NURS 6531 ADVANCED PRACTICE
CARE OF ADULTS EXAM STUDY GUIDE
2026/2027 QUESTIONS AND VERIFIED
ANSWERS| GRADE A+|WALDEN
UNIVERSITY
1. A 65-year-old male with a history of hypertension and heart failure presents with a new
onset of atrial fibrillation. Which of the following is the most appropriate initial assessment
to determine his risk for stroke and the need for anticoagulation?
A. CHA2DS2-VASc Score
B. CHADS2 Score
C. HAS-BLED Score
D. Framingham Risk Score
Answer: A
Conceptual Explanation: The CHA2DS2-VASc score is the current standard for assessing
stroke risk in patients with non-valvular atrial fibrillation to guide anticoagulation therapy.
2. A 52-year-old female patient presents with a TSH level of 7.5 mIU/L and a normal free T4
level. She complains of mild fatigue but has no other symptoms. What is the most
appropriate next step?
A. Start Levothyroxine 25 mcg daily
,B. Start Levothyroxine 50 mcg daily
C. Order a thyroid ultrasound
D. Repeat TSH and free T4 in 3-6 months
Answer: D
Conceptual Explanation: In subclinical hypothyroidism (elevated TSH, normal T4), if the
TSH is less than 10 mIU/L and the patient is asymptomatic or mildly symptomatic, it is
appropriate to monitor and repeat testing in 3-6 months before initiating therapy.
3. According to the JNC 8 guidelines, what is the blood pressure goal for a 62-year-old patient
with chronic kidney disease (CKD)?
A. <120/80 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
D. <150/90 mmHg
Answer: B
Conceptual Explanation: Per JNC 8, for patients aged 18 years or older with CKD or
diabetes, the goal blood pressure is <140/90 mmHg.
4. A 45-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of
the following medications is contraindicated?
A. Metformin
, B. Glipizide
C. Liraglutide
D. Pioglitazone
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the risk of lactic acidosis.
5. Which of the following is considered the ‘gold standard’ for the diagnosis of COPD?
A. Chest X-ray
B. Spirometry showing FEV1/FVC < 0.70 post-bronchodilator
C. High-resolution CT scan
D. Pulse oximetry at rest and during exercise
Answer: B
Conceptual Explanation: Spirometry is required to make the diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio of <0.70 confirms persistent airflow limitation.
6. A 70-year-old patient presents with a sudden onset of a ‘curtain-like’ shadow over their
vision in the right eye. This is most characteristic of:
A. Acute angle-closure glaucoma
B. Cataracts
CARE OF ADULTS EXAM STUDY GUIDE
2026/2027 QUESTIONS AND VERIFIED
ANSWERS| GRADE A+|WALDEN
UNIVERSITY
1. A 65-year-old male with a history of hypertension and heart failure presents with a new
onset of atrial fibrillation. Which of the following is the most appropriate initial assessment
to determine his risk for stroke and the need for anticoagulation?
A. CHA2DS2-VASc Score
B. CHADS2 Score
C. HAS-BLED Score
D. Framingham Risk Score
Answer: A
Conceptual Explanation: The CHA2DS2-VASc score is the current standard for assessing
stroke risk in patients with non-valvular atrial fibrillation to guide anticoagulation therapy.
2. A 52-year-old female patient presents with a TSH level of 7.5 mIU/L and a normal free T4
level. She complains of mild fatigue but has no other symptoms. What is the most
appropriate next step?
A. Start Levothyroxine 25 mcg daily
,B. Start Levothyroxine 50 mcg daily
C. Order a thyroid ultrasound
D. Repeat TSH and free T4 in 3-6 months
Answer: D
Conceptual Explanation: In subclinical hypothyroidism (elevated TSH, normal T4), if the
TSH is less than 10 mIU/L and the patient is asymptomatic or mildly symptomatic, it is
appropriate to monitor and repeat testing in 3-6 months before initiating therapy.
3. According to the JNC 8 guidelines, what is the blood pressure goal for a 62-year-old patient
with chronic kidney disease (CKD)?
A. <120/80 mmHg
B. <140/90 mmHg
C. <130/80 mmHg
D. <150/90 mmHg
Answer: B
Conceptual Explanation: Per JNC 8, for patients aged 18 years or older with CKD or
diabetes, the goal blood pressure is <140/90 mmHg.
4. A 45-year-old patient with Type 2 Diabetes has an eGFR of 28 mL/min/1.73m². Which of
the following medications is contraindicated?
A. Metformin
, B. Glipizide
C. Liraglutide
D. Pioglitazone
Answer: A
Conceptual Explanation: Metformin is contraindicated in patients with an eGFR less than
30 mL/min/1.73m² due to the risk of lactic acidosis.
5. Which of the following is considered the ‘gold standard’ for the diagnosis of COPD?
A. Chest X-ray
B. Spirometry showing FEV1/FVC < 0.70 post-bronchodilator
C. High-resolution CT scan
D. Pulse oximetry at rest and during exercise
Answer: B
Conceptual Explanation: Spirometry is required to make the diagnosis of COPD; a post-
bronchodilator FEV1/FVC ratio of <0.70 confirms persistent airflow limitation.
6. A 70-year-old patient presents with a sudden onset of a ‘curtain-like’ shadow over their
vision in the right eye. This is most characteristic of:
A. Acute angle-closure glaucoma
B. Cataracts
