NURS 6565: Advanced Practice Care of
Adults in Primary Care
Week 3 Assessment: QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Cardiovascular Disorders (Questions 1-15)
1. A 68-year-old male with a history of hypertension presents with a new onset
of a non-productive cough and shortness of breath on exertion. His blood
pressure is 138/88 mmHg. He is currently taking lisinopril 20 mg daily. What
is the most appropriate next step?
a) Add hydrochlorothiazide 12.5 mg daily
b) Increase lisinopril to 40 mg daily
c) Switch to losartan 50 mg daily
d) Add amlodipine 5 mg daily
Rationale: The patient is experiencing a classic side effect of ACE inhibitors
(lisinopril): a dry, non-productive cough. The most appropriate management is to
switch to an angiotensin II receptor blocker (ARB) like losartan, which has a
similar efficacy profile without the bradykinin-mediated cough.
2. Which of the following findings is most characteristic of heart failure with
preserved ejection fraction (HFpEF)?
a) Reduced left ventricular ejection fraction (LVEF) < 40%
b) Left ventricular hypertrophy on echocardiogram
c) Severe mitral valve regurgitation
d) History of a large anterior wall myocardial infarction
Rationale: HFpEF (diastolic heart failure) is often associated with left ventricular
hypertrophy, which leads to impaired ventricular relaxation and increased filling
,pressures. LVEF is normal (>50%). It is more common in older adults, particularly
those with hypertension and atrial fibrillation.
3. A 55-year-old patient with stage 2 hypertension is started on a thiazide
diuretic. Which laboratory value requires the most immediate follow-up?
a) Serum creatinine of 1.1 mg/dL
b) Serum potassium of 3.1 mEq/L
c) Fasting glucose of 110 mg/dL
d) LDL cholesterol of 130 mg/dL
Rationale: Thiazide diuretics can cause hypokalemia (low potassium) by
increasing potassium excretion in the distal tubule. A potassium level of 3.1 mEq/L
is significantly below the normal range (3.5-5.0) and increases the risk of cardiac
arrhythmias, especially in patients also taking digoxin or those with underlying
heart disease.
4. According to the 2024 ACC/AHA guidelines, what is the recommended
LDL-C goal for a 60-year-old patient with diabetes and known coronary
artery disease?
a) < 130 mg/dL
b) < 100 mg/dL
c) < 70 mg/dL
d) < 55 mg/dL
Rationale: The 2024 ACC/AHA guidelines emphasize a "lower is better" approach
for very high-risk patients. A patient with both diabetes and established
atherosclerotic cardiovascular disease (ASCVD) is considered very high-risk, with
a target LDL-C of <55 mg/dL.
5. A patient presents with acute onset of tearing, sharp chest pain radiating to
the back. Blood pressure is 190/110 mmHg in the right arm and 110/70 mmHg
in the left arm. What is the most likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Rationale: The classic presentation of aortic dissection is severe, tearing chest
pain that radiates to the back, often accompanied by a blood pressure differential
, between arms. This is a life-threatening emergency requiring immediate surgical
consultation.
6. What is the first-line pharmacologic treatment for a patient with stable
angina?
a) Amlodipine
b) Metoprolol succinate
c) Isosorbide mononitrate
d) Ranolazine
Rationale: Beta-blockers (e.g., metoprolol succinate) are first-line for stable
angina. They reduce myocardial oxygen demand by decreasing heart rate,
contractility, and blood pressure, thereby improving exercise tolerance and
reducing the frequency of anginal episodes.
7. A 72-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4
and a HAS-BLED score of 3. What is the most appropriate management?
a) Aspirin 81 mg daily
b) No anticoagulation due to high bleeding risk
c) Apixaban for stroke prevention
d) Referral for left atrial appendage closure only
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high risk of stroke, and
anticoagulation is strongly indicated. A HAS-BLED score of 3 indicates a high
bleeding risk, but this should not preclude anticoagulation. Instead, a direct oral
anticoagulant (DOAC) like apixaban is often preferred over warfarin due to a more
favorable bleeding profile in high-risk patients.
8. In the management of acute decompensated heart failure, which medication
is used for its preload-reducing effects via venodilation?
a) Nitroglycerin
b) Dobutamine
c) Furosemide
d) Dopamine
Rationale: Nitroglycerin is a potent venodilator at low doses, which reduces
preload (the volume of blood returning to the heart). This helps relieve pulmonary
congestion in acute heart failure. Dobutamine and dopamine are inotropes;
furosemide is a diuretic that reduces preload by decreasing total blood volume.
Adults in Primary Care
Week 3 Assessment: QUESTIONS AND
ANSWERS WITH RATIONALES/
GRADED A+/2026 UPDATE
/100%CORRECT
Section 1: Cardiovascular Disorders (Questions 1-15)
1. A 68-year-old male with a history of hypertension presents with a new onset
of a non-productive cough and shortness of breath on exertion. His blood
pressure is 138/88 mmHg. He is currently taking lisinopril 20 mg daily. What
is the most appropriate next step?
a) Add hydrochlorothiazide 12.5 mg daily
b) Increase lisinopril to 40 mg daily
c) Switch to losartan 50 mg daily
d) Add amlodipine 5 mg daily
Rationale: The patient is experiencing a classic side effect of ACE inhibitors
(lisinopril): a dry, non-productive cough. The most appropriate management is to
switch to an angiotensin II receptor blocker (ARB) like losartan, which has a
similar efficacy profile without the bradykinin-mediated cough.
2. Which of the following findings is most characteristic of heart failure with
preserved ejection fraction (HFpEF)?
a) Reduced left ventricular ejection fraction (LVEF) < 40%
b) Left ventricular hypertrophy on echocardiogram
c) Severe mitral valve regurgitation
d) History of a large anterior wall myocardial infarction
Rationale: HFpEF (diastolic heart failure) is often associated with left ventricular
hypertrophy, which leads to impaired ventricular relaxation and increased filling
,pressures. LVEF is normal (>50%). It is more common in older adults, particularly
those with hypertension and atrial fibrillation.
3. A 55-year-old patient with stage 2 hypertension is started on a thiazide
diuretic. Which laboratory value requires the most immediate follow-up?
a) Serum creatinine of 1.1 mg/dL
b) Serum potassium of 3.1 mEq/L
c) Fasting glucose of 110 mg/dL
d) LDL cholesterol of 130 mg/dL
Rationale: Thiazide diuretics can cause hypokalemia (low potassium) by
increasing potassium excretion in the distal tubule. A potassium level of 3.1 mEq/L
is significantly below the normal range (3.5-5.0) and increases the risk of cardiac
arrhythmias, especially in patients also taking digoxin or those with underlying
heart disease.
4. According to the 2024 ACC/AHA guidelines, what is the recommended
LDL-C goal for a 60-year-old patient with diabetes and known coronary
artery disease?
a) < 130 mg/dL
b) < 100 mg/dL
c) < 70 mg/dL
d) < 55 mg/dL
Rationale: The 2024 ACC/AHA guidelines emphasize a "lower is better" approach
for very high-risk patients. A patient with both diabetes and established
atherosclerotic cardiovascular disease (ASCVD) is considered very high-risk, with
a target LDL-C of <55 mg/dL.
5. A patient presents with acute onset of tearing, sharp chest pain radiating to
the back. Blood pressure is 190/110 mmHg in the right arm and 110/70 mmHg
in the left arm. What is the most likely diagnosis?
a) Acute myocardial infarction
b) Pulmonary embolism
c) Aortic dissection
d) Pericarditis
Rationale: The classic presentation of aortic dissection is severe, tearing chest
pain that radiates to the back, often accompanied by a blood pressure differential
, between arms. This is a life-threatening emergency requiring immediate surgical
consultation.
6. What is the first-line pharmacologic treatment for a patient with stable
angina?
a) Amlodipine
b) Metoprolol succinate
c) Isosorbide mononitrate
d) Ranolazine
Rationale: Beta-blockers (e.g., metoprolol succinate) are first-line for stable
angina. They reduce myocardial oxygen demand by decreasing heart rate,
contractility, and blood pressure, thereby improving exercise tolerance and
reducing the frequency of anginal episodes.
7. A 72-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4
and a HAS-BLED score of 3. What is the most appropriate management?
a) Aspirin 81 mg daily
b) No anticoagulation due to high bleeding risk
c) Apixaban for stroke prevention
d) Referral for left atrial appendage closure only
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high risk of stroke, and
anticoagulation is strongly indicated. A HAS-BLED score of 3 indicates a high
bleeding risk, but this should not preclude anticoagulation. Instead, a direct oral
anticoagulant (DOAC) like apixaban is often preferred over warfarin due to a more
favorable bleeding profile in high-risk patients.
8. In the management of acute decompensated heart failure, which medication
is used for its preload-reducing effects via venodilation?
a) Nitroglycerin
b) Dobutamine
c) Furosemide
d) Dopamine
Rationale: Nitroglycerin is a potent venodilator at low doses, which reduces
preload (the volume of blood returning to the heart). This helps relieve pulmonary
congestion in acute heart failure. Dobutamine and dopamine are inotropes;
furosemide is a diuretic that reduces preload by decreasing total blood volume.
