NURS 6560 Final Exam
Advanced Practice Nursing – Primary Care of the Family
2026/2027 Comprehensive Edition | 100 Questions | Professor Verified
Instructions: Select the best answer for each question. Correct answers appear in bold cyan. Each question includes a detailed
evidence-based rationale.
Section Questions Points
I. Cardiovascular Conditions 1–10 10
II. Respiratory Conditions 11–18 8
III. Endocrine Conditions 19–26 8
IV. Neurological Conditions 27–33 7
V. Gastrointestinal Conditions 34–39 6
VI. Renal & Urological Conditions 40–44 5
VII. Musculoskeletal Conditions 45–49 5
VIII. Dermatological Conditions 50–54 5
IX. Psychiatric Conditions 55–59 5
X. Health Promotion & Prevention 60–67 8
XI. Diagnostic Reasoning 68–73 6
XII. Pharmacologic Management 74–78 5
XIII. Geriatric Syndromes 79–83 5
XIV. Pediatric & Adolescent Health 84–88 5
XV. Women’s & Men’s Health 89–93 5
XVI. Interprofessional Collaboration 94–100 7
TOTAL 100 Questions 100
1
,Section I: Cardiovascular Conditions
1. According to the AHA/ACC guidelines, what is the recommended blood pressure target for most adults
with hypertension?
A. <150/90 mmHg B. <130/80 mmHg
C. <140/85 mmHg D. <120/70 mmHg
Rationale: The 2017 ACC/AHA hypertension guidelines recommend a BP target of <130/80 mmHg for adults with
hypertension, including those with diabetes, chronic kidney disease, or cardiovascular disease. This target is supported by
the SPRINT trial, which demonstrated reduced cardiovascular events and mortality with intensive BP control.
2. A 55-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. The initial ECG shows ST-segment elevation in leads V1–V4. What is the most appropriate
next step?
A. Administer sublingual nitroglycerin and observe
B. Activate the catheterization laboratory for emergent percutaneous coronary intervention (PCI)
C. Prescribe oral ibuprofen for pain management
D. Order a chest X-ray and discharge if normal
Rationale: ST-segment elevation myocardial infarction (STEMI) requires emergent reperfusion therapy. PCI is the
preferred reperfusion strategy when performed within 120 minutes of first medical contact. Time is critical—door-to-
balloon time should be <90 minutes. Nitroglycerin is contraindicated in right ventricular infarction and does not replace
reperfusion.
3. Which medication class is first-line for rate control in atrial fibrillation?
A. Digoxin
B. Beta-blockers or non-dihydropyridine calcium channel blockers
C. Class IC antiarrhythmics
D. Direct thrombin inhibitors
Rationale: Beta-blockers (metoprolol, atenolol) and non-dihydropyridine CCBs (diltiazem, verapamil) are first-line agents
for rate control in atrial fibrillation per AHA/ACC/HRS guidelines. Digoxin is a second-line agent primarily for sedentary
patients or those with heart failure. Rate control targets are <110 bpm at rest (lenient) or <80 bpm (strict).
4. The CHA₂DS₂-VASc score is used to assess which of the following?
A. Risk of heart failure hospitalization
B. Stroke risk in non-valvular atrial fibrillation
C. Risk of sudden cardiac death
D. Likelihood of coronary artery disease
Rationale: CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke/TIA, Vascular disease, Age
65–74, Sex category) calculates annual stroke risk in non-valvular atrial fibrillation. A score ≥2 (men) or ≥3 (women)
warrants oral anticoagulation with a DOAC (apixaban, rivaroxaban) or warfarin.
2
, 5. A 62-year-old female with heart failure with reduced ejection fraction (HFrEF, EF 35%) is stable on
current therapy. Which medication class should be added to reduce mortality?
A. Amlodipine
B. Mineralocorticoid receptor antagonist (spironolactone)
C. Nifedipine
D. Alpha-blocker
Rationale: Spironolactone or eplerenone (MRAs) are guideline-directed medical therapy (GDMT) for HFrEF (EF ≤40%)
to reduce mortality and hospitalization. The four pillars of HFrEF GDMT include: ACEi/ARB/ARNI, beta-blocker, MRA,
and SGLT2 inhibitor. Amlodipine may be added for hypertension but does not reduce HF mortality.
6. Which finding on physical examination is most consistent with left-sided heart failure?
A. Hepatjugular reflux
B. Bilateral crackles at lung bases (pulmonary edema)
C. Lower extremity pitting edema
D. Ascites
Rationale: Left-sided heart failure causes backward transmission of pressure into the pulmonary circulation, leading to
pulmonary congestion and edema manifesting as bilateral crackles (rales) on auscultation. Hepatjugular reflux, lower
extremity edema, and ascites are signs of right-sided heart failure due to systemic venous congestion.
7. A patient on warfarin therapy has an INR of 6.2 with no bleeding. What is the appropriate management?
A. Administer vitamin K and fresh frozen plasma immediately
B. Hold warfarin and recheck INR in 24–48 hours
C. Increase the warfarin dose
D. Continue current dose and add aspirin
Rationale: For asymptomatic INR elevation (5.0–9.0) without bleeding, warfarin should be held and the INR rechecked in
24–48 hours. Vitamin K is not routinely indicated unless INR >10 or there is significant bleeding. Oral vitamin K (1–2.5
mg) may be considered for INR >10 without bleeding.
8. The ankle-brachial index (ABI) is used to screen for:
A. Deep vein thrombosis
B. Peripheral arterial disease (PAD)
C. Venous insufficiency
D. Atherosclerotic renal artery stenosis
Rationale: ABI is the ratio of systolic BP in the ankle to the brachial artery. An ABI ≤0.90 indicates PAD, values 0.91–
1.00 are borderline, and >1.40 suggests non-compressible vessels (arterial calcification). ABI screening is recommended
for patients aged 50–69 with smoking or diabetes history, and all patients ≥70.
9. A 48-year-old male presents with a BP of 165/100 mmHg, headache, and blurred vision. Funduscopic
exam reveals papilledema. The diagnosis is:
A. Stage 1 hypertension
B. Hypertensive emergency
3
Advanced Practice Nursing – Primary Care of the Family
2026/2027 Comprehensive Edition | 100 Questions | Professor Verified
Instructions: Select the best answer for each question. Correct answers appear in bold cyan. Each question includes a detailed
evidence-based rationale.
Section Questions Points
I. Cardiovascular Conditions 1–10 10
II. Respiratory Conditions 11–18 8
III. Endocrine Conditions 19–26 8
IV. Neurological Conditions 27–33 7
V. Gastrointestinal Conditions 34–39 6
VI. Renal & Urological Conditions 40–44 5
VII. Musculoskeletal Conditions 45–49 5
VIII. Dermatological Conditions 50–54 5
IX. Psychiatric Conditions 55–59 5
X. Health Promotion & Prevention 60–67 8
XI. Diagnostic Reasoning 68–73 6
XII. Pharmacologic Management 74–78 5
XIII. Geriatric Syndromes 79–83 5
XIV. Pediatric & Adolescent Health 84–88 5
XV. Women’s & Men’s Health 89–93 5
XVI. Interprofessional Collaboration 94–100 7
TOTAL 100 Questions 100
1
,Section I: Cardiovascular Conditions
1. According to the AHA/ACC guidelines, what is the recommended blood pressure target for most adults
with hypertension?
A. <150/90 mmHg B. <130/80 mmHg
C. <140/85 mmHg D. <120/70 mmHg
Rationale: The 2017 ACC/AHA hypertension guidelines recommend a BP target of <130/80 mmHg for adults with
hypertension, including those with diabetes, chronic kidney disease, or cardiovascular disease. This target is supported by
the SPRINT trial, which demonstrated reduced cardiovascular events and mortality with intensive BP control.
2. A 55-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis,
and nausea. The initial ECG shows ST-segment elevation in leads V1–V4. What is the most appropriate
next step?
A. Administer sublingual nitroglycerin and observe
B. Activate the catheterization laboratory for emergent percutaneous coronary intervention (PCI)
C. Prescribe oral ibuprofen for pain management
D. Order a chest X-ray and discharge if normal
Rationale: ST-segment elevation myocardial infarction (STEMI) requires emergent reperfusion therapy. PCI is the
preferred reperfusion strategy when performed within 120 minutes of first medical contact. Time is critical—door-to-
balloon time should be <90 minutes. Nitroglycerin is contraindicated in right ventricular infarction and does not replace
reperfusion.
3. Which medication class is first-line for rate control in atrial fibrillation?
A. Digoxin
B. Beta-blockers or non-dihydropyridine calcium channel blockers
C. Class IC antiarrhythmics
D. Direct thrombin inhibitors
Rationale: Beta-blockers (metoprolol, atenolol) and non-dihydropyridine CCBs (diltiazem, verapamil) are first-line agents
for rate control in atrial fibrillation per AHA/ACC/HRS guidelines. Digoxin is a second-line agent primarily for sedentary
patients or those with heart failure. Rate control targets are <110 bpm at rest (lenient) or <80 bpm (strict).
4. The CHA₂DS₂-VASc score is used to assess which of the following?
A. Risk of heart failure hospitalization
B. Stroke risk in non-valvular atrial fibrillation
C. Risk of sudden cardiac death
D. Likelihood of coronary artery disease
Rationale: CHA₂DS₂-VASc (Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke/TIA, Vascular disease, Age
65–74, Sex category) calculates annual stroke risk in non-valvular atrial fibrillation. A score ≥2 (men) or ≥3 (women)
warrants oral anticoagulation with a DOAC (apixaban, rivaroxaban) or warfarin.
2
, 5. A 62-year-old female with heart failure with reduced ejection fraction (HFrEF, EF 35%) is stable on
current therapy. Which medication class should be added to reduce mortality?
A. Amlodipine
B. Mineralocorticoid receptor antagonist (spironolactone)
C. Nifedipine
D. Alpha-blocker
Rationale: Spironolactone or eplerenone (MRAs) are guideline-directed medical therapy (GDMT) for HFrEF (EF ≤40%)
to reduce mortality and hospitalization. The four pillars of HFrEF GDMT include: ACEi/ARB/ARNI, beta-blocker, MRA,
and SGLT2 inhibitor. Amlodipine may be added for hypertension but does not reduce HF mortality.
6. Which finding on physical examination is most consistent with left-sided heart failure?
A. Hepatjugular reflux
B. Bilateral crackles at lung bases (pulmonary edema)
C. Lower extremity pitting edema
D. Ascites
Rationale: Left-sided heart failure causes backward transmission of pressure into the pulmonary circulation, leading to
pulmonary congestion and edema manifesting as bilateral crackles (rales) on auscultation. Hepatjugular reflux, lower
extremity edema, and ascites are signs of right-sided heart failure due to systemic venous congestion.
7. A patient on warfarin therapy has an INR of 6.2 with no bleeding. What is the appropriate management?
A. Administer vitamin K and fresh frozen plasma immediately
B. Hold warfarin and recheck INR in 24–48 hours
C. Increase the warfarin dose
D. Continue current dose and add aspirin
Rationale: For asymptomatic INR elevation (5.0–9.0) without bleeding, warfarin should be held and the INR rechecked in
24–48 hours. Vitamin K is not routinely indicated unless INR >10 or there is significant bleeding. Oral vitamin K (1–2.5
mg) may be considered for INR >10 without bleeding.
8. The ankle-brachial index (ABI) is used to screen for:
A. Deep vein thrombosis
B. Peripheral arterial disease (PAD)
C. Venous insufficiency
D. Atherosclerotic renal artery stenosis
Rationale: ABI is the ratio of systolic BP in the ankle to the brachial artery. An ABI ≤0.90 indicates PAD, values 0.91–
1.00 are borderline, and >1.40 suggests non-compressible vessels (arterial calcification). ABI screening is recommended
for patients aged 50–69 with smoking or diabetes history, and all patients ≥70.
9. A 48-year-old male presents with a BP of 165/100 mmHg, headache, and blurred vision. Funduscopic
exam reveals papilledema. The diagnosis is:
A. Stage 1 hypertension
B. Hypertensive emergency
3
