NURS 6531 FINAL EXAM WEEK 11 SPRING 2026 | All 100
Questions and Correct Answers Already Graded A+ | Walden
University | Primary Care of Adults | Brand New | Pass
Guaranteed
Section 1: Cardiovascular Disorders (15 Questions)
Q1: A 68-year-old male with a 15-year history of hypertension and type 2 diabetes
presents for routine follow-up. His BP is 148/86 mmHg on lisinopril 20 mg daily. His
most recent A1c is 7.2% on metformin 1000 mg BID. Urine albumin-to-creatinine ratio is
45 mg/g. Which medication addition would provide both blood pressure reduction and
renal protection?
A. Add amlodipine 5 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add losartan 50 mg daily
D. Add metoprolol succinate 50 mg daily
Correct Answer: C
Rationale: According to the 2023 ADA Standards of Medical Care and 2017 ACC/AHA
Hypertension Guidelines, patients with diabetes and albuminuria (UACR ≥30 mg/g)
should receive an ACE inhibitor or ARB for renal protection, regardless of baseline BP.
Losartan (ARB) provides both BP reduction and slows progression of diabetic kidney
disease by reducing intraglomerular pressure.
, ● Option A (Amlodipine): Effective for BP control but does not provide renal
protection in diabetic nephropathy; preferred when additional BP control is
needed after ACEi/ARB optimization.
● Option B (HCTZ): Thiazide diuretics lower BP but may worsen glucose
metabolism and do not provide renal protection; not first-line in this scenario.
● Option D (Metoprolol): Beta-blockers reduce BP but mask hypoglycemia
symptoms and do not offer renal protection; not preferred in diabetes with
albuminuria.
Key Guideline: ADA 2023 recommends ACEi/ARB as first-line for hypertension in
diabetes with albuminuria (Level A evidence).
Q2: A 55-year-old female with no prior cardiovascular disease has a 10-year ASCVD risk
of 8.5% on the Pooled Cohort Equations. Her LDL-C is 142 mg/dL, HDL-C is 48 mg/dL,
and triglycerides are 180 mg/dL. She has no diabetes, does not smoke, and her BP is
well-controlled. What is the most appropriate management?
A. Initiate atorvastatin 40 mg daily
B. Initiate rosuvastatin 20 mg daily
C. Recommend lifestyle modifications only; recheck lipids in 6 months
D. Initiate ezetimibe 10 mg daily
Correct Answer: B
Rationale: The 2018 AHA/ACC/Multi-Society Cholesterol Guidelines recommend statin
therapy for primary prevention when 10-year ASCVD risk is ≥7.5% (moderate-intensity
statin indicated). This patient's risk is 8.5%, placing her in the borderline to intermediate
risk category where risk-enhancing factors (premature menopause, elevated
triglycerides) support statin initiation.
, ● Option A (Atorvastatin 40 mg): High-intensity statin indicated for ASCVD risk
≥20% or LDL ≥190 mg/dL; excessive for this primary prevention patient.
● Option C (Lifestyle only): Inappropriate given ASCVD risk >7.5% and age >55 in
women; guidelines recommend shared decision-making with strong
consideration of statin.
● Option D (Ezetimibe): Non-statin therapy reserved for statin-intolerant patients or
when LDL goals not achieved on maximally tolerated statin; not first-line
monotherapy.
Key Concept: Moderate-intensity statins (rosuvastatin 5-10 mg or atorvastatin 10-20
mg) reduce LDL by 30-49% and are indicated for primary prevention with 10-year risk
7.5-19.9%.
Q3: A 72-year-old male presents with chest pressure on exertion relieved by rest. He has
hypertension and hyperlipidemia. ECG shows normal sinus rhythm with lateral T-wave
inversions. Stress testing reveals 2.5 mm ST depression in leads V4-V6 at 6 METS.
Which intervention is most appropriate?
A. Immediate coronary angiography
B. Initiate medical therapy with aspirin, statin, beta-blocker, and sublingual nitroglycerin
C. Refer for coronary artery calcium scoring
D. Schedule repeat stress test in 6 months
Correct Answer: B
Rationale: This patient has stable angina with intermediate-risk findings on stress
testing (2.5 mm ST depression at moderate workload). The 2021 AHA/ACC Chest Pain
Guidelines recommend initial medical therapy for stable angina without high-risk
features (≥3 mm ST depression, hypotensive response, ventricular arrhythmias).
, ● Option A (Immediate angiography): Reserved for high-risk stress test results,
unstable angina, or failed medical therapy; premature without optimization first.
● Option C (CAC scoring): Used for asymptomatic risk stratification, not for
symptomatic patients with known ischemia; would delay appropriate treatment.
● Option D (Repeat stress test): Inappropriate given documented ischemia; delays
necessary intervention and increases MACE risk.
Guideline Reference: 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the
Evaluation and Diagnosis of Chest Pain (Class I recommendation for medical therapy in
stable angina).
Q4: A 64-year-old male with HFrEF (EF 35%) is on lisinopril 20 mg daily, metoprolol
succinate 100 mg daily, and furosemide 40 mg daily. He remains dyspneic on moderate
exertion. His BP is 118/72 mmHg, potassium 4.2 mEq/L, and creatinine 1.3 mg/dL.
Which medication should be added next?
A. Sacubitril/valsartan (Entresto)
B. Dapagliflozin (Farxiga)
C. Spironolactone
D. Digoxin
Correct Answer: B
Rationale: The 2022 AHA/ACC/HFSA Heart Failure Guidelines recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational therapy for HFrEF (Class 1A
recommendation), regardless of diabetes status. They reduce CV death and HF
hospitalization independent of glycemic effects.
● Option A (ARNI): Sacubitril/valsartan is preferred over ACEi in HFrEF, but requires
36-hour washout from ACEi to avoid angioedema; would require stopping
lisinopril first.
Questions and Correct Answers Already Graded A+ | Walden
University | Primary Care of Adults | Brand New | Pass
Guaranteed
Section 1: Cardiovascular Disorders (15 Questions)
Q1: A 68-year-old male with a 15-year history of hypertension and type 2 diabetes
presents for routine follow-up. His BP is 148/86 mmHg on lisinopril 20 mg daily. His
most recent A1c is 7.2% on metformin 1000 mg BID. Urine albumin-to-creatinine ratio is
45 mg/g. Which medication addition would provide both blood pressure reduction and
renal protection?
A. Add amlodipine 5 mg daily
B. Add hydrochlorothiazide 25 mg daily
C. Add losartan 50 mg daily
D. Add metoprolol succinate 50 mg daily
Correct Answer: C
Rationale: According to the 2023 ADA Standards of Medical Care and 2017 ACC/AHA
Hypertension Guidelines, patients with diabetes and albuminuria (UACR ≥30 mg/g)
should receive an ACE inhibitor or ARB for renal protection, regardless of baseline BP.
Losartan (ARB) provides both BP reduction and slows progression of diabetic kidney
disease by reducing intraglomerular pressure.
, ● Option A (Amlodipine): Effective for BP control but does not provide renal
protection in diabetic nephropathy; preferred when additional BP control is
needed after ACEi/ARB optimization.
● Option B (HCTZ): Thiazide diuretics lower BP but may worsen glucose
metabolism and do not provide renal protection; not first-line in this scenario.
● Option D (Metoprolol): Beta-blockers reduce BP but mask hypoglycemia
symptoms and do not offer renal protection; not preferred in diabetes with
albuminuria.
Key Guideline: ADA 2023 recommends ACEi/ARB as first-line for hypertension in
diabetes with albuminuria (Level A evidence).
Q2: A 55-year-old female with no prior cardiovascular disease has a 10-year ASCVD risk
of 8.5% on the Pooled Cohort Equations. Her LDL-C is 142 mg/dL, HDL-C is 48 mg/dL,
and triglycerides are 180 mg/dL. She has no diabetes, does not smoke, and her BP is
well-controlled. What is the most appropriate management?
A. Initiate atorvastatin 40 mg daily
B. Initiate rosuvastatin 20 mg daily
C. Recommend lifestyle modifications only; recheck lipids in 6 months
D. Initiate ezetimibe 10 mg daily
Correct Answer: B
Rationale: The 2018 AHA/ACC/Multi-Society Cholesterol Guidelines recommend statin
therapy for primary prevention when 10-year ASCVD risk is ≥7.5% (moderate-intensity
statin indicated). This patient's risk is 8.5%, placing her in the borderline to intermediate
risk category where risk-enhancing factors (premature menopause, elevated
triglycerides) support statin initiation.
, ● Option A (Atorvastatin 40 mg): High-intensity statin indicated for ASCVD risk
≥20% or LDL ≥190 mg/dL; excessive for this primary prevention patient.
● Option C (Lifestyle only): Inappropriate given ASCVD risk >7.5% and age >55 in
women; guidelines recommend shared decision-making with strong
consideration of statin.
● Option D (Ezetimibe): Non-statin therapy reserved for statin-intolerant patients or
when LDL goals not achieved on maximally tolerated statin; not first-line
monotherapy.
Key Concept: Moderate-intensity statins (rosuvastatin 5-10 mg or atorvastatin 10-20
mg) reduce LDL by 30-49% and are indicated for primary prevention with 10-year risk
7.5-19.9%.
Q3: A 72-year-old male presents with chest pressure on exertion relieved by rest. He has
hypertension and hyperlipidemia. ECG shows normal sinus rhythm with lateral T-wave
inversions. Stress testing reveals 2.5 mm ST depression in leads V4-V6 at 6 METS.
Which intervention is most appropriate?
A. Immediate coronary angiography
B. Initiate medical therapy with aspirin, statin, beta-blocker, and sublingual nitroglycerin
C. Refer for coronary artery calcium scoring
D. Schedule repeat stress test in 6 months
Correct Answer: B
Rationale: This patient has stable angina with intermediate-risk findings on stress
testing (2.5 mm ST depression at moderate workload). The 2021 AHA/ACC Chest Pain
Guidelines recommend initial medical therapy for stable angina without high-risk
features (≥3 mm ST depression, hypotensive response, ventricular arrhythmias).
, ● Option A (Immediate angiography): Reserved for high-risk stress test results,
unstable angina, or failed medical therapy; premature without optimization first.
● Option C (CAC scoring): Used for asymptomatic risk stratification, not for
symptomatic patients with known ischemia; would delay appropriate treatment.
● Option D (Repeat stress test): Inappropriate given documented ischemia; delays
necessary intervention and increases MACE risk.
Guideline Reference: 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the
Evaluation and Diagnosis of Chest Pain (Class I recommendation for medical therapy in
stable angina).
Q4: A 64-year-old male with HFrEF (EF 35%) is on lisinopril 20 mg daily, metoprolol
succinate 100 mg daily, and furosemide 40 mg daily. He remains dyspneic on moderate
exertion. His BP is 118/72 mmHg, potassium 4.2 mEq/L, and creatinine 1.3 mg/dL.
Which medication should be added next?
A. Sacubitril/valsartan (Entresto)
B. Dapagliflozin (Farxiga)
C. Spironolactone
D. Digoxin
Correct Answer: B
Rationale: The 2022 AHA/ACC/HFSA Heart Failure Guidelines recommend SGLT2
inhibitors (dapagliflozin or empagliflozin) as foundational therapy for HFrEF (Class 1A
recommendation), regardless of diabetes status. They reduce CV death and HF
hospitalization independent of glycemic effects.
● Option A (ARNI): Sacubitril/valsartan is preferred over ACEi in HFrEF, but requires
36-hour washout from ACEi to avoid angioedema; would require stopping
lisinopril first.
