NSG 554 PRIMARY CARE EXAM 3 - SOUTH
UNIVERSITY COLLEGE OF NURSING AND HEALTH
SCIENCES - 2026/ QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
INSTANT DOWNLOAD PDF - 130 Questions with Answers
Page 1
,Q1. A 34-year-old patient with type 1 diabetes presents with nausea, vomiting, and
diffuse abdominal pain. Capillary glucose is 245 mg/dL, and urine ketones are large.
The patient's serum potassium is 5.1 mEq/L. Which intervention should the nurse
practitioner implement first?
A. Administer 0.9% sodium chloride bolus at 15 mL/kg
B. Administer insulin lispro 0.1 units/kg IV bolus
C. Administer sodium bicarbonate 50 mEq IV
D. Administer potassium chloride 20 mEq IV
Correct Answer: A. Administer 0.9% sodium chloride bolus at 15 mL/kg
Rationale: In diabetic ketoacidosis (DKA), the initial priority is volume resuscitation to
restore perfusion and correct hyperglycemia-related osmotic diuresis. Insulin should be
delayed until potassium is known to be adequate, and bicarbonate is not routinely
recommended. Potassium replacement is not indicated when serum potassium is >5.0
mEq/L.
Why Wrong:
B - Insulin should not be given until potassium is known to be adequate; with
potassium 5.1, insulin can be started after fluid, but bolus insulin is not the first step.
C - Bicarbonate is reserved for severe acidosis (pH < 6.9) and is not the initial
intervention.
D - Potassium replacement is contraindicated when serum potassium is above 5.0
mEq/L; recheck after fluids and insulin.
Reference: American Diabetes Association. (2026). Standards of Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1).
Q2. A 45-year-old patient with obesity and hypertension is newly diagnosed with type
2 diabetes. GFR is 85 mL/min/1.73 m², and urine albumin-to-creatinine ratio is 150
mg/g. Which medication should be added to the current regimen to reduce
cardiovascular and renal risk?
A. Metformin 500 mg twice daily
B. Empagliflozin 10 mg daily
C. Glipizide 5 mg daily
D. Sitagliptin 100 mg daily
Correct Answer: B. Empagliflozin 10 mg daily
Rationale: SGLT2 inhibitors like empagliflozin have demonstrated cardiovascular and
renal benefits in patients with type 2 diabetes, especially those with albuminuria and
cardiovascular risk factors, independent of glycemic control. Metformin is first-line for
glucose control but does not have the same magnitude of organ protection.
Why Wrong:
A - Metformin is first-line for glycemic control but lacks the specific cardiovascular
Page 2
, and renal outcome benefits shown by SGLT2 inhibitors.
C - Sulfonylureas do not have proven cardiovascular or renal protective effects and
may increase hypoglycemia risk.
D - DPP-4 inhibitors are neutral with respect to cardiovascular outcomes and do not
provide the renal benefit seen with SGLT2 inhibitors.
Reference: American Diabetes Association. (2026). Standards of Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1).
Q3. A patient with persistent asthma is currently using a short-acting beta agonist
(SABA) twice weekly. Spirometry shows FEV1 75% predicted and a positive
bronchodilator response. According to the latest GINA guidelines, what is the
preferred initial controller therapy?
A. Low-dose inhaled corticosteroid (ICS) taken whenever SABA is used
B. Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
C. Medium-dose ICS alone
D. Leukotriene receptor antagonist (LTRA) monotherapy
Correct Answer: B. Low-dose ICS-formoterol as maintenance and reliever therapy
(MART)
Rationale: GINA no longer recommends SABA-only treatment for any asthma severity. For
symptom-driven therapy, low-dose ICS-formoterol as needed is the preferred approach at
Step 1-2, as it reduces severe exacerbations compared to SABA alone.
Why Wrong:
A - While ICS with SABA is better than SABA alone, GINA specifically recommends
ICS-formoterol as the preferred as-needed medication, not ICS alongside SABA.
C - Medium-dose ICS alone is not preferred for initial therapy; low-dose
ICS-formoterol is recommended.
D - LTRA monotherapy is an alternative but not preferred due to lower efficacy in
preventing exacerbations.
Reference: Global Initiative for Asthma (GINA). (2026). Global Strategy for Asthma
Management and Prevention.
Q4. A 28-year-old patient has a blood pressure of 152/96 mm Hg on three separate
occasions. Home readings are similar. No other health issues. Which of the following
is the most appropriate initial management?
A. Start hydrochlorothiazide 25 mg daily and recommend lifestyle changes
B. Start amlodipine 5 mg daily and recommend lifestyle changes
C. Initiate lifestyle modifications and recheck blood pressure in 3-6 months
D. Start lisinopril 10 mg daily and recommend lifestyle changes
Correct Answer: C. Initiate lifestyle modifications and recheck blood pressure in 3-6
Page 3
, months
Rationale: According to ACC/AHA guidelines, stage 1 hypertension (130-139/80-89) with
low ASCVD risk (<10%) should be managed with lifestyle changes for 3-6 months before
initiating medication. This patient has stage 1 hypertension and no comorbidities, so
lifestyle modification is first-line.
Why Wrong:
A - Thiazide diuretics are not indicated as initial therapy in low-risk stage 1
hypertension without a trial of lifestyle changes.
B - Calcium channel blockers are not first-line for this patient; lifestyle modification is
recommended before medication.
D - ACE inhibitors are not indicated without prior lifestyle intervention and are not
preferred in non-Black patients without compelling indications.
Reference: Whelton, P.K., et al. (2018). 2017 ACC/AHA Hypertension Guideline.
Hypertension, 71(6).
Q5. A 60-year-old patient with type 2 diabetes and a 20 pack-year smoking history
presents with acute onset of severe left flank pain radiating to the groin. Urinalysis
shows microscopic hematuria. Non-contrast CT reveals a 4 mm stone at the
ureterovesical junction. What is the most appropriate next step?
A. Refer for urgent extracorporeal shock wave lithotripsy (ESWL)
B. Prescribe tamsulosin 0.4 mg daily and encourage increased fluid intake
C. Admit for intravenous hydration and parenteral analgesics
D. Schedule a cystoscopy with stent placement
Correct Answer: B. Prescribe tamsulosin 0.4 mg daily and encourage increased fluid
intake
Rationale: A 4 mm distal ureteral stone has a high likelihood of spontaneous passage.
Medical expulsive therapy with tamsulosin is indicated for stones >5 mm in the distal
ureter, but for 4 mm, observation with analgesia and hydration is appropriate. Tamsulosin
may be used to facilitate passage, and this patient can be managed as an outpatient.
Why Wrong:
A - ESWL is not first-line for small distal stones; spontaneous passage is expected.
C - Admission is not required for a 4 mm stone without signs of infection, intractable
pain, or renal failure.
D - Cystoscopy with stent is invasive and not indicated for a small stone without
complications.
Reference: European Association of Urology. (2026). Guidelines on Urolithiasis.
Q6. A 55-year-old patient with major depressive disorder has been on sertraline 200
mg daily for 8 weeks with no improvement. Which of the following is the most
Page 4
UNIVERSITY COLLEGE OF NURSING AND HEALTH
SCIENCES - 2026/ QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
INSTANT DOWNLOAD PDF - 130 Questions with Answers
Page 1
,Q1. A 34-year-old patient with type 1 diabetes presents with nausea, vomiting, and
diffuse abdominal pain. Capillary glucose is 245 mg/dL, and urine ketones are large.
The patient's serum potassium is 5.1 mEq/L. Which intervention should the nurse
practitioner implement first?
A. Administer 0.9% sodium chloride bolus at 15 mL/kg
B. Administer insulin lispro 0.1 units/kg IV bolus
C. Administer sodium bicarbonate 50 mEq IV
D. Administer potassium chloride 20 mEq IV
Correct Answer: A. Administer 0.9% sodium chloride bolus at 15 mL/kg
Rationale: In diabetic ketoacidosis (DKA), the initial priority is volume resuscitation to
restore perfusion and correct hyperglycemia-related osmotic diuresis. Insulin should be
delayed until potassium is known to be adequate, and bicarbonate is not routinely
recommended. Potassium replacement is not indicated when serum potassium is >5.0
mEq/L.
Why Wrong:
B - Insulin should not be given until potassium is known to be adequate; with
potassium 5.1, insulin can be started after fluid, but bolus insulin is not the first step.
C - Bicarbonate is reserved for severe acidosis (pH < 6.9) and is not the initial
intervention.
D - Potassium replacement is contraindicated when serum potassium is above 5.0
mEq/L; recheck after fluids and insulin.
Reference: American Diabetes Association. (2026). Standards of Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1).
Q2. A 45-year-old patient with obesity and hypertension is newly diagnosed with type
2 diabetes. GFR is 85 mL/min/1.73 m², and urine albumin-to-creatinine ratio is 150
mg/g. Which medication should be added to the current regimen to reduce
cardiovascular and renal risk?
A. Metformin 500 mg twice daily
B. Empagliflozin 10 mg daily
C. Glipizide 5 mg daily
D. Sitagliptin 100 mg daily
Correct Answer: B. Empagliflozin 10 mg daily
Rationale: SGLT2 inhibitors like empagliflozin have demonstrated cardiovascular and
renal benefits in patients with type 2 diabetes, especially those with albuminuria and
cardiovascular risk factors, independent of glycemic control. Metformin is first-line for
glucose control but does not have the same magnitude of organ protection.
Why Wrong:
A - Metformin is first-line for glycemic control but lacks the specific cardiovascular
Page 2
, and renal outcome benefits shown by SGLT2 inhibitors.
C - Sulfonylureas do not have proven cardiovascular or renal protective effects and
may increase hypoglycemia risk.
D - DPP-4 inhibitors are neutral with respect to cardiovascular outcomes and do not
provide the renal benefit seen with SGLT2 inhibitors.
Reference: American Diabetes Association. (2026). Standards of Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1).
Q3. A patient with persistent asthma is currently using a short-acting beta agonist
(SABA) twice weekly. Spirometry shows FEV1 75% predicted and a positive
bronchodilator response. According to the latest GINA guidelines, what is the
preferred initial controller therapy?
A. Low-dose inhaled corticosteroid (ICS) taken whenever SABA is used
B. Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
C. Medium-dose ICS alone
D. Leukotriene receptor antagonist (LTRA) monotherapy
Correct Answer: B. Low-dose ICS-formoterol as maintenance and reliever therapy
(MART)
Rationale: GINA no longer recommends SABA-only treatment for any asthma severity. For
symptom-driven therapy, low-dose ICS-formoterol as needed is the preferred approach at
Step 1-2, as it reduces severe exacerbations compared to SABA alone.
Why Wrong:
A - While ICS with SABA is better than SABA alone, GINA specifically recommends
ICS-formoterol as the preferred as-needed medication, not ICS alongside SABA.
C - Medium-dose ICS alone is not preferred for initial therapy; low-dose
ICS-formoterol is recommended.
D - LTRA monotherapy is an alternative but not preferred due to lower efficacy in
preventing exacerbations.
Reference: Global Initiative for Asthma (GINA). (2026). Global Strategy for Asthma
Management and Prevention.
Q4. A 28-year-old patient has a blood pressure of 152/96 mm Hg on three separate
occasions. Home readings are similar. No other health issues. Which of the following
is the most appropriate initial management?
A. Start hydrochlorothiazide 25 mg daily and recommend lifestyle changes
B. Start amlodipine 5 mg daily and recommend lifestyle changes
C. Initiate lifestyle modifications and recheck blood pressure in 3-6 months
D. Start lisinopril 10 mg daily and recommend lifestyle changes
Correct Answer: C. Initiate lifestyle modifications and recheck blood pressure in 3-6
Page 3
, months
Rationale: According to ACC/AHA guidelines, stage 1 hypertension (130-139/80-89) with
low ASCVD risk (<10%) should be managed with lifestyle changes for 3-6 months before
initiating medication. This patient has stage 1 hypertension and no comorbidities, so
lifestyle modification is first-line.
Why Wrong:
A - Thiazide diuretics are not indicated as initial therapy in low-risk stage 1
hypertension without a trial of lifestyle changes.
B - Calcium channel blockers are not first-line for this patient; lifestyle modification is
recommended before medication.
D - ACE inhibitors are not indicated without prior lifestyle intervention and are not
preferred in non-Black patients without compelling indications.
Reference: Whelton, P.K., et al. (2018). 2017 ACC/AHA Hypertension Guideline.
Hypertension, 71(6).
Q5. A 60-year-old patient with type 2 diabetes and a 20 pack-year smoking history
presents with acute onset of severe left flank pain radiating to the groin. Urinalysis
shows microscopic hematuria. Non-contrast CT reveals a 4 mm stone at the
ureterovesical junction. What is the most appropriate next step?
A. Refer for urgent extracorporeal shock wave lithotripsy (ESWL)
B. Prescribe tamsulosin 0.4 mg daily and encourage increased fluid intake
C. Admit for intravenous hydration and parenteral analgesics
D. Schedule a cystoscopy with stent placement
Correct Answer: B. Prescribe tamsulosin 0.4 mg daily and encourage increased fluid
intake
Rationale: A 4 mm distal ureteral stone has a high likelihood of spontaneous passage.
Medical expulsive therapy with tamsulosin is indicated for stones >5 mm in the distal
ureter, but for 4 mm, observation with analgesia and hydration is appropriate. Tamsulosin
may be used to facilitate passage, and this patient can be managed as an outpatient.
Why Wrong:
A - ESWL is not first-line for small distal stones; spontaneous passage is expected.
C - Admission is not required for a 4 mm stone without signs of infection, intractable
pain, or renal failure.
D - Cystoscopy with stent is invasive and not indicated for a small stone without
complications.
Reference: European Association of Urology. (2026). Guidelines on Urolithiasis.
Q6. A 55-year-old patient with major depressive disorder has been on sertraline 200
mg daily for 8 weeks with no improvement. Which of the following is the most
Page 4
