NRNP 6540 MIDTERM EXAM LATEST 2025/2026 /NRNP6540 MIDTERM
EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS WITH WELL
DETAILED AND ELABORATE RATIONALES)|WALDEN UNIVERSITY
Question 1
An 80-year-old male is being evaluated for progressive shortness of breath. The nurse
practitioner understands that a normal age-related structural change in the cardiovascular
system is:
A) Decreased arterial stiffness.
B) Left ventricular wall thinning.
C) Increased left ventricular wall thickness.
D) Increased baroreceptor sensitivity.
E) A decreased prevalence of atrial fibrillation.
Correct Answer: C) Increased left ventricular wall thickness.
Rationale: Aging leads to a compensatory increase in left ventricular wall thickness
(hypertrophy), often in response to increased arterial stiffness and afterload. This can lead to
diastolic dysfunction, a common finding in older adults.
Question 2
A 78-year-old female with hypertension has a blood pressure of 155/85 mmHg. The nurse
practitioner initiates a thiazide diuretic. Which of the following potential side effects is most
important to monitor for in this older adult?
A) Hyperkalemia
B) Orthostatic hypotension
C) Bradycardia
D) Dry cough
E) Weight gain
Correct Answer: B) Orthostatic hypotension
Rationale: Older adults have decreased baroreceptor sensitivity and are more susceptible to
postural blood pressure drops. Diuretics reduce volume, which can exacerbate this tendency,
increasing the risk of dizziness, syncope, and falls. It is crucial to monitor for orthostatic
hypotension when initiating or titrating antihypertensives in this population.
,Question 3
An 82-year-old resident of a long-term care facility presents with new-onset confusion, fatigue,
and functional decline. The resident denies chest pain. Given the patient's age, the nurse
practitioner should have a high index of suspicion for which of the following cardiovascular
events?
A) Aortic dissection
B) Acute coronary syndrome (ACS)
C) Pericarditis
D) Hypertensive crisis
E) Atrial fibrillation with rapid ventricular response
Correct Answer: B) Acute coronary syndrome (ACS)
Rationale: Older adults frequently present with atypical symptoms of ACS. Instead of classic
substernal chest pain, they may present with "anginal equivalents" such as dyspnea,
confusion, syncope, fatigue, or a general decline in function. A high index of suspicion is
required to avoid missing this diagnosis.
Question 4
A nurse practitioner is evaluating an 85-year-old female with exertional dyspnea and peripheral
edema. An echocardiogram shows a left ventricular ejection fraction of 60% and evidence of
diastolic dysfunction. This presentation is most consistent with:
A) Heart failure with reduced ejection fraction (HFrEF).
B) Heart failure with preserved ejection fraction (HFpEF).
C) Acute myocardial infarction.
D) Severe aortic regurgitation.
E) Hypertrophic cardiomyopathy.
Correct Answer: B) Heart failure with preserved ejection fraction (HFpEF).
Rationale: HFpEF is a form of heart failure where the ventricle is stiff and does not relax
properly (diastolic dysfunction), but the systolic function (ejection fraction) is normal or
, preserved (typically >50%). It is the most common form of heart failure in older adults,
particularly women with hypertension.
Question 5
During a physical exam of an 88-year-old patient, the nurse practitioner auscultates a harsh,
crescendo-decrescendo systolic ejection murmur at the right upper sternal border that radiates
to the carotid arteries. This finding is most characteristic of:
A) Mitral regurgitation.
B) Aortic stenosis.
C) Aortic regurgitation.
D) Mitral stenosis.
E) Tricuspid regurgitation.
Correct Answer: B) Aortic stenosis.
Rationale: Calcific aortic stenosis is the most common valvular heart disease in older adults. It
produces a classic systolic ejection murmur, best heard at the right upper sternal border, that
radiates to the neck. The murmur's intensity often correlates with the severity of the stenosis.
Question 6
A 75-year-old male with a history of smoking and diabetes complains of pain in his calves that
occurs after walking two blocks and is relieved by rest. This symptom is known as intermittent
claudication and is a hallmark of which condition?
A) Chronic venous insufficiency
B) Deep vein thrombosis (DVT)
C) Peripheral arterial disease (PAD)
D) Diabetic neuropathy
E) Spinal stenosis
Correct Answer: C) Peripheral arterial disease (PAD)
Rationale: Intermittent claudication is ischemic muscle pain that is caused by exercise and
relieved by rest. It is the classic symptom of PAD, where atherosclerotic blockages prevent
adequate blood flow to meet the metabolic demands of the exercising muscle.
EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS WITH WELL
DETAILED AND ELABORATE RATIONALES)|WALDEN UNIVERSITY
Question 1
An 80-year-old male is being evaluated for progressive shortness of breath. The nurse
practitioner understands that a normal age-related structural change in the cardiovascular
system is:
A) Decreased arterial stiffness.
B) Left ventricular wall thinning.
C) Increased left ventricular wall thickness.
D) Increased baroreceptor sensitivity.
E) A decreased prevalence of atrial fibrillation.
Correct Answer: C) Increased left ventricular wall thickness.
Rationale: Aging leads to a compensatory increase in left ventricular wall thickness
(hypertrophy), often in response to increased arterial stiffness and afterload. This can lead to
diastolic dysfunction, a common finding in older adults.
Question 2
A 78-year-old female with hypertension has a blood pressure of 155/85 mmHg. The nurse
practitioner initiates a thiazide diuretic. Which of the following potential side effects is most
important to monitor for in this older adult?
A) Hyperkalemia
B) Orthostatic hypotension
C) Bradycardia
D) Dry cough
E) Weight gain
Correct Answer: B) Orthostatic hypotension
Rationale: Older adults have decreased baroreceptor sensitivity and are more susceptible to
postural blood pressure drops. Diuretics reduce volume, which can exacerbate this tendency,
increasing the risk of dizziness, syncope, and falls. It is crucial to monitor for orthostatic
hypotension when initiating or titrating antihypertensives in this population.
,Question 3
An 82-year-old resident of a long-term care facility presents with new-onset confusion, fatigue,
and functional decline. The resident denies chest pain. Given the patient's age, the nurse
practitioner should have a high index of suspicion for which of the following cardiovascular
events?
A) Aortic dissection
B) Acute coronary syndrome (ACS)
C) Pericarditis
D) Hypertensive crisis
E) Atrial fibrillation with rapid ventricular response
Correct Answer: B) Acute coronary syndrome (ACS)
Rationale: Older adults frequently present with atypical symptoms of ACS. Instead of classic
substernal chest pain, they may present with "anginal equivalents" such as dyspnea,
confusion, syncope, fatigue, or a general decline in function. A high index of suspicion is
required to avoid missing this diagnosis.
Question 4
A nurse practitioner is evaluating an 85-year-old female with exertional dyspnea and peripheral
edema. An echocardiogram shows a left ventricular ejection fraction of 60% and evidence of
diastolic dysfunction. This presentation is most consistent with:
A) Heart failure with reduced ejection fraction (HFrEF).
B) Heart failure with preserved ejection fraction (HFpEF).
C) Acute myocardial infarction.
D) Severe aortic regurgitation.
E) Hypertrophic cardiomyopathy.
Correct Answer: B) Heart failure with preserved ejection fraction (HFpEF).
Rationale: HFpEF is a form of heart failure where the ventricle is stiff and does not relax
properly (diastolic dysfunction), but the systolic function (ejection fraction) is normal or
, preserved (typically >50%). It is the most common form of heart failure in older adults,
particularly women with hypertension.
Question 5
During a physical exam of an 88-year-old patient, the nurse practitioner auscultates a harsh,
crescendo-decrescendo systolic ejection murmur at the right upper sternal border that radiates
to the carotid arteries. This finding is most characteristic of:
A) Mitral regurgitation.
B) Aortic stenosis.
C) Aortic regurgitation.
D) Mitral stenosis.
E) Tricuspid regurgitation.
Correct Answer: B) Aortic stenosis.
Rationale: Calcific aortic stenosis is the most common valvular heart disease in older adults. It
produces a classic systolic ejection murmur, best heard at the right upper sternal border, that
radiates to the neck. The murmur's intensity often correlates with the severity of the stenosis.
Question 6
A 75-year-old male with a history of smoking and diabetes complains of pain in his calves that
occurs after walking two blocks and is relieved by rest. This symptom is known as intermittent
claudication and is a hallmark of which condition?
A) Chronic venous insufficiency
B) Deep vein thrombosis (DVT)
C) Peripheral arterial disease (PAD)
D) Diabetic neuropathy
E) Spinal stenosis
Correct Answer: C) Peripheral arterial disease (PAD)
Rationale: Intermittent claudication is ischemic muscle pain that is caused by exercise and
relieved by rest. It is the classic symptom of PAD, where atherosclerotic blockages prevent
adequate blood flow to meet the metabolic demands of the exercising muscle.
