NURS 6531 EXAM 1 - ADVANCED
PRIMARY CARE PREPARATION
QUESTIONS AND VERIFIED ANSWERS|
GRADE A+|WALDEN UNIVERSITY
1. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotid arteries. What is the most
likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Conceptual Explanation: Aortic stenosis typically presents as a systolic murmur at the
right upper sternal border radiating to the carotids. Mitral regurgitation is holosystolic at
the apex.
2. When evaluating a patient for COPD, which spirometry result is required to confirm the
diagnosis according to GOLD guidelines?
A. FEV1/FVC ratio > 0.70 post-bronchodilator
,B. Peak expiratory flow improvement of 20%
C. FEV1 < 80% predicted
D. Peak expiratory flow improvement of 20%
D. FEV1/FVC ratio < 0.70 post-bronchodilator
Answer: D
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
gold standard for confirming persistent airflow limitation (COPD).
3. An elderly patient reports a sudden onset of ‘curtain coming down’ over their vision and
seeing floaters. This is most characteristic of:
A. Open-angle glaucoma
B. Cataracts
C. Macular degeneration
D. Retinal detachment
Answer: D
Conceptual Explanation: Retinal detachment is a medical emergency often described as a
shadow or curtain over the field of vision, accompanied by floaters or flashes of light.
4. According to JNC 8 guidelines, what is the blood pressure goal for a 62-year-old patient
with Chronic Kidney Disease (CKD)?
A. < 120/70 mmHg
, B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: D
Conceptual Explanation: JNC 8 recommends a goal of < 140/90 mmHg for patients of all
ages with CKD or diabetes. Note: AHA/ACC 2017 guidelines suggest < 130/80, but JNC 8 is
still a common testing standard.
5. A patient presents with a painful, red, swollen area on the lower leg that is poorly
demarcated. There is no fluctuance. The most likely diagnosis and treatment is:
A. Cellulitis; Oral Antibiotics
B. Abscess; Incision and Drainage
C. Erysipelas; Topical Steroids
D. DVT; Anticoagulation
Answer: A
Conceptual Explanation: Cellulitis presents as non-fluctuant, poorly demarcated
erythema and warmth. Treatment is typically oral antibiotics covering Gram-positive
organisms.
6. Which of the following physical exam findings is most specific for Acute Cholecystitis?
A. Murphy’s sign
PRIMARY CARE PREPARATION
QUESTIONS AND VERIFIED ANSWERS|
GRADE A+|WALDEN UNIVERSITY
1. A 65-year-old patient presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotid arteries. What is the most
likely diagnosis?
A. Aortic Stenosis
B. Mitral Regurgitation
C. Aortic Regurgitation
D. Mitral Stenosis
Answer: A
Conceptual Explanation: Aortic stenosis typically presents as a systolic murmur at the
right upper sternal border radiating to the carotids. Mitral regurgitation is holosystolic at
the apex.
2. When evaluating a patient for COPD, which spirometry result is required to confirm the
diagnosis according to GOLD guidelines?
A. FEV1/FVC ratio > 0.70 post-bronchodilator
,B. Peak expiratory flow improvement of 20%
C. FEV1 < 80% predicted
D. Peak expiratory flow improvement of 20%
D. FEV1/FVC ratio < 0.70 post-bronchodilator
Answer: D
Conceptual Explanation: A post-bronchodilator FEV1/FVC ratio of less than 0.70 is the
gold standard for confirming persistent airflow limitation (COPD).
3. An elderly patient reports a sudden onset of ‘curtain coming down’ over their vision and
seeing floaters. This is most characteristic of:
A. Open-angle glaucoma
B. Cataracts
C. Macular degeneration
D. Retinal detachment
Answer: D
Conceptual Explanation: Retinal detachment is a medical emergency often described as a
shadow or curtain over the field of vision, accompanied by floaters or flashes of light.
4. According to JNC 8 guidelines, what is the blood pressure goal for a 62-year-old patient
with Chronic Kidney Disease (CKD)?
A. < 120/70 mmHg
, B. < 130/80 mmHg
C. < 150/90 mmHg
D. < 140/90 mmHg
Answer: D
Conceptual Explanation: JNC 8 recommends a goal of < 140/90 mmHg for patients of all
ages with CKD or diabetes. Note: AHA/ACC 2017 guidelines suggest < 130/80, but JNC 8 is
still a common testing standard.
5. A patient presents with a painful, red, swollen area on the lower leg that is poorly
demarcated. There is no fluctuance. The most likely diagnosis and treatment is:
A. Cellulitis; Oral Antibiotics
B. Abscess; Incision and Drainage
C. Erysipelas; Topical Steroids
D. DVT; Anticoagulation
Answer: A
Conceptual Explanation: Cellulitis presents as non-fluctuant, poorly demarcated
erythema and warmth. Treatment is typically oral antibiotics covering Gram-positive
organisms.
6. Which of the following physical exam findings is most specific for Acute Cholecystitis?
A. Murphy’s sign
