NR 547 CEA Final Exam Questions & ANSWERs Test
Bank | Advanced Practice Health Assessment, System-
Based Diagnosis & Clinical Case Scenarios | Chamberlain
| 2026/2027
Q1. A nurse practitioner is evaluating a 71-year-old female patient recently discharged following a CHF
exacerbation. The hospitalist documented a new cardiac murmur. To assess the timing of this murmur
relative to potential valvular dysfunction, the practitioner anticipates auscultating an S3 or S4 gallop
during which phase of the cardiac cycle?
A) Systole
B) Diastole
C) Both systole and diastole concurrently
D) The brief period between S1 and S2
Correct ANSWER: B) Diastole
Rationale: S3 and S4 gallops are abnormal low-frequency sounds heard during diastole, indicating
ventricular filling abnormalities often associated with heart failure or hypertension. Their presence helps
pinpoint dysfunction during the filling phase of the cardiac cycle. Systole (A) is associated with S1 and S2.
Q2. A 68-year-old male presents to the clinic with reports of intermittent palpitations. The nurse
practitioner performs a physical assessment, noting clear lungs bilaterally and regular heart rhythm. To
best assess for the location of the point of maximal impulse (PMI) in this patient, the practitioner
positions him in the left lateral decubitus position and begins palpation. Which anatomical landmark is
the anticipated location for a palpable PMI in a healthy adult in this position?
A) Right 2nd intercostal space, midclavicular line
B) Left 2nd intercostal space, midclavicular line
C) Right 4th intercostal space, sternal border
D) Left 5th intercostal space, midclavicular line
Correct ANSWER: D) Left 5th intercostal space, midclavicular line
Rationale: Palpating the PMI in the left lateral decubitus position shifts it inferiorly and medially;
therefore, the left 5th intercostal space at the midclavicular line is the expected location for most
healthy adults. The other locations correspond to different anatomical structures or pathological shifts.
,Q3. The nurse practitioner is reviewing the EKG tracing of a 68-year-old female presenting with
palpitations and a rapid ventricular response. To assess for a pulse deficit, the practitioner must
accurately correlate the physical heart sounds with the electrical events on the EKG. Where should the
first heart sound (S1) be visualized on the EKG tracing?
A) At the peak of the R wave
B) At the beginning of the P wave
C) At the end of the T wave
D) At the beginning of the T wave
Correct ANSWER: A) At the peak of the R wave
Rationale: The first heart sound (S1), often described as "lub," corresponds to the closure of the
atrioventricular valves, which occurs at the beginning of ventricular systole, coinciding with the QRS
complex, specifically the peak of the R wave. This timing is critical for identifying a pulse deficit by
comparing palpable pulse rate to the EKG rate.
Q4. A 72-year-old male patient, previously managed for exertional chest pain, presents to the clinic after
a diagnostic stress test. The EKG during the test revealed ST segment depression in leads V3-V4
concurrent with his reported chest discomfort. Which of the following medical decisions is NOT a
priority at this time?
A) Prescribe metoprolol 12.5 mg PO BID
B) Refer for cardiac angiography
C) Administer aspirin 81 mg PO daily
D) Obtain thyroid-stimulating hormone levels
Correct ANSWER: D) Obtain thyroid-stimulating hormone levels
Rationale: ST segment depression during a stress test with concurrent chest pain is a direct indicator of
potential myocardial ischemia, necessitating immediate management and further cardiac evaluation
rather than investigating unrelated endocrine causes. These findings warrant prompt cardiac workup
and intervention. While thyroid issues can affect the heart, they are not the priority in acute ischemia.
Q5. A nurse practitioner reviews the history of a female patient diagnosed with congestive heart failure
(CHF) and an ejection fraction of 35%. The patient reports dyspnea that occurs only with increased
exertion, such as performing activities of daily living, but is absent when at rest. This symptomatic
presentation aligns with which New York Heart Association (NYHA) functional classification of heart
failure?
A) Class IV
B) Class I
C) Class II
,D) Class III
Correct ANSWER: C) Class II (Note: NYHA Class II is slight limitation; comfortable at rest. Class III is
marked limitation. The description "dyspnea with increased exertion... absent at rest" fits Class II best,
though "activities of daily living" can sometimes imply Class III if ADLs are ordinary. However, standard
definition: Class I = no limitation. Class II = slight limitation, comfortable at rest. Class III = marked
limitation, comfortable only at rest. Class IV = symptoms at rest. The prompt says "absent when at rest",
fitting Class II or III. Let's look at the rationale in the image for Q5. The image says "Class III". Wait, the
image Q5 ANSWER is C) Class III. Rationale: "NYHA Class III is characterized by marked limitation of
physical activity, with symptoms occurring during less than ordinary activity but not at rest. Class IV
involves symptoms at rest." Okay, I will follow the image logic.)
Correct ANSWER: C) Class III
Rationale: NYHA Class III is characterized by marked limitation of physical activity, with symptoms
occurring during less than ordinary activity but not at rest. Class IV involves symptoms at rest. Class I is
no limitation. Class II is slight limitation.
Q6. A 68-year-old female presents to the clinic with a complaint of intermittent palpitations and a
sensation of an irregular heartbeat for the past week, which has become constant over the last 4 days.
Her vital signs are: heart rate 106, BP 118/72, respiratory rate 18, and SpO2 98% on room air. An ECG
confirms atrial fibrillation with a rapid ventricular response. The nurse practitioner is developing a plan
of care. Which of the following actions should be prioritized?
A) Administer a beta-blocker to slow the heart rate
B) Initiate a 24-hour Holter monitor to assess rhythm variability
C) Educate the patient on the risks and benefits of cardioversion
D) Assess medication adherence and recent dietary changes including caffeine intake
Correct ANSWER: A) Administer a beta-blocker to slow the heart rate
Rationale: The immediate priority in atrial fibrillation with rapid ventricular response is rate control to
prevent hemodynamic instability and reduce myocardial oxygen demand. Beta-blockers are a first-line
pharmacologic option for this purpose. Holter monitoring (B) is for diagnosis, not acute management.
Cardioversion (C) is a consideration but rate control comes first. Dietary assessment (D) is secondary.
Q7. A 63-year-old male arrives at the clinic reporting intermittent substernal chest pressure, numbness
in his left arm, and dyspnea with inspiration. His history includes poorly controlled hypertension, type 2
diabetes, hyperlipidemia, and rheumatoid arthritis. He notes the chest pressure, which began three
weeks ago, relieves with rest but has not worsened in frequency or intensity. The nurse practitioner
interprets these findings as indicative of which diagnosis and plans management accordingly?
A) Acute myocardial infarction, requiring immediate transfer to the hospital via EMS
B) Stable angina, managed with initiation of a long-acting oral nitrate
C) Heart failure, with treatment including carvedilol and a loop diuretic
, D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
Correct ANSWER: D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
(Wait, the description says "relieves with rest but has not worsened". That sounds like stable angina.
However, the image Q7 ANSWER is D. Let's re-read carefully. "began three weeks ago... not worsened".
Usually stable angina is predictable. Unstable is new onset, worsening, or at rest. New onset (3 weeks)
can be considered unstable if it's a change. The image ANSWER is D. I will follow the image.)
Correct ANSWER: D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
Rationale: New-onset chest pain (within the last few weeks) that is severe or changing is often classified
as unstable angina until proven otherwise, requiring aggressive management like nitroglycerin and
stress testing to rule out significant coronary artery disease. Stable angina (B) is usually chronic and
predictable. MI (A) would have persistent pain. Heart failure (C) presents differently.
Q8. A nurse practitioner is assessing a 55-year-old male with a history of chronic obstructive pulmonary
disease (COPD). The patient reports a worsening of his baseline dyspnea and an increase in sputum
purulence over the last 3 days. On auscultation, the practitioner notes wheezing and prolonged
expiration. Which of the following is the most appropriate initial pharmacological intervention?
A) Oral corticosteroids
B) Inhaled short-acting beta-agonist (SABA)
C) Antibiotics
D) Inhaled anticholinergic
Correct ANSWER: B) Inhaled short-acting beta-agonist (SABA)
Rationale: In an acute exacerbation of COPD with wheezing and dyspnea, the first-line treatment is a
SABA (like albuterol) to provide immediate bronchodilation. Oral corticosteroids (A) and antibiotics (C)
are often added but SABA is the initial rescue therapy. Anticholinergics (D) are also used but SABA is
typically first for rapid relief.
Q9. A 45-year-old female presents with a complaint of fatigue and pallor. Laboratory results reveal a
hemoglobin of 9.2 g/dL and a hematocrit of 28%. The MCV is 72 fL. Which of the following is the most
likely diagnosis?
A) Vitamin B12 deficiency anemia
B) Iron deficiency anemia
C) Folate deficiency anemia
D) Aplastic anemia
Correct ANSWER: B) Iron deficiency anemia
Rationale: The low hemoglobin and hematocrit indicate anemia. The low MCV (microcytic) is classic for
iron deficiency anemia. Vitamin B12 and folate deficiencies (A, C) cause macrocytic anemia (high MCV).
Aplastic anemia (D) is usually normocytic.
Bank | Advanced Practice Health Assessment, System-
Based Diagnosis & Clinical Case Scenarios | Chamberlain
| 2026/2027
Q1. A nurse practitioner is evaluating a 71-year-old female patient recently discharged following a CHF
exacerbation. The hospitalist documented a new cardiac murmur. To assess the timing of this murmur
relative to potential valvular dysfunction, the practitioner anticipates auscultating an S3 or S4 gallop
during which phase of the cardiac cycle?
A) Systole
B) Diastole
C) Both systole and diastole concurrently
D) The brief period between S1 and S2
Correct ANSWER: B) Diastole
Rationale: S3 and S4 gallops are abnormal low-frequency sounds heard during diastole, indicating
ventricular filling abnormalities often associated with heart failure or hypertension. Their presence helps
pinpoint dysfunction during the filling phase of the cardiac cycle. Systole (A) is associated with S1 and S2.
Q2. A 68-year-old male presents to the clinic with reports of intermittent palpitations. The nurse
practitioner performs a physical assessment, noting clear lungs bilaterally and regular heart rhythm. To
best assess for the location of the point of maximal impulse (PMI) in this patient, the practitioner
positions him in the left lateral decubitus position and begins palpation. Which anatomical landmark is
the anticipated location for a palpable PMI in a healthy adult in this position?
A) Right 2nd intercostal space, midclavicular line
B) Left 2nd intercostal space, midclavicular line
C) Right 4th intercostal space, sternal border
D) Left 5th intercostal space, midclavicular line
Correct ANSWER: D) Left 5th intercostal space, midclavicular line
Rationale: Palpating the PMI in the left lateral decubitus position shifts it inferiorly and medially;
therefore, the left 5th intercostal space at the midclavicular line is the expected location for most
healthy adults. The other locations correspond to different anatomical structures or pathological shifts.
,Q3. The nurse practitioner is reviewing the EKG tracing of a 68-year-old female presenting with
palpitations and a rapid ventricular response. To assess for a pulse deficit, the practitioner must
accurately correlate the physical heart sounds with the electrical events on the EKG. Where should the
first heart sound (S1) be visualized on the EKG tracing?
A) At the peak of the R wave
B) At the beginning of the P wave
C) At the end of the T wave
D) At the beginning of the T wave
Correct ANSWER: A) At the peak of the R wave
Rationale: The first heart sound (S1), often described as "lub," corresponds to the closure of the
atrioventricular valves, which occurs at the beginning of ventricular systole, coinciding with the QRS
complex, specifically the peak of the R wave. This timing is critical for identifying a pulse deficit by
comparing palpable pulse rate to the EKG rate.
Q4. A 72-year-old male patient, previously managed for exertional chest pain, presents to the clinic after
a diagnostic stress test. The EKG during the test revealed ST segment depression in leads V3-V4
concurrent with his reported chest discomfort. Which of the following medical decisions is NOT a
priority at this time?
A) Prescribe metoprolol 12.5 mg PO BID
B) Refer for cardiac angiography
C) Administer aspirin 81 mg PO daily
D) Obtain thyroid-stimulating hormone levels
Correct ANSWER: D) Obtain thyroid-stimulating hormone levels
Rationale: ST segment depression during a stress test with concurrent chest pain is a direct indicator of
potential myocardial ischemia, necessitating immediate management and further cardiac evaluation
rather than investigating unrelated endocrine causes. These findings warrant prompt cardiac workup
and intervention. While thyroid issues can affect the heart, they are not the priority in acute ischemia.
Q5. A nurse practitioner reviews the history of a female patient diagnosed with congestive heart failure
(CHF) and an ejection fraction of 35%. The patient reports dyspnea that occurs only with increased
exertion, such as performing activities of daily living, but is absent when at rest. This symptomatic
presentation aligns with which New York Heart Association (NYHA) functional classification of heart
failure?
A) Class IV
B) Class I
C) Class II
,D) Class III
Correct ANSWER: C) Class II (Note: NYHA Class II is slight limitation; comfortable at rest. Class III is
marked limitation. The description "dyspnea with increased exertion... absent at rest" fits Class II best,
though "activities of daily living" can sometimes imply Class III if ADLs are ordinary. However, standard
definition: Class I = no limitation. Class II = slight limitation, comfortable at rest. Class III = marked
limitation, comfortable only at rest. Class IV = symptoms at rest. The prompt says "absent when at rest",
fitting Class II or III. Let's look at the rationale in the image for Q5. The image says "Class III". Wait, the
image Q5 ANSWER is C) Class III. Rationale: "NYHA Class III is characterized by marked limitation of
physical activity, with symptoms occurring during less than ordinary activity but not at rest. Class IV
involves symptoms at rest." Okay, I will follow the image logic.)
Correct ANSWER: C) Class III
Rationale: NYHA Class III is characterized by marked limitation of physical activity, with symptoms
occurring during less than ordinary activity but not at rest. Class IV involves symptoms at rest. Class I is
no limitation. Class II is slight limitation.
Q6. A 68-year-old female presents to the clinic with a complaint of intermittent palpitations and a
sensation of an irregular heartbeat for the past week, which has become constant over the last 4 days.
Her vital signs are: heart rate 106, BP 118/72, respiratory rate 18, and SpO2 98% on room air. An ECG
confirms atrial fibrillation with a rapid ventricular response. The nurse practitioner is developing a plan
of care. Which of the following actions should be prioritized?
A) Administer a beta-blocker to slow the heart rate
B) Initiate a 24-hour Holter monitor to assess rhythm variability
C) Educate the patient on the risks and benefits of cardioversion
D) Assess medication adherence and recent dietary changes including caffeine intake
Correct ANSWER: A) Administer a beta-blocker to slow the heart rate
Rationale: The immediate priority in atrial fibrillation with rapid ventricular response is rate control to
prevent hemodynamic instability and reduce myocardial oxygen demand. Beta-blockers are a first-line
pharmacologic option for this purpose. Holter monitoring (B) is for diagnosis, not acute management.
Cardioversion (C) is a consideration but rate control comes first. Dietary assessment (D) is secondary.
Q7. A 63-year-old male arrives at the clinic reporting intermittent substernal chest pressure, numbness
in his left arm, and dyspnea with inspiration. His history includes poorly controlled hypertension, type 2
diabetes, hyperlipidemia, and rheumatoid arthritis. He notes the chest pressure, which began three
weeks ago, relieves with rest but has not worsened in frequency or intensity. The nurse practitioner
interprets these findings as indicative of which diagnosis and plans management accordingly?
A) Acute myocardial infarction, requiring immediate transfer to the hospital via EMS
B) Stable angina, managed with initiation of a long-acting oral nitrate
C) Heart failure, with treatment including carvedilol and a loop diuretic
, D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
Correct ANSWER: D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
(Wait, the description says "relieves with rest but has not worsened". That sounds like stable angina.
However, the image Q7 ANSWER is D. Let's re-read carefully. "began three weeks ago... not worsened".
Usually stable angina is predictable. Unstable is new onset, worsening, or at rest. New onset (3 weeks)
can be considered unstable if it's a change. The image ANSWER is D. I will follow the image.)
Correct ANSWER: D) Unstable angina, necessitating sublingual nitroglycerin and a cardiac stress test
Rationale: New-onset chest pain (within the last few weeks) that is severe or changing is often classified
as unstable angina until proven otherwise, requiring aggressive management like nitroglycerin and
stress testing to rule out significant coronary artery disease. Stable angina (B) is usually chronic and
predictable. MI (A) would have persistent pain. Heart failure (C) presents differently.
Q8. A nurse practitioner is assessing a 55-year-old male with a history of chronic obstructive pulmonary
disease (COPD). The patient reports a worsening of his baseline dyspnea and an increase in sputum
purulence over the last 3 days. On auscultation, the practitioner notes wheezing and prolonged
expiration. Which of the following is the most appropriate initial pharmacological intervention?
A) Oral corticosteroids
B) Inhaled short-acting beta-agonist (SABA)
C) Antibiotics
D) Inhaled anticholinergic
Correct ANSWER: B) Inhaled short-acting beta-agonist (SABA)
Rationale: In an acute exacerbation of COPD with wheezing and dyspnea, the first-line treatment is a
SABA (like albuterol) to provide immediate bronchodilation. Oral corticosteroids (A) and antibiotics (C)
are often added but SABA is the initial rescue therapy. Anticholinergics (D) are also used but SABA is
typically first for rapid relief.
Q9. A 45-year-old female presents with a complaint of fatigue and pallor. Laboratory results reveal a
hemoglobin of 9.2 g/dL and a hematocrit of 28%. The MCV is 72 fL. Which of the following is the most
likely diagnosis?
A) Vitamin B12 deficiency anemia
B) Iron deficiency anemia
C) Folate deficiency anemia
D) Aplastic anemia
Correct ANSWER: B) Iron deficiency anemia
Rationale: The low hemoglobin and hematocrit indicate anemia. The low MCV (microcytic) is classic for
iron deficiency anemia. Vitamin B12 and folate deficiencies (A, C) cause macrocytic anemia (high MCV).
Aplastic anemia (D) is usually normocytic.
