1|Page
NR566 WEEK 1-4 MIDTERM ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK|NEW AND REVISED
1. A 72-year-old male with a history of hypertension and chronic kidney
disease (CKD Stage 3) is diagnosed with community-acquired
pneumonia. Which of the following antibiotic regimens is most
appropriate for this patient?
A) Amoxicillin 500 mg TID for 7 days
B) Doxycycline 100 mg BID for 7 days
C) Ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily
D) Ciprofloxacin 500 mg BID for 7 days
Rationale: For patients with CKD or comorbidities, guideline-
recommended therapy for CAP includes a beta-lactam (ceftriaxone)
plus a macrolide (azithromycin) to cover atypical pathogens.
Fluoroquinolones (ciprofloxacin) are an alternative but require dose
adjustment in renal impairment; amoxicillin and doxycycline alone
may not provide adequate coverage for severe CAP in this population.
2. A 45-year-old female with a history of major depressive disorder is
started on sertraline 50 mg daily. Which of the following adverse effects
is most commonly associated with this medication during the first few
weeks of therapy?
A) Hypertensive crisis
B) Gastrointestinal upset and nausea
C) Sedation and weight gain
D) Cardiac arrhythmias
,2|Page
Rationale: SSRIs like sertraline commonly cause gastrointestinal
upset, nausea, headache, and insomnia during initial therapy.
Hypertensive crisis is associated with MAOIs; sedation and weight
gain are more common with paroxetine; cardiac arrhythmias are not
typical SSRI adverse effects.
3. A 68-year-old male with type 2 diabetes and hypertension is
prescribed lisinopril. Which of the following laboratory parameters
should be monitored closely after initiating this medication?
A) Serum glucose
B) Serum creatinine and potassium
C) Liver function tests
D) Complete blood count
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia and
acute kidney injury, particularly in patients with diabetes, renal
impairment, or concurrent use of NSAIDs. Serum creatinine and
potassium should be monitored within 1–2 weeks of initiation and
after dose adjustments.
4. A 32-year-old female with a urinary tract infection is prescribed
nitrofurantoin 100 mg BID. Which of the following patient education
points is most important regarding this medication?
A) Take with food to reduce gastrointestinal upset
B) Avoid in patients with G6PD deficiency
C) Complete the full 7-day course of antibiotics
D) May cause orange discoloration of urine
Rationale: Nitrofurantoin is contraindicated in patients with G6PD
deficiency due to risk of hemolytic anemia. It should be taken with
food to enhance absorption and reduce GI upset; a 5-day course is
typical for uncomplicated UTI; orange urine discoloration is
associated with rifampin, not nitrofurantoin.
5. A 55-year-old male with a history of alcohol use disorder is started on
disulfiram for alcohol abstinence. Which of the following adverse
,3|Page
reactions should the patient be warned about if alcohol is consumed?
A) Hypotension and bradycardia
B) Flushing, headache, nausea, and palpitations
C) Respiratory depression
D) Seizures
Rationale: Disulfiram produces an acetaldehyde syndrome when
alcohol is consumed, characterized by flushing, headache, nausea,
vomiting, palpitations, and hypotension. This reaction serves as an
aversive deterrent. Seizures and respiratory depression are not typical
disulfiram-alcohol reactions.
6. A 28-year-old female with acne vulgaris is prescribed isotretinoin.
Which of the following is the most important monitoring requirement
for this medication?
A) Monthly liver function tests
B) Pregnancy testing and use of two forms of contraception
C) Complete blood count with differential
D) Serum glucose monitoring
Rationale: Isotretinoin is a highly teratogenic medication; the
iPLEDGE program requires two negative pregnancy tests and use of
two forms of contraception before, during, and after therapy. Monthly
LFTs and CBC are recommended but pregnancy prevention is the
most critical monitoring requirement.
7. A 62-year-old female with osteoporosis is prescribed alendronate 70
mg once weekly. Which of the following instructions is most important
to provide to this patient?
A) Take with a full glass of milk to enhance absorption
B) Take on an empty stomach with a full glass of water and remain
upright for 30 minutes
C) Take with calcium and vitamin D supplements at the same time
D) Take at bedtime to minimize gastrointestinal side effects
Rationale: Alendronate must be taken on an empty stomach with plain
, 4|Page
water, and the patient must remain upright for at least 30 minutes to
prevent esophageal irritation, ulceration, and stricture. Calcium
supplements interfere with absorption and should be taken at a
different time of day.
8. A 48-year-old male with hypertension is started on
hydrochlorothiazide 25 mg daily. Which of the following electrolyte
abnormalities is most commonly associated with this medication?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Rationale: Thiazide diuretics like hydrochlorothiazide commonly
cause hypokalemia and hyponatremia due to increased potassium and
sodium excretion. Hyperkalemia is associated with potassium-sparing
diuretics and ACE inhibitors; hypercalcemia can occur but is less
common.
9. A 35-year-old female with generalized anxiety disorder is prescribed
buspirone. Which of the following statements regarding buspirone is
correct?
A) It has a rapid onset of action within 24 hours
B) It has no significant abuse potential
C) It should be taken PRN for acute anxiety
D) It is a benzodiazepine
Rationale: Buspirone is a non-benzodiazepine anxiolytic with no
significant abuse potential or withdrawal symptoms. It has a delayed
onset of action (2–4 weeks), is not effective for acute anxiety, and is
not a benzodiazepine; it acts on serotonin receptors.
10. A 72-year-old male with heart failure with reduced ejection fraction
(HFrEF) is started on carvedilol. Which of the following is the most
important consideration when initiating this medication?
A) Start at a high dose for rapid symptom control
NR566 WEEK 1-4 MIDTERM ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK|NEW AND REVISED
1. A 72-year-old male with a history of hypertension and chronic kidney
disease (CKD Stage 3) is diagnosed with community-acquired
pneumonia. Which of the following antibiotic regimens is most
appropriate for this patient?
A) Amoxicillin 500 mg TID for 7 days
B) Doxycycline 100 mg BID for 7 days
C) Ceftriaxone 1 g IV daily plus azithromycin 500 mg IV daily
D) Ciprofloxacin 500 mg BID for 7 days
Rationale: For patients with CKD or comorbidities, guideline-
recommended therapy for CAP includes a beta-lactam (ceftriaxone)
plus a macrolide (azithromycin) to cover atypical pathogens.
Fluoroquinolones (ciprofloxacin) are an alternative but require dose
adjustment in renal impairment; amoxicillin and doxycycline alone
may not provide adequate coverage for severe CAP in this population.
2. A 45-year-old female with a history of major depressive disorder is
started on sertraline 50 mg daily. Which of the following adverse effects
is most commonly associated with this medication during the first few
weeks of therapy?
A) Hypertensive crisis
B) Gastrointestinal upset and nausea
C) Sedation and weight gain
D) Cardiac arrhythmias
,2|Page
Rationale: SSRIs like sertraline commonly cause gastrointestinal
upset, nausea, headache, and insomnia during initial therapy.
Hypertensive crisis is associated with MAOIs; sedation and weight
gain are more common with paroxetine; cardiac arrhythmias are not
typical SSRI adverse effects.
3. A 68-year-old male with type 2 diabetes and hypertension is
prescribed lisinopril. Which of the following laboratory parameters
should be monitored closely after initiating this medication?
A) Serum glucose
B) Serum creatinine and potassium
C) Liver function tests
D) Complete blood count
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia and
acute kidney injury, particularly in patients with diabetes, renal
impairment, or concurrent use of NSAIDs. Serum creatinine and
potassium should be monitored within 1–2 weeks of initiation and
after dose adjustments.
4. A 32-year-old female with a urinary tract infection is prescribed
nitrofurantoin 100 mg BID. Which of the following patient education
points is most important regarding this medication?
A) Take with food to reduce gastrointestinal upset
B) Avoid in patients with G6PD deficiency
C) Complete the full 7-day course of antibiotics
D) May cause orange discoloration of urine
Rationale: Nitrofurantoin is contraindicated in patients with G6PD
deficiency due to risk of hemolytic anemia. It should be taken with
food to enhance absorption and reduce GI upset; a 5-day course is
typical for uncomplicated UTI; orange urine discoloration is
associated with rifampin, not nitrofurantoin.
5. A 55-year-old male with a history of alcohol use disorder is started on
disulfiram for alcohol abstinence. Which of the following adverse
,3|Page
reactions should the patient be warned about if alcohol is consumed?
A) Hypotension and bradycardia
B) Flushing, headache, nausea, and palpitations
C) Respiratory depression
D) Seizures
Rationale: Disulfiram produces an acetaldehyde syndrome when
alcohol is consumed, characterized by flushing, headache, nausea,
vomiting, palpitations, and hypotension. This reaction serves as an
aversive deterrent. Seizures and respiratory depression are not typical
disulfiram-alcohol reactions.
6. A 28-year-old female with acne vulgaris is prescribed isotretinoin.
Which of the following is the most important monitoring requirement
for this medication?
A) Monthly liver function tests
B) Pregnancy testing and use of two forms of contraception
C) Complete blood count with differential
D) Serum glucose monitoring
Rationale: Isotretinoin is a highly teratogenic medication; the
iPLEDGE program requires two negative pregnancy tests and use of
two forms of contraception before, during, and after therapy. Monthly
LFTs and CBC are recommended but pregnancy prevention is the
most critical monitoring requirement.
7. A 62-year-old female with osteoporosis is prescribed alendronate 70
mg once weekly. Which of the following instructions is most important
to provide to this patient?
A) Take with a full glass of milk to enhance absorption
B) Take on an empty stomach with a full glass of water and remain
upright for 30 minutes
C) Take with calcium and vitamin D supplements at the same time
D) Take at bedtime to minimize gastrointestinal side effects
Rationale: Alendronate must be taken on an empty stomach with plain
, 4|Page
water, and the patient must remain upright for at least 30 minutes to
prevent esophageal irritation, ulceration, and stricture. Calcium
supplements interfere with absorption and should be taken at a
different time of day.
8. A 48-year-old male with hypertension is started on
hydrochlorothiazide 25 mg daily. Which of the following electrolyte
abnormalities is most commonly associated with this medication?
A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Rationale: Thiazide diuretics like hydrochlorothiazide commonly
cause hypokalemia and hyponatremia due to increased potassium and
sodium excretion. Hyperkalemia is associated with potassium-sparing
diuretics and ACE inhibitors; hypercalcemia can occur but is less
common.
9. A 35-year-old female with generalized anxiety disorder is prescribed
buspirone. Which of the following statements regarding buspirone is
correct?
A) It has a rapid onset of action within 24 hours
B) It has no significant abuse potential
C) It should be taken PRN for acute anxiety
D) It is a benzodiazepine
Rationale: Buspirone is a non-benzodiazepine anxiolytic with no
significant abuse potential or withdrawal symptoms. It has a delayed
onset of action (2–4 weeks), is not effective for acute anxiety, and is
not a benzodiazepine; it acts on serotonin receptors.
10. A 72-year-old male with heart failure with reduced ejection fraction
(HFrEF) is started on carvedilol. Which of the following is the most
important consideration when initiating this medication?
A) Start at a high dose for rapid symptom control
