(Midterm Exams) NR 603 CEA Chamberlain -
Complete Package Bundle
1. A 62-year-old male with hypertension presents with
substernal chest pressure at rest for 25 minutes. ECG
shows ST depression in leads V3–V6. Troponin is elevated.
What is the most appropriate next step?
A) Aspirin 81 mg and discharge home
B) Exercise stress test within 24 hours
C) Admit for NSTEMI management with heparin and
antiplatelet therapy
D) Prescribe sublingual nitroglycerin and follow up in
clinic
Correct Answer: C
Rationale: Elevated troponin + rest angina + ST
depression = NSTEMI. Requires admission, anticoagulation,
dual antiplatelet therapy, and possible invasive strategy.
2. Which medication has been proven to reduce mortality
in chronic heart failure with reduced ejection fraction
1
,(HFrEF)?
A) Furosemide
B) Metolazone
C) Carvedilol
D) Amlodipine
Correct Answer: C
Rationale: Beta-blockers (carvedilol, bisoprolol,
metoprolol succinate) reduce mortality in HFrEF by
decreasing sympathetic remodeling and sudden cardiac
death.
3. A 78-year-old with atrial fibrillation, CHA₂ DS₂ -
VASc score of 5, and HAS-BLED score of 2 is on warfarin.
INR today is 1.3. What is the best management?
A) Increase warfarin dose and recheck INR in 1 week
B) Start low-molecular-weight heparin bridging and
adjust warfarin
C) Switch to aspirin 81 mg daily
D) Hold warfarin for 3 days
2
,Correct Answer: B
Rationale: Subtherapeutic INR in high-risk AF requires
bridging with LMWH until INR therapeutic to prevent
thromboembolic stroke.
4. Which murmur is best heard at the left sternal border,
increases with Valsalva, and decreases with squatting?
A) Aortic stenosis
B) Mitral valve prolapse
C) Hypertrophic cardiomyopathy
D) Ventricular septal defect
Correct Answer: C
Rationale: HCM murmur increases with decreased
preload (Valsalva, standing) and decreases with
increased preload (squatting).
5. A 55-year-old with palpitations has an ECG showing
irregularly irregular rhythm with no P waves. Ventricular
rate 150 bpm. Blood pressure is 110/70. Next step?
A) Immediate synchronized cardioversion
3
, B) IV metoprolol
C) IV amiodarone
D) IV digoxin
Correct Answer: B
Rationale: Hemodynamically stable atrial fibrillation: rate
control with beta-blocker first-line.
6. What is the first-line anticoagulant for stroke
prevention in non-valvular atrial fibrillation with creatinine
clearance >50 mL/min?
A) Warfarin
B) Rivaroxaban
C) Apixaban
D) Dabigatran
Correct Answer: C
Rationale: Apixaban has the best safety profile (lower
bleeding risk) and efficacy; preferred over warfarin
unless mechanical valve or severe mitral stenosis.
4
Complete Package Bundle
1. A 62-year-old male with hypertension presents with
substernal chest pressure at rest for 25 minutes. ECG
shows ST depression in leads V3–V6. Troponin is elevated.
What is the most appropriate next step?
A) Aspirin 81 mg and discharge home
B) Exercise stress test within 24 hours
C) Admit for NSTEMI management with heparin and
antiplatelet therapy
D) Prescribe sublingual nitroglycerin and follow up in
clinic
Correct Answer: C
Rationale: Elevated troponin + rest angina + ST
depression = NSTEMI. Requires admission, anticoagulation,
dual antiplatelet therapy, and possible invasive strategy.
2. Which medication has been proven to reduce mortality
in chronic heart failure with reduced ejection fraction
1
,(HFrEF)?
A) Furosemide
B) Metolazone
C) Carvedilol
D) Amlodipine
Correct Answer: C
Rationale: Beta-blockers (carvedilol, bisoprolol,
metoprolol succinate) reduce mortality in HFrEF by
decreasing sympathetic remodeling and sudden cardiac
death.
3. A 78-year-old with atrial fibrillation, CHA₂ DS₂ -
VASc score of 5, and HAS-BLED score of 2 is on warfarin.
INR today is 1.3. What is the best management?
A) Increase warfarin dose and recheck INR in 1 week
B) Start low-molecular-weight heparin bridging and
adjust warfarin
C) Switch to aspirin 81 mg daily
D) Hold warfarin for 3 days
2
,Correct Answer: B
Rationale: Subtherapeutic INR in high-risk AF requires
bridging with LMWH until INR therapeutic to prevent
thromboembolic stroke.
4. Which murmur is best heard at the left sternal border,
increases with Valsalva, and decreases with squatting?
A) Aortic stenosis
B) Mitral valve prolapse
C) Hypertrophic cardiomyopathy
D) Ventricular septal defect
Correct Answer: C
Rationale: HCM murmur increases with decreased
preload (Valsalva, standing) and decreases with
increased preload (squatting).
5. A 55-year-old with palpitations has an ECG showing
irregularly irregular rhythm with no P waves. Ventricular
rate 150 bpm. Blood pressure is 110/70. Next step?
A) Immediate synchronized cardioversion
3
, B) IV metoprolol
C) IV amiodarone
D) IV digoxin
Correct Answer: B
Rationale: Hemodynamically stable atrial fibrillation: rate
control with beta-blocker first-line.
6. What is the first-line anticoagulant for stroke
prevention in non-valvular atrial fibrillation with creatinine
clearance >50 mL/min?
A) Warfarin
B) Rivaroxaban
C) Apixaban
D) Dabigatran
Correct Answer: C
Rationale: Apixaban has the best safety profile (lower
bleeding risk) and efficacy; preferred over warfarin
unless mechanical valve or severe mitral stenosis.
4
