1
NGR 6141 Exam 3 Objectives Actual
Exam 2026/2027 | Florida Atlantic
University Advanced Practice Nursing
| Questions with Complete Solutions |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (20 questions)
Case Study 1: Hypertension Management
[Scenario: A 58-year-old African American male presents for follow-up of hypertension. Current
BP 152/94 mmHg on no medications. He has no diabetes, CKD, or cardiovascular disease. He
has tried lifestyle modifications for 6 months without improvement.]
Q1: According to the ACC/AHA hypertension guidelines, what is the most appropriate initial
pharmacotherapy for this patient?
A. Lisinopril
B. Amlodipine
C. Metoprolol
D. Hydrochlorothiazide
Correct Answer: B. [CORRECT] Rationale: ACC/AHA guidelines recommend initial
antihypertensive therapy in African American patients with a thiazide diuretic or calcium channel
blocker (amlodipine) due to lower renin levels and reduced response to ACE inhibitors/ARBs as
monotherapy.
Q2: The patient is started on amlodipine 5 mg daily. At 4-week follow-up, his BP is 148/90
mmHg and he reports bilateral ankle edema. What is the most appropriate next step?
A. Switch to lisinopril
B. Add hydrochlorothiazide
C. Increase amlodipine to 10 mg
D. Switch to metoprolol
,2
Correct Answer: B. [CORRECT] Rationale: BP remains above goal (stage 2 hypertension),
requiring combination therapy. Adding a thiazide diuretic addresses volume expansion and
complements the calcium channel blocker mechanism while potentially reducing edema through
vasodilation and diuretic effect.
Q3: Three months later, the patient's BP is 138/86 on amlodipine 10 mg daily. What is the most
appropriate next step?
A. Add lisinopril
B. Increase amlodipine to 15 mg
C. Continue current therapy and recheck in 6 months
D. Switch to hydrochlorothiazide
Correct Answer: C. [CORRECT] Rationale: BP 138/86 is at goal (<140/90 for patients without
comorbidities). Current therapy is effective and should be continued with follow-up in 6-12
months per guidelines.
Q4: [Standalone] A 62-year-old female with hypertension and type 2 diabetes presents with BP
146/88 mmHg on lisinopril 20 mg daily. Her eGFR is 45 mL/min/1.73m² with albuminuria
(UACR 45 mg/g). What is the optimal BP target and medication adjustment?
A. Target <140/90; continue current therapy
B. Target <130/80; add amlodipine
C. Target <130/80; add losartan
D. Target <120/80; increase lisinopril to 40 mg
Correct Answer: B. [CORRECT] Rationale: In patients with diabetes and CKD (albuminuria
with eGFR <60), ACC/AHA recommends BP target <130/80. ACE inhibitors provide renal
protection, but combination therapy is needed for BP control. Adding a calcium channel blocker
is preferred over ARB combination due to hyperkalemia and renal function concerns with dual
RAAS blockade.
Q5: [Standalone] Which patient requires immediate referral for secondary hypertension
evaluation?
A. 45-year-old with BP 156/92 and family history of hypertension
B. 28-year-old with BP 168/104 and diminished femoral pulses
C. 55-year-old with BP 148/88 and obesity
D. 68-year-old with BP 152/90 and essential hypertension for 10 years
Correct Answer: B. [CORRECT] Rationale: Early-onset hypertension (<30 years) with
significantly elevated BP and diminished femoral pulses suggests coarctation of the aorta, a
secondary cause requiring immediate cardiovascular evaluation and imaging.
Case Study 2: Hyperlipidemia Management
, 3
[Scenario: A 55-year-old male with no prior cardiovascular events presents for preventive care.
Total cholesterol 245 mg/dL, LDL 165 mg/dL, HDL 38 mg/dL, triglycerides 180 mg/dL. BP
132/84 mmHg. He has type 2 diabetes (HbA1c 7.2%) and smokes 1 pack/day.]
Q6: Using the ASCVD Risk Estimator Plus, what is this patient's 10-year ASCVD risk category
and recommended statin intensity?
A. Low risk (<5%); no statin indicated
B. Borderline risk (5-7.5%); moderate-intensity statin if risk enhancers present
C. Intermediate risk (≥7.5%); high-intensity statin
D. High risk (≥20%); high-intensity statin
Correct Answer: D. [CORRECT] Rationale: This patient has diabetes (age 40-75), which
automatically places him in the high-risk category (≥20% 10-year ASCVD risk) per ACC/AHA
guidelines, mandating high-intensity statin therapy regardless of calculated risk score.
Q7: The patient is started on atorvastatin 40 mg. Six weeks later, he reports severe muscle pain
and weakness. CK is 3,500 U/L. What is the most appropriate management?
A. Reduce atorvastatin to 20 mg and recheck CK in 2 weeks
B. Discontinue atorvastatin immediately and monitor renal function
C. Switch to rosuvastatin 10 mg
D. Continue statin and add coenzyme Q10
Correct Answer: B. [CORRECT] Rationale: CK >10x upper limit of normal with muscle
symptoms indicates statin-induced rhabdomyolysis, a medical emergency requiring immediate
discontinuation of the statin, aggressive hydration, and monitoring for acute kidney injury and
compartment syndrome.
Q8: [SATA - Heart Failure Medications] Which medications are considered guideline-directed
medical therapy (GDMT) for HFrEF? Select all that apply.
A. Beta-blockers (carvedilol, metoprolol succinate)
B. ACE inhibitors/ARBs/ARNI
C. Aldosterone antagonists (spironolactone)
D. SGLT2 inhibitors (empagliflozin, dapagliflozin)
E. Calcium channel blockers (amlodipine)
F. Loop diuretics (furosemide)
Correct Answers: A, B, C, D. [CORRECT] Rationale: GDMT for HFrEF includes beta-
blockers, ACE inhibitors/ARBs/ARNI, aldosterone antagonists, and SGLT2 inhibitors. Calcium
channel blockers are not recommended. Loop diuretics manage symptoms but are not GDMT.
Case Study 3: Acute Coronary Syndrome
NGR 6141 Exam 3 Objectives Actual
Exam 2026/2027 | Florida Atlantic
University Advanced Practice Nursing
| Questions with Complete Solutions |
Pass Guaranteed - A+ Graded
SECTION 1: CARDIOVASCULAR DISORDERS (20 questions)
Case Study 1: Hypertension Management
[Scenario: A 58-year-old African American male presents for follow-up of hypertension. Current
BP 152/94 mmHg on no medications. He has no diabetes, CKD, or cardiovascular disease. He
has tried lifestyle modifications for 6 months without improvement.]
Q1: According to the ACC/AHA hypertension guidelines, what is the most appropriate initial
pharmacotherapy for this patient?
A. Lisinopril
B. Amlodipine
C. Metoprolol
D. Hydrochlorothiazide
Correct Answer: B. [CORRECT] Rationale: ACC/AHA guidelines recommend initial
antihypertensive therapy in African American patients with a thiazide diuretic or calcium channel
blocker (amlodipine) due to lower renin levels and reduced response to ACE inhibitors/ARBs as
monotherapy.
Q2: The patient is started on amlodipine 5 mg daily. At 4-week follow-up, his BP is 148/90
mmHg and he reports bilateral ankle edema. What is the most appropriate next step?
A. Switch to lisinopril
B. Add hydrochlorothiazide
C. Increase amlodipine to 10 mg
D. Switch to metoprolol
,2
Correct Answer: B. [CORRECT] Rationale: BP remains above goal (stage 2 hypertension),
requiring combination therapy. Adding a thiazide diuretic addresses volume expansion and
complements the calcium channel blocker mechanism while potentially reducing edema through
vasodilation and diuretic effect.
Q3: Three months later, the patient's BP is 138/86 on amlodipine 10 mg daily. What is the most
appropriate next step?
A. Add lisinopril
B. Increase amlodipine to 15 mg
C. Continue current therapy and recheck in 6 months
D. Switch to hydrochlorothiazide
Correct Answer: C. [CORRECT] Rationale: BP 138/86 is at goal (<140/90 for patients without
comorbidities). Current therapy is effective and should be continued with follow-up in 6-12
months per guidelines.
Q4: [Standalone] A 62-year-old female with hypertension and type 2 diabetes presents with BP
146/88 mmHg on lisinopril 20 mg daily. Her eGFR is 45 mL/min/1.73m² with albuminuria
(UACR 45 mg/g). What is the optimal BP target and medication adjustment?
A. Target <140/90; continue current therapy
B. Target <130/80; add amlodipine
C. Target <130/80; add losartan
D. Target <120/80; increase lisinopril to 40 mg
Correct Answer: B. [CORRECT] Rationale: In patients with diabetes and CKD (albuminuria
with eGFR <60), ACC/AHA recommends BP target <130/80. ACE inhibitors provide renal
protection, but combination therapy is needed for BP control. Adding a calcium channel blocker
is preferred over ARB combination due to hyperkalemia and renal function concerns with dual
RAAS blockade.
Q5: [Standalone] Which patient requires immediate referral for secondary hypertension
evaluation?
A. 45-year-old with BP 156/92 and family history of hypertension
B. 28-year-old with BP 168/104 and diminished femoral pulses
C. 55-year-old with BP 148/88 and obesity
D. 68-year-old with BP 152/90 and essential hypertension for 10 years
Correct Answer: B. [CORRECT] Rationale: Early-onset hypertension (<30 years) with
significantly elevated BP and diminished femoral pulses suggests coarctation of the aorta, a
secondary cause requiring immediate cardiovascular evaluation and imaging.
Case Study 2: Hyperlipidemia Management
, 3
[Scenario: A 55-year-old male with no prior cardiovascular events presents for preventive care.
Total cholesterol 245 mg/dL, LDL 165 mg/dL, HDL 38 mg/dL, triglycerides 180 mg/dL. BP
132/84 mmHg. He has type 2 diabetes (HbA1c 7.2%) and smokes 1 pack/day.]
Q6: Using the ASCVD Risk Estimator Plus, what is this patient's 10-year ASCVD risk category
and recommended statin intensity?
A. Low risk (<5%); no statin indicated
B. Borderline risk (5-7.5%); moderate-intensity statin if risk enhancers present
C. Intermediate risk (≥7.5%); high-intensity statin
D. High risk (≥20%); high-intensity statin
Correct Answer: D. [CORRECT] Rationale: This patient has diabetes (age 40-75), which
automatically places him in the high-risk category (≥20% 10-year ASCVD risk) per ACC/AHA
guidelines, mandating high-intensity statin therapy regardless of calculated risk score.
Q7: The patient is started on atorvastatin 40 mg. Six weeks later, he reports severe muscle pain
and weakness. CK is 3,500 U/L. What is the most appropriate management?
A. Reduce atorvastatin to 20 mg and recheck CK in 2 weeks
B. Discontinue atorvastatin immediately and monitor renal function
C. Switch to rosuvastatin 10 mg
D. Continue statin and add coenzyme Q10
Correct Answer: B. [CORRECT] Rationale: CK >10x upper limit of normal with muscle
symptoms indicates statin-induced rhabdomyolysis, a medical emergency requiring immediate
discontinuation of the statin, aggressive hydration, and monitoring for acute kidney injury and
compartment syndrome.
Q8: [SATA - Heart Failure Medications] Which medications are considered guideline-directed
medical therapy (GDMT) for HFrEF? Select all that apply.
A. Beta-blockers (carvedilol, metoprolol succinate)
B. ACE inhibitors/ARBs/ARNI
C. Aldosterone antagonists (spironolactone)
D. SGLT2 inhibitors (empagliflozin, dapagliflozin)
E. Calcium channel blockers (amlodipine)
F. Loop diuretics (furosemide)
Correct Answers: A, B, C, D. [CORRECT] Rationale: GDMT for HFrEF includes beta-
blockers, ACE inhibitors/ARBs/ARNI, aldosterone antagonists, and SGLT2 inhibitors. Calcium
channel blockers are not recommended. Loop diuretics manage symptoms but are not GDMT.
Case Study 3: Acute Coronary Syndrome
