NR607 Chamberlain Pre-Diagnostic
Exam 2026: Questions &Answers with
Clinical Rationales
Cardiovascular & Respiratory
1. A 58-year-old male with a history of hypertension and
hyperlipidemia presents with substernal chest pressure radiating to the
left arm. An ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending (LAD)
B) Left circumflex (LCx)
C) Right coronary artery (RCA)
D) Left main coronary artery
Correct Answer: C
Rationale: Leads II, III, and aVF reflect the inferior wall of the left ventricle,
supplied by the right coronary artery (RCA) in most right-dominant
circulations. Inferior STEMI = RCA occlusion. LAD occlusion shows anterior
wall changes (V1–V4). LCx occlusion shows lateral wall changes (I, aVL, V5–
V6).
2. A 65-year-old woman with diabetes presents with progressive
dyspnea, orthopnea, and bilateral crackles. A chest X-ray shows
,pulmonary edema with a normal cardiac silhouette. Which type of
heart failure is most likely?
A) Systolic heart failure with reduced ejection fraction (HFrEF)
B) Diastolic heart failure with preserved ejection fraction (HFpEF)
C) High-output heart failure
D) Cor pulmonale
Correct Answer: B
Rationale: HFpEF (diastolic heart failure) is characterized by normal
ejection fraction with impaired ventricular relaxation and filling. Risk factors
include diabetes, hypertension, and older age. The normal cardiac
silhouette with pulmonary edema is classic.
3. The S2 heart sound results from what?
A) Closure of the semilunar valves
B) Opening of the semilunar valves
C) Closure of the atrioventricular valves
D) Opening of the atrioventricular valves
Correct Answer: A
Rationale: The second heart sound (S2) is produced by the closure of the
semilunar valves—the aortic and pulmonary valves—at the beginning of
diastole.
4. A 42-year-old female recalls a brief episode of chest tightness with
no radiation during her new taekwondo class. The pain subsided
during the cool-down period. What is most likely?
A) Pericarditis
B) Acute myocardial infarction
C) Hiatal hernia
, D) Angina pectoris
Correct Answer: D
Rationale: Chest pain with activity that is relieved at rest in a middle-aged
adult should prompt concern for myocardial ischemia (angina pectoris).
Although acute MI is possible, it is less likely given the brief, self-resolving
nature of symptoms.
5. A 68-year-old female with chronic anxiety presents with mild
shortness of breath, fine crackles in the right lower lobe, and a
nonproductive cough. She recently ran out of pills. Which medication
omission most likely caused her symptoms?
A) Metoprolol
B) Lorazepam
C) Furosemide
D) Metformin
Correct Answer: C
Rationale: Furosemide (Lasix) is a diuretic used in managing heart failure.
Omitting it can lead to fluid overload, causing crackles and shortness of
breath. While anxiety can cause dyspnea, crackles indicate fluid overload.
6. A patient presents with respiratory alkalosis. Which of the following
is the most common cause?
A) COPD
B) Hyperventilation
C) Renal failure
D) Diabetic ketoacidosis
Correct Answer: B
Rationale: Respiratory alkalosis is most commonly caused by
, hyperventilation, which leads to excessive loss of CO₂. Causes include
anxiety, pain, fever, and salicylate toxicity.
Renal & Hepatorenal
7. A 50-year-old male with cirrhosis develops massive ascites and
hepatorenal syndrome. Which best describes the pathophysiology?
A) Direct toxic damage to renal tubules
B) Severe renal vasoconstriction from splanchnic vasodilation
C) Obstructive uropathy
D) Glomerulonephritis
Correct Answer: B
Rationale: Hepatorenal syndrome is characterized by severe renal
vasoconstriction resulting from splanchnic arterial vasodilation in cirrhosis.
This reduces renal perfusion, leading to functional renal failure without
intrinsic kidney damage.
8. A patient with lupus nephritis would most likely have which finding
on renal biopsy?
A) Linear IgG deposition
B) Mesangial IgA deposition
C) Subepithelial "humps"
D) Immune complex deposition with "full-house" immunofluorescence
Correct Answer: D
Rationale: Lupus nephritis is characterized by immune complex deposition
with "full-house" immunofluorescence (IgG, IgA, IgM, C3, C1q). Linear IgG is
Exam 2026: Questions &Answers with
Clinical Rationales
Cardiovascular & Respiratory
1. A 58-year-old male with a history of hypertension and
hyperlipidemia presents with substernal chest pressure radiating to the
left arm. An ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A) Left anterior descending (LAD)
B) Left circumflex (LCx)
C) Right coronary artery (RCA)
D) Left main coronary artery
Correct Answer: C
Rationale: Leads II, III, and aVF reflect the inferior wall of the left ventricle,
supplied by the right coronary artery (RCA) in most right-dominant
circulations. Inferior STEMI = RCA occlusion. LAD occlusion shows anterior
wall changes (V1–V4). LCx occlusion shows lateral wall changes (I, aVL, V5–
V6).
2. A 65-year-old woman with diabetes presents with progressive
dyspnea, orthopnea, and bilateral crackles. A chest X-ray shows
,pulmonary edema with a normal cardiac silhouette. Which type of
heart failure is most likely?
A) Systolic heart failure with reduced ejection fraction (HFrEF)
B) Diastolic heart failure with preserved ejection fraction (HFpEF)
C) High-output heart failure
D) Cor pulmonale
Correct Answer: B
Rationale: HFpEF (diastolic heart failure) is characterized by normal
ejection fraction with impaired ventricular relaxation and filling. Risk factors
include diabetes, hypertension, and older age. The normal cardiac
silhouette with pulmonary edema is classic.
3. The S2 heart sound results from what?
A) Closure of the semilunar valves
B) Opening of the semilunar valves
C) Closure of the atrioventricular valves
D) Opening of the atrioventricular valves
Correct Answer: A
Rationale: The second heart sound (S2) is produced by the closure of the
semilunar valves—the aortic and pulmonary valves—at the beginning of
diastole.
4. A 42-year-old female recalls a brief episode of chest tightness with
no radiation during her new taekwondo class. The pain subsided
during the cool-down period. What is most likely?
A) Pericarditis
B) Acute myocardial infarction
C) Hiatal hernia
, D) Angina pectoris
Correct Answer: D
Rationale: Chest pain with activity that is relieved at rest in a middle-aged
adult should prompt concern for myocardial ischemia (angina pectoris).
Although acute MI is possible, it is less likely given the brief, self-resolving
nature of symptoms.
5. A 68-year-old female with chronic anxiety presents with mild
shortness of breath, fine crackles in the right lower lobe, and a
nonproductive cough. She recently ran out of pills. Which medication
omission most likely caused her symptoms?
A) Metoprolol
B) Lorazepam
C) Furosemide
D) Metformin
Correct Answer: C
Rationale: Furosemide (Lasix) is a diuretic used in managing heart failure.
Omitting it can lead to fluid overload, causing crackles and shortness of
breath. While anxiety can cause dyspnea, crackles indicate fluid overload.
6. A patient presents with respiratory alkalosis. Which of the following
is the most common cause?
A) COPD
B) Hyperventilation
C) Renal failure
D) Diabetic ketoacidosis
Correct Answer: B
Rationale: Respiratory alkalosis is most commonly caused by
, hyperventilation, which leads to excessive loss of CO₂. Causes include
anxiety, pain, fever, and salicylate toxicity.
Renal & Hepatorenal
7. A 50-year-old male with cirrhosis develops massive ascites and
hepatorenal syndrome. Which best describes the pathophysiology?
A) Direct toxic damage to renal tubules
B) Severe renal vasoconstriction from splanchnic vasodilation
C) Obstructive uropathy
D) Glomerulonephritis
Correct Answer: B
Rationale: Hepatorenal syndrome is characterized by severe renal
vasoconstriction resulting from splanchnic arterial vasodilation in cirrhosis.
This reduces renal perfusion, leading to functional renal failure without
intrinsic kidney damage.
8. A patient with lupus nephritis would most likely have which finding
on renal biopsy?
A) Linear IgG deposition
B) Mesangial IgA deposition
C) Subepithelial "humps"
D) Immune complex deposition with "full-house" immunofluorescence
Correct Answer: D
Rationale: Lupus nephritis is characterized by immune complex deposition
with "full-house" immunofluorescence (IgG, IgA, IgM, C3, C1q). Linear IgG is
