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MSN 624 ADVANCED PRIMARY CARE CORE – ORIGINAL
PRACTICE EXAM (160) BANK WITH VERIFIED ANSWERS &
DETAILED CLINICAL RATIONALES (NP REVIEW)
Nursing
Exam summary :
• Section 1 (Q1-30): Cardiovascular Disorders & Pharmacology
• Section 2 (Q31-50): Respiratory & Pulmonary Disorders
• Section 3 (Q51-80): Endocrine & Metabolic Disorders
• Section 4 (Q81-105): Gastrointestinal & Hepatic Disorders
• Section 5 (Q106-125): Infectious Diseases & Immunology
• Section 6 (Q126-140): Renal & Genitourinary Disorders
• Section 7 (Q141-160): Neurologic & Psychiatric Disorders
Questions :
Section 1: Cardiovascular Disorders & Pharmacology
(Questions 1-30)
Sources: MSN 624 Core Exam Blueprint; hypertension and lipid
management guidelines.
1. A 72-year-old male with a history of hypertension and type 2
diabetes presents with complaints of dizziness and near-
syncope when standing from a seated position. His blood
pressure drops from 145/88 mmHg supine to 105/65 mmHg
after standing for three minutes. Which medication class is
most likely contributing to his symptoms?
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A) Calcium channel blockers
B) Thiazide diuretics
C) Alpha-blockers
D) ACE inhibitors
CORRECT: C
RATIONALE: Alpha-blockers such as doxazosin and terazosin
cause significant orthostatic hypotension by blocking alpha-1
receptors in the peripheral vasculature, reducing peripheral
vascular resistance and impairing compensatory
vasoconstriction upon standing. This effect is more pronounced
in elderly patients and those on multiple antihypertensive
agents .
2. A 58-year-old female with obesity and hypertension presents
with a blood pressure of 158/96 mmHg on two separate
occasions. Laboratory studies show creatinine 1.2 mg/dL,
potassium 4.1 mEq/L, and urinalysis with proteinuria 2+. Which
antihypertensive agent is most appropriate as initial therapy?
, Page 3 of 126
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Metoprolol
CORRECT: B
RATIONALE: ACE inhibitors like lisinopril are preferred initial
therapy in patients with hypertension and proteinuria due to
their renoprotective effects through reduction of intraglomerular
pressure. They slow progression of kidney disease in diabetic
and nondiabetic patients with proteinuria. Monitoring of
potassium and creatinine is essential .
3. Which medication class is considered first-line treatment for
hypertension according to JNC8 guidelines?
A) Thiazide diuretics only
B) Calcium channel blockers only
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C) ACE inhibitors only
D) Thiazide diuretics, CCBs, ACE inhibitors, or ARBs
CORRECT: D
RATIONALE: First-line treatment for hypertension includes
thiazide diuretics, calcium channel blockers, ACE inhibitors, or
ARBs. The choice depends on patient-specific factors such as
age, race, and comorbidities .
4. A 50-year-old male with hypertension and hyperlipidemia
presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the
right arm and 120/70 mmHg in the left arm. Which imaging
study is most appropriate for diagnosis?
A) Chest X-ray
B) Transthoracic echocardiography
C) CT angiography of the chest
D) Magnetic resonance angiography
MSN 624 ADVANCED PRIMARY CARE CORE – ORIGINAL
PRACTICE EXAM (160) BANK WITH VERIFIED ANSWERS &
DETAILED CLINICAL RATIONALES (NP REVIEW)
Nursing
Exam summary :
• Section 1 (Q1-30): Cardiovascular Disorders & Pharmacology
• Section 2 (Q31-50): Respiratory & Pulmonary Disorders
• Section 3 (Q51-80): Endocrine & Metabolic Disorders
• Section 4 (Q81-105): Gastrointestinal & Hepatic Disorders
• Section 5 (Q106-125): Infectious Diseases & Immunology
• Section 6 (Q126-140): Renal & Genitourinary Disorders
• Section 7 (Q141-160): Neurologic & Psychiatric Disorders
Questions :
Section 1: Cardiovascular Disorders & Pharmacology
(Questions 1-30)
Sources: MSN 624 Core Exam Blueprint; hypertension and lipid
management guidelines.
1. A 72-year-old male with a history of hypertension and type 2
diabetes presents with complaints of dizziness and near-
syncope when standing from a seated position. His blood
pressure drops from 145/88 mmHg supine to 105/65 mmHg
after standing for three minutes. Which medication class is
most likely contributing to his symptoms?
, Page 2 of 126
A) Calcium channel blockers
B) Thiazide diuretics
C) Alpha-blockers
D) ACE inhibitors
CORRECT: C
RATIONALE: Alpha-blockers such as doxazosin and terazosin
cause significant orthostatic hypotension by blocking alpha-1
receptors in the peripheral vasculature, reducing peripheral
vascular resistance and impairing compensatory
vasoconstriction upon standing. This effect is more pronounced
in elderly patients and those on multiple antihypertensive
agents .
2. A 58-year-old female with obesity and hypertension presents
with a blood pressure of 158/96 mmHg on two separate
occasions. Laboratory studies show creatinine 1.2 mg/dL,
potassium 4.1 mEq/L, and urinalysis with proteinuria 2+. Which
antihypertensive agent is most appropriate as initial therapy?
, Page 3 of 126
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Metoprolol
CORRECT: B
RATIONALE: ACE inhibitors like lisinopril are preferred initial
therapy in patients with hypertension and proteinuria due to
their renoprotective effects through reduction of intraglomerular
pressure. They slow progression of kidney disease in diabetic
and nondiabetic patients with proteinuria. Monitoring of
potassium and creatinine is essential .
3. Which medication class is considered first-line treatment for
hypertension according to JNC8 guidelines?
A) Thiazide diuretics only
B) Calcium channel blockers only
, Page 4 of 126
C) ACE inhibitors only
D) Thiazide diuretics, CCBs, ACE inhibitors, or ARBs
CORRECT: D
RATIONALE: First-line treatment for hypertension includes
thiazide diuretics, calcium channel blockers, ACE inhibitors, or
ARBs. The choice depends on patient-specific factors such as
age, race, and comorbidities .
4. A 50-year-old male with hypertension and hyperlipidemia
presents with sudden onset of severe, tearing chest pain
radiating to the back. Blood pressure is 180/100 mmHg in the
right arm and 120/70 mmHg in the left arm. Which imaging
study is most appropriate for diagnosis?
A) Chest X-ray
B) Transthoracic echocardiography
C) CT angiography of the chest
D) Magnetic resonance angiography
