,South College NSG 5544 Final Exam | Primary Care of Adults &
Older Adults (2026) Q&A
1. A 58-year-old male with a history of hypertension and type 2 diabetes presents with a
blood pressure of 148/92 mmHg on three separate occasions despite adherence to lisinopril
20 mg daily and amlodipine 5 mg daily. Which medication adjustment is most appropriate
based on current hypertension guidelines?
A) Increase amlodipine to 10 mg daily and add chlorthalidone 12.5 mg daily
B) Discontinue amlodipine and start hydralazine 50 mg twice daily
C) Add spironolactone 25 mg daily and monitor potassium closely
D) Switch lisinopril to losartan 50 mg daily and add metoprolol 25 mg twice daily
Correct Answer: Increase amlodipine to 10 mg daily and add chlorthalidone 12.5 mg daily
Rationale: For patients with diabetes and hypertension not at goal on two drugs from
different classes, guidelines recommend adding a thiazide diuretic such as chlorthalidone.
Increasing amlodipine to its maximum dose is appropriate before adding a fourth agent.
Hydralazine is not first-line, spironolactone is reserved for resistant hypertension after
thiazide use, and switching an ACE inhibitor to an ARB offers no advantage.
2. According to the USPSTF, a Grade A recommendation indicates which of the following?
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
D) The service is recommended against because harms outweigh benefits
Correct Answer: The service is recommended with high certainty of substantial net benefit
Rationale: Grade A indicates that the USPSTF recommends the service with high certainty
that the net benefit is substantial. Grade B indicates moderate certainty of moderate-to-
substantial benefit, Grade C is selective, and Grade D is recommended against.
,3. 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.
4. A 65-year-old patient with chronic heart failure with reduced ejection fraction (HFrEF) is
being managed in primary care. 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 (carvedilol, metoprolol succinate, bisoprolol)
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: Beta-blockers (carvedilol, metoprolol succinate, 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.
, 5. The "OLDCARTS" mnemonic is used to assess which aspect of a patient's condition?
A) Review of systems
B) History of present illness (HPI)
C) Past surgical history
D) Functional assessment
Correct Answer: History of present illness (HPI)
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors,
Radiation, Timing, Severity) is a standard framework for gathering detailed, subjective data
about the History of Present Illness.
6. A 68-year-old patient presents with sudden-onset, severe headache, nausea, and
photophobia. Vital signs show BP 185/110, HR 52. Which condition is most likely?
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.
7. A 55-year-old patient presents with a history of heavy alcohol use. Which screening tool is
most appropriate for assessing alcohol use disorder in this patient?
A) CAGE questionnaire
B) AUDIT (Alcohol Use Disorders Identification Test)
Older Adults (2026) Q&A
1. A 58-year-old male with a history of hypertension and type 2 diabetes presents with a
blood pressure of 148/92 mmHg on three separate occasions despite adherence to lisinopril
20 mg daily and amlodipine 5 mg daily. Which medication adjustment is most appropriate
based on current hypertension guidelines?
A) Increase amlodipine to 10 mg daily and add chlorthalidone 12.5 mg daily
B) Discontinue amlodipine and start hydralazine 50 mg twice daily
C) Add spironolactone 25 mg daily and monitor potassium closely
D) Switch lisinopril to losartan 50 mg daily and add metoprolol 25 mg twice daily
Correct Answer: Increase amlodipine to 10 mg daily and add chlorthalidone 12.5 mg daily
Rationale: For patients with diabetes and hypertension not at goal on two drugs from
different classes, guidelines recommend adding a thiazide diuretic such as chlorthalidone.
Increasing amlodipine to its maximum dose is appropriate before adding a fourth agent.
Hydralazine is not first-line, spironolactone is reserved for resistant hypertension after
thiazide use, and switching an ACE inhibitor to an ARB offers no advantage.
2. According to the USPSTF, a Grade A recommendation indicates which of the following?
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
D) The service is recommended against because harms outweigh benefits
Correct Answer: The service is recommended with high certainty of substantial net benefit
Rationale: Grade A indicates that the USPSTF recommends the service with high certainty
that the net benefit is substantial. Grade B indicates moderate certainty of moderate-to-
substantial benefit, Grade C is selective, and Grade D is recommended against.
,3. 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.
4. A 65-year-old patient with chronic heart failure with reduced ejection fraction (HFrEF) is
being managed in primary care. 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 (carvedilol, metoprolol succinate, bisoprolol)
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
Correct Answer: Beta-blockers (carvedilol, metoprolol succinate, 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.
, 5. The "OLDCARTS" mnemonic is used to assess which aspect of a patient's condition?
A) Review of systems
B) History of present illness (HPI)
C) Past surgical history
D) Functional assessment
Correct Answer: History of present illness (HPI)
Rationale: OLDCARTS (Onset, Location, Duration, Character, Aggravating/Alleviating factors,
Radiation, Timing, Severity) is a standard framework for gathering detailed, subjective data
about the History of Present Illness.
6. A 68-year-old patient presents with sudden-onset, severe headache, nausea, and
photophobia. Vital signs show BP 185/110, HR 52. Which condition is most likely?
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.
7. A 55-year-old patient presents with a history of heavy alcohol use. Which screening tool is
most appropriate for assessing alcohol use disorder in this patient?
A) CAGE questionnaire
B) AUDIT (Alcohol Use Disorders Identification Test)
