1|Page
# NR 603 WEEK 4 APEA PREDICTOR EXAM TEST
BANK: 150+ QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES – FIRST-
TIME PASS, GRADED A+
# DOMAIN 1: CARDIOVASCULAR DISORDERS## Questions 1-25
**Q1.** A 52-year-old Caucasian male with a past medical history of
COPD comes in for follow-up on his stage 2 hypertension.
Hydrochlorothiazide is at the maximum dose, and a new medication
needs to be added. Which medication would be the best second-line
therapy?
A. A calcium channel blocker such as Cardizem
**B. An ACE inhibitor such as Lisinopril**
C. A beta-blocker such as Metoprolol
D. An alpha-1 receptor blocker such as Cardura
**Answer: B**
*Rationale:* For patients with hypertension, adding an ACE inhibitor is
a recommended second-line agent. Beta-blockers are not first-line for
hypertension without a specific compelling indication (like heart failure
or post-MI), and in COPD patients, non-selective beta-blockers should
be used with caution. Calcium channel blockers are also appropriate but
may have more side effects in this population .
,2|Page
**Q2.** A patient with hypertension has been diagnosed with gout.
Which home medication may have contributed to this episode of gout?
A. Verapamil
B. Metoprolol
C. Lisinopril
**D. Furosemide**
**Answer: D**
*Rationale:* Thiazide and loop diuretics (such as furosemide) can
increase uric acid levels and precipitate gout attacks by reducing renal
excretion of uric acid. ACE inhibitors, calcium channel blockers, and
beta-blockers do not typically cause hyperuricemia .
**Q3.** Which group of BP medications should be discontinued
immediately if pregnancy occurs?
A. Calcium channel blockers
B. Loop diuretics
**C. ACE inhibitors**
D. Beta-blockers
,3|Page
**Answer: C**
*Rationale:* ACE inhibitors (and ARBs) are teratogenic and
contraindicated in pregnancy, especially during the second and third
trimesters, as they can cause fetal renal dysplasia, oligohydramnios, and
neonatal anuria. They should be discontinued as soon as pregnancy is
confirmed .
**Q4.** A 44-year-old female patient has diabetes. Her total cholesterol
(TC) is 250 mg/dL, LDL = 190 mg/dL, HDL = 25 mg/dL, and
triglycerides = 344 mg/dL. What agent would have the greatest effect on
improving her lipid profile and reducing morbidity and mortality
associated with dyslipidemia?
A. Niacin (Niaspan)
**B. Atorvastatin**
C. Omega-3 fatty acids
D. Fenofibrates
**Answer: B**
*Rationale:* Statins are the cornerstone of dyslipidemia management
because they primarily lower LDL-C levels, which is the major culprit in
atherosclerotic heart disease. Target LDL-C is between 50-70 mg/dL for
high-risk patients. Statins also have secondary effects of lowering
triglycerides and increasing HDL-C. Guidelines strongly recommend
statin therapy for diabetic patients with elevated LDL .
, 4|Page
**Q5.** An 80-year-old female who is otherwise well has the following
blood pressure reading: 178/90 mmHg. How should she be managed
pharmacologically?
A. Thiazide diuretic
B. ACE inhibitor
**C. Calcium channel blocker**
D. Angiotensin receptor blocker
**Answer: C**
*Rationale:* In elderly patients (age 80+), initial monotherapy with a
calcium channel blocker is often preferred due to fewer electrolyte
disturbances and less risk of orthostatic hypotension compared to
thiazides. CCBs are effective for isolated systolic hypertension common
in older adults .
**Q6.** A 60-year-old male with a history of type 2 diabetes and HTN
comes in for a follow-up BP check. His BMI is 20. His BP readings
sitting and standing are: 138/80 and 132/76 respectively. What is the best
analysis of the prescribed treatment plan?
**A. His blood pressure is within JNC 8 guidelines so no adjustments
will be made at this time**
B. His BP is within JNC 8 guidelines but there should be less variability
with position change
# NR 603 WEEK 4 APEA PREDICTOR EXAM TEST
BANK: 150+ QUESTIONS WITH VERIFIED
ANSWERS & DETAILED RATIONALES – FIRST-
TIME PASS, GRADED A+
# DOMAIN 1: CARDIOVASCULAR DISORDERS## Questions 1-25
**Q1.** A 52-year-old Caucasian male with a past medical history of
COPD comes in for follow-up on his stage 2 hypertension.
Hydrochlorothiazide is at the maximum dose, and a new medication
needs to be added. Which medication would be the best second-line
therapy?
A. A calcium channel blocker such as Cardizem
**B. An ACE inhibitor such as Lisinopril**
C. A beta-blocker such as Metoprolol
D. An alpha-1 receptor blocker such as Cardura
**Answer: B**
*Rationale:* For patients with hypertension, adding an ACE inhibitor is
a recommended second-line agent. Beta-blockers are not first-line for
hypertension without a specific compelling indication (like heart failure
or post-MI), and in COPD patients, non-selective beta-blockers should
be used with caution. Calcium channel blockers are also appropriate but
may have more side effects in this population .
,2|Page
**Q2.** A patient with hypertension has been diagnosed with gout.
Which home medication may have contributed to this episode of gout?
A. Verapamil
B. Metoprolol
C. Lisinopril
**D. Furosemide**
**Answer: D**
*Rationale:* Thiazide and loop diuretics (such as furosemide) can
increase uric acid levels and precipitate gout attacks by reducing renal
excretion of uric acid. ACE inhibitors, calcium channel blockers, and
beta-blockers do not typically cause hyperuricemia .
**Q3.** Which group of BP medications should be discontinued
immediately if pregnancy occurs?
A. Calcium channel blockers
B. Loop diuretics
**C. ACE inhibitors**
D. Beta-blockers
,3|Page
**Answer: C**
*Rationale:* ACE inhibitors (and ARBs) are teratogenic and
contraindicated in pregnancy, especially during the second and third
trimesters, as they can cause fetal renal dysplasia, oligohydramnios, and
neonatal anuria. They should be discontinued as soon as pregnancy is
confirmed .
**Q4.** A 44-year-old female patient has diabetes. Her total cholesterol
(TC) is 250 mg/dL, LDL = 190 mg/dL, HDL = 25 mg/dL, and
triglycerides = 344 mg/dL. What agent would have the greatest effect on
improving her lipid profile and reducing morbidity and mortality
associated with dyslipidemia?
A. Niacin (Niaspan)
**B. Atorvastatin**
C. Omega-3 fatty acids
D. Fenofibrates
**Answer: B**
*Rationale:* Statins are the cornerstone of dyslipidemia management
because they primarily lower LDL-C levels, which is the major culprit in
atherosclerotic heart disease. Target LDL-C is between 50-70 mg/dL for
high-risk patients. Statins also have secondary effects of lowering
triglycerides and increasing HDL-C. Guidelines strongly recommend
statin therapy for diabetic patients with elevated LDL .
, 4|Page
**Q5.** An 80-year-old female who is otherwise well has the following
blood pressure reading: 178/90 mmHg. How should she be managed
pharmacologically?
A. Thiazide diuretic
B. ACE inhibitor
**C. Calcium channel blocker**
D. Angiotensin receptor blocker
**Answer: C**
*Rationale:* In elderly patients (age 80+), initial monotherapy with a
calcium channel blocker is often preferred due to fewer electrolyte
disturbances and less risk of orthostatic hypotension compared to
thiazides. CCBs are effective for isolated systolic hypertension common
in older adults .
**Q6.** A 60-year-old male with a history of type 2 diabetes and HTN
comes in for a follow-up BP check. His BMI is 20. His BP readings
sitting and standing are: 138/80 and 132/76 respectively. What is the best
analysis of the prescribed treatment plan?
**A. His blood pressure is within JNC 8 guidelines so no adjustments
will be made at this time**
B. His BP is within JNC 8 guidelines but there should be less variability
with position change
