1
Walden University NURS 6531 Final Exam
Spring 2025/2026 | Actual Exam
Questions with Verified Answers &
Rationales | Advanced Practice Nursing |
Pass Guarantee
1. A 58-year-old woman with T2DM and CKD-3 (eGFR 48 mL/min) takes
metformin 1000 mg BID. What is the best next step?
A. Continue current dose
B. Reduce metformin and add empagliflozin 10 mg daily
C. Stop metformin and start basal insulin
D. Switch to sitagliptin 100 mg daily
Answer: B
Rationale: KDIGO 2024 advises reducing metformin when eGFR 30-59 and
adding an SGLT2 inhibitor for cardiorenal protection.
2. First-line non-pharmacologic therapy for a 32-year-old with stage-1 HTN
(138/86 mmHg) and low ASCVD risk is:
A. DASH diet + <1500 mg Na + 150 min exercise/week
B. Biofeedback breathing nightly
C. Replace saturated fat with plant stanols
D. Isometric hand-grip exercises
Answer: A
Rationale: 2024 ACC/AHA guidelines prioritize lifestyle bundle for stage-1
HTN without CVD.
3. Which lipid parameter best quantifies residual ASCVD risk on high-
intensity statin therapy?
A. LDL-C
B. Non-HDL-C
C. Lp(a)
, 2
D. ApoB
Answer: D
Rationale: ApoB reflects atherogenic particle number; 2023 AHA statement
favors it for residual risk.
4. Which antibiotic needs a 50 % dose in Child–Pugh B cirrhosis?
A. Ceftriaxone
B. Azithromycin
C. Levofloxacin
D. Amoxicillin-clavulanate
Answer: C
Rationale: Levofloxacin is 50 % hepatically cleared; reduce dose in
moderate hepatic impairment (Sanford 2025).
5. Per GOLD 2025, which COPD group should start LABA-LAMA dual
therapy?
A. Group A
B. Group B
C. Group E
D. Group C
Answer: C
Rationale: Group E (≥2 exacerbations or 1 hospitalization) warrants initial
LABA-LAMA regardless of symptoms.
6. One-time ultrasound screening for AAA is recommended for:
A. All men 65-75 who ever smoked
B. All women ≥65
C. Men q5 yrs until 80
D. Only if family history
Answer: A
Rationale: USPSTF 2024: one-time US for men 65-75 with ≥100 lifetime
cigarettes.
7. A 72-year-old on warfarin (INR 3.8) has hematochezia. Next best step
before colonoscopy:
, 3
A. Hold warfarin 5 d, bridge with LMWH
B. Continue warfarin, do CT colonography
C. Reduce warfarin to INR 2.0
D. Give vitamin K 2 mg IV tomorrow
Answer: A
Rationale: Anticoagulation hold plus bridging allows safe therapeutic
colonoscopy (ACG 2025).
8. Which vaccine is contraindicated in a 38-year-old on prednisone 40 mg daily
for 3 weeks?
A. RZV
B. PCV20
C. MMR
D. Tdap
Answer: C
Rationale: Live MMR contraindicated with high-dose steroids (≥20 mg/day
≥2 weeks) per CDC 2025.
9. Target BP for a 54-year-old diabetic with albuminuria (ACR 450 mg/g) is:
A. <140/90
B. <130/80
C. <125/75
D. SBP 110-119
Answer: B
Rationale: KDIGO 2024 & ADA 2025 recommend <130/80 in CKD with
albuminuria.
10.Statin therapy is cost-effective for 10-yr ASCVD 4.8 % when LDL-C ≥:
A. 130 mg/dL
B. 160 mg/dL
C. 190 mg/dL
D. >100 mg/dL
Answer: B
Walden University NURS 6531 Final Exam
Spring 2025/2026 | Actual Exam
Questions with Verified Answers &
Rationales | Advanced Practice Nursing |
Pass Guarantee
1. A 58-year-old woman with T2DM and CKD-3 (eGFR 48 mL/min) takes
metformin 1000 mg BID. What is the best next step?
A. Continue current dose
B. Reduce metformin and add empagliflozin 10 mg daily
C. Stop metformin and start basal insulin
D. Switch to sitagliptin 100 mg daily
Answer: B
Rationale: KDIGO 2024 advises reducing metformin when eGFR 30-59 and
adding an SGLT2 inhibitor for cardiorenal protection.
2. First-line non-pharmacologic therapy for a 32-year-old with stage-1 HTN
(138/86 mmHg) and low ASCVD risk is:
A. DASH diet + <1500 mg Na + 150 min exercise/week
B. Biofeedback breathing nightly
C. Replace saturated fat with plant stanols
D. Isometric hand-grip exercises
Answer: A
Rationale: 2024 ACC/AHA guidelines prioritize lifestyle bundle for stage-1
HTN without CVD.
3. Which lipid parameter best quantifies residual ASCVD risk on high-
intensity statin therapy?
A. LDL-C
B. Non-HDL-C
C. Lp(a)
, 2
D. ApoB
Answer: D
Rationale: ApoB reflects atherogenic particle number; 2023 AHA statement
favors it for residual risk.
4. Which antibiotic needs a 50 % dose in Child–Pugh B cirrhosis?
A. Ceftriaxone
B. Azithromycin
C. Levofloxacin
D. Amoxicillin-clavulanate
Answer: C
Rationale: Levofloxacin is 50 % hepatically cleared; reduce dose in
moderate hepatic impairment (Sanford 2025).
5. Per GOLD 2025, which COPD group should start LABA-LAMA dual
therapy?
A. Group A
B. Group B
C. Group E
D. Group C
Answer: C
Rationale: Group E (≥2 exacerbations or 1 hospitalization) warrants initial
LABA-LAMA regardless of symptoms.
6. One-time ultrasound screening for AAA is recommended for:
A. All men 65-75 who ever smoked
B. All women ≥65
C. Men q5 yrs until 80
D. Only if family history
Answer: A
Rationale: USPSTF 2024: one-time US for men 65-75 with ≥100 lifetime
cigarettes.
7. A 72-year-old on warfarin (INR 3.8) has hematochezia. Next best step
before colonoscopy:
, 3
A. Hold warfarin 5 d, bridge with LMWH
B. Continue warfarin, do CT colonography
C. Reduce warfarin to INR 2.0
D. Give vitamin K 2 mg IV tomorrow
Answer: A
Rationale: Anticoagulation hold plus bridging allows safe therapeutic
colonoscopy (ACG 2025).
8. Which vaccine is contraindicated in a 38-year-old on prednisone 40 mg daily
for 3 weeks?
A. RZV
B. PCV20
C. MMR
D. Tdap
Answer: C
Rationale: Live MMR contraindicated with high-dose steroids (≥20 mg/day
≥2 weeks) per CDC 2025.
9. Target BP for a 54-year-old diabetic with albuminuria (ACR 450 mg/g) is:
A. <140/90
B. <130/80
C. <125/75
D. SBP 110-119
Answer: B
Rationale: KDIGO 2024 & ADA 2025 recommend <130/80 in CKD with
albuminuria.
10.Statin therapy is cost-effective for 10-yr ASCVD 4.8 % when LDL-C ≥:
A. 130 mg/dL
B. 160 mg/dL
C. 190 mg/dL
D. >100 mg/dL
Answer: B
