NRNP 6560 Final Exam (Version-1, 100 Q
and A, Latest-2024) / NRNP6560 Final
Exam: Walden University
Section 1: Cardiology & Critical Care
1. A patient presents with an acute myocardial infarction, shortness of breath,
coarse rales, and a grade V/VI systolic murmur loudest at the PMI with radiation
to the midaxillary line. The AGACNP recognizes this as:
• A) Acute mitral valve regurgitation
• B) Acute aortic valve regurgitation
• C) Acute cardiac tamponade
• D) Acute pulmonary embolus
Answer: A
Rationale: Acute mitral valve regurgitation presents with fatigue, dyspnea,
palpitations, and a systolic murmur loudest at the apex (PMI) with radiation to the
axilla. The murmur is often grade III/VI or higher and may be accompanied by
rales from pulmonary congestion .
2. Cardiogenic shock is characterized by which hemodynamic pattern?
• A) High cardiac index, low SVR, low PCWP
• B) Low cardiac index, high SVR, high PCWP
• C) High cardiac index, high SVR, low PCWP
• D) Low cardiac index, low SVR, high PCWP
Answer: B
Rationale: Cardiogenic shock is defined by low cardiac index (<2.2 L/min/m²),
,elevated SVR (compensatory vasoconstriction), and elevated PCWP (>15 mmHg)
due to left ventricular failure .
3. Which medication is NOT indicated for bradyarrhythmia in a post-heart
transplant patient?
• A) Isoproterenol 0.2–0.6 mg IV bolus
• B) External pacemaking
• C) Atropine 0.5 mg IV
• D) Epinephrine 1 mg IV
Answer: C
Rationale: Atropine is ineffective in denervated transplanted hearts because the
heart is no longer under vagal control. Isoproterenol, epinephrine, and external
pacing are appropriate interventions .
4. For a patient with symptomatic aortic regurgitation who has progressed to
activity intolerance, weight gain, and edema, the most appropriate management
is:
• A) Serial echocardiography every 6 months
• B) Begin a calcium channel antagonist
• C) Begin an ACE inhibitor
• D) Surgical consultation and intervention
Answer: D
Rationale: Symptomatic aortic regurgitation with signs of heart failure indicates
declining left ventricular function. Valve replacement surgery is indicated .
,5. A patient has been on warfarin for atrial fibrillation and presents with an INR
of 5.2. The AGACNP should:
• A) Hold warfarin and give vitamin K
• B) Continue warfarin and recheck INR
• C) Hold warfarin and recheck INR in 24 hours
• D) Give fresh frozen plasma immediately
Answer: C
Rationale: For an INR between 5–9 without bleeding, holding the warfarin dose
and rechecking INR is the standard approach. Vitamin K is indicated for higher
INRs or active bleeding .
Section 2: Pulmonary & Shock
6. In a patient with a pulmonary embolism, which cardiac pressure finding is
expected?
• A) Low right ventricular pressure
• B) Elevated pulmonary artery pressure
• C) Low pulmonary capillary wedge pressure
• D) Decreased central venous pressure
Answer: B
Rationale: Pulmonary embolism increases pulmonary vascular resistance, leading
to elevated pulmonary artery pressure and right ventricular strain .
7. A patient with neurogenic shock following spinal cord injury is most likely to
present with:
• A) Tachycardia and hypertension
• B) Bradycardia and hypotension
, • C) Tachycardia and hypotension
• D) Normal heart rate and hypotension
Answer: B
Rationale: Neurogenic shock results from loss of sympathetic tone, causing
bradycardia and hypotension due to unopposed vagal tone. This differs from
hypovolemic or septic shock .
8. A patient with distributive septic shock would demonstrate:
• A) Low cardiac index, high SVR, high PCWP
• B) High cardiac index, low SVR, low PCWP
• C) Low cardiac index, low SVR, high PCWP
• D) High cardiac index, high SVR, low PCWP
Answer: B
Rationale: Septic shock is a distributive shock characterized by high cardiac
output, low systemic vascular resistance (SVR), and normal/low pulmonary
capillary wedge pressure (PCWP) from vasodilation .
9. A positive TB skin test requires treatment in which of the following scenarios?
• A) Recent contact with a TB patient
• B) Induration of 5 mm in an HIV-positive patient
• C) Induration of 10 mm in a patient with no risk factors
• D) Positive test in a patient who previously had BCG vaccine
Answer: B
Rationale: In immunocompromised patients (HIV-positive), an induration of ≥5
mm is considered positive and requires treatment. For the general population
with no risk factors, ≥15 mm is the threshold .
and A, Latest-2024) / NRNP6560 Final
Exam: Walden University
Section 1: Cardiology & Critical Care
1. A patient presents with an acute myocardial infarction, shortness of breath,
coarse rales, and a grade V/VI systolic murmur loudest at the PMI with radiation
to the midaxillary line. The AGACNP recognizes this as:
• A) Acute mitral valve regurgitation
• B) Acute aortic valve regurgitation
• C) Acute cardiac tamponade
• D) Acute pulmonary embolus
Answer: A
Rationale: Acute mitral valve regurgitation presents with fatigue, dyspnea,
palpitations, and a systolic murmur loudest at the apex (PMI) with radiation to the
axilla. The murmur is often grade III/VI or higher and may be accompanied by
rales from pulmonary congestion .
2. Cardiogenic shock is characterized by which hemodynamic pattern?
• A) High cardiac index, low SVR, low PCWP
• B) Low cardiac index, high SVR, high PCWP
• C) High cardiac index, high SVR, low PCWP
• D) Low cardiac index, low SVR, high PCWP
Answer: B
Rationale: Cardiogenic shock is defined by low cardiac index (<2.2 L/min/m²),
,elevated SVR (compensatory vasoconstriction), and elevated PCWP (>15 mmHg)
due to left ventricular failure .
3. Which medication is NOT indicated for bradyarrhythmia in a post-heart
transplant patient?
• A) Isoproterenol 0.2–0.6 mg IV bolus
• B) External pacemaking
• C) Atropine 0.5 mg IV
• D) Epinephrine 1 mg IV
Answer: C
Rationale: Atropine is ineffective in denervated transplanted hearts because the
heart is no longer under vagal control. Isoproterenol, epinephrine, and external
pacing are appropriate interventions .
4. For a patient with symptomatic aortic regurgitation who has progressed to
activity intolerance, weight gain, and edema, the most appropriate management
is:
• A) Serial echocardiography every 6 months
• B) Begin a calcium channel antagonist
• C) Begin an ACE inhibitor
• D) Surgical consultation and intervention
Answer: D
Rationale: Symptomatic aortic regurgitation with signs of heart failure indicates
declining left ventricular function. Valve replacement surgery is indicated .
,5. A patient has been on warfarin for atrial fibrillation and presents with an INR
of 5.2. The AGACNP should:
• A) Hold warfarin and give vitamin K
• B) Continue warfarin and recheck INR
• C) Hold warfarin and recheck INR in 24 hours
• D) Give fresh frozen plasma immediately
Answer: C
Rationale: For an INR between 5–9 without bleeding, holding the warfarin dose
and rechecking INR is the standard approach. Vitamin K is indicated for higher
INRs or active bleeding .
Section 2: Pulmonary & Shock
6. In a patient with a pulmonary embolism, which cardiac pressure finding is
expected?
• A) Low right ventricular pressure
• B) Elevated pulmonary artery pressure
• C) Low pulmonary capillary wedge pressure
• D) Decreased central venous pressure
Answer: B
Rationale: Pulmonary embolism increases pulmonary vascular resistance, leading
to elevated pulmonary artery pressure and right ventricular strain .
7. A patient with neurogenic shock following spinal cord injury is most likely to
present with:
• A) Tachycardia and hypertension
• B) Bradycardia and hypotension
, • C) Tachycardia and hypotension
• D) Normal heart rate and hypotension
Answer: B
Rationale: Neurogenic shock results from loss of sympathetic tone, causing
bradycardia and hypotension due to unopposed vagal tone. This differs from
hypovolemic or septic shock .
8. A patient with distributive septic shock would demonstrate:
• A) Low cardiac index, high SVR, high PCWP
• B) High cardiac index, low SVR, low PCWP
• C) Low cardiac index, low SVR, high PCWP
• D) High cardiac index, high SVR, low PCWP
Answer: B
Rationale: Septic shock is a distributive shock characterized by high cardiac
output, low systemic vascular resistance (SVR), and normal/low pulmonary
capillary wedge pressure (PCWP) from vasodilation .
9. A positive TB skin test requires treatment in which of the following scenarios?
• A) Recent contact with a TB patient
• B) Induration of 5 mm in an HIV-positive patient
• C) Induration of 10 mm in a patient with no risk factors
• D) Positive test in a patient who previously had BCG vaccine
Answer: B
Rationale: In immunocompromised patients (HIV-positive), an induration of ≥5
mm is considered positive and requires treatment. For the general population
with no risk factors, ≥15 mm is the threshold .
