NSG 5544 Exam 3 Study Guide Actual Exam 2026/2027:
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Pharmacology for Primary Care | Q1 – Q10
Section 2 | Management of Chronic Health Conditions | Q11 – Q20
Section 3 | Evidence-Based Clinical Guidelines | Q21 – Q30
Section 4 | Patient Education and Health Promotion | Q31 – Q40
Section 5 | Differential Diagnosis and Clinical Decision-Making | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED PHARMACOLOGY FOR PRIMARY CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old patient with newly diagnosed type 2 diabetes and an eGFR of 45
mL/min/1.73m² is started on metformin 1000 mg twice daily. Three weeks later, the
patient reports nausea, diarrhea, and a metallic taste.
A. The metformin dose should be reduced to 500 mg daily because the eGFR is below
60 and the patient is experiencing dose-related gastrointestinal adverse effects. ✓
CORRECT
B. The patient should be switched to insulin immediately because metformin is
contraindicated in all patients with renal impairment.
C. The patient should take the full dose on an empty stomach to improve absorption
and reduce the metallic taste.
D. The patient should discontinue metformin and start a sulfonylurea because
metformin never causes gastrointestinal symptoms.
Correct Answer: A
,Rationale: Metformin requires dose adjustment and cautious monitoring when eGFR
falls below 45, and gastrointestinal adverse effects are common with rapid dose
escalation. Switching to insulin is unnecessary for mild renal impairment, and taking
metformin on an empty stomach worsens nausea. Sulfonylureas are not first-line and
carry hypoglycemia risk.
Question 2 of 50
A 42-year-old patient with hypertension and asthma is prescribed a beta-blocker for
migraine prophylaxis. The patient reports increased wheezing and shortness of breath
since starting the medication.
A. The patient should increase the beta-blocker dose to achieve better migraine control
and suppress bronchospasm.
B. A nonselective beta-blocker can cause bronchoconstriction by blocking beta-2
receptors in the lungs, so a cardioselective agent or alternative prophylaxis should be
considered. ✓ CORRECT
C. The patient should discontinue the beta-blocker and start an ACE inhibitor for
migraine prevention instead.
D. The wheezing is unrelated to the medication and should be treated with increased
inhaled corticosteroids alone.
Correct Answer: B
Rationale: Nonselective beta-blockers block beta-2 mediated bronchodilation, which is
dangerous in asthma, making cardioselective agents or alternatives like topiramate
preferable. ACE inhibitors are not used for migraine prophylaxis, and attributing
wheezing to unrelated causes while continuing the offending drug is unsafe.
Question 3 of 50
A 67-year-old patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on
warfarin. The INR is therapeutic at 2.5, but the patient begins amoxicillin-clavulanate for
sinusitis.
,A. The INR should be checked weekly because antibiotics never affect warfarin
metabolism.
B. The warfarin dose should be increased by 50% to overcome the antibiotic effect on
vitamin K synthesis.
C. The INR should be rechecked within 3 to 5 days because antibiotics can disrupt gut
flora and potentiate warfarin, increasing bleeding risk. ✓ CORRECT
D. The patient should switch to aspirin because antibiotics make warfarin entirely
ineffective.
Correct Answer: C
Rationale: Antibiotics alter intestinal vitamin K-producing flora and can potentiate
warfarin, so close INR monitoring is essential. Increasing the warfarin dose would
increase bleeding risk, and aspirin is inadequate stroke prevention for a CHA2DS2-VASc
of 4.
Question 4 of 50
A 35-year-old patient with bipolar disorder is stabilized on lithium carbonate 300 mg
twice daily. The patient develops tremor, polyuria, and a serum sodium of 148 mEq/L.
A. The lithium should be stopped immediately because tremor indicates irreversible
neurotoxicity.
B. The patient should be started on a thiazide diuretic to treat the polyuria and mild
hypernatremia.
C. The lithium dose should be doubled to suppress the tremor through stronger mood
stabilization.
D. The lithium level should be checked, the dose held if toxic, and the patient hydrated
because tremor and polyuria are early signs of lithium toxicity or elevated levels. ✓
CORRECT
Correct Answer: D
Rationale: Tremor and polyuria are classic early signs of lithium toxicity, which requires
checking serum levels and holding the dose rather than adjusting empirically. Thiazide
, diuretics reduce lithium clearance and worsen toxicity, and doubling the dose is
dangerous.
Question 5 of 50
A 55-year-old patient with osteoporosis and a history of GERD is prescribed alendronate
70 mg weekly. The patient reports severe chest pain and dysphagia after taking the first
dose with orange juice and then lying down.
A. Alendronate must be taken with a full glass of plain water on an empty stomach, and
the patient must remain upright for 30 minutes to prevent esophageal irritation and
ulceration. ✓ CORRECT
B. The patient should switch to taking alendronate at bedtime with a small sip of water
to improve absorption.
C. The patient should crush the tablet and mix it with applesauce to reduce esophageal
contact.
D. The patient should take calcium carbonate simultaneously to buffer the acid and
protect the esophagus.
Correct Answer: A
Rationale: Bisphosphonates are highly irritating to the esophageal mucosa and require
strict administration with plain water and upright positioning. Taking them with juice,
lying down, or crushing them increases the risk of severe esophagitis. Calcium
interferes with absorption and does not protect the esophagus.
Question 6 of 50
A 48-year-old patient with major depressive disorder is started on fluoxetine 20 mg
daily. After 2 weeks, the patient reports improved mood but new onset anxiety,
insomnia, and restlessness.
A. The fluoxetine should be discontinued immediately because these symptoms
indicate serotonin syndrome.
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Pharmacology for Primary Care | Q1 – Q10
Section 2 | Management of Chronic Health Conditions | Q11 – Q20
Section 3 | Evidence-Based Clinical Guidelines | Q21 – Q30
Section 4 | Patient Education and Health Promotion | Q31 – Q40
Section 5 | Differential Diagnosis and Clinical Decision-Making | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED PHARMACOLOGY FOR PRIMARY CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 58-year-old patient with newly diagnosed type 2 diabetes and an eGFR of 45
mL/min/1.73m² is started on metformin 1000 mg twice daily. Three weeks later, the
patient reports nausea, diarrhea, and a metallic taste.
A. The metformin dose should be reduced to 500 mg daily because the eGFR is below
60 and the patient is experiencing dose-related gastrointestinal adverse effects. ✓
CORRECT
B. The patient should be switched to insulin immediately because metformin is
contraindicated in all patients with renal impairment.
C. The patient should take the full dose on an empty stomach to improve absorption
and reduce the metallic taste.
D. The patient should discontinue metformin and start a sulfonylurea because
metformin never causes gastrointestinal symptoms.
Correct Answer: A
,Rationale: Metformin requires dose adjustment and cautious monitoring when eGFR
falls below 45, and gastrointestinal adverse effects are common with rapid dose
escalation. Switching to insulin is unnecessary for mild renal impairment, and taking
metformin on an empty stomach worsens nausea. Sulfonylureas are not first-line and
carry hypoglycemia risk.
Question 2 of 50
A 42-year-old patient with hypertension and asthma is prescribed a beta-blocker for
migraine prophylaxis. The patient reports increased wheezing and shortness of breath
since starting the medication.
A. The patient should increase the beta-blocker dose to achieve better migraine control
and suppress bronchospasm.
B. A nonselective beta-blocker can cause bronchoconstriction by blocking beta-2
receptors in the lungs, so a cardioselective agent or alternative prophylaxis should be
considered. ✓ CORRECT
C. The patient should discontinue the beta-blocker and start an ACE inhibitor for
migraine prevention instead.
D. The wheezing is unrelated to the medication and should be treated with increased
inhaled corticosteroids alone.
Correct Answer: B
Rationale: Nonselective beta-blockers block beta-2 mediated bronchodilation, which is
dangerous in asthma, making cardioselective agents or alternatives like topiramate
preferable. ACE inhibitors are not used for migraine prophylaxis, and attributing
wheezing to unrelated causes while continuing the offending drug is unsafe.
Question 3 of 50
A 67-year-old patient with atrial fibrillation and a CHA2DS2-VASc score of 4 is started on
warfarin. The INR is therapeutic at 2.5, but the patient begins amoxicillin-clavulanate for
sinusitis.
,A. The INR should be checked weekly because antibiotics never affect warfarin
metabolism.
B. The warfarin dose should be increased by 50% to overcome the antibiotic effect on
vitamin K synthesis.
C. The INR should be rechecked within 3 to 5 days because antibiotics can disrupt gut
flora and potentiate warfarin, increasing bleeding risk. ✓ CORRECT
D. The patient should switch to aspirin because antibiotics make warfarin entirely
ineffective.
Correct Answer: C
Rationale: Antibiotics alter intestinal vitamin K-producing flora and can potentiate
warfarin, so close INR monitoring is essential. Increasing the warfarin dose would
increase bleeding risk, and aspirin is inadequate stroke prevention for a CHA2DS2-VASc
of 4.
Question 4 of 50
A 35-year-old patient with bipolar disorder is stabilized on lithium carbonate 300 mg
twice daily. The patient develops tremor, polyuria, and a serum sodium of 148 mEq/L.
A. The lithium should be stopped immediately because tremor indicates irreversible
neurotoxicity.
B. The patient should be started on a thiazide diuretic to treat the polyuria and mild
hypernatremia.
C. The lithium dose should be doubled to suppress the tremor through stronger mood
stabilization.
D. The lithium level should be checked, the dose held if toxic, and the patient hydrated
because tremor and polyuria are early signs of lithium toxicity or elevated levels. ✓
CORRECT
Correct Answer: D
Rationale: Tremor and polyuria are classic early signs of lithium toxicity, which requires
checking serum levels and holding the dose rather than adjusting empirically. Thiazide
, diuretics reduce lithium clearance and worsen toxicity, and doubling the dose is
dangerous.
Question 5 of 50
A 55-year-old patient with osteoporosis and a history of GERD is prescribed alendronate
70 mg weekly. The patient reports severe chest pain and dysphagia after taking the first
dose with orange juice and then lying down.
A. Alendronate must be taken with a full glass of plain water on an empty stomach, and
the patient must remain upright for 30 minutes to prevent esophageal irritation and
ulceration. ✓ CORRECT
B. The patient should switch to taking alendronate at bedtime with a small sip of water
to improve absorption.
C. The patient should crush the tablet and mix it with applesauce to reduce esophageal
contact.
D. The patient should take calcium carbonate simultaneously to buffer the acid and
protect the esophagus.
Correct Answer: A
Rationale: Bisphosphonates are highly irritating to the esophageal mucosa and require
strict administration with plain water and upright positioning. Taking them with juice,
lying down, or crushing them increases the risk of severe esophagitis. Calcium
interferes with absorption and does not protect the esophagus.
Question 6 of 50
A 48-year-old patient with major depressive disorder is started on fluoxetine 20 mg
daily. After 2 weeks, the patient reports improved mood but new onset anxiety,
insomnia, and restlessness.
A. The fluoxetine should be discontinued immediately because these symptoms
indicate serotonin syndrome.
