NRNP 6531 FINAL EXAM NEWEST 2026/2027 ACTUAL
EXAM TEST BANK| COMPLETE ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+
1. A 58-year-old man with hypertension reports substernal chest
pressure with exertion, relieved by rest. What is the most
appropriate next step?
• A. Order a stress echocardiogram
• B. Prescribe nitroglycerin PRN
• C. Start high-intensity statin
• D. Refer to ER for troponin
Correct Answer: A
Rationale: This presentation describes stable angina. Stress testing
(echocardiogram or nuclear) is indicated to assess for ischemia.
Nitroglycerin provides symptomatic relief but is not diagnostic.
1
,Statins are indicated but not the immediate next step. ER referral is
for unstable angina or acute coronary syndrome .
2. Which ACE inhibitor side effect is most characteristic and
requires monitoring in a 72-year-old with CKD?
• A. Dry cough
• B. Angioedema
• C. Hyperkalemia
• D. Hypotension
Correct Answer: C
Rationale: In CKD, ACE inhibitors reduce aldosterone leading to
potassium retention and hyperkalemia. Dry cough is common but
not unique to CKD. Angioedema is rare but serious. Hypotension
can occur but is not the most characteristic lab finding requiring
monitoring in CKD patients .
2
,3. A 45-year-old female has a blood pressure of 148/92 mmHg
on two visits. No diabetes or CKD. What is first-line
monotherapy?
• A. HCTZ
• B. Lisinopril
• C. Amlodipine
• D. Metoprolol
Correct Answer: B
Rationale: ACE inhibitors (lisinopril) are first-line for non-Black
patients without compelling indications. Thiazides are also
acceptable but ACEi is preferred in younger patients. CCB
(amlodipine) is an alternative. Beta-blockers are not first-line for
uncomplicated hypertension .
4. ECG shows irregularly irregular rhythm with no P waves. Rate
is 110-130 bpm. What is the best initial pharmacotherapy for
rate control?
3
, • A. Amiodarone
• B. Metoprolol
• C. Aspirin
• D. Diltiazem IV
Correct Answer: D
Rationale: This is atrial fibrillation with rapid ventricular response.
IV diltiazem (nondihydropyridine CCB) is first-line for acute rate
control. Metoprolol is also used but diltiazem is often preferred in
the acute setting. Amiodarone is for rhythm control or unstable
patients .
5. A 70-year-old has a blood pressure of 180/100 mmHg with
no symptoms. Repeat in office 5 minutes later is 178/98. What is
the most appropriate next step?
• A. Refer to emergency department
• B. Start amlodipine 10 mg daily
• C. Obtain home BP readings for 1 week
4
EXAM TEST BANK| COMPLETE ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+
1. A 58-year-old man with hypertension reports substernal chest
pressure with exertion, relieved by rest. What is the most
appropriate next step?
• A. Order a stress echocardiogram
• B. Prescribe nitroglycerin PRN
• C. Start high-intensity statin
• D. Refer to ER for troponin
Correct Answer: A
Rationale: This presentation describes stable angina. Stress testing
(echocardiogram or nuclear) is indicated to assess for ischemia.
Nitroglycerin provides symptomatic relief but is not diagnostic.
1
,Statins are indicated but not the immediate next step. ER referral is
for unstable angina or acute coronary syndrome .
2. Which ACE inhibitor side effect is most characteristic and
requires monitoring in a 72-year-old with CKD?
• A. Dry cough
• B. Angioedema
• C. Hyperkalemia
• D. Hypotension
Correct Answer: C
Rationale: In CKD, ACE inhibitors reduce aldosterone leading to
potassium retention and hyperkalemia. Dry cough is common but
not unique to CKD. Angioedema is rare but serious. Hypotension
can occur but is not the most characteristic lab finding requiring
monitoring in CKD patients .
2
,3. A 45-year-old female has a blood pressure of 148/92 mmHg
on two visits. No diabetes or CKD. What is first-line
monotherapy?
• A. HCTZ
• B. Lisinopril
• C. Amlodipine
• D. Metoprolol
Correct Answer: B
Rationale: ACE inhibitors (lisinopril) are first-line for non-Black
patients without compelling indications. Thiazides are also
acceptable but ACEi is preferred in younger patients. CCB
(amlodipine) is an alternative. Beta-blockers are not first-line for
uncomplicated hypertension .
4. ECG shows irregularly irregular rhythm with no P waves. Rate
is 110-130 bpm. What is the best initial pharmacotherapy for
rate control?
3
, • A. Amiodarone
• B. Metoprolol
• C. Aspirin
• D. Diltiazem IV
Correct Answer: D
Rationale: This is atrial fibrillation with rapid ventricular response.
IV diltiazem (nondihydropyridine CCB) is first-line for acute rate
control. Metoprolol is also used but diltiazem is often preferred in
the acute setting. Amiodarone is for rhythm control or unstable
patients .
5. A 70-year-old has a blood pressure of 180/100 mmHg with
no symptoms. Repeat in office 5 minutes later is 178/98. What is
the most appropriate next step?
• A. Refer to emergency department
• B. Start amlodipine 10 mg daily
• C. Obtain home BP readings for 1 week
4
