NRNP 6531 Final Exam (2026) Adult Lifespan Practice Tests Walden PDF.
SECTION 1: OPHTHALMOLOGIC EMERGENCIES (Questions 1-15)
Question 1
A 72-year-old man reports sudden onset of "flashes of light" and multiple new
floaters in his right eye. He states his vision now feels "like a curtain coming
down." He denies eye pain. What is the next best step?
A) Start topical antibiotic drops and arrange follow-up in 48 hours
B) Immediate same-day ophthalmology or emergency department evaluation
C) Reassure the patient this is an age-related change and schedule routine
optometry
D) Start oral antihistamines and advise cold compresses
Answer: B
Rationale: The combination of painless flashes, new floaters, and a "curtain/veil"
sensation is a classic red-flag presentation for retinal detachment, which requires
urgent evaluation to preserve vision. Antibiotics and allergy drops treat
conjunctival/allergic processes and do not address retinal pathology. Reassurance
delays care and risks permanent vision loss.
Question 2
,A 58-year-old presents with burning pain on her forehead followed by a new rash.
Examination shows grouped vesicles on an erythematous base in the V1
distribution extending toward her eyelid. What is the priority action?
A) Treat as allergic contact dermatitis with topical steroids
B) Prescribe oral acyclovir and schedule routine follow-up
C) Start oral antivirals and arrange same-day ophthalmology evaluation
D) Recommend cool compresses and watchful waiting
Answer: C
Rationale: Vesicles in the V1 (ophthalmic) distribution of the trigeminal nerve
indicate herpes zoster ophthalmicus, which can cause serious ocular
complications including corneal scarring and glaucoma. These patients require
urgent ophthalmologic evaluation regardless of eye symptoms at presentation.
Question 3
A 68-year-old with a 40-pack-year smoking history presents with painless vision
loss in her left eye that occurred suddenly this morning. She describes it as "a
shade being pulled down." What is the most likely diagnosis?
A) Retinal detachment
,B) Open-angle glaucoma
C) Central retinal artery occlusion
D) Macular degeneration
Answer: C
Rationale: Sudden, painless, monocular vision loss described as a "curtain" or
"shade" is classic for central retinal artery occlusion (CRAO). Risk factors include
smoking, hypertension, and carotid artery disease. This is an ocular emergency
requiring immediate evaluation to potentially salvage vision.
Question 4
A 45-year-old presents with eye redness, significant pain, photophobia, and
blurred vision for 2 days. The pupil is constricted and irregular. What is the most
likely diagnosis?
A) Conjunctivitis
B) Corneal abrasion
C) Acute anterior uveitis (iritis)
D) Subconjunctival hemorrhage
, Answer: C
Rationale: Acute anterior uveitis presents with pain, photophobia, redness (ciliary
flush), and a constricted or irregular pupil. Unlike conjunctivitis, there is no
discharge. This condition requires slit-lamp examination and ophthalmology
referral.
Question 5
A 70-year-old diabetic reports gradually worsening peripheral vision and difficulty
seeing at night. Tonometer reading is 32 mmHg. What is the most likely
diagnosis?
A) Open-angle glaucoma
B) Closed-angle glaucoma
C) Diabetic retinopathy
D) Cataract
Answer: A
Rationale: Open-angle glaucoma is asymptomatic initially, with gradual peripheral
vision loss (tunnel vision) and elevated intraocular pressure (>21 mmHg). It is the
"silent thief of sight." Angle-closure glaucoma presents acutely with pain, nausea,
and halos around lights.
SECTION 1: OPHTHALMOLOGIC EMERGENCIES (Questions 1-15)
Question 1
A 72-year-old man reports sudden onset of "flashes of light" and multiple new
floaters in his right eye. He states his vision now feels "like a curtain coming
down." He denies eye pain. What is the next best step?
A) Start topical antibiotic drops and arrange follow-up in 48 hours
B) Immediate same-day ophthalmology or emergency department evaluation
C) Reassure the patient this is an age-related change and schedule routine
optometry
D) Start oral antihistamines and advise cold compresses
Answer: B
Rationale: The combination of painless flashes, new floaters, and a "curtain/veil"
sensation is a classic red-flag presentation for retinal detachment, which requires
urgent evaluation to preserve vision. Antibiotics and allergy drops treat
conjunctival/allergic processes and do not address retinal pathology. Reassurance
delays care and risks permanent vision loss.
Question 2
,A 58-year-old presents with burning pain on her forehead followed by a new rash.
Examination shows grouped vesicles on an erythematous base in the V1
distribution extending toward her eyelid. What is the priority action?
A) Treat as allergic contact dermatitis with topical steroids
B) Prescribe oral acyclovir and schedule routine follow-up
C) Start oral antivirals and arrange same-day ophthalmology evaluation
D) Recommend cool compresses and watchful waiting
Answer: C
Rationale: Vesicles in the V1 (ophthalmic) distribution of the trigeminal nerve
indicate herpes zoster ophthalmicus, which can cause serious ocular
complications including corneal scarring and glaucoma. These patients require
urgent ophthalmologic evaluation regardless of eye symptoms at presentation.
Question 3
A 68-year-old with a 40-pack-year smoking history presents with painless vision
loss in her left eye that occurred suddenly this morning. She describes it as "a
shade being pulled down." What is the most likely diagnosis?
A) Retinal detachment
,B) Open-angle glaucoma
C) Central retinal artery occlusion
D) Macular degeneration
Answer: C
Rationale: Sudden, painless, monocular vision loss described as a "curtain" or
"shade" is classic for central retinal artery occlusion (CRAO). Risk factors include
smoking, hypertension, and carotid artery disease. This is an ocular emergency
requiring immediate evaluation to potentially salvage vision.
Question 4
A 45-year-old presents with eye redness, significant pain, photophobia, and
blurred vision for 2 days. The pupil is constricted and irregular. What is the most
likely diagnosis?
A) Conjunctivitis
B) Corneal abrasion
C) Acute anterior uveitis (iritis)
D) Subconjunctival hemorrhage
, Answer: C
Rationale: Acute anterior uveitis presents with pain, photophobia, redness (ciliary
flush), and a constricted or irregular pupil. Unlike conjunctivitis, there is no
discharge. This condition requires slit-lamp examination and ophthalmology
referral.
Question 5
A 70-year-old diabetic reports gradually worsening peripheral vision and difficulty
seeing at night. Tonometer reading is 32 mmHg. What is the most likely
diagnosis?
A) Open-angle glaucoma
B) Closed-angle glaucoma
C) Diabetic retinopathy
D) Cataract
Answer: A
Rationale: Open-angle glaucoma is asymptomatic initially, with gradual peripheral
vision loss (tunnel vision) and elevated intraocular pressure (>21 mmHg). It is the
"silent thief of sight." Angle-closure glaucoma presents acutely with pain, nausea,
and halos around lights.
