NURS 6531 Final Exam Week 11: (Latest 2026/2027
Update) Questions & Answers with Detailed
Rationales | Grade A
SUBTITLE:
50 Exam Questions with Answers & Detailed Rationales
PREPARED FOR:
NURS 6531 Practice Care of Adults - Walden University Final Exam
DOCUMENT INCLUDES:
● Exam-style questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Cardiovascular Disorders
● Respiratory Disorders
● Gastrointestinal Disorders
● Endocrine/Metabolic Disorders
● Neurological Disorders
● Musculoskeletal Disorders
● Renal/Urological Disorders
● Infectious Diseases
● Mental Health
● Pharmacology & Diagnostic Testing
● Chronic & Acute Disease Management
● Geriatric & Health Promotion Considerations
● Hematological/Immunological Disorders
● Integumentary Disorders
● Evidence-Based Practice & Professional Issues
,SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His blood pressure is 88/52 mmHg, heart rate is 110
bpm, and he appears pale and diaphoretic. The 12-lead ECG shows ST-segment
elevation in leads V1-V4. Which is the most appropriate immediate management
priority?
A. Administer sublingual nitroglycerin and schedule elective cardiac catheterization
B. Initiate fibrinolytic therapy immediately and transfer to a PCI-capable center
C. Activate the cardiac catheterization lab for primary PCI and administer aspirin,
clopidogrel, and heparin
D. Perform a chest X-ray and D-dimer to rule out pulmonary embolism before initiating
treatment
Correct Answer: C
Rationale: This patient presents with an acute anterior ST-elevation myocardial
infarction (STEMI) with cardiogenic shock (hypotension, tachycardia, diaphoresis). The
standard of care for STEMI is primary percutaneous coronary intervention (PCI) within
90 minutes of first medical contact. Aspirin (antiplatelet), clopidogrel or ticagrelor
(P2Y12 inhibitor), and unfractionated heparin are standard adjunctive therapies. Option
A is incorrect because nitroglycerin is contraindicated in hypotensive patients and
elective catheterization is inappropriate for STEMI. Option B is incorrect because
fibrinolytics are second-line when PCI cannot be performed within 120 minutes; primary
PCI is preferred. Option D is incorrect because it delays definitive treatment for a classic
STEMI presentation; PE would not present with ST elevation in anterior leads.
,Question 2
A 72-year-old female with a history of hypertension and type 2 diabetes presents with
gradually worsening dyspnea on exertion, orthopnea, and bilateral lower extremity
edema. On examination, she has an S3 gallop, jugular venous distension, and bilateral
crackles on lung auscultation. Her ejection fraction on recent echocardiogram is 35%.
Which medication combination is most appropriate for her long-term management
according to current heart failure guidelines?
A. ACE inhibitor, beta-blocker, loop diuretic, and SGLT2 inhibitor
B. Calcium channel blocker, thiazide diuretic, and digoxin
C. ACE inhibitor alone with periodic monitoring of renal function
D. Beta-blocker and non-dihydropyridine calcium channel blocker
Correct Answer: A
Rationale: This patient has HFrEF (heart failure with reduced ejection fraction) with
classic signs and symptoms. Current ACC/AHA/HFSA guidelines recommend
quadruple therapy for HFrEF: an ACE inhibitor (or ARB/ARNI), evidence-based
beta-blocker (metoprolol succinate, bisoprolol, or carvedilol), mineralocorticoid receptor
antagonist (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or
empagliflozin). A loop diuretic is used for symptomatic volume overload. Option B is
incorrect because calcium channel blockers (except amlodipine) have negative
inotropic effects and are not first-line; digoxin is reserved for symptomatic control or
atrial fibrillation. Option C is incorrect because monotherapy is insufficient. Option D is
incorrect because non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
are contraindicated in HFrEF due to negative inotropic effects.
Question 3
, A 55-year-old male with atrial fibrillation on warfarin therapy presents with a sudden
severe headache, vomiting, and altered mental status. His INR is 4.8. A non-contrast CT
scan of the head reveals an intracranial hemorrhage. Which is the most appropriate
immediate intervention?
A. Administer vitamin K 10 mg IV and fresh frozen plasma (FFP) or four-factor
prothrombin complex concentrate (PCC)
B. Discontinue warfarin and observe with serial neurological examinations
C. Administer aspirin 325 mg and clopidogrel 75 mg for neuroprotection
D. Initiate heparin infusion for anticoagulation bridge therapy
Correct Answer: A
Rationale: Warfarin-associated intracranial hemorrhage is a life-threatening emergency
requiring rapid reversal of anticoagulation. The standard approach includes vitamin K
(to sustain reversal by supporting synthesis of functional clotting factors) and either
FFP or four-factor PCC (to immediately replace vitamin K-dependent clotting factors II,
VII, IX, and X). PCC is preferred due to rapid administration and lower volume. Option B
is incorrect because observation alone is insufficient with active intracranial bleeding
and elevated INR. Option C is incorrect because antiplatelet agents would worsen
bleeding. Option D is incorrect because heparin would exacerbate hemorrhage;
anticoagulation is contraindicated in acute intracranial bleeding.
Question 4
A 45-year-old female presents with episodic palpitations, lightheadedness, and a
sensation of her heart "racing." Event monitor reveals paroxysmal supraventricular
tachycardia (PSVT) with narrow QRS complexes and a regular rhythm at 180 bpm. She
is hemodynamically stable. Which is the most appropriate initial management?
A. Immediate synchronized cardioversion at 100-200 joules
Update) Questions & Answers with Detailed
Rationales | Grade A
SUBTITLE:
50 Exam Questions with Answers & Detailed Rationales
PREPARED FOR:
NURS 6531 Practice Care of Adults - Walden University Final Exam
DOCUMENT INCLUDES:
● Exam-style questions
● Correct answers
● Detailed rationales
● Key topics covered
TOPICS COVERED:
● Cardiovascular Disorders
● Respiratory Disorders
● Gastrointestinal Disorders
● Endocrine/Metabolic Disorders
● Neurological Disorders
● Musculoskeletal Disorders
● Renal/Urological Disorders
● Infectious Diseases
● Mental Health
● Pharmacology & Diagnostic Testing
● Chronic & Acute Disease Management
● Geriatric & Health Promotion Considerations
● Hematological/Immunological Disorders
● Integumentary Disorders
● Evidence-Based Practice & Professional Issues
,SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 68-year-old male presents with crushing substernal chest pain radiating to his left
arm, diaphoresis, and nausea. His blood pressure is 88/52 mmHg, heart rate is 110
bpm, and he appears pale and diaphoretic. The 12-lead ECG shows ST-segment
elevation in leads V1-V4. Which is the most appropriate immediate management
priority?
A. Administer sublingual nitroglycerin and schedule elective cardiac catheterization
B. Initiate fibrinolytic therapy immediately and transfer to a PCI-capable center
C. Activate the cardiac catheterization lab for primary PCI and administer aspirin,
clopidogrel, and heparin
D. Perform a chest X-ray and D-dimer to rule out pulmonary embolism before initiating
treatment
Correct Answer: C
Rationale: This patient presents with an acute anterior ST-elevation myocardial
infarction (STEMI) with cardiogenic shock (hypotension, tachycardia, diaphoresis). The
standard of care for STEMI is primary percutaneous coronary intervention (PCI) within
90 minutes of first medical contact. Aspirin (antiplatelet), clopidogrel or ticagrelor
(P2Y12 inhibitor), and unfractionated heparin are standard adjunctive therapies. Option
A is incorrect because nitroglycerin is contraindicated in hypotensive patients and
elective catheterization is inappropriate for STEMI. Option B is incorrect because
fibrinolytics are second-line when PCI cannot be performed within 120 minutes; primary
PCI is preferred. Option D is incorrect because it delays definitive treatment for a classic
STEMI presentation; PE would not present with ST elevation in anterior leads.
,Question 2
A 72-year-old female with a history of hypertension and type 2 diabetes presents with
gradually worsening dyspnea on exertion, orthopnea, and bilateral lower extremity
edema. On examination, she has an S3 gallop, jugular venous distension, and bilateral
crackles on lung auscultation. Her ejection fraction on recent echocardiogram is 35%.
Which medication combination is most appropriate for her long-term management
according to current heart failure guidelines?
A. ACE inhibitor, beta-blocker, loop diuretic, and SGLT2 inhibitor
B. Calcium channel blocker, thiazide diuretic, and digoxin
C. ACE inhibitor alone with periodic monitoring of renal function
D. Beta-blocker and non-dihydropyridine calcium channel blocker
Correct Answer: A
Rationale: This patient has HFrEF (heart failure with reduced ejection fraction) with
classic signs and symptoms. Current ACC/AHA/HFSA guidelines recommend
quadruple therapy for HFrEF: an ACE inhibitor (or ARB/ARNI), evidence-based
beta-blocker (metoprolol succinate, bisoprolol, or carvedilol), mineralocorticoid receptor
antagonist (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or
empagliflozin). A loop diuretic is used for symptomatic volume overload. Option B is
incorrect because calcium channel blockers (except amlodipine) have negative
inotropic effects and are not first-line; digoxin is reserved for symptomatic control or
atrial fibrillation. Option C is incorrect because monotherapy is insufficient. Option D is
incorrect because non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
are contraindicated in HFrEF due to negative inotropic effects.
Question 3
, A 55-year-old male with atrial fibrillation on warfarin therapy presents with a sudden
severe headache, vomiting, and altered mental status. His INR is 4.8. A non-contrast CT
scan of the head reveals an intracranial hemorrhage. Which is the most appropriate
immediate intervention?
A. Administer vitamin K 10 mg IV and fresh frozen plasma (FFP) or four-factor
prothrombin complex concentrate (PCC)
B. Discontinue warfarin and observe with serial neurological examinations
C. Administer aspirin 325 mg and clopidogrel 75 mg for neuroprotection
D. Initiate heparin infusion for anticoagulation bridge therapy
Correct Answer: A
Rationale: Warfarin-associated intracranial hemorrhage is a life-threatening emergency
requiring rapid reversal of anticoagulation. The standard approach includes vitamin K
(to sustain reversal by supporting synthesis of functional clotting factors) and either
FFP or four-factor PCC (to immediately replace vitamin K-dependent clotting factors II,
VII, IX, and X). PCC is preferred due to rapid administration and lower volume. Option B
is incorrect because observation alone is insufficient with active intracranial bleeding
and elevated INR. Option C is incorrect because antiplatelet agents would worsen
bleeding. Option D is incorrect because heparin would exacerbate hemorrhage;
anticoagulation is contraindicated in acute intracranial bleeding.
Question 4
A 45-year-old female presents with episodic palpitations, lightheadedness, and a
sensation of her heart "racing." Event monitor reveals paroxysmal supraventricular
tachycardia (PSVT) with narrow QRS complexes and a regular rhythm at 180 bpm. She
is hemodynamically stable. Which is the most appropriate initial management?
A. Immediate synchronized cardioversion at 100-200 joules
