NRNP 6531 Final Exam (2026) Adult Lifespan Questions Walden PDF.
CARDIOLOGY (Questions 1-30)
Question 1
A 58-year-old man with hypertension reports substernal chest pressure with
exertion that is relieved by rest. What is the most appropriate next step?
A) Prescribe nitroglycerin PRN
B) Order a stress echocardiogram
C) Start high-intensity statin
D) Refer to ER for troponin
Answer: B
Rationale: This presentation describes stable angina. Stress testing
(echocardiogram or nuclear) is indicated to assess for ischemia. Nitroglycerin
provides symptomatic relief but is not diagnostic. Statin is indicated but not the
immediate next step. ER referral is for unstable angina, not stable symptoms
relieved by rest.
Question 2
Which ACE inhibitor side effect is most characteristic and requires monitoring in a
72-year-old with CKD?
,A) Dry cough
B) Angioedema
C) Hyperkalemia
D) Hypotension
Answer: C
Rationale: In CKD, ACE inhibitors reduce aldosterone secretion → potassium
retention → hyperkalemia. Dry cough is common but not specific to CKD patients.
Angioedema is rare but serious. Hypotension can occur but is not the most
characteristic laboratory finding requiring monitoring in CKD.
Question 3
A 45-year-old female has a blood pressure of 148/92 mmHg on two separate
visits. No diabetes or CKD. What is first-line monotherapy?
A) HCTZ
B) Lisinopril
C) Amlodipine
D) Metoprolol
,Answer: B
Rationale: ACE inhibitors (lisinopril) are first-line for non-Black patients without
compelling indications. Thiazides are also acceptable, but ACE inhibitors are
preferred in younger patients. CCB (amlodipine) is an alternative. Beta-blockers
are not first-line for uncomplicated hypertension.
Question 4
ECG shows irregularly irregular rhythm with no P waves. Rate is 110-130 bpm.
What is the best initial pharmacotherapy for rate control?
A) Amiodarone
B) Metoprolol
C) Aspirin
D) Diltiazem IV
Answer: D
Rationale: This is atrial fibrillation with rapid ventricular response. IV diltiazem
(nondihydropyridine CCB) is first-line for acute rate control. Metoprolol is also
used, but diltiazem is often preferred in the acute setting. Amiodarone is for
rhythm control or unstable patients. Aspirin is not for rate control.
, Question 5
A 70-year-old has a blood pressure of 180/100 mmHg with no symptoms. Repeat
in office 5 minutes later is 178/98. What is the most appropriate next step?
A) Refer to emergency department
B) Start amlodipine 10 mg daily
C) Obtain home BP readings for 1 week
D) Sublingual nifedipine
Answer: C
Rationale: Asymptomatic severe hypertension (hypertensive urgency) does not
require emergency treatment. Home BP monitoring to rule out white coat
hypertension. Slow oral therapy if sustained. Sublingual nifedipine is dangerous
(uncontrolled hypotension, stroke).
Question 6
A 50-year-old with no cardiac history has a murmur: mid-systolic click followed by
late systolic murmur at the apex. What is the diagnosis?
CARDIOLOGY (Questions 1-30)
Question 1
A 58-year-old man with hypertension reports substernal chest pressure with
exertion that is relieved by rest. What is the most appropriate next step?
A) Prescribe nitroglycerin PRN
B) Order a stress echocardiogram
C) Start high-intensity statin
D) Refer to ER for troponin
Answer: B
Rationale: This presentation describes stable angina. Stress testing
(echocardiogram or nuclear) is indicated to assess for ischemia. Nitroglycerin
provides symptomatic relief but is not diagnostic. Statin is indicated but not the
immediate next step. ER referral is for unstable angina, not stable symptoms
relieved by rest.
Question 2
Which ACE inhibitor side effect is most characteristic and requires monitoring in a
72-year-old with CKD?
,A) Dry cough
B) Angioedema
C) Hyperkalemia
D) Hypotension
Answer: C
Rationale: In CKD, ACE inhibitors reduce aldosterone secretion → potassium
retention → hyperkalemia. Dry cough is common but not specific to CKD patients.
Angioedema is rare but serious. Hypotension can occur but is not the most
characteristic laboratory finding requiring monitoring in CKD.
Question 3
A 45-year-old female has a blood pressure of 148/92 mmHg on two separate
visits. No diabetes or CKD. What is first-line monotherapy?
A) HCTZ
B) Lisinopril
C) Amlodipine
D) Metoprolol
,Answer: B
Rationale: ACE inhibitors (lisinopril) are first-line for non-Black patients without
compelling indications. Thiazides are also acceptable, but ACE inhibitors are
preferred in younger patients. CCB (amlodipine) is an alternative. Beta-blockers
are not first-line for uncomplicated hypertension.
Question 4
ECG shows irregularly irregular rhythm with no P waves. Rate is 110-130 bpm.
What is the best initial pharmacotherapy for rate control?
A) Amiodarone
B) Metoprolol
C) Aspirin
D) Diltiazem IV
Answer: D
Rationale: This is atrial fibrillation with rapid ventricular response. IV diltiazem
(nondihydropyridine CCB) is first-line for acute rate control. Metoprolol is also
used, but diltiazem is often preferred in the acute setting. Amiodarone is for
rhythm control or unstable patients. Aspirin is not for rate control.
, Question 5
A 70-year-old has a blood pressure of 180/100 mmHg with no symptoms. Repeat
in office 5 minutes later is 178/98. What is the most appropriate next step?
A) Refer to emergency department
B) Start amlodipine 10 mg daily
C) Obtain home BP readings for 1 week
D) Sublingual nifedipine
Answer: C
Rationale: Asymptomatic severe hypertension (hypertensive urgency) does not
require emergency treatment. Home BP monitoring to rule out white coat
hypertension. Slow oral therapy if sustained. Sublingual nifedipine is dangerous
(uncontrolled hypotension, stroke).
Question 6
A 50-year-old with no cardiac history has a murmur: mid-systolic click followed by
late systolic murmur at the apex. What is the diagnosis?
