NRNP 6531 MIDTERM EXAM CHAMBERLAIN UNIVERSITY
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
NRNP 6531
Advanced Practice Primary Care of Adults Across the Lifespan
Midterm Exam
Question 1
A 28-year-old patient with asthma uses an albuterol inhaler approximately four
days each week and wakes with coughing twice each month. The patient currently
uses no controller medication. Lung examination is clear today. Which treatment is
most appropriate?
A. Continue albuterol as the sole therapy
B. Initiate an inhaled corticosteroid-containing controller regimen
C. Begin a long-acting beta2-agonist as monotherapy
D. Prescribe oral prednisone daily
Answer: B
Rationale: Frequent daytime symptoms and nighttime awakenings indicate that
the patient's asthma is not adequately controlled with a short-acting bronchodilator
alone. An inhaled corticosteroid-containing regimen reduces airway inflammation
and exacerbation risk. LABA monotherapy is inappropriate because LABAs
should not be used alone for asthma, and chronic systemic corticosteroids are
reserved for selected severe cases.
,Question 2
A 67-year-old patient with COPD presents with increased dyspnea, increased
sputum volume, and sputum that has become purulent over the past 3 days.
Temperature is 38.1°C (100.6°F). Oxygen saturation is 88% on room air. Which
finding most strongly supports adding an antibiotic to treatment of this
exacerbation?
A. Increased dyspnea alone
B. Increased sputum volume alone
C. Purulent sputum accompanied by increased respiratory symptoms
D. A history of cigarette smoking
Answer: C
Rationale: COPD exacerbations characterized by increased dyspnea, sputum
volume, and particularly sputum purulence are more likely to have a bacterial
component and may warrant antibiotics. Smoking history establishes COPD risk
but does not itself determine antibiotic treatment.
Question 3
A 45-year-old otherwise healthy adult presents with fever, productive cough,
pleuritic chest pain, and a respiratory rate of 20/min. Chest radiography
demonstrates a new focal infiltrate. The patient has no significant comorbidities, no
recent antibiotic exposure, and no medication allergies. Which is an appropriate
empiric outpatient treatment option?
A. Amoxicillin
B. Vancomycin
C. Meropenem
D. Oral fluconazole
Answer: A
,Rationale: For an otherwise healthy outpatient with community-acquired
pneumonia and no major comorbidities, amoxicillin is an accepted empiric option.
Broad-spectrum agents such as vancomycin or meropenem are not routinely
indicated for uncomplicated outpatient CAP.
Question 4
A 59-year-old patient with hypertension has an average home blood pressure of
148/88 mm Hg despite lifestyle modifications. The patient has no diabetes, chronic
kidney disease, or cardiovascular disease. Which approach is most appropriate?
A. Reassure the patient that the blood pressure is normal
B. Begin antihypertensive therapy in addition to continued lifestyle modification
C. Start an oral corticosteroid
D. Wait until systolic blood pressure exceeds 180 mm Hg
Answer: B
Rationale: Persistent blood pressure in this range is above the recommended
treatment threshold for many adults and warrants pharmacologic therapy together
with lifestyle interventions, depending on overall cardiovascular risk and repeated
measurements. Waiting for severe hypertension unnecessarily increases
cardiovascular risk.
Question 5
A 54-year-old Black patient has newly diagnosed hypertension. The patient does
not have CKD, diabetes, or albuminuria. Which medication class is an appropriate
initial choice?
A. Thiazide-type diuretic
B. ACE inhibitor exclusively because of race
C. Mineralocorticoid receptor antagonist
D. Loop diuretic
Answer: A
, Rationale: Thiazide-type diuretics and calcium channel blockers are effective
first-line options for Black adults with hypertension who do not have CKD with
albuminuria or another compelling indication for renin-angiotensin system
blockade. Loop diuretics and MRAs are not routine first-line choices.
Question 6
A 63-year-old patient with type 2 diabetes has an eGFR of 48 mL/min/1.73 m² and
persistent albuminuria. Blood pressure is 142/84 mm Hg. Which medication class
provides both antihypertensive and kidney-protective benefits?
A. ACE inhibitor
B. Alpha-1 blocker
C. Short-acting nitrate
D. Loop diuretic as monotherapy
Answer: A
Rationale: ACE inhibitors are particularly useful in patients with diabetes,
hypertension, and albuminuric CKD because they lower intraglomerular pressure
and reduce progression of kidney disease. An ARB is an alternative when an ACE
inhibitor is not tolerated.
Question 7
A 48-year-old patient has an LDL-C of 212 mg/dL. The patient has no known
ASCVD and has otherwise normal laboratory results. Which lipid-lowering
strategy is most appropriate?
A. Lifestyle modification alone
B. Low-intensity statin therapy
C. High-intensity statin therapy
D. Niacin monotherapy
Answer: C
ACTUAL EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
NRNP 6531
Advanced Practice Primary Care of Adults Across the Lifespan
Midterm Exam
Question 1
A 28-year-old patient with asthma uses an albuterol inhaler approximately four
days each week and wakes with coughing twice each month. The patient currently
uses no controller medication. Lung examination is clear today. Which treatment is
most appropriate?
A. Continue albuterol as the sole therapy
B. Initiate an inhaled corticosteroid-containing controller regimen
C. Begin a long-acting beta2-agonist as monotherapy
D. Prescribe oral prednisone daily
Answer: B
Rationale: Frequent daytime symptoms and nighttime awakenings indicate that
the patient's asthma is not adequately controlled with a short-acting bronchodilator
alone. An inhaled corticosteroid-containing regimen reduces airway inflammation
and exacerbation risk. LABA monotherapy is inappropriate because LABAs
should not be used alone for asthma, and chronic systemic corticosteroids are
reserved for selected severe cases.
,Question 2
A 67-year-old patient with COPD presents with increased dyspnea, increased
sputum volume, and sputum that has become purulent over the past 3 days.
Temperature is 38.1°C (100.6°F). Oxygen saturation is 88% on room air. Which
finding most strongly supports adding an antibiotic to treatment of this
exacerbation?
A. Increased dyspnea alone
B. Increased sputum volume alone
C. Purulent sputum accompanied by increased respiratory symptoms
D. A history of cigarette smoking
Answer: C
Rationale: COPD exacerbations characterized by increased dyspnea, sputum
volume, and particularly sputum purulence are more likely to have a bacterial
component and may warrant antibiotics. Smoking history establishes COPD risk
but does not itself determine antibiotic treatment.
Question 3
A 45-year-old otherwise healthy adult presents with fever, productive cough,
pleuritic chest pain, and a respiratory rate of 20/min. Chest radiography
demonstrates a new focal infiltrate. The patient has no significant comorbidities, no
recent antibiotic exposure, and no medication allergies. Which is an appropriate
empiric outpatient treatment option?
A. Amoxicillin
B. Vancomycin
C. Meropenem
D. Oral fluconazole
Answer: A
,Rationale: For an otherwise healthy outpatient with community-acquired
pneumonia and no major comorbidities, amoxicillin is an accepted empiric option.
Broad-spectrum agents such as vancomycin or meropenem are not routinely
indicated for uncomplicated outpatient CAP.
Question 4
A 59-year-old patient with hypertension has an average home blood pressure of
148/88 mm Hg despite lifestyle modifications. The patient has no diabetes, chronic
kidney disease, or cardiovascular disease. Which approach is most appropriate?
A. Reassure the patient that the blood pressure is normal
B. Begin antihypertensive therapy in addition to continued lifestyle modification
C. Start an oral corticosteroid
D. Wait until systolic blood pressure exceeds 180 mm Hg
Answer: B
Rationale: Persistent blood pressure in this range is above the recommended
treatment threshold for many adults and warrants pharmacologic therapy together
with lifestyle interventions, depending on overall cardiovascular risk and repeated
measurements. Waiting for severe hypertension unnecessarily increases
cardiovascular risk.
Question 5
A 54-year-old Black patient has newly diagnosed hypertension. The patient does
not have CKD, diabetes, or albuminuria. Which medication class is an appropriate
initial choice?
A. Thiazide-type diuretic
B. ACE inhibitor exclusively because of race
C. Mineralocorticoid receptor antagonist
D. Loop diuretic
Answer: A
, Rationale: Thiazide-type diuretics and calcium channel blockers are effective
first-line options for Black adults with hypertension who do not have CKD with
albuminuria or another compelling indication for renin-angiotensin system
blockade. Loop diuretics and MRAs are not routine first-line choices.
Question 6
A 63-year-old patient with type 2 diabetes has an eGFR of 48 mL/min/1.73 m² and
persistent albuminuria. Blood pressure is 142/84 mm Hg. Which medication class
provides both antihypertensive and kidney-protective benefits?
A. ACE inhibitor
B. Alpha-1 blocker
C. Short-acting nitrate
D. Loop diuretic as monotherapy
Answer: A
Rationale: ACE inhibitors are particularly useful in patients with diabetes,
hypertension, and albuminuric CKD because they lower intraglomerular pressure
and reduce progression of kidney disease. An ARB is an alternative when an ACE
inhibitor is not tolerated.
Question 7
A 48-year-old patient has an LDL-C of 212 mg/dL. The patient has no known
ASCVD and has otherwise normal laboratory results. Which lipid-lowering
strategy is most appropriate?
A. Lifestyle modification alone
B. Low-intensity statin therapy
C. High-intensity statin therapy
D. Niacin monotherapy
Answer: C
