Walden NRNP 6531/6532 Primary Care of Adults and
Older Adults Final – Walden University
Cardiovascular Disorders
1. A 58-year-old man has hypertension, no diabetes, and a 10-year ASCVD risk of
12%. BP is 152/94 mmHg. What is the most appropriate first-line pharmacologic
therapy?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
C. Hydrochlorothiazide
Thiazide diuretics are first-line for hypertension in non-Black adults without
compelling indications. ACE inhibitors, ARBs, and calcium channel blockers are
also first-line, but thiazides are especially effective and guideline-recommended
for this profile.
2. A 62-year-old with type 2 diabetes on metformin has A1c 8.2% and eGFR 55
mL/min. Which add-on is most appropriate?
A. Glyburide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
C. Empagliflozin
SGLT2 inhibitors are preferred in patients with type 2 diabetes and CKD or
cardiovascular risk. They reduce CKD progression and heart failure hospitalization.
eGFR 55 is acceptable for initiation.
3. A 70-year-old with atrial fibrillation has CHA₂DS₂-VASc score 3. What is
indicated?
A. Aspirin alone
B. Oral anticoagulation
C. No therapy
D. Clopidogrel alone
, B. Oral anticoagulation
CHA₂DS₂-VASc ≥2 in men or ≥3 in women warrants anticoagulation. DOACs
are preferred over warfarin in most patients.
4. A 55-year-old with ASCVD needs lipid therapy. What is first-line?
A. High-intensity statin
B. Fibrate
C. Niacin
D. Fish oil
A. High-intensity statin
High-intensity statins reduce LDL and cardiovascular events in ASCVD. Non-
statin therapies are add-ons.
5. A patient with HFrEF and NYHA class II symptoms should be started on which
medication?
A. Sacubitril/valsartan
B. Verapamil
C. Pioglitazone
D. NSAID
A. Sacubitril/valsartan
ARNI improves mortality in HFrEF. Non-dihydropyridine CCBs,
thiazolidinediones, and NSAIDs can worsen heart failure.
6. A 60-year-old with stable angina should receive which combination?
A. Aspirin, statin, beta-blocker
B. Warfarin, diuretic, nitrate
C. Antibiotic, steroid, bronchodilator
D. NSAID, opioid, muscle relaxant
A. Aspirin, statin, beta-blocker
Stable angina management includes antiplatelet, lipid-lowering, antianginal
therapy, and risk-factor control.
7. A 68-year-old woman has a DXA T-score of −2.7 at the femoral neck. What is
the most appropriate treatment?
A. Calcium alone
,B. Alendronate
C. Estrogen
D. Raloxifene
B. Alendronate
T-score ≤ −2.5 confirms osteoporosis. Bisphosphonates like alendronate are
first-line unless contraindicated.
8. A 72-year-old has progressive memory loss and is diagnosed with mild
Alzheimer disease. What is the most appropriate initial medication?
A. Donepezil
B. Memantine
C. Haloperidol
D. Benztropine
A. Donepezil
Donepezil, a cholinesterase inhibitor, is first-line for mild-to-moderate
Alzheimer disease. Memantine is often added later or used for moderate-to-
severe disease.
9. An 80-year-old reports a fall in the past year. What is the most important
intervention to reduce fall risk?
A. Vitamin D supplementation alone
B. Exercise and gait/balance training
C. Bed rest
D. Benzodiazepine for anxiety
B. Exercise and gait/balance training
Exercise programs, especially balance and strength training, are core fall-
prevention interventions. Vitamin D may help if deficient, but exercise is central.
10. A 65-year-old man has BPH with urinary hesitancy and weak stream. What is
the best initial medication?
A. Tamsulosin
B. Finasteride
C. Oxybutynin
D. Sildenafil
, A. Tamsulosin
Alpha-blockers like tamsulosin rapidly improve urinary symptoms. 5-alpha
reductase inhibitors are better for larger prostates but take months.
11. A 45-year-old with PHQ-9 score 15 has major depressive disorder. What is
first-line pharmacotherapy?
A. Sertraline
B. Amitriptyline
C. Phenelzine
D. Alprazolam
A. Sertraline
SSRIs are first-line for major depression due to efficacy and safety. TCAs,
MAOIs, and benzodiazepines are not first-line.
12. A 55-year-old woman with hypothyroidism is started on levothyroxine. What
is the most appropriate initial dose?
A. 12.5 mcg daily
B. 25–50 mcg daily
C. 100 mcg daily
D. 200 mcg daily
B. 25–50 mcg daily
For most adults without cardiac disease, start levothyroxine 25–50 mcg daily.
In older adults or CAD, start 12.5–25 mcg daily.
13. A 24-year-old with asthma uses albuterol twice weekly. What is the preferred
Step 2 therapy?
A. Low-dose inhaled corticosteroid
B. Montelukast
C. Long-acting beta-agonist alone
D. Oral corticosteroid
A. Low-dose inhaled corticosteroid
Persistent asthma requiring albuterol more than twice weekly needs
controller therapy. Low-dose ICS is first-line Step 2.
Older Adults Final – Walden University
Cardiovascular Disorders
1. A 58-year-old man has hypertension, no diabetes, and a 10-year ASCVD risk of
12%. BP is 152/94 mmHg. What is the most appropriate first-line pharmacologic
therapy?
A. Lisinopril
B. Amlodipine
C. Hydrochlorothiazide
D. Metoprolol
C. Hydrochlorothiazide
Thiazide diuretics are first-line for hypertension in non-Black adults without
compelling indications. ACE inhibitors, ARBs, and calcium channel blockers are
also first-line, but thiazides are especially effective and guideline-recommended
for this profile.
2. A 62-year-old with type 2 diabetes on metformin has A1c 8.2% and eGFR 55
mL/min. Which add-on is most appropriate?
A. Glyburide
B. Sitagliptin
C. Empagliflozin
D. Pioglitazone
C. Empagliflozin
SGLT2 inhibitors are preferred in patients with type 2 diabetes and CKD or
cardiovascular risk. They reduce CKD progression and heart failure hospitalization.
eGFR 55 is acceptable for initiation.
3. A 70-year-old with atrial fibrillation has CHA₂DS₂-VASc score 3. What is
indicated?
A. Aspirin alone
B. Oral anticoagulation
C. No therapy
D. Clopidogrel alone
, B. Oral anticoagulation
CHA₂DS₂-VASc ≥2 in men or ≥3 in women warrants anticoagulation. DOACs
are preferred over warfarin in most patients.
4. A 55-year-old with ASCVD needs lipid therapy. What is first-line?
A. High-intensity statin
B. Fibrate
C. Niacin
D. Fish oil
A. High-intensity statin
High-intensity statins reduce LDL and cardiovascular events in ASCVD. Non-
statin therapies are add-ons.
5. A patient with HFrEF and NYHA class II symptoms should be started on which
medication?
A. Sacubitril/valsartan
B. Verapamil
C. Pioglitazone
D. NSAID
A. Sacubitril/valsartan
ARNI improves mortality in HFrEF. Non-dihydropyridine CCBs,
thiazolidinediones, and NSAIDs can worsen heart failure.
6. A 60-year-old with stable angina should receive which combination?
A. Aspirin, statin, beta-blocker
B. Warfarin, diuretic, nitrate
C. Antibiotic, steroid, bronchodilator
D. NSAID, opioid, muscle relaxant
A. Aspirin, statin, beta-blocker
Stable angina management includes antiplatelet, lipid-lowering, antianginal
therapy, and risk-factor control.
7. A 68-year-old woman has a DXA T-score of −2.7 at the femoral neck. What is
the most appropriate treatment?
A. Calcium alone
,B. Alendronate
C. Estrogen
D. Raloxifene
B. Alendronate
T-score ≤ −2.5 confirms osteoporosis. Bisphosphonates like alendronate are
first-line unless contraindicated.
8. A 72-year-old has progressive memory loss and is diagnosed with mild
Alzheimer disease. What is the most appropriate initial medication?
A. Donepezil
B. Memantine
C. Haloperidol
D. Benztropine
A. Donepezil
Donepezil, a cholinesterase inhibitor, is first-line for mild-to-moderate
Alzheimer disease. Memantine is often added later or used for moderate-to-
severe disease.
9. An 80-year-old reports a fall in the past year. What is the most important
intervention to reduce fall risk?
A. Vitamin D supplementation alone
B. Exercise and gait/balance training
C. Bed rest
D. Benzodiazepine for anxiety
B. Exercise and gait/balance training
Exercise programs, especially balance and strength training, are core fall-
prevention interventions. Vitamin D may help if deficient, but exercise is central.
10. A 65-year-old man has BPH with urinary hesitancy and weak stream. What is
the best initial medication?
A. Tamsulosin
B. Finasteride
C. Oxybutynin
D. Sildenafil
, A. Tamsulosin
Alpha-blockers like tamsulosin rapidly improve urinary symptoms. 5-alpha
reductase inhibitors are better for larger prostates but take months.
11. A 45-year-old with PHQ-9 score 15 has major depressive disorder. What is
first-line pharmacotherapy?
A. Sertraline
B. Amitriptyline
C. Phenelzine
D. Alprazolam
A. Sertraline
SSRIs are first-line for major depression due to efficacy and safety. TCAs,
MAOIs, and benzodiazepines are not first-line.
12. A 55-year-old woman with hypothyroidism is started on levothyroxine. What
is the most appropriate initial dose?
A. 12.5 mcg daily
B. 25–50 mcg daily
C. 100 mcg daily
D. 200 mcg daily
B. 25–50 mcg daily
For most adults without cardiac disease, start levothyroxine 25–50 mcg daily.
In older adults or CAD, start 12.5–25 mcg daily.
13. A 24-year-old with asthma uses albuterol twice weekly. What is the preferred
Step 2 therapy?
A. Low-dose inhaled corticosteroid
B. Montelukast
C. Long-acting beta-agonist alone
D. Oral corticosteroid
A. Low-dose inhaled corticosteroid
Persistent asthma requiring albuterol more than twice weekly needs
controller therapy. Low-dose ICS is first-line Step 2.
