NRNP 6540 Week 6
Midterm Exam (All
Correct)
1. A 45-year-old patient presents with BP 148/92 on two separate visits. What is the
most appropriate initial diagnosis?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: ACC/AHA defines Stage 1 HTN as SBP 130–139 or DBP 80–89. However,
persistent ≥140/90 is Stage 2 in updated guidelines—many programs still test mixed
criteria, so always confirm your course standard.
2. First-line medication for uncomplicated hypertension in a non-Black adult?
A. Beta blocker
B. ACE inhibitor
C. Loop diuretic
D. Alpha blocker
Answer: B. ACE inhibitor
Rationale: ACE inhibitors or ARBs are first-line unless contraindicated.
,3. A patient on lisinopril develops a dry cough. What is the best action?
A. Continue medication
B. Add antihistamine
C. Switch to ARB
D. Reduce dose
Answer: C. Switch to ARB
Rationale: ACE inhibitor cough is bradykinin-mediated; ARBs avoid this side effect.
4. Which lab should be monitored in a patient starting ACE inhibitors?
A. Hemoglobin
B. Potassium and creatinine
C. Sodium only
D. Calcium
Answer: B. Potassium and creatinine
Rationale: Risk of hyperkalemia and renal impairment.
5. A patient with chest pain has ST elevation on ECG. Next best step?
A. Aspirin and discharge
B. Immediate referral for PCI
C. Start outpatient beta blocker
D. Order stress test
Answer: B. Immediate PCI referral
Rationale: STEMI is a medical emergency requiring reperfusion.
6. Which finding is most consistent with heart failure exacerbation?
,A. Bradycardia
B. Crackles and weight gain
C. Dry mucous membranes
D. Hypertension only
Answer: B. Crackles and weight gain
Rationale: Fluid overload signs indicate HF exacerbation.
7. Which medication improves mortality in heart failure with reduced EF?
A. Furosemide
B. Digoxin
C. ACE inhibitors
D. Calcium channel blockers
Answer: C. ACE inhibitors
Rationale: ACE inhibitors reduce mortality; diuretics are symptom relief only.
8. A patient with asthma uses albuterol more than 3 times per week. What does this
indicate?
A. Well-controlled asthma
B. Poorly controlled asthma
C. COPD
D. Acute pneumonia
Answer: B. Poorly controlled asthma
Rationale: Frequent SABA use indicates inadequate control.
9. First-line controller medication for persistent asthma?
, A. Oral steroids
B. Inhaled corticosteroids
C. Leukotriene antagonists only
D. Antibiotics
Answer: B. Inhaled corticosteroids
Rationale: ICS are first-line for persistent asthma.
10. A patient presents with unilateral leg swelling and calf pain. Most appropriate
next test?
A. X-ray
B. D-dimer or Doppler ultrasound
C. ECG
D. CT brain
Answer: B. D-dimer or Doppler ultrasound
Rationale: Evaluate for DVT.11. A patient with hypertension is started on
hydrochlorothiazide. What is the most important electrolyte to monitor?
A. Calcium
B. Potassium
C. Magnesium only
D. Phosphate
Answer: B. Potassium
Rationale: Thiazide diuretics commonly cause hypokalemia.
12. Which antihypertensive is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
Midterm Exam (All
Correct)
1. A 45-year-old patient presents with BP 148/92 on two separate visits. What is the
most appropriate initial diagnosis?
A. Normal blood pressure
B. Elevated blood pressure
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: ACC/AHA defines Stage 1 HTN as SBP 130–139 or DBP 80–89. However,
persistent ≥140/90 is Stage 2 in updated guidelines—many programs still test mixed
criteria, so always confirm your course standard.
2. First-line medication for uncomplicated hypertension in a non-Black adult?
A. Beta blocker
B. ACE inhibitor
C. Loop diuretic
D. Alpha blocker
Answer: B. ACE inhibitor
Rationale: ACE inhibitors or ARBs are first-line unless contraindicated.
,3. A patient on lisinopril develops a dry cough. What is the best action?
A. Continue medication
B. Add antihistamine
C. Switch to ARB
D. Reduce dose
Answer: C. Switch to ARB
Rationale: ACE inhibitor cough is bradykinin-mediated; ARBs avoid this side effect.
4. Which lab should be monitored in a patient starting ACE inhibitors?
A. Hemoglobin
B. Potassium and creatinine
C. Sodium only
D. Calcium
Answer: B. Potassium and creatinine
Rationale: Risk of hyperkalemia and renal impairment.
5. A patient with chest pain has ST elevation on ECG. Next best step?
A. Aspirin and discharge
B. Immediate referral for PCI
C. Start outpatient beta blocker
D. Order stress test
Answer: B. Immediate PCI referral
Rationale: STEMI is a medical emergency requiring reperfusion.
6. Which finding is most consistent with heart failure exacerbation?
,A. Bradycardia
B. Crackles and weight gain
C. Dry mucous membranes
D. Hypertension only
Answer: B. Crackles and weight gain
Rationale: Fluid overload signs indicate HF exacerbation.
7. Which medication improves mortality in heart failure with reduced EF?
A. Furosemide
B. Digoxin
C. ACE inhibitors
D. Calcium channel blockers
Answer: C. ACE inhibitors
Rationale: ACE inhibitors reduce mortality; diuretics are symptom relief only.
8. A patient with asthma uses albuterol more than 3 times per week. What does this
indicate?
A. Well-controlled asthma
B. Poorly controlled asthma
C. COPD
D. Acute pneumonia
Answer: B. Poorly controlled asthma
Rationale: Frequent SABA use indicates inadequate control.
9. First-line controller medication for persistent asthma?
, A. Oral steroids
B. Inhaled corticosteroids
C. Leukotriene antagonists only
D. Antibiotics
Answer: B. Inhaled corticosteroids
Rationale: ICS are first-line for persistent asthma.
10. A patient presents with unilateral leg swelling and calf pain. Most appropriate
next test?
A. X-ray
B. D-dimer or Doppler ultrasound
C. ECG
D. CT brain
Answer: B. D-dimer or Doppler ultrasound
Rationale: Evaluate for DVT.11. A patient with hypertension is started on
hydrochlorothiazide. What is the most important electrolyte to monitor?
A. Calcium
B. Potassium
C. Magnesium only
D. Phosphate
Answer: B. Potassium
Rationale: Thiazide diuretics commonly cause hypokalemia.
12. Which antihypertensive is contraindicated in pregnancy?
A. Labetalol
B. Methyldopa
