Walden University NURS 6531 Final Exam (pdf) | 2026/2027 |
Primary Care Q&A | Advanced Practice Nursing
**1. A 58-year-old male with a history of hypertension and hyperlipidemia
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 in African Americans
**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. Hydralazine/isosorbide dinitrate is specifically indicated for African
American patients with HFrEF.
---
,**4. A 45-year-old male with a 20-pack-year smoking history presents with a
chronic productive cough and dyspnea on exertion. Spirometry reveals
FEV1/FVC < 0.70. Which condition should be suspected?**
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Pneumonia
D) Pulmonary fibrosis
**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. Spirometry showing FEV1/FVC < 0.70 confirms the diagnosis.
Asthma typically presents with episodic wheezing, pneumonia with acute
fever and infiltrates, and pulmonary fibrosis with restrictive pattern on
spirometry.
---
**5. Which medication class should be avoided in patients with acute or
chronic bronchitis because it will contribute to ventilation-perfusion
mismatch?**
A) Beta-blockers
B) Anticholinergics
C) Beta-2 agonists
D) Corticosteroids
**Correct Answer: A**
, **Rationale:** Beta-blockers should be avoided in patients with acute or
chronic bronchitis because they can cause bronchoconstriction and worsen
ventilation-perfusion mismatch. They are relatively contraindicated in
patients with reactive airway disease.
---
**6. A patient with elevated lipids has been started on lovastatin. After 3
weeks of therapy, he calls to report generalized muscle aches. The nurse
practitioner should suspect:**
A) A drug interaction
B) Hepatic dysfunction
C) Hypersensitivity to lovastatin
D) Rhabdomyolysis
**Correct Answer: D**
**Rationale:** Generalized muscle aches in a patient taking a statin should
raise concern for rhabdomyolysis, a serious adverse effect of statin therapy.
The CPK level should be checked, and the statin may need to be
discontinued.
---
**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?**
Primary Care Q&A | Advanced Practice Nursing
**1. A 58-year-old male with a history of hypertension and hyperlipidemia
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 in African Americans
**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. Hydralazine/isosorbide dinitrate is specifically indicated for African
American patients with HFrEF.
---
,**4. A 45-year-old male with a 20-pack-year smoking history presents with a
chronic productive cough and dyspnea on exertion. Spirometry reveals
FEV1/FVC < 0.70. Which condition should be suspected?**
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Pneumonia
D) Pulmonary fibrosis
**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. Spirometry showing FEV1/FVC < 0.70 confirms the diagnosis.
Asthma typically presents with episodic wheezing, pneumonia with acute
fever and infiltrates, and pulmonary fibrosis with restrictive pattern on
spirometry.
---
**5. Which medication class should be avoided in patients with acute or
chronic bronchitis because it will contribute to ventilation-perfusion
mismatch?**
A) Beta-blockers
B) Anticholinergics
C) Beta-2 agonists
D) Corticosteroids
**Correct Answer: A**
, **Rationale:** Beta-blockers should be avoided in patients with acute or
chronic bronchitis because they can cause bronchoconstriction and worsen
ventilation-perfusion mismatch. They are relatively contraindicated in
patients with reactive airway disease.
---
**6. A patient with elevated lipids has been started on lovastatin. After 3
weeks of therapy, he calls to report generalized muscle aches. The nurse
practitioner should suspect:**
A) A drug interaction
B) Hepatic dysfunction
C) Hypersensitivity to lovastatin
D) Rhabdomyolysis
**Correct Answer: D**
**Rationale:** Generalized muscle aches in a patient taking a statin should
raise concern for rhabdomyolysis, a serious adverse effect of statin therapy.
The CPK level should be checked, and the statin may need to be
discontinued.
---
**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?**
