NR 571 FINAL CERTIFICATION EVALUATION
SCRIPT 2026 FULL SOLUTION STUDY GUIDE
◉ normal level for Troponin I. Answer: <0.04
◉ normal level for CKMB. Answer: 3-5% of total CK
◉ What is BNP. Answer: B-type natriuretic peptide
◉ Normal BNP levels. Answer: <100 pg/mL
◉ Differential for chest pain. Answer: Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural
effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic,
gastritis
,Psych: anxiety attacks
◉ Revascularization in under ____ minutes. Answer: 90
◉ Initial diagnostics for chest pain. Answer: 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
◉ Requirements for STEMI dx. Answer: new ST elevation in 2
contiguous leads of >0.1 mV except V2&V3
elevated troponin
◉ STEMI findings in V2-V3. Answer: >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
,◉ Difference between NSTEMI and unstable angina. Answer:
NSTEMI involves Elevated Cardiac Bio markers (cell death)
◉ NSTEMI & unstable angina tx. Answer: Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
◉ Dual antiplatelet therapy. Answer: DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
◉ full dose AC. Answer: SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x
baseline
, ◉ High-intensity statin. Answer: atorvastatin 40-80 mg or
rosuvastatin 20-40 mg
◉ Considerations for BB avoiding BB use. Answer: HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
◉ When is NGT contraindicated?. Answer: RV infarct b/c it reduces
preload
◉ Absolute contraindications for fibrinolytic therapy. Answer: Any
prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
active bleeding
SCRIPT 2026 FULL SOLUTION STUDY GUIDE
◉ normal level for Troponin I. Answer: <0.04
◉ normal level for CKMB. Answer: 3-5% of total CK
◉ What is BNP. Answer: B-type natriuretic peptide
◉ Normal BNP levels. Answer: <100 pg/mL
◉ Differential for chest pain. Answer: Consider:
Myocardium- angina, MI, myocarditis, heart failure
Pericardium- pericarditis
Aorta- dissecting aortic aneurysm
Trachea and bronchi- bronchitis
Parietal pleura- pericarditis, pneumonia, pneumothorax, pleural
effusion, pulmonary embolus
Chest wall- costochondritis, herpes zoster
Esophagus- reflux, esophageal spasm, esophageal tear
Referred pain from elsewhere- cervical arthritis, biliary colic,
gastritis
,Psych: anxiety attacks
◉ Revascularization in under ____ minutes. Answer: 90
◉ Initial diagnostics for chest pain. Answer: 12-lead EKG
Troponin q3h x3 at least
BNP - HF
CBC - baseline H&H and Plts
PTT, PT/INR - baseline coagulation status
BMP - renal function and lytes
TSH, Mg, and Phos
ECHO
Cath
◉ Requirements for STEMI dx. Answer: new ST elevation in 2
contiguous leads of >0.1 mV except V2&V3
elevated troponin
◉ STEMI findings in V2-V3. Answer: >0.2mV in >40yo M
>0.25 mV in <40 yo M
>0.15 mV in women
,◉ Difference between NSTEMI and unstable angina. Answer:
NSTEMI involves Elevated Cardiac Bio markers (cell death)
◉ NSTEMI & unstable angina tx. Answer: Dual antiplatelet therapy
Full-dose AC
High-intensity statin
BB
Nitrates
oxygen
pain medication
◉ Dual antiplatelet therapy. Answer: DAPT
Aspirin (325 x1 = daily 81mg)
AND
P2Y2 inhibitor
clopidogrel or ticagrelor
◉ full dose AC. Answer: SQ lovenox 1mg/kg BID
if PCI planned of low GFR use heparin gtt
50-70 units/kg bolus plus 12units/kg/hr titrated to PTT 1.5-2.5 x
baseline
, ◉ High-intensity statin. Answer: atorvastatin 40-80 mg or
rosuvastatin 20-40 mg
◉ Considerations for BB avoiding BB use. Answer: HR <60
SBP <100
EF <30%
PR >240 ms
2nd or 3rd degree HB
active asthma or reactive airway disease
COPD
Cocaine use
◉ When is NGT contraindicated?. Answer: RV infarct b/c it reduces
preload
◉ Absolute contraindications for fibrinolytic therapy. Answer: Any
prior ICH
known structural cerebral vascular lesions
known malignant intracranial neoplasm
Ischemic stroke <3mo unless <4.5 h
suspected aortic dissection
active bleeding
