Walden University NURS 6531 Midterm Exam (pdf) | 2026/2027 |
Primary Care Q&A | Advanced Practice Nursing
**1. A 58-year-old male with a history of hypertension presents with
substernal chest pressure radiating to his left jaw that occurs with exertion
and resolves with rest. What is the most likely diagnosis?**
A) Acute myocardial infarction
B) Stable angina pectoris
C) Unstable angina
D) Pericarditis
**Correct Answer: B**
**Rationale:** Stable angina is characterized by chest discomfort that occurs
predictably with exertion or emotional stress and is relieved by rest or
nitroglycerin. The symptoms are reproducible and stable over time. Acute MI
presents with prolonged pain not relieved by rest, unstable angina occurs at
rest or with increasing frequency, and pericarditis pain is often sharp and
positional.
---
**2. Which medication is first-line therapy for stable angina?**
A) Aspirin
B) Nitroglycerin
C) Beta-blocker
D) Calcium channel blocker
,**Correct Answer: C**
**Rationale:** Beta-blockers are first-line therapy for stable angina because
they decrease myocardial oxygen demand by reducing heart rate and
contractility. Nitroglycerin is used for acute symptom relief, aspirin is for
secondary prevention, and calcium channel blockers are alternative or
adjunctive therapy.
---
**3. A patient with heart failure with reduced ejection fraction (HFrEF) should
be prescribed which medication(s) for mortality benefit? (Select all that
apply)**
A) Beta-blocker (carvedilol, metoprolol succinate)
B) ACE inhibitor or ARB
C) Loop diuretic
D) Hydralazine/isosorbide dinitrate
**Correct Answer: A, B, D**
**Rationale:** Guideline-directed medical therapy (GDMT) for HFrEF includes
beta-blockers (carvedilol, metoprolol succinate, bisoprolol), ACE
inhibitors/ARBs/ARNIs, aldosterone antagonists, and SGLT2 inhibitors. Loop
diuretics are used for symptom management but do not provide mortality
benefit.
---
,**4. Which of the following are non-modifiable risk factors for cardiovascular
disease? (Select all that apply)**
A) Age
B) Gender
C) Hypertension
D) Family history
**Correct Answer: A, B, D**
**Rationale:** Age, gender, and family history are non-modifiable risk
factors. Hypertension, hyperlipidemia, smoking, diabetes, obesity, and
sedentary lifestyle are modifiable risk factors.
---
**5. A 45-year-old male with a 20-pack-year smoking history presents with a
chronic productive cough and dyspnea on exertion. Which condition should
be suspected?**
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Pneumonia
D) Pulmonary embolism
**Correct Answer: B**
**Rationale:** COPD should be suspected in patients with a significant
smoking history who present with chronic productive cough and dyspnea on
, exertion. Asthma typically presents with episodic wheezing, pneumonia with
acute fever and infiltrates, and pulmonary embolism with acute dyspnea and
chest pain.
---
**6. What is the most common cancer found on the auricle?**
A) Actinic keratosis
B) Basal cell carcinoma
C) Squamous cell carcinoma
D) Melanoma
**Correct Answer: B**
**Rationale:** Basal cell carcinoma is the most common cancer found on the
auricle. It is the most common type of skin cancer overall and typically
appears as a pearly nodule on sun-exposed areas.
---
**7. Before initiating an HMG CoA-reductase inhibitor (statin) for
hyperlipidemia, the nurse practitioner orders liver function studies. The
patient's aminotransferase (ALT) is elevated. What laboratory test(s) should
be ordered?**
A) Serologic markers for hepatitis
B) Serum bilirubin
C) Serum cholesterol with HDL and LDL
Primary Care Q&A | Advanced Practice Nursing
**1. A 58-year-old male with a history of hypertension presents with
substernal chest pressure radiating to his left jaw that occurs with exertion
and resolves with rest. What is the most likely diagnosis?**
A) Acute myocardial infarction
B) Stable angina pectoris
C) Unstable angina
D) Pericarditis
**Correct Answer: B**
**Rationale:** Stable angina is characterized by chest discomfort that occurs
predictably with exertion or emotional stress and is relieved by rest or
nitroglycerin. The symptoms are reproducible and stable over time. Acute MI
presents with prolonged pain not relieved by rest, unstable angina occurs at
rest or with increasing frequency, and pericarditis pain is often sharp and
positional.
---
**2. Which medication is first-line therapy for stable angina?**
A) Aspirin
B) Nitroglycerin
C) Beta-blocker
D) Calcium channel blocker
,**Correct Answer: C**
**Rationale:** Beta-blockers are first-line therapy for stable angina because
they decrease myocardial oxygen demand by reducing heart rate and
contractility. Nitroglycerin is used for acute symptom relief, aspirin is for
secondary prevention, and calcium channel blockers are alternative or
adjunctive therapy.
---
**3. A patient with heart failure with reduced ejection fraction (HFrEF) should
be prescribed which medication(s) for mortality benefit? (Select all that
apply)**
A) Beta-blocker (carvedilol, metoprolol succinate)
B) ACE inhibitor or ARB
C) Loop diuretic
D) Hydralazine/isosorbide dinitrate
**Correct Answer: A, B, D**
**Rationale:** Guideline-directed medical therapy (GDMT) for HFrEF includes
beta-blockers (carvedilol, metoprolol succinate, bisoprolol), ACE
inhibitors/ARBs/ARNIs, aldosterone antagonists, and SGLT2 inhibitors. Loop
diuretics are used for symptom management but do not provide mortality
benefit.
---
,**4. Which of the following are non-modifiable risk factors for cardiovascular
disease? (Select all that apply)**
A) Age
B) Gender
C) Hypertension
D) Family history
**Correct Answer: A, B, D**
**Rationale:** Age, gender, and family history are non-modifiable risk
factors. Hypertension, hyperlipidemia, smoking, diabetes, obesity, and
sedentary lifestyle are modifiable risk factors.
---
**5. A 45-year-old male with a 20-pack-year smoking history presents with a
chronic productive cough and dyspnea on exertion. Which condition should
be suspected?**
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Pneumonia
D) Pulmonary embolism
**Correct Answer: B**
**Rationale:** COPD should be suspected in patients with a significant
smoking history who present with chronic productive cough and dyspnea on
, exertion. Asthma typically presents with episodic wheezing, pneumonia with
acute fever and infiltrates, and pulmonary embolism with acute dyspnea and
chest pain.
---
**6. What is the most common cancer found on the auricle?**
A) Actinic keratosis
B) Basal cell carcinoma
C) Squamous cell carcinoma
D) Melanoma
**Correct Answer: B**
**Rationale:** Basal cell carcinoma is the most common cancer found on the
auricle. It is the most common type of skin cancer overall and typically
appears as a pearly nodule on sun-exposed areas.
---
**7. Before initiating an HMG CoA-reductase inhibitor (statin) for
hyperlipidemia, the nurse practitioner orders liver function studies. The
patient's aminotransferase (ALT) is elevated. What laboratory test(s) should
be ordered?**
A) Serologic markers for hepatitis
B) Serum bilirubin
C) Serum cholesterol with HDL and LDL
