Chronic Disease NP Clinical Management
Test Bank – 150 Practice Questions
Answers AND rationale
2025/2026
1. Which of the following is the most appropriate first-line therapy
for a patient newly diagnosed with type 2 diabetes without
contraindications?
A. Glyburide
B. Insulin
C. Metformin
D. Pioglitazone
Rationale: Metformin is the first-line therapy for type 2 diabetes due
to its efficacy in lowering glucose and favorable safety profile.
2. A 65-year-old patient with chronic heart failure presents with
dyspnea on exertion. Which class of drugs has been shown to
improve mortality in HFrEF (heart failure with reduced ejection
fraction)?
A. Loop diuretics
B. ACE inhibitors
C. Digoxin
D. Calcium channel blockers
Rationale: ACE inhibitors reduce mortality in HFrEF by decreasing
afterload and preventing cardiac remodeling.
3. In a patient with hypertension and chronic kidney disease, which
antihypertensive agent is preferred to slow progression of kidney
, disease?
A. Thiazide diuretics
B. Beta-blockers
C. ACE inhibitors or ARBs
D. Calcium channel blockers
Rationale: ACE inhibitors or ARBs provide renal protection by reducing
intraglomerular pressure and proteinuria.
4. A 55-year-old patient with COPD is using albuterol as needed but
reports frequent nighttime symptoms. Which addition is
appropriate?
A. Continue albuterol only
B. Add a long-acting beta-agonist (LABA)
C. Start systemic corticosteroids
D. Initiate inhaled antibiotics
Rationale: A LABA provides better symptom control, especially at
night, in moderate to severe COPD when short-acting agents are
insufficient.
5. Which lifestyle intervention has the greatest effect on lowering
blood pressure in patients with hypertension?
A. Reducing caffeine intake
B. Weight loss
C. Increasing dietary calcium
D. Meditation
Rationale: Weight loss has the strongest evidence for reducing blood
pressure, followed by dietary modification and exercise.
6. A patient with chronic atrial fibrillation requires anticoagulation.
Which risk score is commonly used to guide therapy?
A. APACHE II
, B. CHA2DS2-VASc
C. MELD
D. Framingham Risk Score
Rationale: The CHA2DS2-VASc score estimates stroke risk in atrial
fibrillation and guides anticoagulation decisions.
7. A patient with chronic kidney disease stage 3 has
hyperphosphatemia. Which is the most appropriate initial
treatment?
A. Calcium supplementation only
B. Phosphate binders with dietary phosphate restriction
C. Vitamin D analogs
D. Loop diuretics
Rationale: Phosphate binders reduce phosphate absorption and, along
with dietary restrictions, help manage hyperphosphatemia in CKD.
8. Which medication is preferred for long-term secondary
prevention after myocardial infarction in patients without
contraindications?
A. Calcium channel blockers
B. Beta-blockers
C. ACE inhibitors only
D. Digoxin
Rationale: Beta-blockers reduce mortality, reinfarction risk, and
sudden cardiac death post-MI.
9. A patient with osteoarthritis is using acetaminophen regularly but
reports inadequate pain control. Which is the next recommended
step?
A. Start chronic opioid therapy
B. Add an NSAID
, C. Refer for joint replacement immediately
D. Start corticosteroid injections routinely
Rationale: NSAIDs are the next step after acetaminophen for pain
control in osteoarthritis, considering cardiovascular and
gastrointestinal risks.
10. In patients with chronic hepatitis B infection, which serologic
marker indicates active viral replication?
A. HBsAb
B. HBeAg
C. HBcAb (IgG)
D. HBsAg
Rationale: HBeAg positivity indicates active viral replication and
higher infectivity in hepatitis B infection.
11. A 60-year-old patient with type 2 diabetes has an A1C of 9%
on metformin. Which is the next step?
A. Increase metformin dose only
B. Start sulfonylurea
C. Add a GLP-1 receptor agonist or SGLT2 inhibitor
D. Switch to insulin immediately
Rationale: If A1C remains above target on metformin, guideline-
recommended add-on therapies include GLP-1 receptor agonists or
SGLT2 inhibitors, especially if cardiovascular or renal comorbidities are
present.
12. In chronic heart failure, which class of drugs is indicated to
reduce hospitalizations but not proven to reduce mortality?
A. ACE inhibitors
B. Loop diuretics
Test Bank – 150 Practice Questions
Answers AND rationale
2025/2026
1. Which of the following is the most appropriate first-line therapy
for a patient newly diagnosed with type 2 diabetes without
contraindications?
A. Glyburide
B. Insulin
C. Metformin
D. Pioglitazone
Rationale: Metformin is the first-line therapy for type 2 diabetes due
to its efficacy in lowering glucose and favorable safety profile.
2. A 65-year-old patient with chronic heart failure presents with
dyspnea on exertion. Which class of drugs has been shown to
improve mortality in HFrEF (heart failure with reduced ejection
fraction)?
A. Loop diuretics
B. ACE inhibitors
C. Digoxin
D. Calcium channel blockers
Rationale: ACE inhibitors reduce mortality in HFrEF by decreasing
afterload and preventing cardiac remodeling.
3. In a patient with hypertension and chronic kidney disease, which
antihypertensive agent is preferred to slow progression of kidney
, disease?
A. Thiazide diuretics
B. Beta-blockers
C. ACE inhibitors or ARBs
D. Calcium channel blockers
Rationale: ACE inhibitors or ARBs provide renal protection by reducing
intraglomerular pressure and proteinuria.
4. A 55-year-old patient with COPD is using albuterol as needed but
reports frequent nighttime symptoms. Which addition is
appropriate?
A. Continue albuterol only
B. Add a long-acting beta-agonist (LABA)
C. Start systemic corticosteroids
D. Initiate inhaled antibiotics
Rationale: A LABA provides better symptom control, especially at
night, in moderate to severe COPD when short-acting agents are
insufficient.
5. Which lifestyle intervention has the greatest effect on lowering
blood pressure in patients with hypertension?
A. Reducing caffeine intake
B. Weight loss
C. Increasing dietary calcium
D. Meditation
Rationale: Weight loss has the strongest evidence for reducing blood
pressure, followed by dietary modification and exercise.
6. A patient with chronic atrial fibrillation requires anticoagulation.
Which risk score is commonly used to guide therapy?
A. APACHE II
, B. CHA2DS2-VASc
C. MELD
D. Framingham Risk Score
Rationale: The CHA2DS2-VASc score estimates stroke risk in atrial
fibrillation and guides anticoagulation decisions.
7. A patient with chronic kidney disease stage 3 has
hyperphosphatemia. Which is the most appropriate initial
treatment?
A. Calcium supplementation only
B. Phosphate binders with dietary phosphate restriction
C. Vitamin D analogs
D. Loop diuretics
Rationale: Phosphate binders reduce phosphate absorption and, along
with dietary restrictions, help manage hyperphosphatemia in CKD.
8. Which medication is preferred for long-term secondary
prevention after myocardial infarction in patients without
contraindications?
A. Calcium channel blockers
B. Beta-blockers
C. ACE inhibitors only
D. Digoxin
Rationale: Beta-blockers reduce mortality, reinfarction risk, and
sudden cardiac death post-MI.
9. A patient with osteoarthritis is using acetaminophen regularly but
reports inadequate pain control. Which is the next recommended
step?
A. Start chronic opioid therapy
B. Add an NSAID
, C. Refer for joint replacement immediately
D. Start corticosteroid injections routinely
Rationale: NSAIDs are the next step after acetaminophen for pain
control in osteoarthritis, considering cardiovascular and
gastrointestinal risks.
10. In patients with chronic hepatitis B infection, which serologic
marker indicates active viral replication?
A. HBsAb
B. HBeAg
C. HBcAb (IgG)
D. HBsAg
Rationale: HBeAg positivity indicates active viral replication and
higher infectivity in hepatitis B infection.
11. A 60-year-old patient with type 2 diabetes has an A1C of 9%
on metformin. Which is the next step?
A. Increase metformin dose only
B. Start sulfonylurea
C. Add a GLP-1 receptor agonist or SGLT2 inhibitor
D. Switch to insulin immediately
Rationale: If A1C remains above target on metformin, guideline-
recommended add-on therapies include GLP-1 receptor agonists or
SGLT2 inhibitors, especially if cardiovascular or renal comorbidities are
present.
12. In chronic heart failure, which class of drugs is indicated to
reduce hospitalizations but not proven to reduce mortality?
A. ACE inhibitors
B. Loop diuretics
