NR 603 CEA MIDTERM EXAM NEWEST 2026
TEST BANK| NR603 COMPREHENSIVE EXIT
ASSESSMENT
1. A 68-year-old male with a history of hypertension and type 2 diabetes
presents for a routine visit. His blood pressure is 142/88 mmHg. His labs show a
serum creatinine of 1.6 mg/dL (eGFR 45 mL/min). What is the BEST initial
antihypertensive agent to add to his current regimen of Metformin and Aspirin?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: In patients with CKD (eGFR <60) and diabetes, ACE inhibitors (like
Lisinopril) or ARBs are first-line because they are reno-protective and slow the
progression of nephropathy. Thiazides are less effective with an eGFR <30, and
Beta-blockers are not first-line for uncomplicated HTN.
2. A 72-year-old female presents with progressive shortness of breath,
orthopnea, and 2+ pitting edema to her knees. An S3 gallop is audible. Ejection
fraction is reported as 35%. Which combination of medications represents the
"Guideline-Directed Medical Therapy" (GDMT) for this patient's condition?
A) Furosemide, Digoxin, and Hydralazine
B) Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
C) Carvedilol, Losartan, Amlodipine, and Aspirin
D) Diltiazem, Enalapril, and Isosorbide dinitrate
Answer: B) Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
Rationale: This patient has HFrEF (EF 35%). The "Core 4" therapy includes a Beta-
blocker (Metoprolol Succinate/Carvedilol), an ACEi/ARB/ARNI (Lisinopril), an MRA
,(Spironolactone), and an SGLT2i (Empagliflozin) which is now standard regardless
of diabetes status.
3. A 55-year-old male with a history of CAD and a previous MI is prescribed
Atorvastatin 80 mg daily. He asks why the dose is so high. What is the primary
goal of high-intensity statin therapy in this patient?
A) To reduce LDL cholesterol to < 100 mg/dL
B) To reduce LDL cholesterol by ≥ 50% from baseline
C) To increase HDL cholesterol to > 60 mg/dL
D) To lower triglycerides to < 150 mg/dL
Answer: B) To reduce LDL cholesterol by ≥ 50% from baseline
Rationale: For patients with clinical ASCVD (secondary prevention), high-intensity
statins (Atorvastatin 40-80mg or Rosuvastatin 20-40mg) are indicated to achieve
an LDL reduction of at least 50%.
4. A patient presents to the ER with crushing substernal chest pain radiating to
his left jaw. EKG shows ST-segment elevation in leads V1-V4. His BP is 145/90.
What is the MOST critical immediate intervention?
A) Administer IV Morphine
B) Administer Nitroglycerin sublingual
C) Activate the cath lab for emergent PCI
D) Administer IV Heparin
Answer: C) Activate the cath lab for emergent PCI
Rationale: STEMI is a medical emergency. The gold standard treatment is
emergent percutaneous coronary intervention (PCI) to reopen the occluded
artery. "Time is muscle."
5. A 60-year-old female with hypertension is started on Lisinopril. Two weeks
later, she calls complaining of a persistent dry cough. What is the BEST next
,step?
A) Reassure her that this is a normal side effect that will resolve
B) Prescribe a codeine-based cough syrup
C) Discontinue Lisinopril and start Losartan
D) Perform a chest X-ray to rule out pneumonia
Answer: C) Discontinue Lisinopril and start Losartan
Rationale: ACE inhibitors cause a dry cough due to bradykinin accumulation. It
does not resolve with continued use. The appropriate switch is to an ARB
(Losartan), which has a similar efficacy profile but does not cause the cough.
6. Which EKG finding is MOST characteristic of Atrial Fibrillation?
A) Sawtooth flutter waves
B) Absent P waves with irregularly irregular QRS complexes
C) Wide QRS complexes > 120 ms
D) ST-segment elevation in the inferior leads
Answer: B) Absent P waves with irregularly irregular QRS complexes
Rationale: Atrial fibrillation is defined by chaotic atrial activity leading to the loss
of distinct P waves and an irregularly irregular ventricular response.
7. A patient with CHF is on Furosemide 40 mg daily. He complains of muscle
cramps and weakness. His labs show Na+ 140, K+ 3.0, Cl- 98. What is the primary
concern?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia
Rationale: Loop diuretics (Furosemide) cause significant potassium wasting.
Hypokalemia (K < 3.5) can precipitate fatal arrhythmias in cardiac patients. He
needs potassium repletion.
, 8. A 78-year-old male presents with a BP of 172/95 mmHg. He has no other
comorbidities. According to the 2017 ACC/AHA guidelines, what is his BP goal?
A) < 150/90 mmHg
B) < 140/90 mmHg
C) < 130/80 mmHg
D) < 120/80 mmHg
Answer: C) < 130/80 mmHg
Rationale: The ACC/AHA guidelines recommend a target BP of <130/80 mmHg for
all adults, including those >65 years old, if they can tolerate it.
9. Digoxin toxicity is associated with which electrolyte imbalance that increases
the risk of arrhythmias?
A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hypernatremia
Answer: B) Hypokalemia
Rationale: Hypokalemia increases the binding of digoxin to the Na/K-ATPase
pump, potentiating its toxic effects and increasing the risk of ventricular
arrhythmias.
10. A patient reports intermittent claudication in his calves when walking that
resolves with rest. He has absent dorsalis pedis pulses. What is the definitive
diagnostic test for this condition?
A) Venous Doppler ultrasound
B) Ankle-Brachial Index (ABI)
C) CT Angiography of the chest
D) Serum Lipid Panel
TEST BANK| NR603 COMPREHENSIVE EXIT
ASSESSMENT
1. A 68-year-old male with a history of hypertension and type 2 diabetes
presents for a routine visit. His blood pressure is 142/88 mmHg. His labs show a
serum creatinine of 1.6 mg/dL (eGFR 45 mL/min). What is the BEST initial
antihypertensive agent to add to his current regimen of Metformin and Aspirin?
A) Hydrochlorothiazide
B) Amlodipine
C) Lisinopril
D) Metoprolol
Answer: C) Lisinopril
Rationale: In patients with CKD (eGFR <60) and diabetes, ACE inhibitors (like
Lisinopril) or ARBs are first-line because they are reno-protective and slow the
progression of nephropathy. Thiazides are less effective with an eGFR <30, and
Beta-blockers are not first-line for uncomplicated HTN.
2. A 72-year-old female presents with progressive shortness of breath,
orthopnea, and 2+ pitting edema to her knees. An S3 gallop is audible. Ejection
fraction is reported as 35%. Which combination of medications represents the
"Guideline-Directed Medical Therapy" (GDMT) for this patient's condition?
A) Furosemide, Digoxin, and Hydralazine
B) Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
C) Carvedilol, Losartan, Amlodipine, and Aspirin
D) Diltiazem, Enalapril, and Isosorbide dinitrate
Answer: B) Metoprolol succinate, Lisinopril, Spironolactone, and Empagliflozin
Rationale: This patient has HFrEF (EF 35%). The "Core 4" therapy includes a Beta-
blocker (Metoprolol Succinate/Carvedilol), an ACEi/ARB/ARNI (Lisinopril), an MRA
,(Spironolactone), and an SGLT2i (Empagliflozin) which is now standard regardless
of diabetes status.
3. A 55-year-old male with a history of CAD and a previous MI is prescribed
Atorvastatin 80 mg daily. He asks why the dose is so high. What is the primary
goal of high-intensity statin therapy in this patient?
A) To reduce LDL cholesterol to < 100 mg/dL
B) To reduce LDL cholesterol by ≥ 50% from baseline
C) To increase HDL cholesterol to > 60 mg/dL
D) To lower triglycerides to < 150 mg/dL
Answer: B) To reduce LDL cholesterol by ≥ 50% from baseline
Rationale: For patients with clinical ASCVD (secondary prevention), high-intensity
statins (Atorvastatin 40-80mg or Rosuvastatin 20-40mg) are indicated to achieve
an LDL reduction of at least 50%.
4. A patient presents to the ER with crushing substernal chest pain radiating to
his left jaw. EKG shows ST-segment elevation in leads V1-V4. His BP is 145/90.
What is the MOST critical immediate intervention?
A) Administer IV Morphine
B) Administer Nitroglycerin sublingual
C) Activate the cath lab for emergent PCI
D) Administer IV Heparin
Answer: C) Activate the cath lab for emergent PCI
Rationale: STEMI is a medical emergency. The gold standard treatment is
emergent percutaneous coronary intervention (PCI) to reopen the occluded
artery. "Time is muscle."
5. A 60-year-old female with hypertension is started on Lisinopril. Two weeks
later, she calls complaining of a persistent dry cough. What is the BEST next
,step?
A) Reassure her that this is a normal side effect that will resolve
B) Prescribe a codeine-based cough syrup
C) Discontinue Lisinopril and start Losartan
D) Perform a chest X-ray to rule out pneumonia
Answer: C) Discontinue Lisinopril and start Losartan
Rationale: ACE inhibitors cause a dry cough due to bradykinin accumulation. It
does not resolve with continued use. The appropriate switch is to an ARB
(Losartan), which has a similar efficacy profile but does not cause the cough.
6. Which EKG finding is MOST characteristic of Atrial Fibrillation?
A) Sawtooth flutter waves
B) Absent P waves with irregularly irregular QRS complexes
C) Wide QRS complexes > 120 ms
D) ST-segment elevation in the inferior leads
Answer: B) Absent P waves with irregularly irregular QRS complexes
Rationale: Atrial fibrillation is defined by chaotic atrial activity leading to the loss
of distinct P waves and an irregularly irregular ventricular response.
7. A patient with CHF is on Furosemide 40 mg daily. He complains of muscle
cramps and weakness. His labs show Na+ 140, K+ 3.0, Cl- 98. What is the primary
concern?
A) Hypernatremia
B) Hypokalemia
C) Hypercalcemia
D) Hypomagnesemia
Answer: B) Hypokalemia
Rationale: Loop diuretics (Furosemide) cause significant potassium wasting.
Hypokalemia (K < 3.5) can precipitate fatal arrhythmias in cardiac patients. He
needs potassium repletion.
, 8. A 78-year-old male presents with a BP of 172/95 mmHg. He has no other
comorbidities. According to the 2017 ACC/AHA guidelines, what is his BP goal?
A) < 150/90 mmHg
B) < 140/90 mmHg
C) < 130/80 mmHg
D) < 120/80 mmHg
Answer: C) < 130/80 mmHg
Rationale: The ACC/AHA guidelines recommend a target BP of <130/80 mmHg for
all adults, including those >65 years old, if they can tolerate it.
9. Digoxin toxicity is associated with which electrolyte imbalance that increases
the risk of arrhythmias?
A) Hyperkalemia
B) Hypokalemia
C) Hypermagnesemia
D) Hypernatremia
Answer: B) Hypokalemia
Rationale: Hypokalemia increases the binding of digoxin to the Na/K-ATPase
pump, potentiating its toxic effects and increasing the risk of ventricular
arrhythmias.
10. A patient reports intermittent claudication in his calves when walking that
resolves with rest. He has absent dorsalis pedis pulses. What is the definitive
diagnostic test for this condition?
A) Venous Doppler ultrasound
B) Ankle-Brachial Index (ABI)
C) CT Angiography of the chest
D) Serum Lipid Panel
