1
Walden University NURS 6531 Final Exam
Bundle Spring 2025/2026 | Actual Exam
Questions | Version 1 & 2 with 200 Evidence-
Based Items | Advanced Practice Nursing |
Pass Guarantee
VERSION 1 (100 QUESTIONS)
A. MULTIPLE-CHOICE – 75 items (pathophysiology, diagnostics, chronic
disease, geriatrics, ethics, systems)
1. A 58-year-old man with T2DM (A1c 9.2 %, eGFR 44 mL/min/1.73 m²) is
taking metformin 1000 mg BID. Which action is MOST appropriate?
A. Increase metformin to 1500 mg BID
B. Switch to empagliflozin 10 mg daily
C. Add once-daily NPH insulin
D. Stop metformin and start dulaglutide 0.75 mg weekly
Answer: D. Metformin is contraindicated when eGFR <45; GLP-1 RA
(dulaglutide) gives cardio-renal benefit and lowers A1c 1–1.5 %. (ADA
2025)
2. A 72-year-old woman presents with 2 weeks of temporal headache, jaw
claudication, and ESR 92 mm/h. BP 168/92, funduscopic exam normal. Next
best step?
A. Start high-dose ibuprofen
B. Order temporal artery ultrasound
C. Initiate prednisone 60 mg daily immediately
D. Schedule outpatient neurology in 1 week
Answer: C. Clinical temporal arteritis = start steroids at once to prevent
blindness; biopsy within 2 weeks. (ACR 2025)
3. A 60-year-old former smoker presents with exertional dyspnea, FEV₁ 58 %,
FEV₁/FVC 0.63. Which inhaler combo is FIRST-LINE?
, 2
A. LABA/ICS
B. LAMA
C. LABA/LAMA
D. SABA PRN only
Answer: B. GOLD 2025 group B (dyspnea, low risk) = start LAMA.
4. A 69-year-old man on warfarin (INR 2.8) needs screening colonoscopy.
Polyp removal likely. Which plan is correct?
A. Stop warfarin 5 days, no bridging
B. Bridge with enoxaparin 1 mg/kg BID
C. Continue warfarin and perform polypectomy
D. Switch to DOAC for 1 week
Answer: A. Low thrombotic risk (CHADS-VASc 2) → no bridging safer.
(ACCP 2025)
5. A 55-year-old woman has 3-month history of anovulatory cycles and BMI
34. Endometrial biopsy shows simple hyperplasia. Management?
A. Combined OCP × 3 months
B. Levonorgestrel IUD
C. Total hysterectomy
D. Observation
Answer: B. ACOG 2025: LNG-IUD >90 % regression, less systemic
progestin.
6. A 63-year-old man with HTN reports new erectile dysfunction. Which
antihypertensive is MOST likely causative?
A. Amlodipine
B. Hydrochlorothiazide
C. Lisinopril
D. Losartan
Answer: B. Thiazides strongly linked; others neutral or may improve. (AHA
2025)
7. A 48-year-old woman has fatigue, TSH 8.2 mIU/L (normal free T4). She is
trying to conceive. Plan?
, 3
A. Repeat TSH in 6 months
B. Start levothyroxine 25 mcg daily
C. Start levothyroxine 50 mcg daily aiming TSH <2.5
D. Refer to endocrinology only
Answer: C. Subclinical hypothyroidism + fertility goal → treat to TSH <2.5.
(ATA 2025)
8. A 75-year-old woman has frequent falls, no orthostasis, normal neuro exam.
Vitamin D level 18 ng/mL. Prescribe:
A. Vitamin D₃ 400 IU daily
B. Vitamin D₂ 50,000 IU weekly × 6 then recheck
C. Calcitriol 0.25 mcg daily
D. No supplementation
Answer: B. Deficiency <20: high-dose ergocalciferol. (Endocrine Soc 2025)
9. A 66-year-old man has Stage 3 CKD (eGFR 35) and new-onset gout flare.
BEST acute treatment?
A. Indomethacin 50 mg TID
B. Colchicine 0.6 mg BID × 1 dose
C. Prednisone 40 mg daily × 3 days
D. Febuxostat 40 mg
Answer: C. Steroids safest in CKD; NSAIDs & colchicine toxicity risk.
(ACR 2025)
10.A 54-year-old woman with MS on fingolimod presents with 3-day
progressive dyspnea and bilateral crackles. HR 102, BP 96/60. NT-proBNP
3200 pg/mL. Most likely etiology?
A. Relapse-induced respiratory failure
B. Fingolimod-related cardiomyopathy
C. Community-acquired pneumonia
D. Pulmonary embolism
Answer: B. Drug label warning for first-dose bradycardia & long-term HF.
(FDA 2025)
, 4
11.A 70-year-old woman has iron-deficiency anemia (Hb 9.8 g/dL, ferritin 6
ng/mL, hemoccult negative). Next step?
A. Oral iron × 3 months
B. IV iron weekly
C. EGD/colonoscopy
D. Start ESA injection
Answer: C. Post-menopausal: rule out GI malignancy. (AGA 2025)
12.A 59-year-old man has stable angina despite maximal guideline-directed
therapy. Coronary CT shows 65 % mid-LAD stenosis, FFR 0.76. Plan?
A. Add ranolazine
B. PCI with DES
C. CABG referral
D. Continue meds only
Answer: B. FFR ≤0.80 → PCI improves prognosis. (ACC 2025)
13.A 68-year-old woman with RA on methotrexate 20 mg weekly has low-
grade fever, dry cough, and CXR bibasilar infiltrates. Most urgent test?
A. Sputum culture
B. High-resolution CT
C. LDH
D. Pneumocystis PCR
Answer: D. Methotrexate → cellular immunity; PJP possible. (IDSA 2025)
14.A 52-year-old man with HTN, BMI 31, has 10-year ASCVD risk 6.8 %.
Statin decision?
A. No statin (<7.5 %)
B. Moderate-intensity statin
C. High-intensity statin
D. Coronary calcium score first
Answer: B. 2025 ACC expert decision pathway: risk 5–20 % → moderate
statin.
15.A 64-year-old man with COPD GOLD D is hospitalized for exacerbation.
Discharge inhalers?
Walden University NURS 6531 Final Exam
Bundle Spring 2025/2026 | Actual Exam
Questions | Version 1 & 2 with 200 Evidence-
Based Items | Advanced Practice Nursing |
Pass Guarantee
VERSION 1 (100 QUESTIONS)
A. MULTIPLE-CHOICE – 75 items (pathophysiology, diagnostics, chronic
disease, geriatrics, ethics, systems)
1. A 58-year-old man with T2DM (A1c 9.2 %, eGFR 44 mL/min/1.73 m²) is
taking metformin 1000 mg BID. Which action is MOST appropriate?
A. Increase metformin to 1500 mg BID
B. Switch to empagliflozin 10 mg daily
C. Add once-daily NPH insulin
D. Stop metformin and start dulaglutide 0.75 mg weekly
Answer: D. Metformin is contraindicated when eGFR <45; GLP-1 RA
(dulaglutide) gives cardio-renal benefit and lowers A1c 1–1.5 %. (ADA
2025)
2. A 72-year-old woman presents with 2 weeks of temporal headache, jaw
claudication, and ESR 92 mm/h. BP 168/92, funduscopic exam normal. Next
best step?
A. Start high-dose ibuprofen
B. Order temporal artery ultrasound
C. Initiate prednisone 60 mg daily immediately
D. Schedule outpatient neurology in 1 week
Answer: C. Clinical temporal arteritis = start steroids at once to prevent
blindness; biopsy within 2 weeks. (ACR 2025)
3. A 60-year-old former smoker presents with exertional dyspnea, FEV₁ 58 %,
FEV₁/FVC 0.63. Which inhaler combo is FIRST-LINE?
, 2
A. LABA/ICS
B. LAMA
C. LABA/LAMA
D. SABA PRN only
Answer: B. GOLD 2025 group B (dyspnea, low risk) = start LAMA.
4. A 69-year-old man on warfarin (INR 2.8) needs screening colonoscopy.
Polyp removal likely. Which plan is correct?
A. Stop warfarin 5 days, no bridging
B. Bridge with enoxaparin 1 mg/kg BID
C. Continue warfarin and perform polypectomy
D. Switch to DOAC for 1 week
Answer: A. Low thrombotic risk (CHADS-VASc 2) → no bridging safer.
(ACCP 2025)
5. A 55-year-old woman has 3-month history of anovulatory cycles and BMI
34. Endometrial biopsy shows simple hyperplasia. Management?
A. Combined OCP × 3 months
B. Levonorgestrel IUD
C. Total hysterectomy
D. Observation
Answer: B. ACOG 2025: LNG-IUD >90 % regression, less systemic
progestin.
6. A 63-year-old man with HTN reports new erectile dysfunction. Which
antihypertensive is MOST likely causative?
A. Amlodipine
B. Hydrochlorothiazide
C. Lisinopril
D. Losartan
Answer: B. Thiazides strongly linked; others neutral or may improve. (AHA
2025)
7. A 48-year-old woman has fatigue, TSH 8.2 mIU/L (normal free T4). She is
trying to conceive. Plan?
, 3
A. Repeat TSH in 6 months
B. Start levothyroxine 25 mcg daily
C. Start levothyroxine 50 mcg daily aiming TSH <2.5
D. Refer to endocrinology only
Answer: C. Subclinical hypothyroidism + fertility goal → treat to TSH <2.5.
(ATA 2025)
8. A 75-year-old woman has frequent falls, no orthostasis, normal neuro exam.
Vitamin D level 18 ng/mL. Prescribe:
A. Vitamin D₃ 400 IU daily
B. Vitamin D₂ 50,000 IU weekly × 6 then recheck
C. Calcitriol 0.25 mcg daily
D. No supplementation
Answer: B. Deficiency <20: high-dose ergocalciferol. (Endocrine Soc 2025)
9. A 66-year-old man has Stage 3 CKD (eGFR 35) and new-onset gout flare.
BEST acute treatment?
A. Indomethacin 50 mg TID
B. Colchicine 0.6 mg BID × 1 dose
C. Prednisone 40 mg daily × 3 days
D. Febuxostat 40 mg
Answer: C. Steroids safest in CKD; NSAIDs & colchicine toxicity risk.
(ACR 2025)
10.A 54-year-old woman with MS on fingolimod presents with 3-day
progressive dyspnea and bilateral crackles. HR 102, BP 96/60. NT-proBNP
3200 pg/mL. Most likely etiology?
A. Relapse-induced respiratory failure
B. Fingolimod-related cardiomyopathy
C. Community-acquired pneumonia
D. Pulmonary embolism
Answer: B. Drug label warning for first-dose bradycardia & long-term HF.
(FDA 2025)
, 4
11.A 70-year-old woman has iron-deficiency anemia (Hb 9.8 g/dL, ferritin 6
ng/mL, hemoccult negative). Next step?
A. Oral iron × 3 months
B. IV iron weekly
C. EGD/colonoscopy
D. Start ESA injection
Answer: C. Post-menopausal: rule out GI malignancy. (AGA 2025)
12.A 59-year-old man has stable angina despite maximal guideline-directed
therapy. Coronary CT shows 65 % mid-LAD stenosis, FFR 0.76. Plan?
A. Add ranolazine
B. PCI with DES
C. CABG referral
D. Continue meds only
Answer: B. FFR ≤0.80 → PCI improves prognosis. (ACC 2025)
13.A 68-year-old woman with RA on methotrexate 20 mg weekly has low-
grade fever, dry cough, and CXR bibasilar infiltrates. Most urgent test?
A. Sputum culture
B. High-resolution CT
C. LDH
D. Pneumocystis PCR
Answer: D. Methotrexate → cellular immunity; PJP possible. (IDSA 2025)
14.A 52-year-old man with HTN, BMI 31, has 10-year ASCVD risk 6.8 %.
Statin decision?
A. No statin (<7.5 %)
B. Moderate-intensity statin
C. High-intensity statin
D. Coronary calcium score first
Answer: B. 2025 ACC expert decision pathway: risk 5–20 % → moderate
statin.
15.A 64-year-old man with COPD GOLD D is hospitalized for exacerbation.
Discharge inhalers?
