NR 667 MIDTERM EXAM HIGH-LEVEL
STUDY GUIDE QUESTIONS AND
ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 65-year-old male with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF) presents for a follow-up. His current medications include Lisinopril and
Carvedilol. His potassium is 4.8 mEq/L and CrCl is 45 mL/min. Which medication class is the
most appropriate next step to improve survival?
A. Loop Diuretic
B. Long-acting Nitrate
C. Calcium Channel Blocker
D. Mineralocorticoid Receptor Antagonist (MRA)
Answer: D
Conceptual Explanation: MRAs like Spironolactone are indicated in HFrEF (NYHA Class II-
IV) to reduce mortality, provided potassium and renal function are monitored.
,2. A 24-year-old female presents with a 2-day history of dysuria, frequency, and urgency. She
denies fever or flank pain. She is 10 weeks pregnant. What is the most appropriate first-line
treatment?
A. Ciprofloxacin
B. Trimethoprim-Sulfamethoxazole
C. Doxycycline
D. Nitrofurantoin
Answer: D
Conceptual Explanation: Nitrofurantoin is generally considered safe in the first and
second trimesters for cystitis. Fluoroquinolones and Tetracyclines are contraindicated.
3. According to the GINA guidelines, what is the preferred reliever therapy for a patient with
Step 2 Asthma?
A. Albuterol (SABA) PRN
B. Daily low-dose ICS plus SABA PRN
C. Low-dose ICS-formoterol PRN
D. Montelukast
Answer: C
Conceptual Explanation: GINA guidelines now recommend low-dose ICS-formoterol as
the preferred reliever across most steps to reduce the risk of severe exacerbations.
, 4. A patient presents with a ‘herald patch’ followed by a Christmas tree distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Pityriasis Rosea
B. Tinea Corporis
C. Guttate Psoriasis
D. Secondary Syphilis
Answer: A
Conceptual Explanation: Pityriasis Rosea typically begins with a herald patch and evolves
into a Christmas tree pattern on the cleavage lines of the trunk.
5. Which of the following physical exam findings is most suggestive of Acute Cholecystitis?
A. McBurney’s Point tenderness
B. Rovsing’s Sign
C. Murphy’s Sign
D. Grey Turner’s Sign
Answer: C
Conceptual Explanation: Murphy’s sign (arrest of inspiration on deep palpation of the
RUQ) is a classic finding for acute cholecystitis.
STUDY GUIDE QUESTIONS AND
ANSWERS 2026/2027 UPDATE. 100%
VERIFIED
1. A 65-year-old male with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF) presents for a follow-up. His current medications include Lisinopril and
Carvedilol. His potassium is 4.8 mEq/L and CrCl is 45 mL/min. Which medication class is the
most appropriate next step to improve survival?
A. Loop Diuretic
B. Long-acting Nitrate
C. Calcium Channel Blocker
D. Mineralocorticoid Receptor Antagonist (MRA)
Answer: D
Conceptual Explanation: MRAs like Spironolactone are indicated in HFrEF (NYHA Class II-
IV) to reduce mortality, provided potassium and renal function are monitored.
,2. A 24-year-old female presents with a 2-day history of dysuria, frequency, and urgency. She
denies fever or flank pain. She is 10 weeks pregnant. What is the most appropriate first-line
treatment?
A. Ciprofloxacin
B. Trimethoprim-Sulfamethoxazole
C. Doxycycline
D. Nitrofurantoin
Answer: D
Conceptual Explanation: Nitrofurantoin is generally considered safe in the first and
second trimesters for cystitis. Fluoroquinolones and Tetracyclines are contraindicated.
3. According to the GINA guidelines, what is the preferred reliever therapy for a patient with
Step 2 Asthma?
A. Albuterol (SABA) PRN
B. Daily low-dose ICS plus SABA PRN
C. Low-dose ICS-formoterol PRN
D. Montelukast
Answer: C
Conceptual Explanation: GINA guidelines now recommend low-dose ICS-formoterol as
the preferred reliever across most steps to reduce the risk of severe exacerbations.
, 4. A patient presents with a ‘herald patch’ followed by a Christmas tree distribution of
smaller maculopapular lesions on the trunk. What is the most likely diagnosis?
A. Pityriasis Rosea
B. Tinea Corporis
C. Guttate Psoriasis
D. Secondary Syphilis
Answer: A
Conceptual Explanation: Pityriasis Rosea typically begins with a herald patch and evolves
into a Christmas tree pattern on the cleavage lines of the trunk.
5. Which of the following physical exam findings is most suggestive of Acute Cholecystitis?
A. McBurney’s Point tenderness
B. Rovsing’s Sign
C. Murphy’s Sign
D. Grey Turner’s Sign
Answer: C
Conceptual Explanation: Murphy’s sign (arrest of inspiration on deep palpation of the
RUQ) is a classic finding for acute cholecystitis.
