Walden NRNP 6531 Primary Care of Adults
Final Exam Official Practice Exam Actual
Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
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SECTION 1: CARDIOVASCULAR & RESPIRATORY PRIMARY CARE Q1 – Q10
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Question 1 of 50
58-year-old male presents with progressive dyspnea on exertion and bilateral lower extremity
A
edema. An echocardiogram reveals a left ventricular ejection fraction of 30%. He is currently
taking lisinopril 20 mg daily. Based on current guideline-directed medical therapy for HFrEF, the
most appropriate next step in management is to add which medication?
. Amlodipine 5 mg daily
A
B. Sacubitril/valsartan 24/26 mg twice daily ✓ CORRECT
C. Hydrochlorothiazide 25 mg daily
D. Digoxin 0.125 mg daily
orrect Answer: B
C
Rationale: Sacubitril/valsartan is an ARNI recommended by ACC/AHA guidelines as a first-line
replacement for ACE inhibitors or ARBs in HFrEF to reduce morbidity and mortality. Amlodipine
does not improve mortality in heart failure, and adding it instead of an ARNI is a common
management error. Always transition stable HFrEF patients from an ACE inhibitor to an ARNI
unless contraindicated.
Question 2 of 50
65-year-old female presents to the clinic with acute onset of severe substernal chest pain
A
radiating to her left arm, lasting 40 minutes. Her ECG shows ST-segment elevations in leads II,
III, and aVF. The most critical immediate action is to:
. Administer a GI cocktail to rule out esophageal spasm
A
B. Order a troponin test and wait for results before deciding
C. Start a heparin drip and schedule a stress test for the next day
,D. Activate the cardiac catheterization lab for emergent reperfusion therapy ✓ CORRECT
orrect Answer: D
C
Rationale: ST-elevation myocardial infarction (STEMI) requires immediate reperfusion, with
primary percutaneous coronary intervention being the gold standard, ideally within 90 minutes of
first medical contact. Waiting for troponin results delays life-saving reperfusion and is a
dangerous trap in acute coronary syndrome management. Time is myocardium; door-to-balloon
time is the critical metric.
Question 3 of 50
52-year-old African American male with no past medical history presents for a routine
A
checkup. His blood pressure is 152/98 mmHg on two separate occasions. According to the
ACC/AHA guidelines, the most appropriate initial pharmacologic therapy is:
. Lisinopril 10 mg daily
A
B. Valsartan 160 mg daily
C. Amlodipine 5 mg daily ✓ CORRECT
D. Metoprolol succinate 50 mg daily
orrect Answer: C
C
Rationale: In African American patients without heart failure or chronic kidney disease, calcium
channel blockers or thiazide diuretics are recommended as initial therapy due to their superior
efficacy in this population. ACE inhibitors and ARBs are less effective monotherapy for
hypertension in African American patients and carry a higher risk of angioedema. Know the
race-specific guidelines for initial hypertensive management.
Question 4 of 50
68-year-old male with a 40-pack-year smoking history presents with chronic dyspnea and a
A
chronic productive cough. Spirometry shows an FEV1/FVC ratio of 0.60 and a
post-bronchodilator FEV1 of 55% predicted. He has had two moderate exacerbations in the past
year requiring oral steroids. The most appropriate initial maintenance therapy is:
. Inhaled corticosteroid alone
A
B. Short-acting beta-agonist alone
C. Long-acting muscarinic antagonist alone
D. Long-acting beta-agonist and long-acting muscarinic antagonist ✓ CORRECT
orrect Answer: D
C
Rationale: This patient has COPD GOLD Stage 3 with a high exacerbation risk, warranting dual
bronchodilation with a LABA/LAMA as first-line maintenance therapy. Starting an inhaled
corticosteroid alone is inappropriate in COPD without a concurrent long-acting bronchodilator
, nd is reserved for patients with eosinophilic phenotypes. Dual bronchodilation improves lung
a
function and reduces exacerbation rates better than monotherapy.
Question 5 of 50
22-year-old female with a history of asthma presents with daytime symptoms three times a
A
week and nighttime awakenings once a week. She is not currently taking any controller
medications. Her FEV1 is 85% predicted. According to the GINA stepwise approach, the most
appropriate initial treatment is:
. Low-dose inhaled corticosteroid ✓ CORRECT
A
B. Medium-dose inhaled corticosteroid
C. Low-dose inhaled corticosteroid plus a long-acting beta-agonist
D. Leukotriene receptor antagonist alone
orrect Answer: A
C
Rationale: This patient has mild persistent asthma (Step 2), which is appropriately treated with a
daily low-dose inhaled corticosteroid, the most effective controller medication. Starting a
medium-dose ICS or ICS/LABA is excessive for initial therapy, and leukotriene receptor
antagonists are less effective than ICS as monotherapy. Always start with the lowest effective
dose of ICS to minimize side effects.
Question 6 of 50
45-year-old female presents with acute onset dyspnea, pleuritic chest pain, and right lower
A
extremity swelling two weeks after a knee arthroscopy. Her Wells score is 7.5. The most
appropriate next step in management is to:
. Order a D-dimer
A
B. Start a direct oral anticoagulant
C. Obtain a CT pulmonary angiogram ✓ CORRECT
D. Administer low-dose aspirin
orrect Answer: C
C
Rationale: A Wells score > 4 indicates a high probability of pulmonary embolism, making a
D-dimer unhelpful as a negative result cannot rule out PE in this clinical context. The next step
is definitive imaging with a CT pulmonary angiogram. Starting a DOAC without imaging is
premature, and aspirin is not a treatment for venous thromboembolism. In high-probability PE,
skip the D-dimer and go straight to imaging.
Question 7 of 50
Final Exam Official Practice Exam Actual
Exam 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | Pass
Guaranteed – A+ Graded
═════════════════════════════════════
═
SECTION 1: CARDIOVASCULAR & RESPIRATORY PRIMARY CARE Q1 – Q10
══════════════════════════════════════
Question 1 of 50
58-year-old male presents with progressive dyspnea on exertion and bilateral lower extremity
A
edema. An echocardiogram reveals a left ventricular ejection fraction of 30%. He is currently
taking lisinopril 20 mg daily. Based on current guideline-directed medical therapy for HFrEF, the
most appropriate next step in management is to add which medication?
. Amlodipine 5 mg daily
A
B. Sacubitril/valsartan 24/26 mg twice daily ✓ CORRECT
C. Hydrochlorothiazide 25 mg daily
D. Digoxin 0.125 mg daily
orrect Answer: B
C
Rationale: Sacubitril/valsartan is an ARNI recommended by ACC/AHA guidelines as a first-line
replacement for ACE inhibitors or ARBs in HFrEF to reduce morbidity and mortality. Amlodipine
does not improve mortality in heart failure, and adding it instead of an ARNI is a common
management error. Always transition stable HFrEF patients from an ACE inhibitor to an ARNI
unless contraindicated.
Question 2 of 50
65-year-old female presents to the clinic with acute onset of severe substernal chest pain
A
radiating to her left arm, lasting 40 minutes. Her ECG shows ST-segment elevations in leads II,
III, and aVF. The most critical immediate action is to:
. Administer a GI cocktail to rule out esophageal spasm
A
B. Order a troponin test and wait for results before deciding
C. Start a heparin drip and schedule a stress test for the next day
,D. Activate the cardiac catheterization lab for emergent reperfusion therapy ✓ CORRECT
orrect Answer: D
C
Rationale: ST-elevation myocardial infarction (STEMI) requires immediate reperfusion, with
primary percutaneous coronary intervention being the gold standard, ideally within 90 minutes of
first medical contact. Waiting for troponin results delays life-saving reperfusion and is a
dangerous trap in acute coronary syndrome management. Time is myocardium; door-to-balloon
time is the critical metric.
Question 3 of 50
52-year-old African American male with no past medical history presents for a routine
A
checkup. His blood pressure is 152/98 mmHg on two separate occasions. According to the
ACC/AHA guidelines, the most appropriate initial pharmacologic therapy is:
. Lisinopril 10 mg daily
A
B. Valsartan 160 mg daily
C. Amlodipine 5 mg daily ✓ CORRECT
D. Metoprolol succinate 50 mg daily
orrect Answer: C
C
Rationale: In African American patients without heart failure or chronic kidney disease, calcium
channel blockers or thiazide diuretics are recommended as initial therapy due to their superior
efficacy in this population. ACE inhibitors and ARBs are less effective monotherapy for
hypertension in African American patients and carry a higher risk of angioedema. Know the
race-specific guidelines for initial hypertensive management.
Question 4 of 50
68-year-old male with a 40-pack-year smoking history presents with chronic dyspnea and a
A
chronic productive cough. Spirometry shows an FEV1/FVC ratio of 0.60 and a
post-bronchodilator FEV1 of 55% predicted. He has had two moderate exacerbations in the past
year requiring oral steroids. The most appropriate initial maintenance therapy is:
. Inhaled corticosteroid alone
A
B. Short-acting beta-agonist alone
C. Long-acting muscarinic antagonist alone
D. Long-acting beta-agonist and long-acting muscarinic antagonist ✓ CORRECT
orrect Answer: D
C
Rationale: This patient has COPD GOLD Stage 3 with a high exacerbation risk, warranting dual
bronchodilation with a LABA/LAMA as first-line maintenance therapy. Starting an inhaled
corticosteroid alone is inappropriate in COPD without a concurrent long-acting bronchodilator
, nd is reserved for patients with eosinophilic phenotypes. Dual bronchodilation improves lung
a
function and reduces exacerbation rates better than monotherapy.
Question 5 of 50
22-year-old female with a history of asthma presents with daytime symptoms three times a
A
week and nighttime awakenings once a week. She is not currently taking any controller
medications. Her FEV1 is 85% predicted. According to the GINA stepwise approach, the most
appropriate initial treatment is:
. Low-dose inhaled corticosteroid ✓ CORRECT
A
B. Medium-dose inhaled corticosteroid
C. Low-dose inhaled corticosteroid plus a long-acting beta-agonist
D. Leukotriene receptor antagonist alone
orrect Answer: A
C
Rationale: This patient has mild persistent asthma (Step 2), which is appropriately treated with a
daily low-dose inhaled corticosteroid, the most effective controller medication. Starting a
medium-dose ICS or ICS/LABA is excessive for initial therapy, and leukotriene receptor
antagonists are less effective than ICS as monotherapy. Always start with the lowest effective
dose of ICS to minimize side effects.
Question 6 of 50
45-year-old female presents with acute onset dyspnea, pleuritic chest pain, and right lower
A
extremity swelling two weeks after a knee arthroscopy. Her Wells score is 7.5. The most
appropriate next step in management is to:
. Order a D-dimer
A
B. Start a direct oral anticoagulant
C. Obtain a CT pulmonary angiogram ✓ CORRECT
D. Administer low-dose aspirin
orrect Answer: C
C
Rationale: A Wells score > 4 indicates a high probability of pulmonary embolism, making a
D-dimer unhelpful as a negative result cannot rule out PE in this clinical context. The next step
is definitive imaging with a CT pulmonary angiogram. Starting a DOAC without imaging is
premature, and aspirin is not a treatment for venous thromboembolism. In high-probability PE,
skip the D-dimer and go straight to imaging.
Question 7 of 50
