NURS 5433 MIDTERM EXAM
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 62-year-old male presents with new-onset fatigue, polyuria, and blurred vision.
His fasting blood glucose is 165 mg/dL. Which of the following is the most
appropriate next step?
A. Repeat fasting glucose in 2 weeks
B. Order a hemoglobin A1c
C. Start metformin immediately
D. Order a 2-hour OGTT
Answer: B
Rationale: HbA1c provides an overall assessment of glucose control and is appropriate
for diagnosis in adults with symptoms and elevated fasting glucose.
2. A patient with COPD presents with increased dyspnea, wheezing, and sputum
production. Which of the following is the most appropriate initial management?
A. Oral antibiotics only
B. Inhaled corticosteroid alone
C. Short-acting bronchodilator and systemic steroids
D. Long-acting bronchodilator only
Answer: C
Rationale: Acute exacerbations are treated with short-acting bronchodilators and
systemic corticosteroids; antibiotics may be added if bacterial infection is suspected.
1|Page
,3. A 45-year-old female with a history of GERD complains of dysphagia for solids
and weight loss. Which is the most concerning diagnosis?
A. Esophagitis
B. Schatzki ring
C. Achalasia
D. Esophageal cancer
Answer: D
Rationale: Dysphagia with weight loss is a red flag for malignancy and warrants
immediate evaluation (endoscopy).
4. A patient presents with sudden onset of severe chest pain radiating to the back
and unequal blood pressures in the arms. What is the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Unequal arm blood pressures and tearing chest pain strongly suggest aortic
dissection and require emergency evaluation.
5. Which medication is contraindicated in patients with a history of
angioedema related to ACE inhibitors?
A. Losartan
B. Valsartan
C. Enalapril
D. Amlodipine
2|Page
,Answer: C
Rationale: ACE inhibitors can cause angioedema and should be avoided in patients
with prior episodes.
Part II: Scenario-Based Questions (2 points each)
6. A 72-year-old male with CHF presents with worsening edema, weight gain, and
dyspnea. He is currently taking lisinopril, furosemide, and metoprolol. On exam, he
has crackles in the lungs and 3+ pitting edema. Which adjustment is most
appropriate?
A. Increase furosemide dose
B. Add spironolactone
C. Discontinue lisinopril
D. Add amlodipine
Answer: A
Rationale: Worsening CHF symptoms with fluid overload should first be managed by
increasing diuretic therapy, while monitoring electrolytes and renal function.
7. A 29-year-old female presents with a rash on her cheeks and joint pain. Labs
reveal positive ANA and anti-dsDNA. What is the most important next step?
A. Start methotrexate immediately
B. Order urinalysis and renal function
C. Prescribe topical steroids
D. Reassure and observe
Answer: B
Rationale: Lupus nephritis is a serious complication; renal function and urinalysis must
be assessed early.
3|Page
, 8. A patient with type 2 diabetes reports fasting glucose levels of 180–200 mg/dL
despite lifestyle modifications. He is not on medication. What is the most
appropriate next step?
A. Start insulin therapy
B. Start metformin
C. Start sulfonylurea
D. Increase exercise only
Answer: B
Rationale: Metformin is first-line therapy in type 2 diabetes and is appropriate when
lifestyle changes alone are insufficient.
9. A 55-year-old male has persistent cough for 8 weeks and has smoked 1 pack per
day for 30 years. Which is the most appropriate next step?
A. Treat as acute bronchitis
B. Order chest X-ray
C. Prescribe inhaled steroid
D. Recommend smoking cessation only
Answer: B
Rationale: Chronic cough in a long-term smoker requires imaging to rule out
malignancy or chronic lung disease.
10. A patient presents with sudden unilateral facial droop, inability to close the eye,
and drooling. He also reports decreased taste sensation. Which diagnosis is most
likely?
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
4|Page
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+ LATEST
1. A 62-year-old male presents with new-onset fatigue, polyuria, and blurred vision.
His fasting blood glucose is 165 mg/dL. Which of the following is the most
appropriate next step?
A. Repeat fasting glucose in 2 weeks
B. Order a hemoglobin A1c
C. Start metformin immediately
D. Order a 2-hour OGTT
Answer: B
Rationale: HbA1c provides an overall assessment of glucose control and is appropriate
for diagnosis in adults with symptoms and elevated fasting glucose.
2. A patient with COPD presents with increased dyspnea, wheezing, and sputum
production. Which of the following is the most appropriate initial management?
A. Oral antibiotics only
B. Inhaled corticosteroid alone
C. Short-acting bronchodilator and systemic steroids
D. Long-acting bronchodilator only
Answer: C
Rationale: Acute exacerbations are treated with short-acting bronchodilators and
systemic corticosteroids; antibiotics may be added if bacterial infection is suspected.
1|Page
,3. A 45-year-old female with a history of GERD complains of dysphagia for solids
and weight loss. Which is the most concerning diagnosis?
A. Esophagitis
B. Schatzki ring
C. Achalasia
D. Esophageal cancer
Answer: D
Rationale: Dysphagia with weight loss is a red flag for malignancy and warrants
immediate evaluation (endoscopy).
4. A patient presents with sudden onset of severe chest pain radiating to the back
and unequal blood pressures in the arms. What is the most likely diagnosis?
A. Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Answer: B
Rationale: Unequal arm blood pressures and tearing chest pain strongly suggest aortic
dissection and require emergency evaluation.
5. Which medication is contraindicated in patients with a history of
angioedema related to ACE inhibitors?
A. Losartan
B. Valsartan
C. Enalapril
D. Amlodipine
2|Page
,Answer: C
Rationale: ACE inhibitors can cause angioedema and should be avoided in patients
with prior episodes.
Part II: Scenario-Based Questions (2 points each)
6. A 72-year-old male with CHF presents with worsening edema, weight gain, and
dyspnea. He is currently taking lisinopril, furosemide, and metoprolol. On exam, he
has crackles in the lungs and 3+ pitting edema. Which adjustment is most
appropriate?
A. Increase furosemide dose
B. Add spironolactone
C. Discontinue lisinopril
D. Add amlodipine
Answer: A
Rationale: Worsening CHF symptoms with fluid overload should first be managed by
increasing diuretic therapy, while monitoring electrolytes and renal function.
7. A 29-year-old female presents with a rash on her cheeks and joint pain. Labs
reveal positive ANA and anti-dsDNA. What is the most important next step?
A. Start methotrexate immediately
B. Order urinalysis and renal function
C. Prescribe topical steroids
D. Reassure and observe
Answer: B
Rationale: Lupus nephritis is a serious complication; renal function and urinalysis must
be assessed early.
3|Page
, 8. A patient with type 2 diabetes reports fasting glucose levels of 180–200 mg/dL
despite lifestyle modifications. He is not on medication. What is the most
appropriate next step?
A. Start insulin therapy
B. Start metformin
C. Start sulfonylurea
D. Increase exercise only
Answer: B
Rationale: Metformin is first-line therapy in type 2 diabetes and is appropriate when
lifestyle changes alone are insufficient.
9. A 55-year-old male has persistent cough for 8 weeks and has smoked 1 pack per
day for 30 years. Which is the most appropriate next step?
A. Treat as acute bronchitis
B. Order chest X-ray
C. Prescribe inhaled steroid
D. Recommend smoking cessation only
Answer: B
Rationale: Chronic cough in a long-term smoker requires imaging to rule out
malignancy or chronic lung disease.
10. A patient presents with sudden unilateral facial droop, inability to close the eye,
and drooling. He also reports decreased taste sensation. Which diagnosis is most
likely?
A. Stroke
B. Bell’s palsy
C. Myasthenia gravis
D. Trigeminal neuralgia
4|Page
