NSG 6001 EXAM 1; ADVANCED NURSING
PRACTICE I-SOUTH UNIVERSITY |NEWEST
2026-2027 UPDATE
Question 1
A 58-year-old male with newly diagnosed hypertension has a blood pressure of
158/96 mmHg. He has no other cardiovascular risk factors. According to JNC-8
guidelines, what is the first-line pharmacological treatment?
A. ACE inhibitor
B. Thiazide-type diuretic
C. Beta-blocker
D. Calcium channel blocker
Correct Answer: B
Rationale: Per JNC-8, thiazide-type diuretics, CCBs, ACE inhibitors, and ARBs are all
acceptable first-line for non-Black patients. Thiazide diuretics are often preferred
due to strong CV outcomes evidence and low cost. Beta-blockers are no longer first-
line unless compelling indication (post-MI, HF, angina).
Question 2
Which of the following is the primary mechanism of action of metformin in type 2
diabetes mellitus?
A. Stimulates insulin secretion from pancreatic beta cells
B. Decreases hepatic glucose production and improves peripheral insulin sensitivity
C. Delays carbohydrate absorption in the intestine
D. Increases renal glucose excretion
Correct Answer: B
Rationale: Metformin is a biguanide that primarily suppresses hepatic
gluconeogenesis and enhances peripheral insulin sensitivity. It does NOT stimulate
1
, insulin secretion (sulfonylureas), delay carb absorption (alpha-glucosidase
inhibitors), or increase renal glucose excretion (SGLT2 inhibitors).
Question 3
A patient with heart failure with reduced ejection fraction (HFrEF) is started on an ACE
inhibitor. What is the primary benefit of this medication in this patient population?
A. Decreases preload by causing venodilation
B. Reduces afterload and prevents ventricular remodeling
C. Increases heart rate and contractility
D. Promotes diuresis through sodium excretion
Correct Answer: B
Rationale: ACE inhibitors block RAAS, reducing afterload (systemic vascular
resistance) and preventing adverse ventricular remodeling—central to improving
survival and reducing hospitalizations in HFrEF.
Question 4
Which lipid-lowering agent is most effective at lowering LDL cholesterol and has the
strongest evidence for reducing cardiovascular mortality?
A. Ezetimibe
B. Niacin
C. Statins
D. Fibrates
Correct Answer: C
Rationale: Statins (HMG-CoA reductase inhibitors) are the most potent LDL-lowering
agents with the most robust RCT evidence demonstrating reductions in MACE,
stroke, and all-cause mortality. Ezetimibe is add-on therapy. Niacin and fibrates
primarily affect triglycerides and HDL.
2
,Question 5
A 45-year-old female presents with symptoms of hyperthyroidism. Labs show
suppressed TSH and elevated free T4. Which is the most common cause of
hyperthyroidism?
A. Toxic multinodular goiter
B. Graves' disease
C. Subacute thyroiditis
D. Iodine-induced hyperthyroidism
Correct Answer: B
Rationale: Graves' disease (autoimmune, TSH receptor-stimulating antibodies)
accounts for 70-80% of hyperthyroidism cases in the US. Toxic multinodular goiter is
more common in older adults. Subacute thyroiditis is self-limited. Iodine-induced
hyperthyroidism (Jod-Basedow) is uncommon.
Question 6
A patient with asthma is prescribed a long-acting beta-agonist (LABA) combined with
an inhaled corticosteroid (ICS). What is the rationale for this combination?
A. The LABA reduces inflammation while the ICS dilates bronchi
B. The ICS reduces inflammation and the LABA provides sustained bronchodilation
C. The LABA prevents exercise-induced bronchospasm only
D. The ICS is used to treat acute asthma exacerbations
Correct Answer: B
Rationale: ICS reduces airway inflammation; LABA provides 12+ hours of
bronchodilation. They are synergistic in asthma control. LABAs should NEVER be
used as monotherapy in asthma due to mortality risk. ICS are NOT for acute rescue
(SABAs are).
3
, Question 7
Which is the most appropriate initial antibiotic for a healthy adult with community-
acquired pneumonia (CAP) who does not require hospitalization?
A. Vancomycin
B. Amoxicillin or doxycycline
C. Piperacillin-tazobactam
D. Ceftriaxone and azithromycin
Correct Answer: B
Rationale: For healthy outpatients with CAP, IDSA/ATS recommends amoxicillin
(high dose), doxycycline, or a macrolide (if local resistance <25%). Vancomycin and
pip-tazo are for hospitalized patients with MRSA/Pseudomonas risk. Ceftriaxone +
azithromycin is for hospitalized patients.
Question 8
A patient with GERD has failed lifestyle modifications. Which medication class is first-
line for symptom relief and healing of erosive esophagitis?
A. H2 receptor antagonists
B. Proton pump inhibitors (PPIs)
C. Antacids
D. Prokinetic agents
Correct Answer: B
Rationale: PPIs are the most potent acid suppressors and first-line for GERD
symptom relief and healing erosive esophagitis. H2 blockers are less effective for
severe disease. Antacids provide temporary relief. Prokinetics have limited efficacy
and significant side effects (tardive dyskinesia).
4
PRACTICE I-SOUTH UNIVERSITY |NEWEST
2026-2027 UPDATE
Question 1
A 58-year-old male with newly diagnosed hypertension has a blood pressure of
158/96 mmHg. He has no other cardiovascular risk factors. According to JNC-8
guidelines, what is the first-line pharmacological treatment?
A. ACE inhibitor
B. Thiazide-type diuretic
C. Beta-blocker
D. Calcium channel blocker
Correct Answer: B
Rationale: Per JNC-8, thiazide-type diuretics, CCBs, ACE inhibitors, and ARBs are all
acceptable first-line for non-Black patients. Thiazide diuretics are often preferred
due to strong CV outcomes evidence and low cost. Beta-blockers are no longer first-
line unless compelling indication (post-MI, HF, angina).
Question 2
Which of the following is the primary mechanism of action of metformin in type 2
diabetes mellitus?
A. Stimulates insulin secretion from pancreatic beta cells
B. Decreases hepatic glucose production and improves peripheral insulin sensitivity
C. Delays carbohydrate absorption in the intestine
D. Increases renal glucose excretion
Correct Answer: B
Rationale: Metformin is a biguanide that primarily suppresses hepatic
gluconeogenesis and enhances peripheral insulin sensitivity. It does NOT stimulate
1
, insulin secretion (sulfonylureas), delay carb absorption (alpha-glucosidase
inhibitors), or increase renal glucose excretion (SGLT2 inhibitors).
Question 3
A patient with heart failure with reduced ejection fraction (HFrEF) is started on an ACE
inhibitor. What is the primary benefit of this medication in this patient population?
A. Decreases preload by causing venodilation
B. Reduces afterload and prevents ventricular remodeling
C. Increases heart rate and contractility
D. Promotes diuresis through sodium excretion
Correct Answer: B
Rationale: ACE inhibitors block RAAS, reducing afterload (systemic vascular
resistance) and preventing adverse ventricular remodeling—central to improving
survival and reducing hospitalizations in HFrEF.
Question 4
Which lipid-lowering agent is most effective at lowering LDL cholesterol and has the
strongest evidence for reducing cardiovascular mortality?
A. Ezetimibe
B. Niacin
C. Statins
D. Fibrates
Correct Answer: C
Rationale: Statins (HMG-CoA reductase inhibitors) are the most potent LDL-lowering
agents with the most robust RCT evidence demonstrating reductions in MACE,
stroke, and all-cause mortality. Ezetimibe is add-on therapy. Niacin and fibrates
primarily affect triglycerides and HDL.
2
,Question 5
A 45-year-old female presents with symptoms of hyperthyroidism. Labs show
suppressed TSH and elevated free T4. Which is the most common cause of
hyperthyroidism?
A. Toxic multinodular goiter
B. Graves' disease
C. Subacute thyroiditis
D. Iodine-induced hyperthyroidism
Correct Answer: B
Rationale: Graves' disease (autoimmune, TSH receptor-stimulating antibodies)
accounts for 70-80% of hyperthyroidism cases in the US. Toxic multinodular goiter is
more common in older adults. Subacute thyroiditis is self-limited. Iodine-induced
hyperthyroidism (Jod-Basedow) is uncommon.
Question 6
A patient with asthma is prescribed a long-acting beta-agonist (LABA) combined with
an inhaled corticosteroid (ICS). What is the rationale for this combination?
A. The LABA reduces inflammation while the ICS dilates bronchi
B. The ICS reduces inflammation and the LABA provides sustained bronchodilation
C. The LABA prevents exercise-induced bronchospasm only
D. The ICS is used to treat acute asthma exacerbations
Correct Answer: B
Rationale: ICS reduces airway inflammation; LABA provides 12+ hours of
bronchodilation. They are synergistic in asthma control. LABAs should NEVER be
used as monotherapy in asthma due to mortality risk. ICS are NOT for acute rescue
(SABAs are).
3
, Question 7
Which is the most appropriate initial antibiotic for a healthy adult with community-
acquired pneumonia (CAP) who does not require hospitalization?
A. Vancomycin
B. Amoxicillin or doxycycline
C. Piperacillin-tazobactam
D. Ceftriaxone and azithromycin
Correct Answer: B
Rationale: For healthy outpatients with CAP, IDSA/ATS recommends amoxicillin
(high dose), doxycycline, or a macrolide (if local resistance <25%). Vancomycin and
pip-tazo are for hospitalized patients with MRSA/Pseudomonas risk. Ceftriaxone +
azithromycin is for hospitalized patients.
Question 8
A patient with GERD has failed lifestyle modifications. Which medication class is first-
line for symptom relief and healing of erosive esophagitis?
A. H2 receptor antagonists
B. Proton pump inhibitors (PPIs)
C. Antacids
D. Prokinetic agents
Correct Answer: B
Rationale: PPIs are the most potent acid suppressors and first-line for GERD
symptom relief and healing erosive esophagitis. H2 blockers are less effective for
severe disease. Antacids provide temporary relief. Prokinetics have limited efficacy
and significant side effects (tardive dyskinesia).
4
