NURS 6531: ADVANCED PRACTICE
CARE OF ADULTS - COMPREHENSIVE
EXAM
1. A 55-year-old male presents with a blood pressure of 165/95 mmHg on two separate
occasions. He has no history of diabetes or chronic kidney disease. According to current JNC-8
guidelines, what is the appropriate initial management?
A. Initiate lifestyle modifications only for 6 months.
B. Start a single antihypertensive agent such as a beta-blocker.
C. Refer to cardiology for secondary hypertension workup.
D. Initiate two antihypertensive agents from different classes.
Answer: D
Conceptual Explanation: For Stage 2 hypertension (BP >160/100), guidelines
recommend initiating two agents from different classes (ACEI/ARB, CCB, or Thiazide) to
achieve goal blood pressure more effectively.
,2. A 68-year-old patient with COPD presents with increased sputum purulence and worsening
dyspnea. The patient is currently using a LAMA and SABA. What is the most appropriate next
step in pharmacological management?
A. Start a short course of oral corticosteroids and antibiotics.
B. Increase the dose of the LAMA.
C. Discontinue LAMA and start a LABA only.
D. Prescribe daily low-dose aspirin to reduce inflammation.
Answer: A
Conceptual Explanation: Increased sputum purulence and dyspnea indicate an acute
COPD exacerbation. Management typically includes bronchodilators, oral corticosteroids,
and antibiotics if signs of bacterial infection (like purulence) are present.
3. Which of the following physical exam findings is most specific for a diagnosis of Heart
Failure with Reduced Ejection Fraction (HFrEF)?
A. Bilateral pitting edema of the lower extremities.
B. Jugular venous distention (JVD).
C. Presence of a third heart sound (S3 gallop).
D. Basilar crackles on lung auscultation.
Answer: C
, Conceptual Explanation: An S3 gallop is a highly specific physical finding for ventricular
fluid overload and systolic heart failure, whereas edema and JVD can occur in other
conditions.
4. A 45-year-old female reports a history of heartburn and regurgitation for 6 months. She
has tried OTC antacids without relief. What is the gold standard for diagnosing
Gastroesophageal Reflux Disease (GERD) if symptoms persist after trial therapy?
A. Barium swallow study.
B. Abdominal ultrasound.
C. Upper Endoscopy (EGD).
D. Ambulatory pH monitoring.
Answer: D
Conceptual Explanation: While EGD is used to assess for complications like Barrett’s
esophagus, ambulatory 24-hour pH monitoring is considered the gold standard for
confirming the diagnosis of GERD by correlating symptoms with acid reflux episodes.
5. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID. Their latest
HbA1c is 8.2%. The patient has a history of atherosclerotic cardiovascular disease (ASCVD).
What is the preferred add-on therapy?
A. A Sulfonylurea such as Glipizide.
B. A GLP-1 receptor agonist with proven CVD benefit.
C. Basal insulin glargine.
CARE OF ADULTS - COMPREHENSIVE
EXAM
1. A 55-year-old male presents with a blood pressure of 165/95 mmHg on two separate
occasions. He has no history of diabetes or chronic kidney disease. According to current JNC-8
guidelines, what is the appropriate initial management?
A. Initiate lifestyle modifications only for 6 months.
B. Start a single antihypertensive agent such as a beta-blocker.
C. Refer to cardiology for secondary hypertension workup.
D. Initiate two antihypertensive agents from different classes.
Answer: D
Conceptual Explanation: For Stage 2 hypertension (BP >160/100), guidelines
recommend initiating two agents from different classes (ACEI/ARB, CCB, or Thiazide) to
achieve goal blood pressure more effectively.
,2. A 68-year-old patient with COPD presents with increased sputum purulence and worsening
dyspnea. The patient is currently using a LAMA and SABA. What is the most appropriate next
step in pharmacological management?
A. Start a short course of oral corticosteroids and antibiotics.
B. Increase the dose of the LAMA.
C. Discontinue LAMA and start a LABA only.
D. Prescribe daily low-dose aspirin to reduce inflammation.
Answer: A
Conceptual Explanation: Increased sputum purulence and dyspnea indicate an acute
COPD exacerbation. Management typically includes bronchodilators, oral corticosteroids,
and antibiotics if signs of bacterial infection (like purulence) are present.
3. Which of the following physical exam findings is most specific for a diagnosis of Heart
Failure with Reduced Ejection Fraction (HFrEF)?
A. Bilateral pitting edema of the lower extremities.
B. Jugular venous distention (JVD).
C. Presence of a third heart sound (S3 gallop).
D. Basilar crackles on lung auscultation.
Answer: C
, Conceptual Explanation: An S3 gallop is a highly specific physical finding for ventricular
fluid overload and systolic heart failure, whereas edema and JVD can occur in other
conditions.
4. A 45-year-old female reports a history of heartburn and regurgitation for 6 months. She
has tried OTC antacids without relief. What is the gold standard for diagnosing
Gastroesophageal Reflux Disease (GERD) if symptoms persist after trial therapy?
A. Barium swallow study.
B. Abdominal ultrasound.
C. Upper Endoscopy (EGD).
D. Ambulatory pH monitoring.
Answer: D
Conceptual Explanation: While EGD is used to assess for complications like Barrett’s
esophagus, ambulatory 24-hour pH monitoring is considered the gold standard for
confirming the diagnosis of GERD by correlating symptoms with acid reflux episodes.
5. A patient with Type 2 Diabetes is currently taking Metformin 1000mg BID. Their latest
HbA1c is 8.2%. The patient has a history of atherosclerotic cardiovascular disease (ASCVD).
What is the preferred add-on therapy?
A. A Sulfonylurea such as Glipizide.
B. A GLP-1 receptor agonist with proven CVD benefit.
C. Basal insulin glargine.
