NU 623
Adult Healthcare
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice (10)
Which of the following is the most appropriate first-line antihypertensive medication for an
adult patient with hypertension and chronic kidney disease?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril slow progression of CKD by reducing glomerular pressure
and proteinuria. Other agents are less renoprotective.
A 60-year-old presents with new onset atrial fibrillation. What is the most important next step in
management?
A) Start beta-blockers
B) Assess stroke risk with CHA2DS2-VASc score
C) Immediate cardioversion
D) Begin anticoagulation without further assessment
Answer: B) Assess stroke risk with CHA2DS2-VASc score
Rationale: Stroke risk assessment guides anticoagulation therapy; immediate cardioversion
depends on hemodynamic stability and duration of AF.
Which of the following lab values is the most sensitive indicator of developing acute kidney
injury (AKI)?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Urine output
D) Serum potassium
Answer: C) Urine output
Rationale: Reduced urine output often precedes creatinine rise; close monitoring helps early
detection.
In management of diabetes mellitus type 2, the addition of which medication class has proven
cardiovascular benefit?
A) Sulfonylureas
B) DPP-4 inhibitors
C) SGLT2 inhibitors
,D) Thiazolidinediones
Answer: C) SGLT2 inhibitors
Rationale: SGLT2 inhibitors reduce hospitalizations for heart failure and cardiovascular mortality
beyond glucose lowering.
Which of the following symptoms would most specifically indicate right heart failure?
A) Pulmonary edema
B) Jugular venous distension
C) Orthopnea
D) Paroxysmal nocturnal dyspnea
Answer: B) Jugular venous distension
Rationale: JVD reflects elevated central venous pressure, characteristic of right heart failure.
The most common cause of community-acquired pneumonia in adults is:
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Mycoplasma pneumoniae
D) Klebsiella pneumoniae
Answer: A) Streptococcus pneumoniae
Rationale: S. pneumoniae is the predominant pathogen; guides empiric antibiotic choice.
Which of the following drugs is contraindicated in heart failure with reduced ejection fraction
(HFrEF)?
A) Spironolactone
B) Beta-blockers
C) NSAIDs
D) ACE inhibitors
Answer: C) NSAIDs
Rationale: NSAIDs worsen fluid retention, increase risk of decompensation.
An elderly patient on warfarin presents with a sudden severe headache and neurologic deficits.
The most likely diagnosis is:
A) Ischemic stroke
B) Intracerebral hemorrhage
C) Transient ischemic attack
D) Migraine
Answer: B) Intracerebral hemorrhage
Rationale: Warfarin increases bleeding risk; sudden headache + deficits suggest hemorrhage.
Regarding COPD management, which of the following statements is true?
A) Inhaled corticosteroids are first-line in mild COPD
B) Long-acting bronchodilators improve quality of life and reduce exacerbations
C) Oxygen therapy is indicated only during acute exacerbation
D) Antibiotics are used continuously to prevent infection
Answer: B) Long-acting bronchodilators improve quality of life and reduce exacerbations
Rationale: They reduce symptoms and exacerbations; steroids reserved for frequent
exacerbators.
What electrolyte abnormality is most often associated with the use of thiazide diuretics?
, A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hyperphosphatemia
Answer: B) Hypokalemia
Rationale: Thiazides promote potassium loss in urine, causing hypokalemia which requires
monitoring.
True/False (10)
Beta-blockers are contraindicated in patients with asthma.
Answer: False
Rationale: Selective beta-1 blockers can be cautiously used; non-selective beta-blockers are
avoided due to bronchospasm risk.
HbA1c levels above 6.5% are diagnostic of diabetes mellitus.
Answer: True
Rationale: ADA criteria include HbA1c ≥6.5% for diagnosis.
Statins must be stopped immediately in patients with any elevation in liver enzymes.
Answer: False
Rationale: Mild transient elevation is common; only discontinue if severe hepatotoxicity
develops.
ACE inhibitors can cause a persistent dry cough in some patients.
Answer: True
Rationale: The cough results from bradykinin accumulation; common side effect leading to
discontinuation.
Diagnostic suspicion of pulmonary embolism is low in patients with sudden chest pain and
normal D-dimer results.
Answer: True
Rationale: A negative D-dimer in low pre-test probability effectively excludes PE.
Patients with heart failure should restrict sodium intake to less than 2 grams per day.
Answer: True
Rationale: Sodium restriction limits fluid retention and symptoms.
Metformin is contraindicated in patients with eGFR below 30 mL/min/1.73 m².
Answer: True
Rationale: Risk of lactic acidosis rises; metformin requires renal function monitoring.
Chronic alcohol use can lead to macrocytic anemia.
Answer: True
Rationale: Due to nutritional deficiencies and bone marrow toxicity.
All adults over 50 should receive annual influenza vaccination.
Answer: True
Rationale: Flu vaccine reduces morbidity and mortality in older adults.
Adult Healthcare
Proctored Midterm Exam
2026
(With Solutions)
Multiple Choice (10)
Which of the following is the most appropriate first-line antihypertensive medication for an
adult patient with hypertension and chronic kidney disease?
A) Lisinopril
B) Amlodipine
C) Hydrochlorothiazide
D) Metoprolol
Answer: A) Lisinopril
Rationale: ACE inhibitors like lisinopril slow progression of CKD by reducing glomerular pressure
and proteinuria. Other agents are less renoprotective.
A 60-year-old presents with new onset atrial fibrillation. What is the most important next step in
management?
A) Start beta-blockers
B) Assess stroke risk with CHA2DS2-VASc score
C) Immediate cardioversion
D) Begin anticoagulation without further assessment
Answer: B) Assess stroke risk with CHA2DS2-VASc score
Rationale: Stroke risk assessment guides anticoagulation therapy; immediate cardioversion
depends on hemodynamic stability and duration of AF.
Which of the following lab values is the most sensitive indicator of developing acute kidney
injury (AKI)?
A) Serum creatinine
B) Blood urea nitrogen (BUN)
C) Urine output
D) Serum potassium
Answer: C) Urine output
Rationale: Reduced urine output often precedes creatinine rise; close monitoring helps early
detection.
In management of diabetes mellitus type 2, the addition of which medication class has proven
cardiovascular benefit?
A) Sulfonylureas
B) DPP-4 inhibitors
C) SGLT2 inhibitors
,D) Thiazolidinediones
Answer: C) SGLT2 inhibitors
Rationale: SGLT2 inhibitors reduce hospitalizations for heart failure and cardiovascular mortality
beyond glucose lowering.
Which of the following symptoms would most specifically indicate right heart failure?
A) Pulmonary edema
B) Jugular venous distension
C) Orthopnea
D) Paroxysmal nocturnal dyspnea
Answer: B) Jugular venous distension
Rationale: JVD reflects elevated central venous pressure, characteristic of right heart failure.
The most common cause of community-acquired pneumonia in adults is:
A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Mycoplasma pneumoniae
D) Klebsiella pneumoniae
Answer: A) Streptococcus pneumoniae
Rationale: S. pneumoniae is the predominant pathogen; guides empiric antibiotic choice.
Which of the following drugs is contraindicated in heart failure with reduced ejection fraction
(HFrEF)?
A) Spironolactone
B) Beta-blockers
C) NSAIDs
D) ACE inhibitors
Answer: C) NSAIDs
Rationale: NSAIDs worsen fluid retention, increase risk of decompensation.
An elderly patient on warfarin presents with a sudden severe headache and neurologic deficits.
The most likely diagnosis is:
A) Ischemic stroke
B) Intracerebral hemorrhage
C) Transient ischemic attack
D) Migraine
Answer: B) Intracerebral hemorrhage
Rationale: Warfarin increases bleeding risk; sudden headache + deficits suggest hemorrhage.
Regarding COPD management, which of the following statements is true?
A) Inhaled corticosteroids are first-line in mild COPD
B) Long-acting bronchodilators improve quality of life and reduce exacerbations
C) Oxygen therapy is indicated only during acute exacerbation
D) Antibiotics are used continuously to prevent infection
Answer: B) Long-acting bronchodilators improve quality of life and reduce exacerbations
Rationale: They reduce symptoms and exacerbations; steroids reserved for frequent
exacerbators.
What electrolyte abnormality is most often associated with the use of thiazide diuretics?
, A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hyperphosphatemia
Answer: B) Hypokalemia
Rationale: Thiazides promote potassium loss in urine, causing hypokalemia which requires
monitoring.
True/False (10)
Beta-blockers are contraindicated in patients with asthma.
Answer: False
Rationale: Selective beta-1 blockers can be cautiously used; non-selective beta-blockers are
avoided due to bronchospasm risk.
HbA1c levels above 6.5% are diagnostic of diabetes mellitus.
Answer: True
Rationale: ADA criteria include HbA1c ≥6.5% for diagnosis.
Statins must be stopped immediately in patients with any elevation in liver enzymes.
Answer: False
Rationale: Mild transient elevation is common; only discontinue if severe hepatotoxicity
develops.
ACE inhibitors can cause a persistent dry cough in some patients.
Answer: True
Rationale: The cough results from bradykinin accumulation; common side effect leading to
discontinuation.
Diagnostic suspicion of pulmonary embolism is low in patients with sudden chest pain and
normal D-dimer results.
Answer: True
Rationale: A negative D-dimer in low pre-test probability effectively excludes PE.
Patients with heart failure should restrict sodium intake to less than 2 grams per day.
Answer: True
Rationale: Sodium restriction limits fluid retention and symptoms.
Metformin is contraindicated in patients with eGFR below 30 mL/min/1.73 m².
Answer: True
Rationale: Risk of lactic acidosis rises; metformin requires renal function monitoring.
Chronic alcohol use can lead to macrocytic anemia.
Answer: True
Rationale: Due to nutritional deficiencies and bone marrow toxicity.
All adults over 50 should receive annual influenza vaccination.
Answer: True
Rationale: Flu vaccine reduces morbidity and mortality in older adults.
