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EXAMS
(2026) Adult Lifespan Questions | FNP Review (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam (2026) Adult Lifespan Questions | FNP
Review (PDF) - 2026/2027 Update
Page 1
,Question 1
A 55-year-old man with type 2 diabetes and hypertension presents for follow-up. Current
medications: metformin 1000 mg BID, lisinopril 20 mg daily, atorvastatin 20 mg daily. Blood
pressure is 145/90 mmHg, heart rate 72 bpm. Labs: serum creatinine 1.1 mg/dL, eGFR 65
mL/min/1.73m², potassium 4.8 mEq/L, HbA1c 7.2%. Urine albumin-to-creatinine ratio (UACR) is
45 mg/g. According to KDIGO 2024 guidelines, which pharmacologic addition is most appropriate
to reduce cardiovascular and renal risk?
A) Add amlodipine 5 mg daily
B) Add dapagliflozin 10 mg daily
C) Add spironolactone 25 mg daily
D) Increase lisinopril to 40 mg daily
Answer: B) Add dapagliflozin 10 mg daily
Explanation: KDIGO 2024 recommends SGLT2 inhibitors (e.g., dapagliflozin) as first-line add-on
therapy for patients with T2DM, CKD (eGFR "e25), and albuminuria (UACR "e30) due
to proven cardiovascular and renal benefit. Amlodipine is not preferred for
renoprotection; spironolactone risks hyperkalemia with lisinopril; and while increasing
lisinopril is an option, the presence of albuminuria and eGFR >60 makes SGLT2i the
priority.
Question 2
A 68-year-old woman with a 40-pack-year smoking history reports progressive dyspnea on
exertion and a chronic cough for 3 years. Spirometry shows FEV1/FVC = 0.62, FEV1 = 55%
predicted, with no significant bronchodilator response. Which of the following would be the most
appropriate initial pharmacotherapy according to GOLD 2025 guidelines for Group B?
A) LAMA monotherapy (e.g., tiotropium)
B) LABA/ICS combination (e.g., salmeterol/fluticasone)
C) LAMA/LABA combination (e.g., tiotropium/olodaterol)
D) PRN short-acting beta-agonist alone
Answer: A) LAMA monotherapy (e.g., tiotropium)
Explanation: GOLD 2025 classifies this patient as Group B (high symptom burden, low exacerbation
risk, FEV1 <80% predicted). Initial therapy is a single long-acting bronchodilator, with
LAMA preferred over LABA due to greater effect on exacerbation reduction.
LABA/ICS is reserved for Groups E with high eosinophils; LAMA/LABA is step-up for
persistent symptoms; PRN alone is insufficient.
Page 2
,Question 3
A 72-year-old man with a history of heart failure with reduced ejection fraction (HFrEF, EF 35%),
chronic kidney disease stage 3b (eGFR 40 mL/min/1.73m²), and type 2 diabetes is on
guideline-directed medical therapy including metoprolol succinate 200 mg daily,
sacubitril/valsartan 49/51 mg BID, and dapagliflozin 10 mg daily. He presents with fatigue and
lightheadedness. Labs: potassium 5.6 mEq/L, creatinine 1.8 mg/dL (baseline 1.5), eGFR 35. Which
medication adjustment is most appropriate?
A) Discontinue dapagliflozin and start empagliflozin
B) Reduce sacubitril/valsartan to 24/26 mg BID
C) Add furosemide 40 mg daily
D) Discontinue metoprolol succinate and start carvedilol
Answer: B) Reduce sacubitril/valsartan to 24/26 mg BID
Explanation: Hyperkalemia (K+ 5.6) with worsening renal function is a known complication of
sacubitril/valsartan (ARNI). The appropriate management is to reduce the dose or
temporarily hold it, especially with eGFR decline and K+ >5.5. Dapagliflozin does not
cause hyperkalemia; switching SGLT2i is not indicated. Adding furosemide may worsen
renal function. Switching beta-blockers is unlikely to address hyperkalemia.
Question 4
A 62-year-old woman with hypertension and osteoarthritis presents with a 2-week history of
bilateral proximal muscle weakness, difficulty rising from a chair, and a rash over her knuckles
and eyelids. Creatine kinase is 3500 U/L. Which autoantibody is most likely to be positive and
associated with an increased risk of malignancy?
A) Anti-Jo-1 antibody
B) Anti-MDA5 antibody
C) Anti-TIF1-gamma antibody
D) Anti-SRP antibody
Answer: C) Anti-TIF1-gamma antibody
Explanation: Anti-TIF1-gamma (transcriptional intermediary factor 1 gamma) antibody is strongly
associated with dermatomyositis and carries a high risk of underlying malignancy,
especially in older adults. Anti-Jo-1 is linked to antisynthetase syndrome (interstitial
lung disease). Anti-MDA5 is associated with rapidly progressive ILD. Anti-SRP is
associated with necrotizing myopathy without rash.
Page 3
, Question 5
A 58-year-old man with a history of recurrent calcium oxalate kidney stones is found to have a
24-hour urine calcium of 400 mg/day, urine oxalate 30 mg/day, and serum parathyroid hormone
(PTH) 35 pg/mL (normal 10-65). Which of the following is the most appropriate initial
pharmacotherapy to reduce stone recurrence?
A) Hydrochlorothiazide 25 mg daily
B) Allopurinol 300 mg daily
C) Potassium citrate 20 mEq BID
D) Chlorthalidone 50 mg daily
Answer: A) Hydrochlorothiazide 25 mg daily
Explanation: This patient has idiopathic hypercalciuria (urine Ca >250 mg/day) with normal PTH,
which is the most common metabolic abnormality in calcium stone formers. Thiazide
diuretics (e.g., hydrochlorothiazide) reduce urinary calcium excretion and are first-line.
Chlorthalidone is more potent but has higher risk of hypokalemia; HCTZ is preferred
initially. Allopurinol is for hyperuricosuria; potassium citrate is for hypocitraturia or
uric acid stones.
Question 6
A 65-year-old woman with hypertension and type 2 diabetes presents with a 3-day history of
painful, grouped vesicles on an erythematous base along the right T10 dermatome. Pain is
described as burning and severe. She has not had chickenpox or shingles vaccine. Which of the
following is the most appropriate antiviral regimen to reduce the risk of postherpetic neuralgia?
A) Acyclovir 800 mg orally 5 times daily for 7 days
B) Valacyclovir 1 g orally three times daily for 7 days
C) Famciclovir 500 mg orally three times daily for 7 days
D) Acyclovir 10 mg/kg IV every 8 hours for 7 days
Answer: B) Valacyclovir 1 g orally three times daily for 7 days
Explanation: Valacyclovir 1 g TID for 7 days is the preferred oral antiviral for herpes zoster in
immunocompetent adults due to superior bioavailability and convenient dosing, and it
reduces the risk of postherpetic neuralgia when started within 72 hours. Acyclovir
requires 5x daily dosing, reducing adherence. Famciclovir is also effective but
valacyclovir is often preferred. IV acyclovir is reserved for immunocompromised or
complicated cases.
Page 4
Download Download
EXAMS
(2026) Adult Lifespan Questions | FNP Review (PDF) | Questions &
Answers (Verified Answers) With Rationales ( Update)
This Document Contains:
NRNP 6531 Midterm Exam Exam
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
NRNP 6531 Midterm Exam (2026) Adult Lifespan Questions | FNP
Review (PDF) - 2026/2027 Update
Page 1
,Question 1
A 55-year-old man with type 2 diabetes and hypertension presents for follow-up. Current
medications: metformin 1000 mg BID, lisinopril 20 mg daily, atorvastatin 20 mg daily. Blood
pressure is 145/90 mmHg, heart rate 72 bpm. Labs: serum creatinine 1.1 mg/dL, eGFR 65
mL/min/1.73m², potassium 4.8 mEq/L, HbA1c 7.2%. Urine albumin-to-creatinine ratio (UACR) is
45 mg/g. According to KDIGO 2024 guidelines, which pharmacologic addition is most appropriate
to reduce cardiovascular and renal risk?
A) Add amlodipine 5 mg daily
B) Add dapagliflozin 10 mg daily
C) Add spironolactone 25 mg daily
D) Increase lisinopril to 40 mg daily
Answer: B) Add dapagliflozin 10 mg daily
Explanation: KDIGO 2024 recommends SGLT2 inhibitors (e.g., dapagliflozin) as first-line add-on
therapy for patients with T2DM, CKD (eGFR "e25), and albuminuria (UACR "e30) due
to proven cardiovascular and renal benefit. Amlodipine is not preferred for
renoprotection; spironolactone risks hyperkalemia with lisinopril; and while increasing
lisinopril is an option, the presence of albuminuria and eGFR >60 makes SGLT2i the
priority.
Question 2
A 68-year-old woman with a 40-pack-year smoking history reports progressive dyspnea on
exertion and a chronic cough for 3 years. Spirometry shows FEV1/FVC = 0.62, FEV1 = 55%
predicted, with no significant bronchodilator response. Which of the following would be the most
appropriate initial pharmacotherapy according to GOLD 2025 guidelines for Group B?
A) LAMA monotherapy (e.g., tiotropium)
B) LABA/ICS combination (e.g., salmeterol/fluticasone)
C) LAMA/LABA combination (e.g., tiotropium/olodaterol)
D) PRN short-acting beta-agonist alone
Answer: A) LAMA monotherapy (e.g., tiotropium)
Explanation: GOLD 2025 classifies this patient as Group B (high symptom burden, low exacerbation
risk, FEV1 <80% predicted). Initial therapy is a single long-acting bronchodilator, with
LAMA preferred over LABA due to greater effect on exacerbation reduction.
LABA/ICS is reserved for Groups E with high eosinophils; LAMA/LABA is step-up for
persistent symptoms; PRN alone is insufficient.
Page 2
,Question 3
A 72-year-old man with a history of heart failure with reduced ejection fraction (HFrEF, EF 35%),
chronic kidney disease stage 3b (eGFR 40 mL/min/1.73m²), and type 2 diabetes is on
guideline-directed medical therapy including metoprolol succinate 200 mg daily,
sacubitril/valsartan 49/51 mg BID, and dapagliflozin 10 mg daily. He presents with fatigue and
lightheadedness. Labs: potassium 5.6 mEq/L, creatinine 1.8 mg/dL (baseline 1.5), eGFR 35. Which
medication adjustment is most appropriate?
A) Discontinue dapagliflozin and start empagliflozin
B) Reduce sacubitril/valsartan to 24/26 mg BID
C) Add furosemide 40 mg daily
D) Discontinue metoprolol succinate and start carvedilol
Answer: B) Reduce sacubitril/valsartan to 24/26 mg BID
Explanation: Hyperkalemia (K+ 5.6) with worsening renal function is a known complication of
sacubitril/valsartan (ARNI). The appropriate management is to reduce the dose or
temporarily hold it, especially with eGFR decline and K+ >5.5. Dapagliflozin does not
cause hyperkalemia; switching SGLT2i is not indicated. Adding furosemide may worsen
renal function. Switching beta-blockers is unlikely to address hyperkalemia.
Question 4
A 62-year-old woman with hypertension and osteoarthritis presents with a 2-week history of
bilateral proximal muscle weakness, difficulty rising from a chair, and a rash over her knuckles
and eyelids. Creatine kinase is 3500 U/L. Which autoantibody is most likely to be positive and
associated with an increased risk of malignancy?
A) Anti-Jo-1 antibody
B) Anti-MDA5 antibody
C) Anti-TIF1-gamma antibody
D) Anti-SRP antibody
Answer: C) Anti-TIF1-gamma antibody
Explanation: Anti-TIF1-gamma (transcriptional intermediary factor 1 gamma) antibody is strongly
associated with dermatomyositis and carries a high risk of underlying malignancy,
especially in older adults. Anti-Jo-1 is linked to antisynthetase syndrome (interstitial
lung disease). Anti-MDA5 is associated with rapidly progressive ILD. Anti-SRP is
associated with necrotizing myopathy without rash.
Page 3
, Question 5
A 58-year-old man with a history of recurrent calcium oxalate kidney stones is found to have a
24-hour urine calcium of 400 mg/day, urine oxalate 30 mg/day, and serum parathyroid hormone
(PTH) 35 pg/mL (normal 10-65). Which of the following is the most appropriate initial
pharmacotherapy to reduce stone recurrence?
A) Hydrochlorothiazide 25 mg daily
B) Allopurinol 300 mg daily
C) Potassium citrate 20 mEq BID
D) Chlorthalidone 50 mg daily
Answer: A) Hydrochlorothiazide 25 mg daily
Explanation: This patient has idiopathic hypercalciuria (urine Ca >250 mg/day) with normal PTH,
which is the most common metabolic abnormality in calcium stone formers. Thiazide
diuretics (e.g., hydrochlorothiazide) reduce urinary calcium excretion and are first-line.
Chlorthalidone is more potent but has higher risk of hypokalemia; HCTZ is preferred
initially. Allopurinol is for hyperuricosuria; potassium citrate is for hypocitraturia or
uric acid stones.
Question 6
A 65-year-old woman with hypertension and type 2 diabetes presents with a 3-day history of
painful, grouped vesicles on an erythematous base along the right T10 dermatome. Pain is
described as burning and severe. She has not had chickenpox or shingles vaccine. Which of the
following is the most appropriate antiviral regimen to reduce the risk of postherpetic neuralgia?
A) Acyclovir 800 mg orally 5 times daily for 7 days
B) Valacyclovir 1 g orally three times daily for 7 days
C) Famciclovir 500 mg orally three times daily for 7 days
D) Acyclovir 10 mg/kg IV every 8 hours for 7 days
Answer: B) Valacyclovir 1 g orally three times daily for 7 days
Explanation: Valacyclovir 1 g TID for 7 days is the preferred oral antiviral for herpes zoster in
immunocompetent adults due to superior bioavailability and convenient dosing, and it
reduces the risk of postherpetic neuralgia when started within 72 hours. Acyclovir
requires 5x daily dosing, reducing adherence. Famciclovir is also effective but
valacyclovir is often preferred. IV acyclovir is reserved for immunocompromised or
complicated cases.
Page 4
