,NRNP 6540 Advanced Practice Care of
Older Adults Exam Prep —
Comprehensive Review + Practice
MCQs — Walden University 2025/2026
1. A 72-year-old patient presents with newly diagnosed stage 2 hypertension (BP 162/98) and has type 2
diabetes. Which class of antihypertensive medication provides the greatest dual benefit for this patient?
A. Thiazide diuretics
B. ACE inhibitors
C. Beta-blockers
D. Alpha-blockers
Correct Answer: B. ACE inhibitors
Rationale: ACE inhibitors are first-line therapy in older adults with hypertension and comorbid diabetes
because they provide renoprotective effects by reducing intraglomerular pressure and slowing progression of
diabetic nephropathy. While thiazides are effective antihypertensives, they do not offer the same renal
protection. Beta-blockers and alpha-blockers are not preferred first-line agents in uncomplicated hypertension
with diabetes.
2. An 80-year-old patient with heart failure with reduced ejection fraction (HFrEF) is being optimized on
guideline-directed medical therapy. Which combination represents the most appropriate regimen?
A. Verapamil, digoxin, and furosemide
B. ACE inhibitor (or ARNI), evidence-based beta-blocker, and mineralocorticoid receptor antagonist
,C. Amlodipine, hydralazine, and isosorbide dinitrate
D. Diltiazem, aspirin, and statin
Correct Answer: B. ACE inhibitor (or ARNI), evidence-based beta-blocker, and mineralocorticoid receptor
antagonist
Rationale: Guideline-directed medical therapy for HFrEF includes a renin-angiotensin system inhibitor (ACE
inhibitor, ARB, or ARNI), an evidence-based beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), and a
mineralocorticoid receptor antagonist (spironolactone or eplerenone). Non-dihydropyridine calcium channel
blockers like verapamil and diltiazem are contraindicated in HFrEF as they can worsen systolic function.
3. An older adult patient on lisinopril for hypertension returns for follow-up. Which laboratory changes most
warrant clinical attention after initiating therapy?
A. Falling potassium and glucose
B. Rising serum potassium and creatinine
C. Falling white blood cell count
D. Rising hemoglobin and hematocrit
Correct Answer: B. Rising serum potassium and creatinine
Rationale: ACE inhibitors can cause hyperkalemia and elevations in serum creatinine due to their effects on the
renin-angiotensin-aldosterone system. Both parameters should be monitored after initiation and dose
adjustments. ACE inhibitors do not characteristically cause leukopenia or significant changes in hemoglobin.
4. A 78-year-old patient with HFrEF reports a 4-pound weight gain over 2 days with increasing dyspnea and
lower extremity edema. What is the most appropriate initial intervention?
, A. Increase the beta-blocker dose
B. Add a calcium channel blocker
C. Contact the provider for possible diuretic adjustment
D. Restrict fluids to 500 mL per day without provider notification
Correct Answer: C. Contact the provider for possible diuretic adjustment
Rationale: Rapid weight gain with worsening dyspnea and edema in a patient with HFrEF suggests fluid
overload and possible acute decompensation. The most appropriate initial action is to notify the provider for
evaluation and possible diuretic adjustment. Increasing beta-blocker or adding a calcium channel blocker
would not address volume overload and could worsen the condition. Fluid restriction without provider
guidance is not appropriate as an independent intervention.
5. Which beta-blocker has demonstrated mortality benefit in heart failure with reduced ejection fraction?
A. Propranolol
B. Atenolol
C. Carvedilol
D. Sotalol
Correct Answer: C. Carvedilol
Rationale: Carvedilol, along with metoprolol succinate and bisoprolol, has been proven in clinical trials to
reduce mortality in patients with HFrEF. Propranolol, atenolol, and sotalol have not demonstrated this
mortality benefit and are not preferred agents for HFrEF management.
Older Adults Exam Prep —
Comprehensive Review + Practice
MCQs — Walden University 2025/2026
1. A 72-year-old patient presents with newly diagnosed stage 2 hypertension (BP 162/98) and has type 2
diabetes. Which class of antihypertensive medication provides the greatest dual benefit for this patient?
A. Thiazide diuretics
B. ACE inhibitors
C. Beta-blockers
D. Alpha-blockers
Correct Answer: B. ACE inhibitors
Rationale: ACE inhibitors are first-line therapy in older adults with hypertension and comorbid diabetes
because they provide renoprotective effects by reducing intraglomerular pressure and slowing progression of
diabetic nephropathy. While thiazides are effective antihypertensives, they do not offer the same renal
protection. Beta-blockers and alpha-blockers are not preferred first-line agents in uncomplicated hypertension
with diabetes.
2. An 80-year-old patient with heart failure with reduced ejection fraction (HFrEF) is being optimized on
guideline-directed medical therapy. Which combination represents the most appropriate regimen?
A. Verapamil, digoxin, and furosemide
B. ACE inhibitor (or ARNI), evidence-based beta-blocker, and mineralocorticoid receptor antagonist
,C. Amlodipine, hydralazine, and isosorbide dinitrate
D. Diltiazem, aspirin, and statin
Correct Answer: B. ACE inhibitor (or ARNI), evidence-based beta-blocker, and mineralocorticoid receptor
antagonist
Rationale: Guideline-directed medical therapy for HFrEF includes a renin-angiotensin system inhibitor (ACE
inhibitor, ARB, or ARNI), an evidence-based beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), and a
mineralocorticoid receptor antagonist (spironolactone or eplerenone). Non-dihydropyridine calcium channel
blockers like verapamil and diltiazem are contraindicated in HFrEF as they can worsen systolic function.
3. An older adult patient on lisinopril for hypertension returns for follow-up. Which laboratory changes most
warrant clinical attention after initiating therapy?
A. Falling potassium and glucose
B. Rising serum potassium and creatinine
C. Falling white blood cell count
D. Rising hemoglobin and hematocrit
Correct Answer: B. Rising serum potassium and creatinine
Rationale: ACE inhibitors can cause hyperkalemia and elevations in serum creatinine due to their effects on the
renin-angiotensin-aldosterone system. Both parameters should be monitored after initiation and dose
adjustments. ACE inhibitors do not characteristically cause leukopenia or significant changes in hemoglobin.
4. A 78-year-old patient with HFrEF reports a 4-pound weight gain over 2 days with increasing dyspnea and
lower extremity edema. What is the most appropriate initial intervention?
, A. Increase the beta-blocker dose
B. Add a calcium channel blocker
C. Contact the provider for possible diuretic adjustment
D. Restrict fluids to 500 mL per day without provider notification
Correct Answer: C. Contact the provider for possible diuretic adjustment
Rationale: Rapid weight gain with worsening dyspnea and edema in a patient with HFrEF suggests fluid
overload and possible acute decompensation. The most appropriate initial action is to notify the provider for
evaluation and possible diuretic adjustment. Increasing beta-blocker or adding a calcium channel blocker
would not address volume overload and could worsen the condition. Fluid restriction without provider
guidance is not appropriate as an independent intervention.
5. Which beta-blocker has demonstrated mortality benefit in heart failure with reduced ejection fraction?
A. Propranolol
B. Atenolol
C. Carvedilol
D. Sotalol
Correct Answer: C. Carvedilol
Rationale: Carvedilol, along with metoprolol succinate and bisoprolol, has been proven in clinical trials to
reduce mortality in patients with HFrEF. Propranolol, atenolol, and sotalol have not demonstrated this
mortality benefit and are not preferred agents for HFrEF management.
