NURS 6531 Midterm & Final Exam Study
Guide 2026/2027
Section 1: Cardiovascular Disorders (Questions 1-15)
1. A 55-year-old male with hypertension presents for a routine check. His BP today is 142/88
mmHg. According to JNC 8 guidelines, what is the first-line pharmacologic therapy?
A. Thiazide diuretic
B. ACE Inhibitor
C. Beta-blocker
D. Calcium channel blocker
Answer: A
*Rationale: For the general non-black population, including those with diabetes, JNC 8
recommends thiazide diuretics, ACEIs, ARBs, or CCBs as initial therapy. Thiazides are a classic,
evidence-based first choice for uncomplicated hypertension.*
2. A patient with atrial fibrillation (CHADS2VA2Sc score of 3) requires anticoagulation. They
have a history of GI bleed 5 years ago. Which agent is most appropriate?
A. Warfarin
B. Apixaban
C. Aspirin
D. Clopidogrel
Answer: B
*Rationale: With a CHA2DS2-VASc score of 3, anticoagulation is indicated. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for stroke prevention in non-
valvular AFib, offering similar efficacy with lower risk of intracranial hemorrhage. A remote GI
bleed requires caution but is not an absolute contraindication; DOACs may still be used with
close monitoring.*
3. The classic triad of symptoms for heart failure is:
A. Chest pain, palpitations, syncope
B. Dyspnea, fatigue, fluid retention (edema)
C. Cough, fever, night sweats
D. Nausea, diaphoresis, jaw pain
Answer: B
,Rationale: Dyspnea (often exertional or orthopnea), fatigue/weakness, and fluid overload
(peripheral edema, pulmonary rales) are the hallmark symptoms of congestive heart failure.
4. A patient presents with sudden onset of "tearing" back pain and a blood pressure
difference of >20 mmHg between arms. You suspect:
A. Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Pancreatitis
Answer: B
Rationale: Sudden, severe tearing/ripping pain (often in chest/back) with pulse or blood pressure
differential between limbs is highly suggestive of aortic dissection, a medical emergency.
5. First-line therapy for stable angina typically includes:
A. Nitroglycerin (PRN) and a statin
B. Beta-blocker and aspirin
C. Calcium channel blocker and sublingual nitroglycerin
D. ACE inhibitor and clopidogrel
Answer: B
Rationale: First-line pharmacologic management for stable ischemic heart disease includes
antiplatelet therapy (aspirin) and anti-anginal therapy (beta-blockers to reduce myocardial
oxygen demand). Sublingual nitroglycerin is for acute relief.
Section 2: Respiratory Disorders (Questions 16-30)
6. The diagnostic gold standard for COPD is:
A. Chest X-ray
B. Spirometry (post-bronchodilator FEV1/FVC < 0.70)
C. Clinical history of smoking
D. Arterial Blood Gas
Answer: B
*Rationale: Spirometry showing a post-bronchodilator fixed ratio of FEV1/FVC < 0.70 is required
for the diagnosis of COPD, distinguishing it from asthma.*
7. A 25-year-old with no history presents with acute dyspnea, pleuritic chest pain, and
tachycardia. Wells Criteria suggest moderate probability for PE. Next best step?
A. D-dimer
B. CT Pulmonary Angiography
C. Start therapeutic enoxaparin
,D. V/Q Scan
Answer: A
Rationale: In a patient with a low or moderate pre-test probability for PE, a high-sensitivity D-
dimer is the appropriate initial test. If negative, PE can be ruled out. CTPA is typically reserved
for positive D-dimer or high pre-test probability.
8. First-line long-term controller medication for persistent asthma in an adult is:
A. Short-acting beta-agonist (SABA) PRN
B. Inhaled corticosteroid (ICS)
C. Oral corticosteroid burst
D. Leukotriene receptor antagonist (LTRA)
Answer: B
Rationale: According to GINA guidelines, low-dose inhaled corticosteroids (ICS) are the preferred
first-line controller therapy for persistent asthma to reduce inflammation and prevent
exacerbations.
9. A "walking pneumonia" typical of Mycoplasma pneumoniae is best treated with:
A. Amoxicillin
B. Doxycycline or a macrolide
C. Levofloxacin
D. Vancomycin
Answer: B
Rationale: Atypical pneumonias (Mycoplasma, Chlamydia pneumoniae) lack a cell wall, making
beta-lactams like amoxicillin ineffective. First-line treatment is a macrolide (azithromycin) or
tetracycline (doxycycline).
10. A key distinguishing feature between viral and bacterial sinusitis is:
A. Duration of symptoms <10 days without worsening suggests viral
B. Green nasal discharge confirms bacterial infection
C. Fever is only present in bacterial cases
D. Facial pain is pathognomonic for bacterial sinusitis
Answer: A
*Rationale: The IDSA guidelines recommend diagnosing acute bacterial rhinosinusitis when
symptoms persist for ≥10 days without improvement, or worsen after an initial improvement
("double-worsening"). Symptoms <10 days are likely viral.*
Section 3: Endocrine & Metabolic Disorders (Questions 31-45)
, 11. Diagnostic criteria for Diabetes Mellitus Type 2 includes:
A. Fasting plasma glucose ≥126 mg/dL on two occasions
B. Random glucose >140 mg/dL
C. HbA1c of 6.2%
D. Presence of polyuria and polydipsia
Answer: A
*Rationale: Diagnosis requires one of four criteria: 1) FPG ≥126 mg/dL, 2) 2-hr plasma glucose
≥200 mg/dL during OGTT, 3) HbA1c ≥6.5%, or 4) Random glucose ≥200 mg/dL in a patient with
classic symptoms. Option A is a standard laboratory criterion.*
12. First-line pharmacotherapy for Type 2 Diabetes in a patient without cardiovascular disease
is:
A. Metformin
B. Insulin glargine
C. Empagliflozin
D. Sitagliptin
Answer: A
*Rationale: Metformin remains the first-line initial oral medication for most patients with Type 2
DM, due to efficacy, minimal hypoglycemia, potential weight benefit, and low cost.*
13. A patient with fatigue, weight gain, cold intolerance, and a TSH of 25 mIU/L (normal 0.4-
4.5) should be started on:
A. Liothyronine (T3)
B. Levothyroxine (T4)
C. Methimazole
D. Observation only
Answer: B
*Rationale: Elevated TSH with classic symptoms indicates primary hypothyroidism.
Levothyroxine (synthetic T4) is the standard replacement therapy, started at low doses (e.g., 1.6
mcg/kg/day, often 25-50 mcg) and titrated based on TSH.*
14. The most common cause of hyperthyroidism is:
A. Toxic multinodular goiter
B. Graves' disease
C. Thyroiditis
D. Solitary toxic adenoma
Answer: B
*Rationale: Graves' disease, an autoimmune disorder, accounts for 60-80% of all cases of
hyperthyroidism.*
Guide 2026/2027
Section 1: Cardiovascular Disorders (Questions 1-15)
1. A 55-year-old male with hypertension presents for a routine check. His BP today is 142/88
mmHg. According to JNC 8 guidelines, what is the first-line pharmacologic therapy?
A. Thiazide diuretic
B. ACE Inhibitor
C. Beta-blocker
D. Calcium channel blocker
Answer: A
*Rationale: For the general non-black population, including those with diabetes, JNC 8
recommends thiazide diuretics, ACEIs, ARBs, or CCBs as initial therapy. Thiazides are a classic,
evidence-based first choice for uncomplicated hypertension.*
2. A patient with atrial fibrillation (CHADS2VA2Sc score of 3) requires anticoagulation. They
have a history of GI bleed 5 years ago. Which agent is most appropriate?
A. Warfarin
B. Apixaban
C. Aspirin
D. Clopidogrel
Answer: B
*Rationale: With a CHA2DS2-VASc score of 3, anticoagulation is indicated. Direct oral
anticoagulants (DOACs) like apixaban are preferred over warfarin for stroke prevention in non-
valvular AFib, offering similar efficacy with lower risk of intracranial hemorrhage. A remote GI
bleed requires caution but is not an absolute contraindication; DOACs may still be used with
close monitoring.*
3. The classic triad of symptoms for heart failure is:
A. Chest pain, palpitations, syncope
B. Dyspnea, fatigue, fluid retention (edema)
C. Cough, fever, night sweats
D. Nausea, diaphoresis, jaw pain
Answer: B
,Rationale: Dyspnea (often exertional or orthopnea), fatigue/weakness, and fluid overload
(peripheral edema, pulmonary rales) are the hallmark symptoms of congestive heart failure.
4. A patient presents with sudden onset of "tearing" back pain and a blood pressure
difference of >20 mmHg between arms. You suspect:
A. Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Pancreatitis
Answer: B
Rationale: Sudden, severe tearing/ripping pain (often in chest/back) with pulse or blood pressure
differential between limbs is highly suggestive of aortic dissection, a medical emergency.
5. First-line therapy for stable angina typically includes:
A. Nitroglycerin (PRN) and a statin
B. Beta-blocker and aspirin
C. Calcium channel blocker and sublingual nitroglycerin
D. ACE inhibitor and clopidogrel
Answer: B
Rationale: First-line pharmacologic management for stable ischemic heart disease includes
antiplatelet therapy (aspirin) and anti-anginal therapy (beta-blockers to reduce myocardial
oxygen demand). Sublingual nitroglycerin is for acute relief.
Section 2: Respiratory Disorders (Questions 16-30)
6. The diagnostic gold standard for COPD is:
A. Chest X-ray
B. Spirometry (post-bronchodilator FEV1/FVC < 0.70)
C. Clinical history of smoking
D. Arterial Blood Gas
Answer: B
*Rationale: Spirometry showing a post-bronchodilator fixed ratio of FEV1/FVC < 0.70 is required
for the diagnosis of COPD, distinguishing it from asthma.*
7. A 25-year-old with no history presents with acute dyspnea, pleuritic chest pain, and
tachycardia. Wells Criteria suggest moderate probability for PE. Next best step?
A. D-dimer
B. CT Pulmonary Angiography
C. Start therapeutic enoxaparin
,D. V/Q Scan
Answer: A
Rationale: In a patient with a low or moderate pre-test probability for PE, a high-sensitivity D-
dimer is the appropriate initial test. If negative, PE can be ruled out. CTPA is typically reserved
for positive D-dimer or high pre-test probability.
8. First-line long-term controller medication for persistent asthma in an adult is:
A. Short-acting beta-agonist (SABA) PRN
B. Inhaled corticosteroid (ICS)
C. Oral corticosteroid burst
D. Leukotriene receptor antagonist (LTRA)
Answer: B
Rationale: According to GINA guidelines, low-dose inhaled corticosteroids (ICS) are the preferred
first-line controller therapy for persistent asthma to reduce inflammation and prevent
exacerbations.
9. A "walking pneumonia" typical of Mycoplasma pneumoniae is best treated with:
A. Amoxicillin
B. Doxycycline or a macrolide
C. Levofloxacin
D. Vancomycin
Answer: B
Rationale: Atypical pneumonias (Mycoplasma, Chlamydia pneumoniae) lack a cell wall, making
beta-lactams like amoxicillin ineffective. First-line treatment is a macrolide (azithromycin) or
tetracycline (doxycycline).
10. A key distinguishing feature between viral and bacterial sinusitis is:
A. Duration of symptoms <10 days without worsening suggests viral
B. Green nasal discharge confirms bacterial infection
C. Fever is only present in bacterial cases
D. Facial pain is pathognomonic for bacterial sinusitis
Answer: A
*Rationale: The IDSA guidelines recommend diagnosing acute bacterial rhinosinusitis when
symptoms persist for ≥10 days without improvement, or worsen after an initial improvement
("double-worsening"). Symptoms <10 days are likely viral.*
Section 3: Endocrine & Metabolic Disorders (Questions 31-45)
, 11. Diagnostic criteria for Diabetes Mellitus Type 2 includes:
A. Fasting plasma glucose ≥126 mg/dL on two occasions
B. Random glucose >140 mg/dL
C. HbA1c of 6.2%
D. Presence of polyuria and polydipsia
Answer: A
*Rationale: Diagnosis requires one of four criteria: 1) FPG ≥126 mg/dL, 2) 2-hr plasma glucose
≥200 mg/dL during OGTT, 3) HbA1c ≥6.5%, or 4) Random glucose ≥200 mg/dL in a patient with
classic symptoms. Option A is a standard laboratory criterion.*
12. First-line pharmacotherapy for Type 2 Diabetes in a patient without cardiovascular disease
is:
A. Metformin
B. Insulin glargine
C. Empagliflozin
D. Sitagliptin
Answer: A
*Rationale: Metformin remains the first-line initial oral medication for most patients with Type 2
DM, due to efficacy, minimal hypoglycemia, potential weight benefit, and low cost.*
13. A patient with fatigue, weight gain, cold intolerance, and a TSH of 25 mIU/L (normal 0.4-
4.5) should be started on:
A. Liothyronine (T3)
B. Levothyroxine (T4)
C. Methimazole
D. Observation only
Answer: B
*Rationale: Elevated TSH with classic symptoms indicates primary hypothyroidism.
Levothyroxine (synthetic T4) is the standard replacement therapy, started at low doses (e.g., 1.6
mcg/kg/day, often 25-50 mcg) and titrated based on TSH.*
14. The most common cause of hyperthyroidism is:
A. Toxic multinodular goiter
B. Graves' disease
C. Thyroiditis
D. Solitary toxic adenoma
Answer: B
*Rationale: Graves' disease, an autoimmune disorder, accounts for 60-80% of all cases of
hyperthyroidism.*
