NURS 6531 Final Exam ACTUAL EXAM
2026/2027 Version 1 2 | NURS 6531 | Verified
Q&A | Pass Guaranteed - A+ Graded
VERSION 1 (100 Questions)
Section 1: Cardiovascular Disorders (20 questions)
Q1: A 55-year-old male with hypertension and Type 2 diabetes presents for follow-up. BP is 142/88
mmHg. Current meds: lisinopril 20mg daily, metformin 1000mg BID, atorvastatin 20mg daily. Recent
labs: HbA1c 7.2%, LDL 85 mg/dL, Cr 1.0 mg/dL, eGFR 85 mL/min. What is the most appropriate next
step?
A. Increase lisinopril to 40mg daily
B. Add amlodipine 5mg daily
C. Add hydrochlorothiazide 25mg daily
D. Increase atorvastatin to 40mg
Correct Answer: B
Rationale: ACC/AHA guidelines recommend BP target <130/80 in diabetes; adding a CCB (amlodipine) is
appropriate as second-line therapy when ACE inhibitor monotherapy fails to achieve goal, with
complementary mechanisms and metabolic neutrality.
Q2: A 68-year-old with HFrEF (EF 35%) on metoprolol succinate 50mg daily, lisinopril 20mg daily, and
furosemide 40mg daily presents with worsening dyspnea and peripheral edema. Which medication
should be added per GDMT?
A. Digoxin 0.25mg daily
B. Spironolactone 25mg daily
C. Hydralazine 75mg TID
D. Diltiazem 240mg daily
Correct Answer: B
Rationale: Quadruple therapy for HFrEF includes beta-blocker, ACE inhibitor/ARB/ARNI,
mineralocorticoid receptor antagonist (spironolactone/eplerenone), and SGLT2 inhibitor; spironolactone
reduces mortality and hospitalization in Class II-IV HF.
,Q3: A 62-year-old with atrial fibrillation (CHA₂DS₂-VASc score 4) and no contraindications to
anticoagulation should receive which therapy for stroke prevention?
A. Aspirin 325mg daily
B. Apixaban 5mg BID
C. Clopidogrel 75mg daily
D. Warfarin 5mg daily (target INR 2-3)
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for non-
valvular AF due to lower bleeding risk, no monitoring requirements, and fixed dosing; apixaban has the
lowest bleeding risk among DOACs.
Q4: A patient with STEMI presents 90 minutes after symptom onset. Which intervention is most
appropriate?
A. Thrombolytic therapy with tPA
B. Primary PCI with stent placement
C. Medical management with heparin only
D. Transfer to facility with cardiac surgery only
Correct Answer: B
Rationale: Primary PCI within 90 minutes of first medical contact is the gold standard for STEMI; it
achieves higher TIMI 3 flow, lower reocclusion rates, and improved survival compared to thrombolysis
when available within time goals.
Q5: A 58-year-old with stable angina on metoprolol 50mg BID and atorvastatin 40mg daily reports chest
pain with walking 2 blocks. Which addition is most appropriate?
A. Amlodipine 5mg daily
B. Nitroglycerin 0.4mg SL PRN
C. Isosorbide mononitrate 30mg daily
D. Ranolazine 1000mg BID
Correct Answer: B
Rationale: Sublingual nitroglycerin is first-line for acute angina relief; patients with stable angina should
have PRN nitroglycerin for exertional symptoms, with instructions to seek emergency care if pain
persists >5 minutes or occurs at rest.
Q6: A patient on warfarin for mechanical mitral valve presents with INR 5.2 and no bleeding. Which
management is appropriate?
,A. Hold warfarin and give vitamin K 10mg IV
B. Hold 1-2 warfarin doses and recheck INR in 2-3 days
C. Continue current dose and recheck in 1 week
D. Switch to apixaban 5mg BID immediately
Correct Answer: B
Rationale: INR 5-9 without bleeding requires holding 1-2 warfarin doses and more frequent monitoring;
vitamin K is reserved for INR >9 or serious bleeding, and DOACs are contraindicated in mechanical valves
due to thrombosis risk.
Q7: A 45-year-old with LDL 195 mg/dL and no ASCVD or diabetes requires which statin intensity per
ACC/AHA guidelines?
A. Low-intensity (pravastatin 10mg)
B. Moderate-intensity (atorvastatin 10mg)
C. High-intensity (atorvastatin 40-80mg)
D. No statin therapy needed
Correct Answer: C
Rationale: LDL ≥190 mg/dL indicates severe hyperlipidemia requiring high-intensity statin regardless of
10-year ASCVD risk; this reduces LDL ≥50% and addresses lifetime cardiovascular risk.
Q8: A patient with acute DVT (Wells score 6) and no contraindications should receive which initial
anticoagulation?
A. Warfarin 5mg daily with LMWH bridge
B. Apixaban 10mg BID for 7 days then 5mg BID
C. Aspirin 325mg daily
D. Rivaroxaban 15mg BID with food
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban) are preferred for acute DVT; apixaban and rivaroxaban allow
immediate treatment without parenteral bridging (apixaban 10mg BID × 7 days, then 5mg BID;
rivaroxaban 15mg BID × 21 days, then 20mg daily).
Q9: A 72-year-old with HFpEF (EF 55%) and persistent dyspnea despite diuretic therapy should receive
which evidence-based therapy?
A. Sacubitril/valsartan 24/26mg BID
B. Empagliflozin 10mg daily
C. Carvedilol 12.5mg BID
D. Digoxin 0.125mg daily
, Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce cardiovascular death and heart failure
hospitalization in HFpEF regardless of diabetes status; beta-blockers and ACE inhibitors show no
mortality benefit in HFpEF trials.
Q10: A patient with symptomatic aortic stenosis (valve area 0.8 cm², mean gradient 45 mmHg) and
intermediate surgical risk should be evaluated for:
A. Medical management with ACE inhibitors
B. Surgical aortic valve replacement (SAVR)
C. Transcatheter aortic valve replacement (TAVR)
D. Balloon valvuloplasty as definitive therapy
Correct Answer: C
Rationale: TAVR is now recommended for symptomatic severe AS across all surgical risk categories (low,
intermediate, high) based on randomized trials showing non-inferiority to SAVR with lower procedural
morbidity.
Q11: A 50-year-old with hypertension and gout requires diuretic therapy. Which agent is preferred?
A. Hydrochlorothiazide 25mg daily
B. Chlorthalidone 12.5mg daily
C. Indapamide 1.25mg daily
D. Metolazone 2.5mg daily
Correct Answer: C
Rationale: Indapamide has less effect on uric acid metabolism compared to other thiazides; while all
thiazides can exacerbate gout, indapamide and chlorthalidone have more favorable metabolic profiles,
though uric acid monitoring is still required.
Q12: A patient with NSTEMI and TIMI risk score 5 should receive which antiplatelet regimen?
A. Aspirin 325mg daily only
B. Aspirin 81mg + clopidogrel 75mg daily
C. Aspirin 81mg + ticagrelor 90mg BID
D. Ticagrelor 90mg BID only
Correct Answer: C
Rationale: Dual antiplatelet therapy with aspirin plus P2Y12 inhibitor (ticagrelor or prasugrel preferred
over clopidogrel in ACS) reduces cardiovascular events; ticagrelor has faster onset and greater platelet
inhibition than clopidogrel.
2026/2027 Version 1 2 | NURS 6531 | Verified
Q&A | Pass Guaranteed - A+ Graded
VERSION 1 (100 Questions)
Section 1: Cardiovascular Disorders (20 questions)
Q1: A 55-year-old male with hypertension and Type 2 diabetes presents for follow-up. BP is 142/88
mmHg. Current meds: lisinopril 20mg daily, metformin 1000mg BID, atorvastatin 20mg daily. Recent
labs: HbA1c 7.2%, LDL 85 mg/dL, Cr 1.0 mg/dL, eGFR 85 mL/min. What is the most appropriate next
step?
A. Increase lisinopril to 40mg daily
B. Add amlodipine 5mg daily
C. Add hydrochlorothiazide 25mg daily
D. Increase atorvastatin to 40mg
Correct Answer: B
Rationale: ACC/AHA guidelines recommend BP target <130/80 in diabetes; adding a CCB (amlodipine) is
appropriate as second-line therapy when ACE inhibitor monotherapy fails to achieve goal, with
complementary mechanisms and metabolic neutrality.
Q2: A 68-year-old with HFrEF (EF 35%) on metoprolol succinate 50mg daily, lisinopril 20mg daily, and
furosemide 40mg daily presents with worsening dyspnea and peripheral edema. Which medication
should be added per GDMT?
A. Digoxin 0.25mg daily
B. Spironolactone 25mg daily
C. Hydralazine 75mg TID
D. Diltiazem 240mg daily
Correct Answer: B
Rationale: Quadruple therapy for HFrEF includes beta-blocker, ACE inhibitor/ARB/ARNI,
mineralocorticoid receptor antagonist (spironolactone/eplerenone), and SGLT2 inhibitor; spironolactone
reduces mortality and hospitalization in Class II-IV HF.
,Q3: A 62-year-old with atrial fibrillation (CHA₂DS₂-VASc score 4) and no contraindications to
anticoagulation should receive which therapy for stroke prevention?
A. Aspirin 325mg daily
B. Apixaban 5mg BID
C. Clopidogrel 75mg daily
D. Warfarin 5mg daily (target INR 2-3)
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for non-
valvular AF due to lower bleeding risk, no monitoring requirements, and fixed dosing; apixaban has the
lowest bleeding risk among DOACs.
Q4: A patient with STEMI presents 90 minutes after symptom onset. Which intervention is most
appropriate?
A. Thrombolytic therapy with tPA
B. Primary PCI with stent placement
C. Medical management with heparin only
D. Transfer to facility with cardiac surgery only
Correct Answer: B
Rationale: Primary PCI within 90 minutes of first medical contact is the gold standard for STEMI; it
achieves higher TIMI 3 flow, lower reocclusion rates, and improved survival compared to thrombolysis
when available within time goals.
Q5: A 58-year-old with stable angina on metoprolol 50mg BID and atorvastatin 40mg daily reports chest
pain with walking 2 blocks. Which addition is most appropriate?
A. Amlodipine 5mg daily
B. Nitroglycerin 0.4mg SL PRN
C. Isosorbide mononitrate 30mg daily
D. Ranolazine 1000mg BID
Correct Answer: B
Rationale: Sublingual nitroglycerin is first-line for acute angina relief; patients with stable angina should
have PRN nitroglycerin for exertional symptoms, with instructions to seek emergency care if pain
persists >5 minutes or occurs at rest.
Q6: A patient on warfarin for mechanical mitral valve presents with INR 5.2 and no bleeding. Which
management is appropriate?
,A. Hold warfarin and give vitamin K 10mg IV
B. Hold 1-2 warfarin doses and recheck INR in 2-3 days
C. Continue current dose and recheck in 1 week
D. Switch to apixaban 5mg BID immediately
Correct Answer: B
Rationale: INR 5-9 without bleeding requires holding 1-2 warfarin doses and more frequent monitoring;
vitamin K is reserved for INR >9 or serious bleeding, and DOACs are contraindicated in mechanical valves
due to thrombosis risk.
Q7: A 45-year-old with LDL 195 mg/dL and no ASCVD or diabetes requires which statin intensity per
ACC/AHA guidelines?
A. Low-intensity (pravastatin 10mg)
B. Moderate-intensity (atorvastatin 10mg)
C. High-intensity (atorvastatin 40-80mg)
D. No statin therapy needed
Correct Answer: C
Rationale: LDL ≥190 mg/dL indicates severe hyperlipidemia requiring high-intensity statin regardless of
10-year ASCVD risk; this reduces LDL ≥50% and addresses lifetime cardiovascular risk.
Q8: A patient with acute DVT (Wells score 6) and no contraindications should receive which initial
anticoagulation?
A. Warfarin 5mg daily with LMWH bridge
B. Apixaban 10mg BID for 7 days then 5mg BID
C. Aspirin 325mg daily
D. Rivaroxaban 15mg BID with food
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban) are preferred for acute DVT; apixaban and rivaroxaban allow
immediate treatment without parenteral bridging (apixaban 10mg BID × 7 days, then 5mg BID;
rivaroxaban 15mg BID × 21 days, then 20mg daily).
Q9: A 72-year-old with HFpEF (EF 55%) and persistent dyspnea despite diuretic therapy should receive
which evidence-based therapy?
A. Sacubitril/valsartan 24/26mg BID
B. Empagliflozin 10mg daily
C. Carvedilol 12.5mg BID
D. Digoxin 0.125mg daily
, Correct Answer: B
Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) reduce cardiovascular death and heart failure
hospitalization in HFpEF regardless of diabetes status; beta-blockers and ACE inhibitors show no
mortality benefit in HFpEF trials.
Q10: A patient with symptomatic aortic stenosis (valve area 0.8 cm², mean gradient 45 mmHg) and
intermediate surgical risk should be evaluated for:
A. Medical management with ACE inhibitors
B. Surgical aortic valve replacement (SAVR)
C. Transcatheter aortic valve replacement (TAVR)
D. Balloon valvuloplasty as definitive therapy
Correct Answer: C
Rationale: TAVR is now recommended for symptomatic severe AS across all surgical risk categories (low,
intermediate, high) based on randomized trials showing non-inferiority to SAVR with lower procedural
morbidity.
Q11: A 50-year-old with hypertension and gout requires diuretic therapy. Which agent is preferred?
A. Hydrochlorothiazide 25mg daily
B. Chlorthalidone 12.5mg daily
C. Indapamide 1.25mg daily
D. Metolazone 2.5mg daily
Correct Answer: C
Rationale: Indapamide has less effect on uric acid metabolism compared to other thiazides; while all
thiazides can exacerbate gout, indapamide and chlorthalidone have more favorable metabolic profiles,
though uric acid monitoring is still required.
Q12: A patient with NSTEMI and TIMI risk score 5 should receive which antiplatelet regimen?
A. Aspirin 325mg daily only
B. Aspirin 81mg + clopidogrel 75mg daily
C. Aspirin 81mg + ticagrelor 90mg BID
D. Ticagrelor 90mg BID only
Correct Answer: C
Rationale: Dual antiplatelet therapy with aspirin plus P2Y12 inhibitor (ticagrelor or prasugrel preferred
over clopidogrel in ACS) reduces cardiovascular events; ticagrelor has faster onset and greater platelet
inhibition than clopidogrel.
