NR 511 Differential Diagnosis and Primary Care 2025/2026 NP
Practice Questions with Verified Answers & Rationales/ All
topics fully covered/ New version
1. A 48-year-old patient presents for a routine check-up. His blood pressure
readings over three visits are 138/88, 142/90, and 140/89 mmHg. According
to ACC/AHA guidelines, how would you classify his hypertension, and
what initial management strategy is recommended?
Stage 2 hypertension; initiate lifestyle modifications including sodium
restriction, increased physical activity, weight loss, and consider starting
antihypertensive medication based on cardiovascular risk factors
2. A patient complains of shortness of breath on exertion and swelling in both
ankles. Echocardiogram reveals an ejection fraction of 35%. What type of
heart failure is this, and which medications have been shown to improve
survival in this condition?
Systolic heart failure (HFrEF); ACE inhibitors or ARBs, beta-blockers, and
mineralocorticoid receptor antagonists improve survival
3. Fill in the blank: In patients with heart failure, daily __________ is
recommended to monitor for early signs of fluid retention and prevent acute
decompensation.
weight measurement
, 4. Case Study: A 62-year-old woman with longstanding hypertension reports
sudden weight gain of 4 pounds in 3 days, increased leg swelling, and
difficulty breathing at night. She is already taking an ACE inhibitor and a
low-dose diuretic. What is the likely cause of her symptoms, and what
immediate intervention is indicated?
Acute fluid overload due to decompensated heart failure; administer loop
diuretics, monitor renal function and electrolytes, and adjust chronic therapy
as needed
5. Which lifestyle modification has the greatest impact on reducing systolic
blood pressure in adults with hypertension?
Weight reduction and dietary sodium restriction
6. A 55-year-old male presents with fatigue, orthopnea, and paroxysmal
nocturnal dyspnea. On exam, his blood pressure is 135/85 mmHg, heart rate
is 78 bpm, and EF is 38%. What type of heart failure is this, and which
therapy specifically improves survival?
Systolic heart failure (HFrEF); ACE inhibitor or ARB therapy along with
beta-blocker and diuretics for symptom relief
7. Fill in the blank: ___________ heart failure typically presents with
preserved ejection fraction but impaired ventricular relaxation, often caused
by long-standing hypertension or aging.
Diastolic (HFpEF)
8. A patient with HFpEF presents with pulmonary congestion and mild edema.
Which class of medication is primarily used to relieve symptoms without
necessarily improving mortality?
,Loop diuretics
9. Explain why beta-blockers, despite slowing heart rate and potentially
reducing contractility, are beneficial in patients with HFrEF.
Beta-blockers reduce harmful sympathetic nervous system activation, prevent
adverse ventricular remodeling, improve left ventricular function over time,
and decrease mortality
10.Case Study: A 70-year-old male with HFrEF presents for follow-up. He
reports increased fatigue and a 3-pound weight gain in two days. His current
medications include an ACE inhibitor and a loop diuretic. Which adjustment
in therapy would be most appropriate?
Add a beta-blocker to improve survival and adjust diuretic dosage to manage
fluid retention
11.A patient with newly diagnosed stage 1 hypertension asks which non-
pharmacologic interventions are recommended. List at least three.
Sodium restriction, regular aerobic exercise, weight loss, moderation of
alcohol intake, smoking cessation
12.Fill in the blank: An ejection fraction of less than _____% is considered
indicative of systolic heart failure.
40
13.A 68-year-old woman with long-standing hypertension presents with
exertional dyspnea and nocturnal cough. Echocardiogram shows preserved
EF. What is the primary focus of treatment?
, Control blood pressure, manage comorbidities, and relieve symptoms with
diuretics if needed
14.Case Study: A 60-year-old man with hypertension reports fatigue and mild
ankle swelling. Blood pressure is 165/100 mmHg. Laboratory studies are
within normal limits. What is the most important initial step in management?
Initiate or intensify antihypertensive therapy, implement lifestyle
modifications, and monitor for signs of heart failure
15.Why is daily blood pressure monitoring important for patients with
hypertension?
To track treatment effectiveness, detect uncontrolled hypertension early, and
guide adjustments in therapy
16.A patient with HFrEF remains symptomatic despite being on ACE inhibitors
and loop diuretics. Which additional therapy may improve survival, and
what monitoring is required?
Mineralocorticoid receptor antagonist (spironolactone or eplerenone);
monitor potassium and renal function to avoid hyperkalemia
17.Fill in the blank: The most common precipitating factor for acute
decompensated heart failure is ___________.
myocardial ischemia
18.Explain how left-sided heart failure leads to pulmonary congestion.
Practice Questions with Verified Answers & Rationales/ All
topics fully covered/ New version
1. A 48-year-old patient presents for a routine check-up. His blood pressure
readings over three visits are 138/88, 142/90, and 140/89 mmHg. According
to ACC/AHA guidelines, how would you classify his hypertension, and
what initial management strategy is recommended?
Stage 2 hypertension; initiate lifestyle modifications including sodium
restriction, increased physical activity, weight loss, and consider starting
antihypertensive medication based on cardiovascular risk factors
2. A patient complains of shortness of breath on exertion and swelling in both
ankles. Echocardiogram reveals an ejection fraction of 35%. What type of
heart failure is this, and which medications have been shown to improve
survival in this condition?
Systolic heart failure (HFrEF); ACE inhibitors or ARBs, beta-blockers, and
mineralocorticoid receptor antagonists improve survival
3. Fill in the blank: In patients with heart failure, daily __________ is
recommended to monitor for early signs of fluid retention and prevent acute
decompensation.
weight measurement
, 4. Case Study: A 62-year-old woman with longstanding hypertension reports
sudden weight gain of 4 pounds in 3 days, increased leg swelling, and
difficulty breathing at night. She is already taking an ACE inhibitor and a
low-dose diuretic. What is the likely cause of her symptoms, and what
immediate intervention is indicated?
Acute fluid overload due to decompensated heart failure; administer loop
diuretics, monitor renal function and electrolytes, and adjust chronic therapy
as needed
5. Which lifestyle modification has the greatest impact on reducing systolic
blood pressure in adults with hypertension?
Weight reduction and dietary sodium restriction
6. A 55-year-old male presents with fatigue, orthopnea, and paroxysmal
nocturnal dyspnea. On exam, his blood pressure is 135/85 mmHg, heart rate
is 78 bpm, and EF is 38%. What type of heart failure is this, and which
therapy specifically improves survival?
Systolic heart failure (HFrEF); ACE inhibitor or ARB therapy along with
beta-blocker and diuretics for symptom relief
7. Fill in the blank: ___________ heart failure typically presents with
preserved ejection fraction but impaired ventricular relaxation, often caused
by long-standing hypertension or aging.
Diastolic (HFpEF)
8. A patient with HFpEF presents with pulmonary congestion and mild edema.
Which class of medication is primarily used to relieve symptoms without
necessarily improving mortality?
,Loop diuretics
9. Explain why beta-blockers, despite slowing heart rate and potentially
reducing contractility, are beneficial in patients with HFrEF.
Beta-blockers reduce harmful sympathetic nervous system activation, prevent
adverse ventricular remodeling, improve left ventricular function over time,
and decrease mortality
10.Case Study: A 70-year-old male with HFrEF presents for follow-up. He
reports increased fatigue and a 3-pound weight gain in two days. His current
medications include an ACE inhibitor and a loop diuretic. Which adjustment
in therapy would be most appropriate?
Add a beta-blocker to improve survival and adjust diuretic dosage to manage
fluid retention
11.A patient with newly diagnosed stage 1 hypertension asks which non-
pharmacologic interventions are recommended. List at least three.
Sodium restriction, regular aerobic exercise, weight loss, moderation of
alcohol intake, smoking cessation
12.Fill in the blank: An ejection fraction of less than _____% is considered
indicative of systolic heart failure.
40
13.A 68-year-old woman with long-standing hypertension presents with
exertional dyspnea and nocturnal cough. Echocardiogram shows preserved
EF. What is the primary focus of treatment?
, Control blood pressure, manage comorbidities, and relieve symptoms with
diuretics if needed
14.Case Study: A 60-year-old man with hypertension reports fatigue and mild
ankle swelling. Blood pressure is 165/100 mmHg. Laboratory studies are
within normal limits. What is the most important initial step in management?
Initiate or intensify antihypertensive therapy, implement lifestyle
modifications, and monitor for signs of heart failure
15.Why is daily blood pressure monitoring important for patients with
hypertension?
To track treatment effectiveness, detect uncontrolled hypertension early, and
guide adjustments in therapy
16.A patient with HFrEF remains symptomatic despite being on ACE inhibitors
and loop diuretics. Which additional therapy may improve survival, and
what monitoring is required?
Mineralocorticoid receptor antagonist (spironolactone or eplerenone);
monitor potassium and renal function to avoid hyperkalemia
17.Fill in the blank: The most common precipitating factor for acute
decompensated heart failure is ___________.
myocardial ischemia
18.Explain how left-sided heart failure leads to pulmonary congestion.
