Walden nRnP 6531/6532 PRimaRy CaRe of adults and oldeR
adults final aCtual exam – Walden univeRsity – 2026/2027
aCademiC yeaR – veRified Questions and ansWeRs foR GRaduate-
level nuRse PRaCtitioneR students|| Just Released.
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 62-year-old male with a history of hypertension and type 2 diabetes presents with exertional chest pain
that is relieved by rest. His blood pressure is 148/88 mmHg, and heart rate is 72 bpm. An ECG shows no
acute changes. Which of the following is the most appropriate initial diagnostic test?
A) Cardiac catheterization
B) Exercise stress test
C) Echocardiogram
D) Coronary CT angiography
CoRReCt ansWeR: B) Exercise stress test
<span style="color:red">Rationale: In a patient with stable angina, an exercise stress test is the initial
diagnostic test of choice. It assesses for inducible ischemia and helps determine prognosis. Cardiac
catheterization is reserved for high-risk patients or those who fail medical management. An
echocardiogram evaluates structural heart disease but is not the first-line test for ischemia.</span>
Question 2
A 70-year-old female with heart failure with reduced ejection fraction (HFrEF) is on lisinopril, carvedilol,
and furosemide. She continues to have dyspnea on exertion. According to current guidelines, which
medication should be added to reduce mortality?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Diltiazem
CoRReCt ansWeR: B) Spironolactone
<span style="color:red">Rationale: Spironolactone (a mineralocorticoid receptor antagonist) reduces
mortality in patients with NYHA Class III-IV HFrEF. Digoxin reduces hospitalizations but not mortality.
Hydralazine is indicated in African American patients. Calcium channel blockers are contraindicated in
HFrEF.</span>
Question 3
, A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the
recommended anticoagulation strategy?
A) Aspirin 81 mg daily
B) Aspirin 325 mg daily
C) Oral anticoagulation (warfarin or DOAC)
D) No anticoagulation
CoRReCt ansWeR: C) Oral anticoagulation (warfarin or DOAC)
<span style="color:red">Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high
stroke risk, and oral anticoagulation is recommended. DOACs (apixaban, rivaroxaban, dabigatran,
edoxaban) are preferred over warfarin in many cases. Aspirin alone is not sufficient for stroke prevention
in high-risk patients.</span>
Question 4
A patient presents with a sudden onset of severe, "tearing" chest pain that radiates to the back between
the scapulae. Blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
CoRReCt ansWeR: B) Aortic dissection
<span style="color:red">Rationale: Aortic dissection presents with acute, severe tearing chest pain
radiating to the back, and a blood pressure differential between arms. This is a life-threatening emergency
requiring immediate CT angiography. Myocardial infarction presents with substernal chest pain but not
typically with a blood pressure differential.</span>
Question 5
A patient with newly diagnosed hypertension has a blood pressure of 162/98 mmHg on two separate
occasions. He has no other comorbidities. What is the most appropriate initial pharmacologic treatment?
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Any of the above as first-line options
CoRReCt ansWeR: D) Any of the above as first-line options
<span style="color:red">Rationale: According to ACC/AHA guidelines, first-line antihypertensive options
include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers. The choice depends on
patient-specific factors, but all are acceptable initial options.</span>
Question 6
adults final aCtual exam – Walden univeRsity – 2026/2027
aCademiC yeaR – veRified Questions and ansWeRs foR GRaduate-
level nuRse PRaCtitioneR students|| Just Released.
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 62-year-old male with a history of hypertension and type 2 diabetes presents with exertional chest pain
that is relieved by rest. His blood pressure is 148/88 mmHg, and heart rate is 72 bpm. An ECG shows no
acute changes. Which of the following is the most appropriate initial diagnostic test?
A) Cardiac catheterization
B) Exercise stress test
C) Echocardiogram
D) Coronary CT angiography
CoRReCt ansWeR: B) Exercise stress test
<span style="color:red">Rationale: In a patient with stable angina, an exercise stress test is the initial
diagnostic test of choice. It assesses for inducible ischemia and helps determine prognosis. Cardiac
catheterization is reserved for high-risk patients or those who fail medical management. An
echocardiogram evaluates structural heart disease but is not the first-line test for ischemia.</span>
Question 2
A 70-year-old female with heart failure with reduced ejection fraction (HFrEF) is on lisinopril, carvedilol,
and furosemide. She continues to have dyspnea on exertion. According to current guidelines, which
medication should be added to reduce mortality?
A) Digoxin
B) Spironolactone
C) Hydralazine
D) Diltiazem
CoRReCt ansWeR: B) Spironolactone
<span style="color:red">Rationale: Spironolactone (a mineralocorticoid receptor antagonist) reduces
mortality in patients with NYHA Class III-IV HFrEF. Digoxin reduces hospitalizations but not mortality.
Hydralazine is indicated in African American patients. Calcium channel blockers are contraindicated in
HFrEF.</span>
Question 3
, A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the
recommended anticoagulation strategy?
A) Aspirin 81 mg daily
B) Aspirin 325 mg daily
C) Oral anticoagulation (warfarin or DOAC)
D) No anticoagulation
CoRReCt ansWeR: C) Oral anticoagulation (warfarin or DOAC)
<span style="color:red">Rationale: A CHA₂DS₂-VASc score ≥2 in men or ≥3 in women indicates high
stroke risk, and oral anticoagulation is recommended. DOACs (apixaban, rivaroxaban, dabigatran,
edoxaban) are preferred over warfarin in many cases. Aspirin alone is not sufficient for stroke prevention
in high-risk patients.</span>
Question 4
A patient presents with a sudden onset of severe, "tearing" chest pain that radiates to the back between
the scapulae. Blood pressure is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is
the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
CoRReCt ansWeR: B) Aortic dissection
<span style="color:red">Rationale: Aortic dissection presents with acute, severe tearing chest pain
radiating to the back, and a blood pressure differential between arms. This is a life-threatening emergency
requiring immediate CT angiography. Myocardial infarction presents with substernal chest pain but not
typically with a blood pressure differential.</span>
Question 5
A patient with newly diagnosed hypertension has a blood pressure of 162/98 mmHg on two separate
occasions. He has no other comorbidities. What is the most appropriate initial pharmacologic treatment?
A) Hydrochlorothiazide
B) Lisinopril
C) Amlodipine
D) Any of the above as first-line options
CoRReCt ansWeR: D) Any of the above as first-line options
<span style="color:red">Rationale: According to ACC/AHA guidelines, first-line antihypertensive options
include thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers. The choice depends on
patient-specific factors, but all are acceptable initial options.</span>
Question 6
