NRNP 6550 Final Exam – Walden
University 2026/2027 Verified Questions
& Correct Clinical Answers with
Rationales Advanced Practice Care of
Adults in Acute Settings II | 100%
Correct | Graded A+
Q01 A 68-year-old male with a history of atrial fibrillation on warfarin presents with melena and
hemoglobin of 7.2 g/dL. INR is 4.8. What is the most appropriate initial reversal agent?
Answer: 4-factor prothrombin complex concentrate (4F-PCC)
Rationale: For life-threatening or major bleeding with supratherapeutic INR on warfarin, 4F-
PCC provides the fastest and most effective reversal of anticoagulation compared with fresh
frozen plasma.
Q02 A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is on
maximal doses of carvedilol, sacubitril/valsartan, spironolactone, and empagliflozin. Resting
heart rate is 78 bpm in sinus rhythm. Which additional agent is indicated?
Answer: Ivabradine
Rationale: Ivabradine is indicated (Class IIa) in HFrEF when heart rate remains ≥70 bpm
despite optimal guideline-directed medical therapy (SHIFT trial evidence).
Q03 A 55-year-old male with type 2 diabetes and established ASCVD has an A1C of 8.6% on
metformin. Which agent class has the strongest evidence for reducing major adverse
cardiovascular events (MACE)?
Answer: GLP-1 receptor agonist with proven cardiovascular benefit
Rationale: ADA 2025 guidelines give A-level recommendation to GLP-1 RA (semaglutide,
dulaglutide) or SGLT2i with demonstrated CV benefit in patients with T2DM and ASCVD.
, Q04 A 48-year-old male with type 2 diabetes, eGFR 38 mL/min/1.73 m², and persistent
albuminuria despite maximal ACE inhibitor therapy. Which medication has the strongest
evidence for slowing CKD progression?
Answer: Finerenone
Rationale: FIDELIO-DKD and FIGARO-DKD trials showed finerenone significantly reduces
CKD progression and cardiovascular events in patients with T2DM and albuminuric CKD.
Q05 A 62-year-old male with chronic stable angina remains symptomatic on maximal beta-
blocker and long-acting nitrate therapy. What is the most appropriate next anti-anginal agent?
Answer: Ranolazine
Rationale: Ranolazine is indicated as add-on therapy for chronic angina when symptoms persist
despite β-blockers, calcium channel blockers, or long-acting nitrates.
Q06 A 47-year-old male with acute gout flare has serum creatinine 2.1 mg/dL. Which agent is
the safest and most effective first-line treatment?
Answer: Prednisone 30–40 mg daily × 5 days
Rationale: Systemic corticosteroids are preferred over NSAIDs or colchicine in patients with
moderate–severe renal impairment during acute gout attacks.
Q07 A 51-year-old male with recurrent gout flares has serum urate 7.9 mg/dL despite allopurinol
300 mg daily. What is the next recommended step?
Answer: Switch to febuxostat or add probenecid
Rationale: When target serum urate (<6.0 mg/dL) is not achieved on maximal allopurinol,
switch to another xanthine oxidase inhibitor (febuxostat) or add a uricosuric agent.
Q08 A 41-year-old female started sertraline 50 mg daily 10 days ago for major depressive
disorder. She reports increased anxiety, restlessness, and insomnia. Most appropriate response?
Answer: "These are common transient activation symptoms that usually resolve within 1–2
weeks."
Rationale: Initial activation/jitteriness is a frequent early side effect of SSRIs and typically
improves with continued use.
Q09 A 78-year-old male with Parkinson disease experiences wearing-off symptoms on
levodopa/carbidopa. Which adjunctive agent is most appropriate?
Answer: Entacapone (COMT inhibitor)
University 2026/2027 Verified Questions
& Correct Clinical Answers with
Rationales Advanced Practice Care of
Adults in Acute Settings II | 100%
Correct | Graded A+
Q01 A 68-year-old male with a history of atrial fibrillation on warfarin presents with melena and
hemoglobin of 7.2 g/dL. INR is 4.8. What is the most appropriate initial reversal agent?
Answer: 4-factor prothrombin complex concentrate (4F-PCC)
Rationale: For life-threatening or major bleeding with supratherapeutic INR on warfarin, 4F-
PCC provides the fastest and most effective reversal of anticoagulation compared with fresh
frozen plasma.
Q02 A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is on
maximal doses of carvedilol, sacubitril/valsartan, spironolactone, and empagliflozin. Resting
heart rate is 78 bpm in sinus rhythm. Which additional agent is indicated?
Answer: Ivabradine
Rationale: Ivabradine is indicated (Class IIa) in HFrEF when heart rate remains ≥70 bpm
despite optimal guideline-directed medical therapy (SHIFT trial evidence).
Q03 A 55-year-old male with type 2 diabetes and established ASCVD has an A1C of 8.6% on
metformin. Which agent class has the strongest evidence for reducing major adverse
cardiovascular events (MACE)?
Answer: GLP-1 receptor agonist with proven cardiovascular benefit
Rationale: ADA 2025 guidelines give A-level recommendation to GLP-1 RA (semaglutide,
dulaglutide) or SGLT2i with demonstrated CV benefit in patients with T2DM and ASCVD.
, Q04 A 48-year-old male with type 2 diabetes, eGFR 38 mL/min/1.73 m², and persistent
albuminuria despite maximal ACE inhibitor therapy. Which medication has the strongest
evidence for slowing CKD progression?
Answer: Finerenone
Rationale: FIDELIO-DKD and FIGARO-DKD trials showed finerenone significantly reduces
CKD progression and cardiovascular events in patients with T2DM and albuminuric CKD.
Q05 A 62-year-old male with chronic stable angina remains symptomatic on maximal beta-
blocker and long-acting nitrate therapy. What is the most appropriate next anti-anginal agent?
Answer: Ranolazine
Rationale: Ranolazine is indicated as add-on therapy for chronic angina when symptoms persist
despite β-blockers, calcium channel blockers, or long-acting nitrates.
Q06 A 47-year-old male with acute gout flare has serum creatinine 2.1 mg/dL. Which agent is
the safest and most effective first-line treatment?
Answer: Prednisone 30–40 mg daily × 5 days
Rationale: Systemic corticosteroids are preferred over NSAIDs or colchicine in patients with
moderate–severe renal impairment during acute gout attacks.
Q07 A 51-year-old male with recurrent gout flares has serum urate 7.9 mg/dL despite allopurinol
300 mg daily. What is the next recommended step?
Answer: Switch to febuxostat or add probenecid
Rationale: When target serum urate (<6.0 mg/dL) is not achieved on maximal allopurinol,
switch to another xanthine oxidase inhibitor (febuxostat) or add a uricosuric agent.
Q08 A 41-year-old female started sertraline 50 mg daily 10 days ago for major depressive
disorder. She reports increased anxiety, restlessness, and insomnia. Most appropriate response?
Answer: "These are common transient activation symptoms that usually resolve within 1–2
weeks."
Rationale: Initial activation/jitteriness is a frequent early side effect of SSRIs and typically
improves with continued use.
Q09 A 78-year-old male with Parkinson disease experiences wearing-off symptoms on
levodopa/carbidopa. Which adjunctive agent is most appropriate?
Answer: Entacapone (COMT inhibitor)
