NRNP 6540 Advanced Practice Care of
Adults Across the Lifespan, Walden
University, 2026/2027 – midterm exam with
latest questions and verified answers
1. A 68-year-old male with a 40-pack-
jh jh jh jh jh jh
year smoking history presents with a new onset of a non-
jh jh jh jh jh jh jh jh jh jh
productive cough, dyspnea on exertion, and hoarseness. A chest X- jh jh jh jh jh jh jh jh jh
ray reveals a large right hilar mass. Which of the following is the most likely diagnosis?
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
A) Small cell lung cancer
jh jh jh jh
B) Squamous cell carcinoma
jh jh jh
C) Adenocarcinoma
jh
D) Large cell carcinoma
jh jh jh
E) Mesothelioma
jh
Correct Answer: B) Squamous cell carcinoma
jh jh jh jh jh
2. A 72-year-old female with a history of hypertension and osteoarthritis presents with a 3-
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
month history of progressive bilateral lower extremity edema, jugular venous distention (J
jh jh jh jh jh jh jh jh jh jh jh
VD), and a systolic ejection murmur. An echocardiogram reveals aortic stenosis. What is the
jh jh jh jh jh jh jh jh jh jh jh jh jh
gold standard treatment for symptomatic severe aortic stenosis in this patient?
jh jh jh jh jh jh jh jh jh jh jh
A) Balloon valvuloplasty
jh jh
B) Aortic valve replacement (SAVR or TAVR)
jh jh jh jh jh jh
C) High-dose diuretics and digoxin
jh jh jh jh
D) Antibiotic prophylaxis
jh jh
E) Beta-blocker therapy
jh jh
Correct Answer: B) Aortic valve replacement (SAVR or TAVR)
jh jh jh jh jh jh jh jh
3. An 82-year-
jh jh
old male with Alzheimer’s disease is brought in by his daughter. She states he has become i
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ncreasingly agitated over the past week, is pulling at his clothes, and seems to be seeing thi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ngs that are not there. His vital signs are stable. Which of the following is the most appropr
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
iate first- jh
line pharmacological management for behavioral and psychological symptoms of dementi
jh jh jh jh jh jh jh jh jh
a (BPSD) in this patient?
jh jh jh jh
,A) Haloperidol
jh
B) Risperidone
jh
C) Citalopram
jh
D) Trazodone
jh
E) Lorazepam
jh
Correct Answer: D) Trazodone jh jh jh
4. A 55-year-
jh jh
old female presents with complaints of a "racing heart" and dizziness. Her ECG shows an irr
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
egularly irregular rhythm with no discernible P-
jh jh jh jh jh jh
waves and a ventricular rate of 130. What is the most appropriate initial treatment for rate
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
control if she is hemodynamically stable?
jh jh jh jh jh
A) Synchronized cardioversion
jh jh
B) Digoxin
jh
C) Metoprolol
jh
D) Amiodarone
jh
E) Aspirin
jh
Correct Answer: C) Metoprolol jh jh jh
5. You are evaluating a 67-year-
jh jh jh jh jh
old male with a known history of coronary artery disease. He reports that his prescribed as
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
pirin upsets his stomach. You decide to switch him to a different antiplatelet. Which of the
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
following would be the best alternative in this patient?
jh jh jh jh jh jh jh jh
A) Ibuprofen
jh
B) Warfarin
jh
C) Clopidogrel
jh
D) Acetaminophen
jh
E) Dipyridamole
jh
Correct Answer: C) Clopidogrel jh jh jh
6. A 78-year-
jh jh
old male with Type 2 Diabetes presents with nocturia, urinary frequency, and a weak strea
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
m. His post-
jh jh
void residual (PVR) is elevated. A digital rectal exam (DRE) reveals a smooth, enlarged pros
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tate. What is the most likely diagnosis?
jh jh jh jh jh jh
A) Prostate cancer
jh jh
,B) Benign Prostatic Hyperplasia (BPH)
jh jh jh jh
C) Urinary tract infection
jh jh jh
D) Prostatitis
jh
E) Bladder calculi
jh jh
Correct Answer: B) Benign Prostatic Hyperplasia (BPH)
jh jh jh jh jh jh
7. A 58-year-
jh jh
old female with a history of hypothyroidism presents with a swollen, painful left great toe.
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
The joint is warm, erythematous, and exquisitely tender. Serum uric acid is 8.9 mg/dL. Whic
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
h of the following is the most appropriate initial treatment for this acute gout flare?
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
A) Allopurinol
jh
B) Colchicine (low-dose)
jh jh
C) Probenecid
jh
D) Febuxostat
jh
E) Acetaminophen
jh
Correct Answer: B) Colchicine (low-dose)
jh jh jh jh
8. An 80-year-old female presents with a 4-
jh jh jh jh jh jh jh
hour history of acute, sharp right upper quadrant pain radiating to her right shoulder, naus
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ea, and vomiting. Her temperature is 101.3°F (38.5°C), and the physical exam reveals a posi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tive Murphy's sign. What is the most appropriate imaging modality to diagnose this condit
jh jh jh jh jh jh jh jh jh jh jh jh jh
ion?
A) CT scan of the abdomen
jh jh jh jh jh
B) Magnetic resonance cholangiopancreatography (MRCP)
jh jh jh jh
C) Abdominal ultrasound
jh jh
D) Upper GI series
jh jh jh
E) HIDA scan
jh jh
Correct Answer: C) Abdominal ultrasound
jh jh jh jh
9. A 70-year-
jh jh
old male with a history of heart failure with preserved ejection fraction (HFpEF) is evaluate
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
d for new-
jh jh
onset dyspnea on exertion. Which of the following medications has been shown to reduce
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
hospitalizations for heart failure in this specific population? jh jh jh jh jh jh jh
A) SGLT2 inhibitors (e.g., Empagliflozin)
jh jh jh jh
B) High-dose loop diuretics
jh jh jh
, C) Spironolactone
jh
D) Entresto (sacubitril/valsartan)
jh jh
E) Digitalis
jh
Correct Answer: A) SGLT2 inhibitors (e.g., Empagliflozin)
jh jh jh jh jh jh
10. A 65-year-
jh jh
old female with osteoporosis is started on a bisphosphonate. Which of the following is the
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
most important patient education point regarding the administration of this medication?
jh jh jh jh jh jh jh jh jh jh
A) Take with calcium-rich foods
jh jh jh jh
B) Take on an empty stomach with a full glass of water and remain upright for 30 minutes
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
C) Take at bedtime with a small snack to prevent nausea
jh jh jh jh jh jh jh jh jh jh
D) Take with grapefruit juice to enhance absorption
jh jh jh jh jh jh jh
E) Take with magnesium supplements
jh jh jh jh
Correct Answer: B) Take on an empty stomach with a full glass of water and remain upright for 30
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh j
minutes
h
11. A 45-year-
jh jh
old male is diagnosed with Hypertension. He is prescribed Lisinopril (ACE inhibitor). Two w
jh jh jh jh jh jh jh jh jh jh jh jh jh
eeks later, he calls complaining of a persistent, dry cough. What is the most likely cause of t
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
his cough, and what is the appropriate management?
jh jh jh jh jh jh jh
A) Heart failure; switch to an ARB
jh jh jh jh jh jh
B) ACE inhibitor side effect; switch to an ARB
jh jh jh jh jh jh jh jh
C) Allergic reaction; stop the medication immediately
jh jh jh jh jh jh
D) Asthma exacerbation; start an inhaler
jh jh jh jh jh
E) GERD; start a PPI
jh jh jh jh
Correct Answer: B) ACE inhibitor side effect; switch to an ARB
jh jh jh jh jh jh jh jh jh jh
12. A 62-year-
jh jh
old female with a history of hypertension and CKD stage 3 is noted to have a serum potassi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
um of 5.9 mEq/L. Her medications include lisinopril and spironolactone. Which of the follo
jh jh jh jh jh jh jh jh jh jh jh jh jh
wing should be the provider’s first action?
jh jh jh jh jh jh
A) Administer intravenous calcium gluconate
jh jh jh jh
B) Hold the spironolactone and lisinopril
jh jh jh jh jh
C) Start insulin and dextrose IV
jh jh jh jh jh
D) Order a stat EKG
jh jh jh jh
E) Kayexalate (sodium polystyrene sulfonate)
jh jh jh jh
Adults Across the Lifespan, Walden
University, 2026/2027 – midterm exam with
latest questions and verified answers
1. A 68-year-old male with a 40-pack-
jh jh jh jh jh jh
year smoking history presents with a new onset of a non-
jh jh jh jh jh jh jh jh jh jh
productive cough, dyspnea on exertion, and hoarseness. A chest X- jh jh jh jh jh jh jh jh jh
ray reveals a large right hilar mass. Which of the following is the most likely diagnosis?
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
A) Small cell lung cancer
jh jh jh jh
B) Squamous cell carcinoma
jh jh jh
C) Adenocarcinoma
jh
D) Large cell carcinoma
jh jh jh
E) Mesothelioma
jh
Correct Answer: B) Squamous cell carcinoma
jh jh jh jh jh
2. A 72-year-old female with a history of hypertension and osteoarthritis presents with a 3-
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
month history of progressive bilateral lower extremity edema, jugular venous distention (J
jh jh jh jh jh jh jh jh jh jh jh
VD), and a systolic ejection murmur. An echocardiogram reveals aortic stenosis. What is the
jh jh jh jh jh jh jh jh jh jh jh jh jh
gold standard treatment for symptomatic severe aortic stenosis in this patient?
jh jh jh jh jh jh jh jh jh jh jh
A) Balloon valvuloplasty
jh jh
B) Aortic valve replacement (SAVR or TAVR)
jh jh jh jh jh jh
C) High-dose diuretics and digoxin
jh jh jh jh
D) Antibiotic prophylaxis
jh jh
E) Beta-blocker therapy
jh jh
Correct Answer: B) Aortic valve replacement (SAVR or TAVR)
jh jh jh jh jh jh jh jh
3. An 82-year-
jh jh
old male with Alzheimer’s disease is brought in by his daughter. She states he has become i
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ncreasingly agitated over the past week, is pulling at his clothes, and seems to be seeing thi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ngs that are not there. His vital signs are stable. Which of the following is the most appropr
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
iate first- jh
line pharmacological management for behavioral and psychological symptoms of dementi
jh jh jh jh jh jh jh jh jh
a (BPSD) in this patient?
jh jh jh jh
,A) Haloperidol
jh
B) Risperidone
jh
C) Citalopram
jh
D) Trazodone
jh
E) Lorazepam
jh
Correct Answer: D) Trazodone jh jh jh
4. A 55-year-
jh jh
old female presents with complaints of a "racing heart" and dizziness. Her ECG shows an irr
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
egularly irregular rhythm with no discernible P-
jh jh jh jh jh jh
waves and a ventricular rate of 130. What is the most appropriate initial treatment for rate
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
control if she is hemodynamically stable?
jh jh jh jh jh
A) Synchronized cardioversion
jh jh
B) Digoxin
jh
C) Metoprolol
jh
D) Amiodarone
jh
E) Aspirin
jh
Correct Answer: C) Metoprolol jh jh jh
5. You are evaluating a 67-year-
jh jh jh jh jh
old male with a known history of coronary artery disease. He reports that his prescribed as
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
pirin upsets his stomach. You decide to switch him to a different antiplatelet. Which of the
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
following would be the best alternative in this patient?
jh jh jh jh jh jh jh jh
A) Ibuprofen
jh
B) Warfarin
jh
C) Clopidogrel
jh
D) Acetaminophen
jh
E) Dipyridamole
jh
Correct Answer: C) Clopidogrel jh jh jh
6. A 78-year-
jh jh
old male with Type 2 Diabetes presents with nocturia, urinary frequency, and a weak strea
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
m. His post-
jh jh
void residual (PVR) is elevated. A digital rectal exam (DRE) reveals a smooth, enlarged pros
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tate. What is the most likely diagnosis?
jh jh jh jh jh jh
A) Prostate cancer
jh jh
,B) Benign Prostatic Hyperplasia (BPH)
jh jh jh jh
C) Urinary tract infection
jh jh jh
D) Prostatitis
jh
E) Bladder calculi
jh jh
Correct Answer: B) Benign Prostatic Hyperplasia (BPH)
jh jh jh jh jh jh
7. A 58-year-
jh jh
old female with a history of hypothyroidism presents with a swollen, painful left great toe.
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
The joint is warm, erythematous, and exquisitely tender. Serum uric acid is 8.9 mg/dL. Whic
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
h of the following is the most appropriate initial treatment for this acute gout flare?
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
A) Allopurinol
jh
B) Colchicine (low-dose)
jh jh
C) Probenecid
jh
D) Febuxostat
jh
E) Acetaminophen
jh
Correct Answer: B) Colchicine (low-dose)
jh jh jh jh
8. An 80-year-old female presents with a 4-
jh jh jh jh jh jh jh
hour history of acute, sharp right upper quadrant pain radiating to her right shoulder, naus
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
ea, and vomiting. Her temperature is 101.3°F (38.5°C), and the physical exam reveals a posi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
tive Murphy's sign. What is the most appropriate imaging modality to diagnose this condit
jh jh jh jh jh jh jh jh jh jh jh jh jh
ion?
A) CT scan of the abdomen
jh jh jh jh jh
B) Magnetic resonance cholangiopancreatography (MRCP)
jh jh jh jh
C) Abdominal ultrasound
jh jh
D) Upper GI series
jh jh jh
E) HIDA scan
jh jh
Correct Answer: C) Abdominal ultrasound
jh jh jh jh
9. A 70-year-
jh jh
old male with a history of heart failure with preserved ejection fraction (HFpEF) is evaluate
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
d for new-
jh jh
onset dyspnea on exertion. Which of the following medications has been shown to reduce
jh jh jh jh jh jh jh jh jh jh jh jh jh jh
hospitalizations for heart failure in this specific population? jh jh jh jh jh jh jh
A) SGLT2 inhibitors (e.g., Empagliflozin)
jh jh jh jh
B) High-dose loop diuretics
jh jh jh
, C) Spironolactone
jh
D) Entresto (sacubitril/valsartan)
jh jh
E) Digitalis
jh
Correct Answer: A) SGLT2 inhibitors (e.g., Empagliflozin)
jh jh jh jh jh jh
10. A 65-year-
jh jh
old female with osteoporosis is started on a bisphosphonate. Which of the following is the
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
most important patient education point regarding the administration of this medication?
jh jh jh jh jh jh jh jh jh jh
A) Take with calcium-rich foods
jh jh jh jh
B) Take on an empty stomach with a full glass of water and remain upright for 30 minutes
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
C) Take at bedtime with a small snack to prevent nausea
jh jh jh jh jh jh jh jh jh jh
D) Take with grapefruit juice to enhance absorption
jh jh jh jh jh jh jh
E) Take with magnesium supplements
jh jh jh jh
Correct Answer: B) Take on an empty stomach with a full glass of water and remain upright for 30
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh j
minutes
h
11. A 45-year-
jh jh
old male is diagnosed with Hypertension. He is prescribed Lisinopril (ACE inhibitor). Two w
jh jh jh jh jh jh jh jh jh jh jh jh jh
eeks later, he calls complaining of a persistent, dry cough. What is the most likely cause of t
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
his cough, and what is the appropriate management?
jh jh jh jh jh jh jh
A) Heart failure; switch to an ARB
jh jh jh jh jh jh
B) ACE inhibitor side effect; switch to an ARB
jh jh jh jh jh jh jh jh
C) Allergic reaction; stop the medication immediately
jh jh jh jh jh jh
D) Asthma exacerbation; start an inhaler
jh jh jh jh jh
E) GERD; start a PPI
jh jh jh jh
Correct Answer: B) ACE inhibitor side effect; switch to an ARB
jh jh jh jh jh jh jh jh jh jh
12. A 62-year-
jh jh
old female with a history of hypertension and CKD stage 3 is noted to have a serum potassi
jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh jh
um of 5.9 mEq/L. Her medications include lisinopril and spironolactone. Which of the follo
jh jh jh jh jh jh jh jh jh jh jh jh jh
wing should be the provider’s first action?
jh jh jh jh jh jh
A) Administer intravenous calcium gluconate
jh jh jh jh
B) Hold the spironolactone and lisinopril
jh jh jh jh jh
C) Start insulin and dextrose IV
jh jh jh jh jh
D) Order a stat EKG
jh jh jh jh
E) Kayexalate (sodium polystyrene sulfonate)
jh jh jh jh
