Walden University NURS 6531 Final Exam 2026 | Advanced Practice Care
Practice Questions & Verified Answers.
Cardiovascular System (Questions 1-15)
Question 1
A patient is brought to the emergency department with symptoms of acute ST-
segment elevation MI (STEMI). The nearest hospital that can perform
percutaneous coronary intervention (PCI) is 3 hours away. What is the initial
treatment for this patient?
A) Give the patient an oral beta blocker
B) Transfer to the PCI-capable institution
C) Administer heparin
D) Initiate fibrinolytic treatment
Answer: D
Rationale: When PCI cannot be performed within 120 minutes of first medical
contact, fibrinolytic therapy is indicated for eligible patients with STEMI. The
"door-to-needle" time should be within 30 minutes. Transfer for PCI would delay
treatment beyond the recommended window .
,Question 2
A patient reports sustained, irregular heart palpitations. What is the most likely
cause of these symptoms?
A) Atrial fibrillation
B) Anemia
C) Extrasystole
D) Paroxysmal attacks
Answer: A
Rationale: Atrial fibrillation is characterized by sustained, irregularly irregular
palpitations. While anemia and extrasystole can cause palpitations, they do not
typically present as "sustained and irregular." Paroxysmal attacks are episodic by
definition .
Question 3
A patient has a cardiac murmur that peaks in midsystole and is best heard along
the left sternal border. The murmur decreases in intensity when the patient
changes from standing to squatting and increases with the Valsalva maneuver.
Which cause should the provider suspect?
,A) Aortic stenosis
B) Tricuspid regurgitation
C) Hypertrophic cardiomyopathy
D) Mitral valve prolapse
Answer: C
Rationale: Hypertrophic cardiomyopathy produces a murmur that increases with
Valsalva (decreased preload) and decreases with squatting (increased preload).
This is a distinguishing feature from aortic stenosis, which typically does not
change with these maneuvers .
Question 4
An African-American patient being treated with a thiazide diuretic for chronic
hypertension reports blurred vision and shortness of breath. Blood pressure is
185/115. What is the recommended action?
A) Increase the dose of the thiazide medication
B) Add a beta blocker to the patient's regimen
C) Admit to the hospital for evaluation and treatment
, D) Prescribe a calcium channel blocker
Answer: C
Rationale: This patient has hypertensive urgency/emergency with symptoms
(blurred vision, shortness of breath) and severely elevated BP. Hospital admission
for evaluation and treatment is indicated. Outpatient medication adjustments
would be inappropriate given the acuity .
Question 5
Which laboratory values representing parathyroid hormone (PTH) and serum
calcium are consistent with a diagnosis of primary hyperparathyroidism?
A) Appropriately increased PTH and low or normal serum calcium
B) Inappropriate secretion of PTH along with hypercalcemia
C) Appropriately high PTH along with hypocalcemia
D) Prolonged inappropriate secretion of PTH with subsequent hypercalcemia
Answer: B
Rationale: Primary hyperparathyroidism is characterized by inappropriate
(autonomous) PTH secretion in the setting of hypercalcemia. In a normal
physiologic response, hypercalcemia should suppress PTH secretion .
Practice Questions & Verified Answers.
Cardiovascular System (Questions 1-15)
Question 1
A patient is brought to the emergency department with symptoms of acute ST-
segment elevation MI (STEMI). The nearest hospital that can perform
percutaneous coronary intervention (PCI) is 3 hours away. What is the initial
treatment for this patient?
A) Give the patient an oral beta blocker
B) Transfer to the PCI-capable institution
C) Administer heparin
D) Initiate fibrinolytic treatment
Answer: D
Rationale: When PCI cannot be performed within 120 minutes of first medical
contact, fibrinolytic therapy is indicated for eligible patients with STEMI. The
"door-to-needle" time should be within 30 minutes. Transfer for PCI would delay
treatment beyond the recommended window .
,Question 2
A patient reports sustained, irregular heart palpitations. What is the most likely
cause of these symptoms?
A) Atrial fibrillation
B) Anemia
C) Extrasystole
D) Paroxysmal attacks
Answer: A
Rationale: Atrial fibrillation is characterized by sustained, irregularly irregular
palpitations. While anemia and extrasystole can cause palpitations, they do not
typically present as "sustained and irregular." Paroxysmal attacks are episodic by
definition .
Question 3
A patient has a cardiac murmur that peaks in midsystole and is best heard along
the left sternal border. The murmur decreases in intensity when the patient
changes from standing to squatting and increases with the Valsalva maneuver.
Which cause should the provider suspect?
,A) Aortic stenosis
B) Tricuspid regurgitation
C) Hypertrophic cardiomyopathy
D) Mitral valve prolapse
Answer: C
Rationale: Hypertrophic cardiomyopathy produces a murmur that increases with
Valsalva (decreased preload) and decreases with squatting (increased preload).
This is a distinguishing feature from aortic stenosis, which typically does not
change with these maneuvers .
Question 4
An African-American patient being treated with a thiazide diuretic for chronic
hypertension reports blurred vision and shortness of breath. Blood pressure is
185/115. What is the recommended action?
A) Increase the dose of the thiazide medication
B) Add a beta blocker to the patient's regimen
C) Admit to the hospital for evaluation and treatment
, D) Prescribe a calcium channel blocker
Answer: C
Rationale: This patient has hypertensive urgency/emergency with symptoms
(blurred vision, shortness of breath) and severely elevated BP. Hospital admission
for evaluation and treatment is indicated. Outpatient medication adjustments
would be inappropriate given the acuity .
Question 5
Which laboratory values representing parathyroid hormone (PTH) and serum
calcium are consistent with a diagnosis of primary hyperparathyroidism?
A) Appropriately increased PTH and low or normal serum calcium
B) Inappropriate secretion of PTH along with hypercalcemia
C) Appropriately high PTH along with hypocalcemia
D) Prolonged inappropriate secretion of PTH with subsequent hypercalcemia
Answer: B
Rationale: Primary hyperparathyroidism is characterized by inappropriate
(autonomous) PTH secretion in the setting of hypercalcemia. In a normal
physiologic response, hypercalcemia should suppress PTH secretion .
