1
,NRNP 6531 Midterm Exam | (2026) Primary Care
Questions | Nursing Exam (PDF)
1. A 55-year-old man with hypertension has a BP of
150/92 mm Hg on lisinopril 20 mg daily. His labs: K+
4.2, Cr 0.9. What is the best next step?
A) Add hydrochlorothiazide
B) Increase lisinopril to 40 mg
C) Switch to amlodipine
D) Order renal artery duplex
Answer: A
Rationale: Adding a thiazide diuretic (HCTZ) provides
synergistic effect. Lisinopril max dose is 40 mg, but
adding a low-dose diuretic is preferred for Stage 2
hypertension (ACC/AHA 2017). No indication for renal
artery imaging.
2. Which finding is most concerning in a patient taking
amlodipine?
A) Ankle edema
2
,B) Gingival hyperplasia
C) Flushing
D) New heart block
Answer: D
Rationale: Heart block is not typical for amlodipine
(dihydropyridine CCB). Ankle edema, flushing, and
gingival hyperplasia are known side effects but not
immediately dangerous. New heart block suggests
another issue (e.g., beta-blocker, digoxin).
3. A 68-year-old with HFrEF (EF 35%) presents with DOE
and 2+ LE edema. Medications: lisinopril, metoprolol
succinate, furosemide. Pulse 52, BP 100/65. Next step?
A) Increase furosemide
B) Add digoxin
C) Decrease metoprolol
D) Add spironolactone
Answer: C
Rationale: Bradycardia (pulse 52) may limit beta-blocker
3
, tolerance. Decrease metoprolol dose first. Spironolactone is
k k k k k k
indicatedbutnotbeforeaddressing bradycardia.
k k k k k k
Digoxin is third-line. k k
4. Which lipid-lowering drug reduces cardiovascular
k k k k
k events but does not lower LDL significantly?
k k k k k k
A) Atorvastatin
B) Ezetimibe
C) Icosapent ethyl k
D) Rosuvastatin
Answer: C
k k
Rationale: Icosapent ethyl (pure EPA) reduces triglycerides
k k k k k k
k and CV events in statin-treated patients with elevated TG
k k k k k k k k
(REDUCE-IT). Statins and ezetimibe lower LDL.
k k k k k k
5. A 45-year-old smoker presents with sudden tearing
k k k k k k
chest pain radiating to back,BP 160/100 in right arm,
k k k k k k k k k
100/70 inleftarm.Most likelydiagnosis?
k k k k k k k
A) Myocardial infarction k
4
,NRNP 6531 Midterm Exam | (2026) Primary Care
Questions | Nursing Exam (PDF)
1. A 55-year-old man with hypertension has a BP of
150/92 mm Hg on lisinopril 20 mg daily. His labs: K+
4.2, Cr 0.9. What is the best next step?
A) Add hydrochlorothiazide
B) Increase lisinopril to 40 mg
C) Switch to amlodipine
D) Order renal artery duplex
Answer: A
Rationale: Adding a thiazide diuretic (HCTZ) provides
synergistic effect. Lisinopril max dose is 40 mg, but
adding a low-dose diuretic is preferred for Stage 2
hypertension (ACC/AHA 2017). No indication for renal
artery imaging.
2. Which finding is most concerning in a patient taking
amlodipine?
A) Ankle edema
2
,B) Gingival hyperplasia
C) Flushing
D) New heart block
Answer: D
Rationale: Heart block is not typical for amlodipine
(dihydropyridine CCB). Ankle edema, flushing, and
gingival hyperplasia are known side effects but not
immediately dangerous. New heart block suggests
another issue (e.g., beta-blocker, digoxin).
3. A 68-year-old with HFrEF (EF 35%) presents with DOE
and 2+ LE edema. Medications: lisinopril, metoprolol
succinate, furosemide. Pulse 52, BP 100/65. Next step?
A) Increase furosemide
B) Add digoxin
C) Decrease metoprolol
D) Add spironolactone
Answer: C
Rationale: Bradycardia (pulse 52) may limit beta-blocker
3
, tolerance. Decrease metoprolol dose first. Spironolactone is
k k k k k k
indicatedbutnotbeforeaddressing bradycardia.
k k k k k k
Digoxin is third-line. k k
4. Which lipid-lowering drug reduces cardiovascular
k k k k
k events but does not lower LDL significantly?
k k k k k k
A) Atorvastatin
B) Ezetimibe
C) Icosapent ethyl k
D) Rosuvastatin
Answer: C
k k
Rationale: Icosapent ethyl (pure EPA) reduces triglycerides
k k k k k k
k and CV events in statin-treated patients with elevated TG
k k k k k k k k
(REDUCE-IT). Statins and ezetimibe lower LDL.
k k k k k k
5. A 45-year-old smoker presents with sudden tearing
k k k k k k
chest pain radiating to back,BP 160/100 in right arm,
k k k k k k k k k
100/70 inleftarm.Most likelydiagnosis?
k k k k k k k
A) Myocardial infarction k
4
