wave inversion in leads V5–V6
Correct Answer: B
, Rationale: PR segment depression (or elevation in aVR) is a classic, highly specific ECG
finding for acute pericarditis, reflecting atrial involvement. ST-segment elevation is also common
but less specific. Pathologic Q waves indicate infarction. T wave inversion is nonspecific.
8. A patient with nonvalvular atrial fibrillation and a CHA₂DS₂-VASc score of 4 is being
considered for anticoagulation. The patient has a history of gastrointestinal bleeding 6 months
ago. Which anticoagulation strategy is most appropriate?
A. Aspirin 81 mg daily plus clopidogrel 75 mg daily
B. Warfarin with target INR 2–3
C. Apixaban 5 mg twice daily
D. Left atrial appendage occlusion device
Correct Answer: C
Rationale: Direct oral anticoagulants (DOACs) like apixaban have lower risk of major
bleeding compared to warfarin, especially GI bleeding. Apixaban is preferred over warfarin in
patients with prior GI bleed. Aspirin plus clopidogrel is inferior for stroke prevention. LAA
occlusion is considered if contraindications to anticoagulation exist, but prior GI bleed is not an
absolute contraindication.
9. A patient with heart failure with reduced ejection fraction (HFrEF) of 35% is on lisinopril 40
mg daily, carvedilol 25 mg twice daily, and furosemide 40 mg daily. Despite adherence, the
patient remains symptomatic with NYHA class III symptoms. Which medication addition is most
likely to reduce mortality?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily
C. Hydralazine 50 mg three times daily plus isosorbide dinitrate 40 mg three times daily
D. Ivabradine 5 mg twice daily
Correct Answer: B
Rationale: In HFrEF, aldosterone antagonists (spironolactone or eplerenone) reduce
mortality in NYHA class II–IV patients already on ACEi/ARB and beta-blocker. Digoxin reduces
hospitalizations but not mortality. Hydralazine/nitrates are second-line for African Americans or
if ACEi/ARB intolerant. Ivabradine is for patients in sinus rhythm with HR >70 despite beta-
blocker, but does not reduce mortality in this scenario.
NEWEST 2026 EXAM TEST BANK|
NSG5544 PRIMARY CARE FOR ADULTS
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–25)
1. A 68-year-old male with HFrEF (EF 35%) presents with worsening dyspnea over 3 days.
Current medications: lisinopril 20 mg daily, metoprolol succinate 100 mg daily, furosemide 40
mg daily. Vital signs: BP 98/62 mmHg, HR 58 bpm, RR 24/min, SpO₂ 88% on room air. Labs: K⁺
5.4 mEq/L, BUN 38 mg/dL, Cr 1.8 mg/dL (baseline 1.1). Which is the priority action?
A. Increase furosemide to 80 mg IV and add spironolactone
B. Discontinue metoprolol and start dobutamine infusion
C. Hold lisinopril, administer IV furosemide, and monitor potassium closely
D. Start nesiritide and add hydralazine-isosorbide dinitrate
Correct Answer: C
Rationale: Hyperkalemia (K⁺ 5.4) with hypotension and acute kidney injury in the setting of
ACE inhibitor use requires immediate discontinuation of the ACE inhibitor; IV diuresis addresses
volume overload while close potassium monitoring prevents life-threatening arrhythmias.
Always verify potassium and renal function before continuing or escalating RAAS blockade in
decompensated heart failure.
2. A 54-year-old female with type 2 diabetes presents with chest pressure radiating to the jaw,
diaphoresis, and nausea for 45 minutes. ECG shows ST-segment elevation in leads V1–V4. BP
156/94, HR 92. Which medication should be administered first?
A. Metoprolol 25 mg PO
B. Aspirin 325 mg chewable (if not already given) and sublingual nitroglycerin
C. Clopidogrel 600 mg loading dose
D. Heparin 60 units/kg IV bolus
Correct Answer: B
Rationale: Immediate aspirin administration (if not already given by EMS) and sublingual
nitroglycerin for ongoing chest pain are the priority interventions while preparing for emergent
,PCI; antiplatelet and anticoagulant loading follow but do not supersede initial anti-ischemic
therapy. In STEMI, aspirin and nitrates remain the first-line pharmacologic interventions before
definitive reperfusion therapy.
3. A 72-year-old with atrial fibrillation on warfarin (INR 2.5) presents with acute-onset left-sided
weakness and aphasia. CT head shows no hemorrhage. NIHSS score is 14. Time from last known
well is 2.5 hours. Which is the next best step?
A. Administer IV tPA 0.9 mg/kg immediately
B. Hold warfarin, check INR, and if ≤1.7, administer IV tPA
C. Perform emergent CTA of head and neck before any intervention
D. Start aspirin 325 mg and admit for observation
Correct Answer: B
Rationale: IV tPA is contraindicated if INR >1.7 on warfarin; verifying the INR is critical
before thrombolysis, and if acceptable, tPA remains the standard of care within the 4.5-hour
window for eligible patients. Anticoagulation status must be verified before thrombolytic
administration in acute ischemic stroke.
4. A 45-year-old male with HTN presents for follow-up. BP averages 148/92 on home monitoring
despite lisinopril 20 mg daily. Labs: K⁺ 3.2 mEq/L, aldosterone elevated, renin low. CT abdomen
shows a 1.2 cm adrenal nodule. Which is the most likely diagnosis?
A. Pheochromocytoma
B. Primary hyperaldosteronism (Conn syndrome)
C. Cushing syndrome
D. Renal artery stenosis
Correct Answer: B
Rationale: Hypertension with hypokalemia, elevated aldosterone, suppressed renin, and an
adrenal nodule is classic for primary hyperaldosteronism. This is the most common cause of
secondary hypertension. Pheochromocytoma presents with paroxysmal symptoms; Cushing
syndrome has cortisol excess features; renal artery stenosis would show elevated renin.
5. A 50-year-old with hypertension and hyperlipidemia presents with sudden onset of severe
tearing chest pain radiating to the back. BP is 200/110 mmHg in the right arm and 140/80
,mmHg in the left arm. Chest X-ray shows widened mediastinum. What is the most appropriate
diagnostic test to confirm the diagnosis?
A. Transthoracic echocardiogram
B. CT angiography of the chest
C. Coronary angiography
D. Ventilation-perfusion scan
Correct Answer: B
Rationale: This presentation is classic for aortic dissection. CT angiography is the gold
standard for diagnosis, providing rapid, high-resolution images of the aorta. Transthoracic echo
may miss some dissections, especially Type B. Coronary angiography is not diagnostic for
dissection. V/Q scan is for pulmonary embolism.
6. A 60-year-old with chronic kidney disease stage 3 (eGFR 45 mL/min) has hypertension. Which
antihypertensive medication is most likely to slow progression of kidney disease?
A. Amlodipine
B. Metoprolol
C. Lisinopril
D. Hydralazine
Correct Answer: C
Rationale: ACE inhibitors (lisinopril) and ARBs have renoprotective effects independent of
blood pressure lowering, reducing proteinuria and slowing CKD progression. They are first-line
for hypertension with CKD and proteinuria. Amlodipine, metoprolol, and hydralazine do not
have the same evidence for renoprotection.
7. Which of the following ECG findings is most specific for acute pericarditis?
A. ST-segment depression in leads V1–V3
B. PR segment depression in leads II, III, and aVF
C. Pathologic Q waves in leads II, III, and aVF
D. T wave inversion in leads V5–V6
Correct Answer: B
, Rationale: PR segment depression (or elevation in aVR) is a classic, highly specific ECG
finding for acute pericarditis, reflecting atrial involvement. ST-segment elevation is also common
but less specific. Pathologic Q waves indicate infarction. T wave inversion is nonspecific.
8. A patient with nonvalvular atrial fibrillation and a CHA₂DS₂-VASc score of 4 is being
considered for anticoagulation. The patient has a history of gastrointestinal bleeding 6 months
ago. Which anticoagulation strategy is most appropriate?
A. Aspirin 81 mg daily plus clopidogrel 75 mg daily
B. Warfarin with target INR 2–3
C. Apixaban 5 mg twice daily
D. Left atrial appendage occlusion device
Correct Answer: C
Rationale: Direct oral anticoagulants (DOACs) like apixaban have lower risk of major
bleeding compared to warfarin, especially GI bleeding. Apixaban is preferred over warfarin in
patients with prior GI bleed. Aspirin plus clopidogrel is inferior for stroke prevention. LAA
occlusion is considered if contraindications to anticoagulation exist, but prior GI bleed is not an
absolute contraindication.
9. A patient with heart failure with reduced ejection fraction (HFrEF) of 35% is on lisinopril 40
mg daily, carvedilol 25 mg twice daily, and furosemide 40 mg daily. Despite adherence, the
patient remains symptomatic with NYHA class III symptoms. Which medication addition is most
likely to reduce mortality?
A. Digoxin 0.125 mg daily
B. Spironolactone 25 mg daily
C. Hydralazine 50 mg three times daily plus isosorbide dinitrate 40 mg three times daily
D. Ivabradine 5 mg twice daily
Correct Answer: B
Rationale: In HFrEF, aldosterone antagonists (spironolactone or eplerenone) reduce
mortality in NYHA class II–IV patients already on ACEi/ARB and beta-blocker. Digoxin reduces
hospitalizations but not mortality. Hydralazine/nitrates are second-line for African Americans or
if ACEi/ARB intolerant. Ivabradine is for patients in sinus rhythm with HR >70 despite beta-
blocker, but does not reduce mortality in this scenario.
