NRNP 6540 MIDTERM EXAM SPRING/FALL 2026
EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
WALDEN UNIVERSITY
Question 1
A 62-year-old male presents with fatigue, polyuria, and polydipsia. His fasting
blood glucose is 165 mg/dL. He reports a family history of type 2 diabetes. Which
initial management strategy is most appropriate?
A. Begin insulin therapy immediately
B. Recommend lifestyle modifications and metformin therapy
C. Schedule for an oral glucose tolerance test only
D. Reassure patient; repeat fasting glucose in 6 months
Answer: B. Recommend lifestyle modifications and metformin therapy
Rationale: The patient meets criteria for type 2 diabetes. First-line management
includes lifestyle modifications and metformin, unless there are contraindications.
Immediate insulin is not required in most initial cases unless glucose is severely
elevated or symptomatic.
Question 2
A patient presents with a new-onset heart murmur. On auscultation, you hear a
mid-systolic click followed by a late systolic murmur at the apex. Which condition
is most likely?
A. Mitral valve prolapse
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: A. Mitral valve prolapse
Rationale: The classic finding of a mid-systolic click followed by a late systolic
murmur at the apex is characteristic of mitral valve prolapse.
,Question 3
A 45-year-old female presents with sudden onset right eye pain, blurred vision,
halos around lights, and nausea. Intraocular pressure is 42 mmHg. Which is the
most appropriate immediate intervention?
A. Prescribe topical antibiotics
B. Begin oral acetazolamide and refer to ophthalmology
C. Recommend observation at home
D. Prescribe corticosteroid eye drops
Answer: B. Begin oral acetazolamide and refer to ophthalmology
Rationale: These symptoms indicate acute angle-closure glaucoma, which is an
ocular emergency. Immediate lowering of intraocular pressure with medications
such as acetazolamide and prompt ophthalmology referral is essential.
Question 4
Which of the following laboratory findings is most indicative of chronic kidney
disease?
A. Serum creatinine 0.9 mg/dL
B. GFR 45 mL/min/1.73 m²
C. Blood urea nitrogen 12 mg/dL
D. Urinalysis negative for protein
Answer: B. GFR 45 mL/min/1.73 m²
Rationale: A GFR less than 60 mL/min/1.73 m² for ≥3 months is a key criterion
for chronic kidney disease. Serum creatinine alone may not reflect kidney function
accurately, and absence of proteinuria does not rule out CKD.
,Question 5
A patient with COPD reports increased sputum production, wheezing, and
shortness of breath. Which initial pharmacologic therapy is most appropriate for an
acute exacerbation?
A. Long-acting beta-agonist inhaler only
B. Short-acting beta-agonist inhaler with systemic corticosteroids
C. Antibiotics only
D. Oxygen therapy only
Answer: B. Short-acting beta-agonist inhaler with systemic corticosteroids
Rationale: Acute exacerbations of COPD are treated with short-acting
bronchodilators and systemic corticosteroids. Antibiotics are indicated if bacterial
infection is suspected.
Question 6
A 30-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Labs reveal TSH 12 mIU/L (normal 0.4–4.0) and free T4 low. What is
the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Observation only
Answer: B. Levothyroxine
Rationale: The patient has primary hypothyroidism (elevated TSH, low T4).
Levothyroxine is the standard treatment to normalize thyroid hormone levels.
, Question 7
A patient presents with acute abdominal pain in the right lower quadrant, fever,
and anorexia. Laboratory studies reveal leukocytosis. Which is the most
appropriate next step?
A. Begin empiric antibiotics and discharge
B. Order imaging to confirm diagnosis before surgical consult
C. Prescribe antispasmodics only
D. Schedule elective colonoscopy
Answer: B. Order imaging to confirm diagnosis before surgical consult
Rationale: Suspected acute appendicitis requires prompt imaging (usually
ultrasound or CT) for confirmation before surgical intervention. Early diagnosis
reduces complications such as perforation.
Question 8
Which of the following is a common adverse effect of ACE inhibitors?
A. Hyperkalemia
B. Hypoglycemia
C. Bradycardia
D. Peripheral neuropathy
Answer: A. Hyperkalemia
Rationale: ACE inhibitors can increase potassium levels by decreasing
aldosterone-mediated excretion. Cough is another common side effect.
EXAM QUESTIONS AND 100% VERIFIED ANSWERS
WITH RATIONALES GRADED A+ LATEST
WALDEN UNIVERSITY
Question 1
A 62-year-old male presents with fatigue, polyuria, and polydipsia. His fasting
blood glucose is 165 mg/dL. He reports a family history of type 2 diabetes. Which
initial management strategy is most appropriate?
A. Begin insulin therapy immediately
B. Recommend lifestyle modifications and metformin therapy
C. Schedule for an oral glucose tolerance test only
D. Reassure patient; repeat fasting glucose in 6 months
Answer: B. Recommend lifestyle modifications and metformin therapy
Rationale: The patient meets criteria for type 2 diabetes. First-line management
includes lifestyle modifications and metformin, unless there are contraindications.
Immediate insulin is not required in most initial cases unless glucose is severely
elevated or symptomatic.
Question 2
A patient presents with a new-onset heart murmur. On auscultation, you hear a
mid-systolic click followed by a late systolic murmur at the apex. Which condition
is most likely?
A. Mitral valve prolapse
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonic stenosis
Answer: A. Mitral valve prolapse
Rationale: The classic finding of a mid-systolic click followed by a late systolic
murmur at the apex is characteristic of mitral valve prolapse.
,Question 3
A 45-year-old female presents with sudden onset right eye pain, blurred vision,
halos around lights, and nausea. Intraocular pressure is 42 mmHg. Which is the
most appropriate immediate intervention?
A. Prescribe topical antibiotics
B. Begin oral acetazolamide and refer to ophthalmology
C. Recommend observation at home
D. Prescribe corticosteroid eye drops
Answer: B. Begin oral acetazolamide and refer to ophthalmology
Rationale: These symptoms indicate acute angle-closure glaucoma, which is an
ocular emergency. Immediate lowering of intraocular pressure with medications
such as acetazolamide and prompt ophthalmology referral is essential.
Question 4
Which of the following laboratory findings is most indicative of chronic kidney
disease?
A. Serum creatinine 0.9 mg/dL
B. GFR 45 mL/min/1.73 m²
C. Blood urea nitrogen 12 mg/dL
D. Urinalysis negative for protein
Answer: B. GFR 45 mL/min/1.73 m²
Rationale: A GFR less than 60 mL/min/1.73 m² for ≥3 months is a key criterion
for chronic kidney disease. Serum creatinine alone may not reflect kidney function
accurately, and absence of proteinuria does not rule out CKD.
,Question 5
A patient with COPD reports increased sputum production, wheezing, and
shortness of breath. Which initial pharmacologic therapy is most appropriate for an
acute exacerbation?
A. Long-acting beta-agonist inhaler only
B. Short-acting beta-agonist inhaler with systemic corticosteroids
C. Antibiotics only
D. Oxygen therapy only
Answer: B. Short-acting beta-agonist inhaler with systemic corticosteroids
Rationale: Acute exacerbations of COPD are treated with short-acting
bronchodilators and systemic corticosteroids. Antibiotics are indicated if bacterial
infection is suspected.
Question 6
A 30-year-old woman presents with fatigue, weight gain, constipation, and cold
intolerance. Labs reveal TSH 12 mIU/L (normal 0.4–4.0) and free T4 low. What is
the most appropriate initial treatment?
A. Methimazole
B. Levothyroxine
C. Radioactive iodine
D. Observation only
Answer: B. Levothyroxine
Rationale: The patient has primary hypothyroidism (elevated TSH, low T4).
Levothyroxine is the standard treatment to normalize thyroid hormone levels.
, Question 7
A patient presents with acute abdominal pain in the right lower quadrant, fever,
and anorexia. Laboratory studies reveal leukocytosis. Which is the most
appropriate next step?
A. Begin empiric antibiotics and discharge
B. Order imaging to confirm diagnosis before surgical consult
C. Prescribe antispasmodics only
D. Schedule elective colonoscopy
Answer: B. Order imaging to confirm diagnosis before surgical consult
Rationale: Suspected acute appendicitis requires prompt imaging (usually
ultrasound or CT) for confirmation before surgical intervention. Early diagnosis
reduces complications such as perforation.
Question 8
Which of the following is a common adverse effect of ACE inhibitors?
A. Hyperkalemia
B. Hypoglycemia
C. Bradycardia
D. Peripheral neuropathy
Answer: A. Hyperkalemia
Rationale: ACE inhibitors can increase potassium levels by decreasing
aldosterone-mediated excretion. Cough is another common side effect.
