NUR 254 Exam 2 Actual Exam 2026/2027 |
Cardiovascular Respiratory Endocrine GI Renal with
Detailed Rationales | Pass Guaranteed – A+ Graded
CARDIOVASCULAR DISORDERS (12 Questions)
Q1: A 62-year-old Black male with hypertension (BP 148/88 mmHg on three visits) has
no other comorbidities. His 10-year ASCVD risk is 12%. According to ACC/AHA 2017
guidelines, which initial antihypertensive medication is MOST appropriate?
A. Lisinopril
B. Amlodipine [CORRECT]
C. Metoprolol
D. Hydrochlorothiazide
Rationale: Correct because ACC/AHA guidelines recommend CCB (amlodipine) or
thiazide diuretic as first-line for Black patients with hypertension due to lower renin
profile; ACEi/ARB are less effective as monotherapy in Black patients; beta-blockers are
not first-line for uncomplicated hypertension.
Q2: A 58-year-old female with type 2 diabetes and CKD stage 3b (eGFR 38 mL/min,
UACR 450 mg/g) has BP 142/90 mmHg on lifestyle modifications. Which
antihypertensive regimen is MOST appropriate to initiate?
A. Amlodipine monotherapy
,B. Lisinopril [CORRECT]
C. Chlorthalidone monotherapy
D. Metoprolol succinate
Rationale: Correct because ACE inhibitors (or ARBs) are first-line in diabetes with
albuminuria (>300 mg/g) due to renal protective effects and reduction of proteinuria;
they slow progression of CKD; diuretics and CCB are add-on agents but do not provide
the same renoprotection.
Q3: A 55-year-old male with hypertension has been adherent to lisinopril, amlodipine,
and chlorthalidone for 6 months. Home BP readings remain 158/96 mmHg. Labs show
potassium 3.2 mEq/L. Which is the BEST next step?
A. Switch lisinopril to losartan
B. Add metoprolol succinate
C. Add spironolactone [CORRECT]
D. Switch to hydralazine
Rationale: Correct because this is resistant hypertension (uncontrolled on 3 agents
including a diuretic); spironolactone is the most effective fourth-line agent for resistant
hypertension and will also correct hypokalemia; switching within the same class or
adding beta-blocker provides less BP reduction.
Q4: A 68-year-old male presents with BP 220/130 mmHg, headache, confusion, and
acute pulmonary edema. Which management approach is MOST appropriate for the
FIRST hour?
, A. Lower BP to <140/90 within 30 minutes
B. Reduce MAP by no more than 25% using IV nicardipine [CORRECT]
C. Administer sublingual nifedipine for rapid reduction
D. Begin oral lisinopril and discharge when stable
Rationale: Correct because hypertensive emergency requires controlled reduction; IV
nicardipine is appropriate; MAP should not drop >25% in the first hour to prevent
cerebral hypoperfusion; sublingual nifedipine causes precipitous drops and is
contraindicated; oral agents are inappropriate for emergency.
Q5: A 64-year-old male reports chest pressure with walking 2 blocks that resolves with
rest. Troponin is negative. ECG shows no ST changes. Which diagnosis is MOST likely?
A. STEMI
B. NSTEMI
C. Unstable angina
D. Stable angina [CORRECT]
Rationale: Correct because symptoms are predictable with exertion, relieved by rest, and
troponin is negative; this defines stable angina; unstable angina would be crescendo or
at rest; NSTEMI and STEMI involve elevated troponins.
Q6: A 59-year-old male has crushing substernal chest pain for 2 hours. ECG shows ST
elevation in leads II, III, and aVF. Which intervention has the STRONGEST mortality
benefit?
Cardiovascular Respiratory Endocrine GI Renal with
Detailed Rationales | Pass Guaranteed – A+ Graded
CARDIOVASCULAR DISORDERS (12 Questions)
Q1: A 62-year-old Black male with hypertension (BP 148/88 mmHg on three visits) has
no other comorbidities. His 10-year ASCVD risk is 12%. According to ACC/AHA 2017
guidelines, which initial antihypertensive medication is MOST appropriate?
A. Lisinopril
B. Amlodipine [CORRECT]
C. Metoprolol
D. Hydrochlorothiazide
Rationale: Correct because ACC/AHA guidelines recommend CCB (amlodipine) or
thiazide diuretic as first-line for Black patients with hypertension due to lower renin
profile; ACEi/ARB are less effective as monotherapy in Black patients; beta-blockers are
not first-line for uncomplicated hypertension.
Q2: A 58-year-old female with type 2 diabetes and CKD stage 3b (eGFR 38 mL/min,
UACR 450 mg/g) has BP 142/90 mmHg on lifestyle modifications. Which
antihypertensive regimen is MOST appropriate to initiate?
A. Amlodipine monotherapy
,B. Lisinopril [CORRECT]
C. Chlorthalidone monotherapy
D. Metoprolol succinate
Rationale: Correct because ACE inhibitors (or ARBs) are first-line in diabetes with
albuminuria (>300 mg/g) due to renal protective effects and reduction of proteinuria;
they slow progression of CKD; diuretics and CCB are add-on agents but do not provide
the same renoprotection.
Q3: A 55-year-old male with hypertension has been adherent to lisinopril, amlodipine,
and chlorthalidone for 6 months. Home BP readings remain 158/96 mmHg. Labs show
potassium 3.2 mEq/L. Which is the BEST next step?
A. Switch lisinopril to losartan
B. Add metoprolol succinate
C. Add spironolactone [CORRECT]
D. Switch to hydralazine
Rationale: Correct because this is resistant hypertension (uncontrolled on 3 agents
including a diuretic); spironolactone is the most effective fourth-line agent for resistant
hypertension and will also correct hypokalemia; switching within the same class or
adding beta-blocker provides less BP reduction.
Q4: A 68-year-old male presents with BP 220/130 mmHg, headache, confusion, and
acute pulmonary edema. Which management approach is MOST appropriate for the
FIRST hour?
, A. Lower BP to <140/90 within 30 minutes
B. Reduce MAP by no more than 25% using IV nicardipine [CORRECT]
C. Administer sublingual nifedipine for rapid reduction
D. Begin oral lisinopril and discharge when stable
Rationale: Correct because hypertensive emergency requires controlled reduction; IV
nicardipine is appropriate; MAP should not drop >25% in the first hour to prevent
cerebral hypoperfusion; sublingual nifedipine causes precipitous drops and is
contraindicated; oral agents are inappropriate for emergency.
Q5: A 64-year-old male reports chest pressure with walking 2 blocks that resolves with
rest. Troponin is negative. ECG shows no ST changes. Which diagnosis is MOST likely?
A. STEMI
B. NSTEMI
C. Unstable angina
D. Stable angina [CORRECT]
Rationale: Correct because symptoms are predictable with exertion, relieved by rest, and
troponin is negative; this defines stable angina; unstable angina would be crescendo or
at rest; NSTEMI and STEMI involve elevated troponins.
Q6: A 59-year-old male has crushing substernal chest pain for 2 hours. ECG shows ST
elevation in leads II, III, and aVF. Which intervention has the STRONGEST mortality
benefit?
