NR 601 Primary Care Midterm Exam
Review 300 Questions with Answers
(2026/2027) Complete Question Bank
with Verified
Answers |Advanced Study Pack Latest now
The percentage of the FVC expired in one second is
Answer: FEV1/FVC ratio
Expert Rationale
The FEV1/FVC ratio (forced expiratory volume in one second divided by forced vital
capacity) is a critical pulmonary function test measurement used to diagnose and
classify obstructive and restrictive lung diseases. This ratio represents the
percentage of the total FVC that a patient can exhale in the first second of a forced
exhalation. A normal FEV1/FVC ratio is typically 70–80% or higher in healthy adults.
A reduced ratio (<70%) indicates an obstructive ventilatory defect, such as asthma
,or COPD, where the patient cannot quickly exhale air due to airway narrowing. In
restrictive lung diseases, the FEV1/FVC ratio may be normal or even elevated, as
both FEV1 and FVC are reduced proportionally. This measurement is essential for
differentiating between obstructive and restrictive pulmonary disorders, guiding
diagnosis, staging disease severity, and monitoring response to therapy.
DIF: Cognitive Level: Understand (Comprehension) TOP: Pulmonary Function Testing
MSC: NCLEX: Physiological Integrity
The aging process causes what normal physiological changes in the heart
Answer: The heart valve thickens and becomes rigid, secondary to fibrosis and
sclerosis
Expert Rationale
Normal aging of the cardiovascular system involves several structural and functional
changes, including thickening and rigidity of the heart valves due to progressive
fibrosis and sclerosis. The aortic and mitral valves are most commonly affected,
leading to aortic sclerosis and mitral annular calcification. These age-related
valvular changes result from years of hemodynamic stress, lipid deposition, and
collagen cross-linking. The thickening and rigidity of the valves can produce systolic
ejection murmurs (aortic sclerosis) without significant obstruction. Other age-
related cardiac changes include decreased left ventricular compliance (diastolic
dysfunction), reduced beta-adrenergic responsiveness, increased myocardial
stiffness, and progressive calcification of the cardiac conduction system. While
these changes are considered part of normal aging, they can predispose older
adults to conditions such as heart failure with preserved ejection fraction (HFpEF),
atrial fibrillation, and valvular heart disease.
DIF: Cognitive Level: Understand (Comprehension) TOP: Age-Related Cardiovascular
Changes MSC: NCLEX: Health Promotion and Maintenance
A 55 yo Caucasian male follows up after referral to cardiologist. He thinks his med
is causing a cough and sometimes he has difficulty breathing. Which med was
,most likely prescribed?
Answer: Lisinopril
Expert Rationale
Lisinopril is an ACE inhibitor that is commonly prescribed for hypertension, heart
failure, and post-myocardial infarction management. One of the most well-known
side effects of ACE inhibitors is a persistent, dry, non-productive cough, which
occurs in approximately 5–20% of patients. This cough is caused by the
accumulation of bradykinin and substance P in the respiratory tract due to ACE
inhibition. The patient's complaint of cough and difficulty breathing is consistent
with this medication side effect. In patients who develop this cough, the ACE
inhibitor should be discontinued and replaced with an angiotensin receptor blocker
(ARB), which has a much lower incidence of cough. Other side effects of lisinopril
include hyperkalemia, hypotension, and angioedema (rare but serious). The NP
should confirm that the cough is not due to other causes such as heart failure,
pulmonary disease, or post-nasal drip before attributing it to the medication.
DIF: Cognitive Level: Apply (Application) TOP: Pharmacological
Management/Adverse Effects MSC: NCLEX: Pharmacological and Parenteral
Therapies
MJ presents with h/o structural damage with current s/s of HF. Treatment will be
based on his stage of HF which is
Answer: Stage C
Expert Rationale
Heart failure is classified into four stages (A, B, C, and D) based on the American
College of Cardiology/American Heart Association (ACC/AHA) staging system. Stage
A includes patients at high risk for heart failure but without structural heart disease
or symptoms. Stage B includes patients with structural heart disease but without
current or prior symptoms of heart failure. Stage C includes patients with structural
heart disease and current or prior symptoms of heart failure. Stage D includes
patients with refractory heart failure requiring advanced interventions. This patient
has a history of structural damage and current signs and symptoms of heart failure,
which places him in Stage C. Treatment for Stage C heart failure includes guideline-
, directed medical therapy (GDMT) such as ACE inhibitors/ARBs, beta-blockers,
aldosterone antagonists, diuretics for symptom management, and lifestyle
modifications. The NP should initiate and titrate these medications to target doses
as tolerated, monitor for adverse effects, and educate the patient on symptom
management and self-care.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Staging MSC: NCLEX:
Physiological Integrity
65 yo Caucasian presents with mitral valve stenosis, physical exam is
unremarkable. you know her stage of HF is
Answer: Stage B
Expert Rationale
According to the ACC/AHA heart failure staging system, Stage B includes patients
with structural heart disease (such as mitral valve stenosis, left ventricular
hypertrophy, or previous myocardial infarction) but without current or prior
symptoms of heart failure. This patient has mitral valve stenosis (structural heart
disease) but her physical exam is unremarkable, indicating she is asymptomatic.
Therefore, she is classified as Stage B heart failure. Treatment for Stage B includes
managing the underlying structural disease, controlling cardiovascular risk factors
(hypertension, diabetes, hyperlipidemia), and considering ACE inhibitors or beta-
blockers in selected patients to prevent progression to symptomatic heart failure.
The NP should monitor her with regular echocardiograms to assess the severity of
mitral stenosis and watch for the development of symptoms such as dyspnea,
palpitations, or decreased exercise tolerance.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Staging MSC: NCLEX:
Physiological Integrity
The best way to diagnose structural heart disease/dysfunction noninvasively is
Answer: Echocardiogram
Review 300 Questions with Answers
(2026/2027) Complete Question Bank
with Verified
Answers |Advanced Study Pack Latest now
The percentage of the FVC expired in one second is
Answer: FEV1/FVC ratio
Expert Rationale
The FEV1/FVC ratio (forced expiratory volume in one second divided by forced vital
capacity) is a critical pulmonary function test measurement used to diagnose and
classify obstructive and restrictive lung diseases. This ratio represents the
percentage of the total FVC that a patient can exhale in the first second of a forced
exhalation. A normal FEV1/FVC ratio is typically 70–80% or higher in healthy adults.
A reduced ratio (<70%) indicates an obstructive ventilatory defect, such as asthma
,or COPD, where the patient cannot quickly exhale air due to airway narrowing. In
restrictive lung diseases, the FEV1/FVC ratio may be normal or even elevated, as
both FEV1 and FVC are reduced proportionally. This measurement is essential for
differentiating between obstructive and restrictive pulmonary disorders, guiding
diagnosis, staging disease severity, and monitoring response to therapy.
DIF: Cognitive Level: Understand (Comprehension) TOP: Pulmonary Function Testing
MSC: NCLEX: Physiological Integrity
The aging process causes what normal physiological changes in the heart
Answer: The heart valve thickens and becomes rigid, secondary to fibrosis and
sclerosis
Expert Rationale
Normal aging of the cardiovascular system involves several structural and functional
changes, including thickening and rigidity of the heart valves due to progressive
fibrosis and sclerosis. The aortic and mitral valves are most commonly affected,
leading to aortic sclerosis and mitral annular calcification. These age-related
valvular changes result from years of hemodynamic stress, lipid deposition, and
collagen cross-linking. The thickening and rigidity of the valves can produce systolic
ejection murmurs (aortic sclerosis) without significant obstruction. Other age-
related cardiac changes include decreased left ventricular compliance (diastolic
dysfunction), reduced beta-adrenergic responsiveness, increased myocardial
stiffness, and progressive calcification of the cardiac conduction system. While
these changes are considered part of normal aging, they can predispose older
adults to conditions such as heart failure with preserved ejection fraction (HFpEF),
atrial fibrillation, and valvular heart disease.
DIF: Cognitive Level: Understand (Comprehension) TOP: Age-Related Cardiovascular
Changes MSC: NCLEX: Health Promotion and Maintenance
A 55 yo Caucasian male follows up after referral to cardiologist. He thinks his med
is causing a cough and sometimes he has difficulty breathing. Which med was
,most likely prescribed?
Answer: Lisinopril
Expert Rationale
Lisinopril is an ACE inhibitor that is commonly prescribed for hypertension, heart
failure, and post-myocardial infarction management. One of the most well-known
side effects of ACE inhibitors is a persistent, dry, non-productive cough, which
occurs in approximately 5–20% of patients. This cough is caused by the
accumulation of bradykinin and substance P in the respiratory tract due to ACE
inhibition. The patient's complaint of cough and difficulty breathing is consistent
with this medication side effect. In patients who develop this cough, the ACE
inhibitor should be discontinued and replaced with an angiotensin receptor blocker
(ARB), which has a much lower incidence of cough. Other side effects of lisinopril
include hyperkalemia, hypotension, and angioedema (rare but serious). The NP
should confirm that the cough is not due to other causes such as heart failure,
pulmonary disease, or post-nasal drip before attributing it to the medication.
DIF: Cognitive Level: Apply (Application) TOP: Pharmacological
Management/Adverse Effects MSC: NCLEX: Pharmacological and Parenteral
Therapies
MJ presents with h/o structural damage with current s/s of HF. Treatment will be
based on his stage of HF which is
Answer: Stage C
Expert Rationale
Heart failure is classified into four stages (A, B, C, and D) based on the American
College of Cardiology/American Heart Association (ACC/AHA) staging system. Stage
A includes patients at high risk for heart failure but without structural heart disease
or symptoms. Stage B includes patients with structural heart disease but without
current or prior symptoms of heart failure. Stage C includes patients with structural
heart disease and current or prior symptoms of heart failure. Stage D includes
patients with refractory heart failure requiring advanced interventions. This patient
has a history of structural damage and current signs and symptoms of heart failure,
which places him in Stage C. Treatment for Stage C heart failure includes guideline-
, directed medical therapy (GDMT) such as ACE inhibitors/ARBs, beta-blockers,
aldosterone antagonists, diuretics for symptom management, and lifestyle
modifications. The NP should initiate and titrate these medications to target doses
as tolerated, monitor for adverse effects, and educate the patient on symptom
management and self-care.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Staging MSC: NCLEX:
Physiological Integrity
65 yo Caucasian presents with mitral valve stenosis, physical exam is
unremarkable. you know her stage of HF is
Answer: Stage B
Expert Rationale
According to the ACC/AHA heart failure staging system, Stage B includes patients
with structural heart disease (such as mitral valve stenosis, left ventricular
hypertrophy, or previous myocardial infarction) but without current or prior
symptoms of heart failure. This patient has mitral valve stenosis (structural heart
disease) but her physical exam is unremarkable, indicating she is asymptomatic.
Therefore, she is classified as Stage B heart failure. Treatment for Stage B includes
managing the underlying structural disease, controlling cardiovascular risk factors
(hypertension, diabetes, hyperlipidemia), and considering ACE inhibitors or beta-
blockers in selected patients to prevent progression to symptomatic heart failure.
The NP should monitor her with regular echocardiograms to assess the severity of
mitral stenosis and watch for the development of symptoms such as dyspnea,
palpitations, or decreased exercise tolerance.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Staging MSC: NCLEX:
Physiological Integrity
The best way to diagnose structural heart disease/dysfunction noninvasively is
Answer: Echocardiogram
