MSN 624 Advanced Primary Care Core Exam
Prep
2026/2027 Edition
150 Verified Questions with Detailed Rationales
Instant PDF Download
150 original board-style questions · Full rationales · Why wrong explanations · Updated for 2026/2027
Written by Advanced Practice Nursing Faculty, DNP, FNP-BC — 15 Years Primary Care
Educator
MSN 624 Advanced Primary Care Core Exam: High-Yield Content | Verified: 2026/2027 Academic Year
About This Exam Prep Document
This comprehensive MSN 624 Advanced Primary Care Core Exam Prep Document contains 150 original, high-
yield, board-style questions that mirror the advanced primary care certification exam in content, difficulty, and
structure. Each question is paired with a verified correct answer, a detailed expert rationale, and a "Why Wrong"
breakdown for every incorrect option. Updated for the 2026/2027 cycle, this guide covers all core primary care
content areas including cardiovascular, pulmonary, endocrine, neurological, musculoskeletal, dermatological,
gastrointestinal, renal, and reproductive health.
Key Features
150 original, high-yield board-style questions
Detailed expert rationales and clinical implications for each question
"Why Wrong" sections for every incorrect option (A, B, C, D)
Covers all MSN 624 exam content areas with accurate weight distribution
Tests knowledge, clinical reasoning, diagnosis, treatment planning, and critical thinking
Balanced range of difficulty levels
Based on AACN essentials, NONPF competencies, and current clinical guidelines
,Section Key Topics Questions Weight
Cardiovascular & Pulmonary HTN, CAD, HF, COPD, Asthma, Arrhythmias, PE, PAD 25 17%
Health
Endocrine & Metabolic DM, Thyroid Disorders, Metabolic Syndrome, Adrenal 20 13%
Disorders Disorders, Hyperlipidemia
Neurological & Mental Stroke, Headache, Dementia, Depression, Anxiety, 18 12%
Health Epilepsy, Parkinson's
Musculoskeletal & Arthritis, Osteoporosis, Gout, Polymyalgia Rheumatica, 18 12%
Rheumatologic Fibromyalgia
Dermatological & Infectious Skin Lesions, Bacterial/Viral/Fungal Infections, STIs, 18 12%
Disease TB, Zoster
Gastrointestinal & Renal GERD, PUD, IBD, Hepatitis, Renal Failure, UTI, 18 12%
Health Nephrolithiasis
Reproductive & PID, BPH, UTI, Menstrual Disorders, Prolactinoma, 18 12%
Genitourinary Health Testicular Torsion
Preventive Care & Health Cancer Screening, Immunizations, Risk Assessment, 15 10%
Promotion Wellness, Age-Based Care
,Cardiovascular & Pulmonary Health (25 questions)
1. A 62-year-old male with a 40-pack-year smoking history presents with a 3-month
history of progressive exertional dyspnea, chronic cough, and wheezing. Spirometry
shows FEV1/FVC ratio of 0.65 and FEV1 55% of predicted. Which of the following is the
most appropriate initial pharmacological management?
A. LAMA/LABA combination therapy with an inhaled corticosteroid for exacerbation risk
B. Short-acting beta-agonist (SABA) as needed for symptom relief
C. Inhaled corticosteroid monotherapy as first-line treatment
D. Oral corticosteroid taper for acute symptom management
✓ Correct answer: A. LAMA/LABA combination therapy with an inhaled corticosteroid for
exacerbation risk
Rationale: The patient has moderate COPD (GOLD 2) with symptoms and exacerbation risk. GOLD
guidelines recommend LAMA/LABA combination therapy as initial treatment for patients with
moderate COPD and symptoms, especially those with exacerbation risk.
Why the others are wrong:
B: SABA monotherapy is insufficient for moderate COPD with persistent symptoms and exacerbation risk.
C: Inhaled corticosteroid monotherapy is not recommended as first-line without LABA/LAMA.
D: Oral corticosteroids are for acute exacerbations, not chronic maintenance.
Reference: GOLD 2026 Guidelines · UpToDate · AACN Essentials.
2. A 55-year-old female with hypertension and hyperlipidemia presents with acute onset
of severe, tearing chest pain radiating to the back, with a blood pressure of 180/95 mmHg
in the right arm and 100/60 mmHg in the left arm. What is the most appropriate initial
diagnostic test?
A. CT angiography of the chest
B. ECG and cardiac enzymes
C. Chest X-ray
D. Transthoracic echocardiogram
✓ Correct answer: A. CT angiography of the chest
Rationale: This presentation is highly concerning for acute aortic dissection. CT angiography is the
diagnostic test of choice for aortic dissection and should be obtained emergently.
Why the others are wrong:
B: ECG and cardiac enzymes rule out MI but do not diagnose aortic dissection.
C: Chest X-ray may show a widened mediastinum but is not definitive.
D: TTE is limited for visualizing the thoracic aorta.
Reference: AHA/ACC Guidelines on Aortic Disease.
, 3. A 45-year-old male with no significant medical history presents with palpitations,
diaphoresis, and a blood pressure of 160/100 mmHg. ECG shows narrow-complex
tachycardia at 180 bpm. Which of the following is the most appropriate initial
management for this unstable patient?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Vagal maneuvers
D. Metoprolol 5 mg IV push
✓ Correct answer: A. Synchronized cardioversion
Rationale: The patient is unstable with tachycardia. Synchronized cardioversion is the treatment of
choice for unstable tachyarrhythmias.
Why the others are wrong:
B: Adenosine is for stable narrow-complex tachycardia.
C: Vagal maneuvers are for stable patients.
D: Metoprolol is not first-line for unstable tachycardia.
Reference: AHA/ACC Guidelines for Arrhythmia Management · ACLS Protocols.
4. A 68-year-old female with a history of hypertension and type 2 diabetes presents with
exertional chest pain that is relieved by rest, and ECG shows ST-segment depression in
the inferior leads. What is the most appropriate next step in management?
A. Referral for coronary angiography
B. Aspirin 325 mg and sublingual nitroglycerin PRN
C. Initiation of beta-blocker therapy
D. Cardiac stress testing
✓ Correct answer: A. Referral for coronary angiography
Rationale: This patient has unstable angina with high-risk features. Coronary angiography is
indicated to identify and treat coronary lesions.
Why the others are wrong:
B: Aspirin and nitroglycerin are appropriate but not the definitive next step.
C: Beta-blockers should not delay angiography in high-risk patients.
D: Stress testing is contraindicated in patients with unstable angina.
Reference: ACC/AHA Guidelines for Unstable Angina and NSTEMI.
Prep
2026/2027 Edition
150 Verified Questions with Detailed Rationales
Instant PDF Download
150 original board-style questions · Full rationales · Why wrong explanations · Updated for 2026/2027
Written by Advanced Practice Nursing Faculty, DNP, FNP-BC — 15 Years Primary Care
Educator
MSN 624 Advanced Primary Care Core Exam: High-Yield Content | Verified: 2026/2027 Academic Year
About This Exam Prep Document
This comprehensive MSN 624 Advanced Primary Care Core Exam Prep Document contains 150 original, high-
yield, board-style questions that mirror the advanced primary care certification exam in content, difficulty, and
structure. Each question is paired with a verified correct answer, a detailed expert rationale, and a "Why Wrong"
breakdown for every incorrect option. Updated for the 2026/2027 cycle, this guide covers all core primary care
content areas including cardiovascular, pulmonary, endocrine, neurological, musculoskeletal, dermatological,
gastrointestinal, renal, and reproductive health.
Key Features
150 original, high-yield board-style questions
Detailed expert rationales and clinical implications for each question
"Why Wrong" sections for every incorrect option (A, B, C, D)
Covers all MSN 624 exam content areas with accurate weight distribution
Tests knowledge, clinical reasoning, diagnosis, treatment planning, and critical thinking
Balanced range of difficulty levels
Based on AACN essentials, NONPF competencies, and current clinical guidelines
,Section Key Topics Questions Weight
Cardiovascular & Pulmonary HTN, CAD, HF, COPD, Asthma, Arrhythmias, PE, PAD 25 17%
Health
Endocrine & Metabolic DM, Thyroid Disorders, Metabolic Syndrome, Adrenal 20 13%
Disorders Disorders, Hyperlipidemia
Neurological & Mental Stroke, Headache, Dementia, Depression, Anxiety, 18 12%
Health Epilepsy, Parkinson's
Musculoskeletal & Arthritis, Osteoporosis, Gout, Polymyalgia Rheumatica, 18 12%
Rheumatologic Fibromyalgia
Dermatological & Infectious Skin Lesions, Bacterial/Viral/Fungal Infections, STIs, 18 12%
Disease TB, Zoster
Gastrointestinal & Renal GERD, PUD, IBD, Hepatitis, Renal Failure, UTI, 18 12%
Health Nephrolithiasis
Reproductive & PID, BPH, UTI, Menstrual Disorders, Prolactinoma, 18 12%
Genitourinary Health Testicular Torsion
Preventive Care & Health Cancer Screening, Immunizations, Risk Assessment, 15 10%
Promotion Wellness, Age-Based Care
,Cardiovascular & Pulmonary Health (25 questions)
1. A 62-year-old male with a 40-pack-year smoking history presents with a 3-month
history of progressive exertional dyspnea, chronic cough, and wheezing. Spirometry
shows FEV1/FVC ratio of 0.65 and FEV1 55% of predicted. Which of the following is the
most appropriate initial pharmacological management?
A. LAMA/LABA combination therapy with an inhaled corticosteroid for exacerbation risk
B. Short-acting beta-agonist (SABA) as needed for symptom relief
C. Inhaled corticosteroid monotherapy as first-line treatment
D. Oral corticosteroid taper for acute symptom management
✓ Correct answer: A. LAMA/LABA combination therapy with an inhaled corticosteroid for
exacerbation risk
Rationale: The patient has moderate COPD (GOLD 2) with symptoms and exacerbation risk. GOLD
guidelines recommend LAMA/LABA combination therapy as initial treatment for patients with
moderate COPD and symptoms, especially those with exacerbation risk.
Why the others are wrong:
B: SABA monotherapy is insufficient for moderate COPD with persistent symptoms and exacerbation risk.
C: Inhaled corticosteroid monotherapy is not recommended as first-line without LABA/LAMA.
D: Oral corticosteroids are for acute exacerbations, not chronic maintenance.
Reference: GOLD 2026 Guidelines · UpToDate · AACN Essentials.
2. A 55-year-old female with hypertension and hyperlipidemia presents with acute onset
of severe, tearing chest pain radiating to the back, with a blood pressure of 180/95 mmHg
in the right arm and 100/60 mmHg in the left arm. What is the most appropriate initial
diagnostic test?
A. CT angiography of the chest
B. ECG and cardiac enzymes
C. Chest X-ray
D. Transthoracic echocardiogram
✓ Correct answer: A. CT angiography of the chest
Rationale: This presentation is highly concerning for acute aortic dissection. CT angiography is the
diagnostic test of choice for aortic dissection and should be obtained emergently.
Why the others are wrong:
B: ECG and cardiac enzymes rule out MI but do not diagnose aortic dissection.
C: Chest X-ray may show a widened mediastinum but is not definitive.
D: TTE is limited for visualizing the thoracic aorta.
Reference: AHA/ACC Guidelines on Aortic Disease.
, 3. A 45-year-old male with no significant medical history presents with palpitations,
diaphoresis, and a blood pressure of 160/100 mmHg. ECG shows narrow-complex
tachycardia at 180 bpm. Which of the following is the most appropriate initial
management for this unstable patient?
A. Synchronized cardioversion
B. Adenosine 6 mg IV push
C. Vagal maneuvers
D. Metoprolol 5 mg IV push
✓ Correct answer: A. Synchronized cardioversion
Rationale: The patient is unstable with tachycardia. Synchronized cardioversion is the treatment of
choice for unstable tachyarrhythmias.
Why the others are wrong:
B: Adenosine is for stable narrow-complex tachycardia.
C: Vagal maneuvers are for stable patients.
D: Metoprolol is not first-line for unstable tachycardia.
Reference: AHA/ACC Guidelines for Arrhythmia Management · ACLS Protocols.
4. A 68-year-old female with a history of hypertension and type 2 diabetes presents with
exertional chest pain that is relieved by rest, and ECG shows ST-segment depression in
the inferior leads. What is the most appropriate next step in management?
A. Referral for coronary angiography
B. Aspirin 325 mg and sublingual nitroglycerin PRN
C. Initiation of beta-blocker therapy
D. Cardiac stress testing
✓ Correct answer: A. Referral for coronary angiography
Rationale: This patient has unstable angina with high-risk features. Coronary angiography is
indicated to identify and treat coronary lesions.
Why the others are wrong:
B: Aspirin and nitroglycerin are appropriate but not the definitive next step.
C: Beta-blockers should not delay angiography in high-risk patients.
D: Stress testing is contraindicated in patients with unstable angina.
Reference: ACC/AHA Guidelines for Unstable Angina and NSTEMI.
