NURS 6531 EXAM 2: ADVANCED
PRACTICE CARE OF ADULTS
QUESTIONS AND VERIFIED ANSWERS|
GRADE A+|WALDEN UNIVERSITY
1. A 68-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotids. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Tricuspid Stenosis
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a systolic crescendo-
decrescendo murmur at the right upper sternal border that radiates to the neck.
2. Which of the following is the most appropriate first-line treatment for a patient with Stage
C Heart Failure with Reduced Ejection Fraction (HFrEF) according to the latest guidelines?
A. Loop Diuretic monotherapy
B. ARNI, Beta-blocker, MRA, and SGLT2 inhibitor
,C. Calcium Channel Blocker
D. Digoxin and Hydralazine
Answer: B
Conceptual Explanation: Guideline-directed medical therapy (GDMT) for HFrEF now
includes the four pillars: ARNI/ACEI/ARB, evidence-based beta-blockers, Mineralocorticoid
Receptor Antagonists (MRA), and SGLT2 inhibitors.
3. A 55-year-old female with a history of COPD presents with increased sputum purulence
and volume. Her FEV1 is 60% of predicted. Which classification of COPD severity does this
represent per GOLD criteria?
A. GOLD 1 (Mild)
B. GOLD 2 (Moderate)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: B
Conceptual Explanation: GOLD 2 (Moderate) is defined as an FEV1 between 50% and
79% of the predicted value.
4. In a patient with chronic kidney disease (CKD), at what estimated Glomerular Filtration
Rate (eGFR) should Metformin be discontinued?
A. Below 60 mL/min/1.73m2
, B. Below 45 mL/min/1.73m2
C. Below 30 mL/min/1.73m2
D. Below 15 mL/min/1.73m2
Answer: C
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the risk of lactic acidosis.
5. A patient presents with a ‘curtain coming down’ over their vision in the right eye, which
resolved after 10 minutes. This most likely represents:
A. Retinal Detachment
B. Amaurosis Fugax
C. Temporal Arteritis
D. Glaucoma
Answer: B
Conceptual Explanation: Amaurosis fugax is a transient monocular vision loss often
described as a curtain being pulled down, typically caused by carotid artery disease (TIA).
6. What is the primary diagnostic test for a patient suspected of having Giant Cell Arteritis?
A. Temporal Artery Biopsy
B. CT Angiography of the head
PRACTICE CARE OF ADULTS
QUESTIONS AND VERIFIED ANSWERS|
GRADE A+|WALDEN UNIVERSITY
1. A 68-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotids. What is the most likely
diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Tricuspid Stenosis
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a systolic crescendo-
decrescendo murmur at the right upper sternal border that radiates to the neck.
2. Which of the following is the most appropriate first-line treatment for a patient with Stage
C Heart Failure with Reduced Ejection Fraction (HFrEF) according to the latest guidelines?
A. Loop Diuretic monotherapy
B. ARNI, Beta-blocker, MRA, and SGLT2 inhibitor
,C. Calcium Channel Blocker
D. Digoxin and Hydralazine
Answer: B
Conceptual Explanation: Guideline-directed medical therapy (GDMT) for HFrEF now
includes the four pillars: ARNI/ACEI/ARB, evidence-based beta-blockers, Mineralocorticoid
Receptor Antagonists (MRA), and SGLT2 inhibitors.
3. A 55-year-old female with a history of COPD presents with increased sputum purulence
and volume. Her FEV1 is 60% of predicted. Which classification of COPD severity does this
represent per GOLD criteria?
A. GOLD 1 (Mild)
B. GOLD 2 (Moderate)
C. GOLD 3 (Severe)
D. GOLD 4 (Very Severe)
Answer: B
Conceptual Explanation: GOLD 2 (Moderate) is defined as an FEV1 between 50% and
79% of the predicted value.
4. In a patient with chronic kidney disease (CKD), at what estimated Glomerular Filtration
Rate (eGFR) should Metformin be discontinued?
A. Below 60 mL/min/1.73m2
, B. Below 45 mL/min/1.73m2
C. Below 30 mL/min/1.73m2
D. Below 15 mL/min/1.73m2
Answer: C
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR below 30
mL/min/1.73m2 due to the risk of lactic acidosis.
5. A patient presents with a ‘curtain coming down’ over their vision in the right eye, which
resolved after 10 minutes. This most likely represents:
A. Retinal Detachment
B. Amaurosis Fugax
C. Temporal Arteritis
D. Glaucoma
Answer: B
Conceptual Explanation: Amaurosis fugax is a transient monocular vision loss often
described as a curtain being pulled down, typically caused by carotid artery disease (TIA).
6. What is the primary diagnostic test for a patient suspected of having Giant Cell Arteritis?
A. Temporal Artery Biopsy
B. CT Angiography of the head
