,South College NSG 5544 Exam 3 | Primary Care of Adults & Older
Adults (2026) Q&A
1. A 68-year-old patient with a history of hypertension and type 2 diabetes presents with a
blood pressure of 145/88 mmHg. According to the ACC/AHA guidelines, what is the
recommended blood pressure target for this patient?
A) < 120/80 mmHg
B) < 130/80 mmHg
C) < 140/90 mmHg
D) < 150/90 mmHg
Correct Answer: < 130/80 mmHg
Rationale: For patients with diabetes and hypertension, the ACC/AHA guidelines
recommend a blood pressure target of < 130/80 mmHg to reduce the risk of cardiovascular
events and microvascular complications. This is a stricter target than for the general
population without comorbidities.
2. A 72-year-old patient with stable angina is prescribed sublingual nitroglycerin. Which
instruction is most important to include in patient teaching?
A) "Store the tablets in a warm, bright place to maintain potency."
B) "You may take up to four doses, five minutes apart, for a single angina episode."
C) "Take one tablet at the first sign of chest pain; if pain persists after 5 minutes, call 911 and
take a second tablet."
D) "Swallow the tablet whole with a full glass of water for the fastest effect."
Correct Answer: Take one tablet at the first sign of chest pain; if pain persists after 5
minutes, call 911 and take a second tablet.
Rationale: Correct nitroglycerin administration is crucial. The patient should take one dose
sublingually and, if pain is unrelieved in 5 minutes, they should call 911 while taking a
,second tablet. A third tablet may be taken 5 minutes later if pain persists. The medication
should be stored in a cool, dark place.
3. A patient with heart failure with reduced ejection fraction (HFrEF) is being managed in the
primary care setting. Which class of medication has been shown to provide both a mortality
benefit and symptom relief?
A) Calcium channel blockers
B) Thiazolidinediones (TZDs)
C) Beta-blockers (specifically carvedilol, metoprolol succinate, or bisoprolol)
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: Beta-blockers (specifically carvedilol, metoprolol succinate, or bisoprolol)
Rationale: Specific beta-blockers are a cornerstone of HFrEF therapy, proven to reduce
mortality and hospitalizations while improving symptoms. Calcium channel blockers and
TZDs are generally not recommended in HFrEF, and NSAIDs can worsen heart failure.
4. A 68-year-old patient presents with sudden-onset, severe headache, nausea, and
photophobia. Vital signs show BP 185/110, HR 52. The nurse suspects which condition?
A) Migraine headache
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Correct Answer: Subarachnoid hemorrhage
Rationale: A sudden-onset "thunderclap" headache with hypertension, bradycardia, and
photophobia is classic for a subarachnoid hemorrhage. Migraines typically have a gradual
onset, and cluster headaches are characterized by unilateral orbital pain. This is a medical
emergency requiring immediate imaging.
, 5. A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which instruction
should the nurse include in patient teaching?
A) "Take the medication with a high-protein meal."
B) "Discontinue the medication immediately if side effects occur."
C) "Expect therapeutic effects within 24 hours."
D) "Report any episodes of dyskinesia or uncontrolled movements."
Correct Answer: Report any episodes of dyskinesia or uncontrolled movements.
Rationale: Dyskinesia is a common side effect of levodopa and should be reported, as it may
indicate the need for dosage adjustment. High-protein meals interfere with absorption. The
medication should never be abruptly discontinued. Therapeutic effects may take weeks.
6. A patient presents with ascending muscle weakness starting in the lower extremities, with
decreased deep tendon reflexes. Which condition is most likely?
A) Myasthenia gravis
B) Guillain-Barré syndrome
C) Multiple sclerosis
D) Amyotrophic lateral sclerosis
Correct Answer: Guillain-Barré syndrome
Rationale: Guillain-Barré syndrome is characterized by ascending muscle weakness, starting
in the lower extremities, and decreased or absent deep tendon reflexes. Myasthenia gravis
presents with fluctuating muscle weakness, often starting with ocular symptoms.
7. According to the USPSTF, a Grade A recommendation indicates:
A) The service is selectively recommended based on patient situation and judgment.
B) There is insufficient evidence to make a recommendation.
C) The service is recommended with high certainty of substantial net benefit.
Adults (2026) Q&A
1. A 68-year-old patient with a history of hypertension and type 2 diabetes presents with a
blood pressure of 145/88 mmHg. According to the ACC/AHA guidelines, what is the
recommended blood pressure target for this patient?
A) < 120/80 mmHg
B) < 130/80 mmHg
C) < 140/90 mmHg
D) < 150/90 mmHg
Correct Answer: < 130/80 mmHg
Rationale: For patients with diabetes and hypertension, the ACC/AHA guidelines
recommend a blood pressure target of < 130/80 mmHg to reduce the risk of cardiovascular
events and microvascular complications. This is a stricter target than for the general
population without comorbidities.
2. A 72-year-old patient with stable angina is prescribed sublingual nitroglycerin. Which
instruction is most important to include in patient teaching?
A) "Store the tablets in a warm, bright place to maintain potency."
B) "You may take up to four doses, five minutes apart, for a single angina episode."
C) "Take one tablet at the first sign of chest pain; if pain persists after 5 minutes, call 911 and
take a second tablet."
D) "Swallow the tablet whole with a full glass of water for the fastest effect."
Correct Answer: Take one tablet at the first sign of chest pain; if pain persists after 5
minutes, call 911 and take a second tablet.
Rationale: Correct nitroglycerin administration is crucial. The patient should take one dose
sublingually and, if pain is unrelieved in 5 minutes, they should call 911 while taking a
,second tablet. A third tablet may be taken 5 minutes later if pain persists. The medication
should be stored in a cool, dark place.
3. A patient with heart failure with reduced ejection fraction (HFrEF) is being managed in the
primary care setting. Which class of medication has been shown to provide both a mortality
benefit and symptom relief?
A) Calcium channel blockers
B) Thiazolidinediones (TZDs)
C) Beta-blockers (specifically carvedilol, metoprolol succinate, or bisoprolol)
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: Beta-blockers (specifically carvedilol, metoprolol succinate, or bisoprolol)
Rationale: Specific beta-blockers are a cornerstone of HFrEF therapy, proven to reduce
mortality and hospitalizations while improving symptoms. Calcium channel blockers and
TZDs are generally not recommended in HFrEF, and NSAIDs can worsen heart failure.
4. A 68-year-old patient presents with sudden-onset, severe headache, nausea, and
photophobia. Vital signs show BP 185/110, HR 52. The nurse suspects which condition?
A) Migraine headache
B) Subarachnoid hemorrhage
C) Tension headache
D) Cluster headache
Correct Answer: Subarachnoid hemorrhage
Rationale: A sudden-onset "thunderclap" headache with hypertension, bradycardia, and
photophobia is classic for a subarachnoid hemorrhage. Migraines typically have a gradual
onset, and cluster headaches are characterized by unilateral orbital pain. This is a medical
emergency requiring immediate imaging.
, 5. A patient with Parkinson's disease is prescribed carbidopa-levodopa. Which instruction
should the nurse include in patient teaching?
A) "Take the medication with a high-protein meal."
B) "Discontinue the medication immediately if side effects occur."
C) "Expect therapeutic effects within 24 hours."
D) "Report any episodes of dyskinesia or uncontrolled movements."
Correct Answer: Report any episodes of dyskinesia or uncontrolled movements.
Rationale: Dyskinesia is a common side effect of levodopa and should be reported, as it may
indicate the need for dosage adjustment. High-protein meals interfere with absorption. The
medication should never be abruptly discontinued. Therapeutic effects may take weeks.
6. A patient presents with ascending muscle weakness starting in the lower extremities, with
decreased deep tendon reflexes. Which condition is most likely?
A) Myasthenia gravis
B) Guillain-Barré syndrome
C) Multiple sclerosis
D) Amyotrophic lateral sclerosis
Correct Answer: Guillain-Barré syndrome
Rationale: Guillain-Barré syndrome is characterized by ascending muscle weakness, starting
in the lower extremities, and decreased or absent deep tendon reflexes. Myasthenia gravis
presents with fluctuating muscle weakness, often starting with ocular symptoms.
7. According to the USPSTF, a Grade A recommendation indicates:
A) The service is selectively recommended based on patient situation and judgment.
B) There is insufficient evidence to make a recommendation.
C) The service is recommended with high certainty of substantial net benefit.
