NURS 6531 EXAM 3: ADVANCED
PRACTICE CARE OF ADULTS ACROSS
THE LIFESPAN (CORRECT Q & A)
SATISFACTION GUARANTEED
1. A 68-year-old male with a history of HFrEF (EF 35%) presents for a follow-up. He is currently
taking Lisinopril 10mg and Carvedilol 6.25mg BID. He reports persistent NYHA Class II
symptoms. Which of the following is the most appropriate next step in his pharmacological
management?
A. Switch Lisinopril to Sacubitril/Valsartan
B. Increase Carvedilol to 12.5mg BID
C. Add Spironolactone 25mg daily
D. Add Digoxin 0.125mg daily
Answer: A
Conceptual Explanation: Current guidelines recommend switching an ACEI or ARB to an
ARNI (Sacubitril/Valsartan) in patients with HFrEF who remain symptomatic to further
reduce morbidity and mortality.
2. Which of the following physical exam findings is most characteristic of chronic venous
insufficiency rather than peripheral arterial disease?
A. Dependent rubor and pallor with elevation
,B. Diminished or absent pedal pulses
C. Hyperpigmentation and stasis dermatitis at the ankles
D. Intermittent claudication relieved by rest
Answer: C
Conceptual Explanation: Chronic venous insufficiency typically presents with lower
extremity edema, brownish hyperpigmentation (hemosiderin staining), and stasis
dermatitis, whereas PAD is characterized by pulse deficits and rubor.
3. A 54-year-old African American male has a blood pressure of 152/94 mmHg. A repeat
reading one week later is 150/92 mmHg. He has no history of diabetes or CKD. According to
JNC 8 guidelines, which is the preferred initial treatment?
A. Lisinopril
B. Metoprolol
C. Amlodipine
D. Losartan
Answer: C
Conceptual Explanation: For the general African American population, including those
with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or
a calcium channel blocker (CCB).
, 4. A patient with COPD presents with increased sputum purulence, increased sputum volume,
and increased dyspnea. According to the GOLD guidelines, what is the most appropriate
management?
A. Increase the dose of his daily LABA
B. Schedule a pulmonary function test immediately
C. Initiate a course of oral corticosteroids and antibiotics
D. Order a chest CT to rule out pulmonary embolism
Answer: C
Conceptual Explanation: The triad of increased dyspnea, sputum volume, and purulence
indicates a COPD exacerbation, which is typically treated with short-acting
bronchodilators, systemic corticosteroids, and antibiotics.
5. A 72-year-old female presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right upper sternal border, radiating to the carotids. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
PRACTICE CARE OF ADULTS ACROSS
THE LIFESPAN (CORRECT Q & A)
SATISFACTION GUARANTEED
1. A 68-year-old male with a history of HFrEF (EF 35%) presents for a follow-up. He is currently
taking Lisinopril 10mg and Carvedilol 6.25mg BID. He reports persistent NYHA Class II
symptoms. Which of the following is the most appropriate next step in his pharmacological
management?
A. Switch Lisinopril to Sacubitril/Valsartan
B. Increase Carvedilol to 12.5mg BID
C. Add Spironolactone 25mg daily
D. Add Digoxin 0.125mg daily
Answer: A
Conceptual Explanation: Current guidelines recommend switching an ACEI or ARB to an
ARNI (Sacubitril/Valsartan) in patients with HFrEF who remain symptomatic to further
reduce morbidity and mortality.
2. Which of the following physical exam findings is most characteristic of chronic venous
insufficiency rather than peripheral arterial disease?
A. Dependent rubor and pallor with elevation
,B. Diminished or absent pedal pulses
C. Hyperpigmentation and stasis dermatitis at the ankles
D. Intermittent claudication relieved by rest
Answer: C
Conceptual Explanation: Chronic venous insufficiency typically presents with lower
extremity edema, brownish hyperpigmentation (hemosiderin staining), and stasis
dermatitis, whereas PAD is characterized by pulse deficits and rubor.
3. A 54-year-old African American male has a blood pressure of 152/94 mmHg. A repeat
reading one week later is 150/92 mmHg. He has no history of diabetes or CKD. According to
JNC 8 guidelines, which is the preferred initial treatment?
A. Lisinopril
B. Metoprolol
C. Amlodipine
D. Losartan
Answer: C
Conceptual Explanation: For the general African American population, including those
with diabetes, initial antihypertensive treatment should include a thiazide-type diuretic or
a calcium channel blocker (CCB).
, 4. A patient with COPD presents with increased sputum purulence, increased sputum volume,
and increased dyspnea. According to the GOLD guidelines, what is the most appropriate
management?
A. Increase the dose of his daily LABA
B. Schedule a pulmonary function test immediately
C. Initiate a course of oral corticosteroids and antibiotics
D. Order a chest CT to rule out pulmonary embolism
Answer: C
Conceptual Explanation: The triad of increased dyspnea, sputum volume, and purulence
indicates a COPD exacerbation, which is typically treated with short-acting
bronchodilators, systemic corticosteroids, and antibiotics.
5. A 72-year-old female presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right upper sternal border, radiating to the carotids. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Aortic Stenosis
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
