NR 545 EXAM 2 COMPREHENSIVE
EXAM PREP 2026/2027 | VERIFIED
Q&A | CHAMBERLAIN UNIVERSITY
Question 1
A 58-year-old patient presents to the clinic with complaints of
severe, squeezing chest tightness that radiates down his left arm
and into his jaw. The chest pain occurs primarily during
exertional activities and subsides within 5 minutes of rest.
Which underlying pathophysiological mechanism best accounts
for this patient's clinical presentation?
• A. Irreversible necrosis of the subendocardial tissue
• B. Transient myocardial ischemia resulting from an
imbalance in oxygen supply and demand
• C. Rupture of a vulnerable plaque leading to complete
coronary arterial thrombosis
• D. Inflammation of the pericardial sac causing friction
between the parietal and visceral layers
Correct Answer: B
Rationale: Angina pectoris occurs when localized tissue
ischemia develops due to a temporary imbalance between
myocardial oxygen demand and supply. Unlike myocardial
infarction, this ischemia is transient and reversible with rest or
nitrates before myocardial cell death occurs.
,Question 2
A primary care nurse practitioner is evaluating a patient
experiencing an acute episode of stable angina. The provider
decides to administer sublingual Nitroglycerin. What is the
primary mechanism by which Nitroglycerin relieves chest pain?
• A. Increasing cardiac contractility to enhance stroke
volume
• B. Selectively blocking beta-1 adrenergic receptors to
decrease myocardial oxygen consumption
• C. Systemic venodilation resulting in reduced preload and
decreased cardiac workload
• D. Direct inhibition of the sodium-potassium ATPase pump
in myocardial cells
Correct Answer: C
Rationale: Nitroglycerin relaxes vascular smooth muscle,
predominantly producing venous dilation. This reduces venous
return (preload), which lowers ventricular wall tension and
cardiac workload, thereby reducing myocardial oxygen demand.
Question 3
A patient experiencing stable angina is prescribed sublingual
Nitroglycerin. What is the correct dosing schedule and
maximum limit for this medication during an acute attack before
seeking emergency care?
, • A. 0.3–0.6 mg every 5 minutes, up to a maximum of 3
doses
• B. 0.3–0.6 mg every 10 minutes, up to a maximum of 5
doses
• C. 1.0 mg every 3 minutes, up to a maximum of 2 doses
• D. 0.3 mg every 15 minutes, up to a maximum of 4 doses
Correct Answer: A
Rationale: Sublingual Nitroglycerin should be administered at
0.3–0.6 mg every 5 minutes as needed. If chest pain is not
relieved after a maximum of 3 doses (over a 15-minute
window), emergency medical services should be contacted
immediately.
Question 4
A patient with a history of hypertension and stable angina is
being evaluated for long-term pharmacological management to
reduce cardiac workload and prevent cardiovascular remodeling.
Which long-term combination of medication classes is
recommended?
• A. Loop diuretics and Calcium Channel Blockers
• B. ACE Inhibitors and Beta-Blockers
• C. Direct Thrombin Inhibitors and NSAIDs
• D. Antiarrhythmics and HCN Channel Blockers
Correct Answer: B
, Rationale: ACE inhibitors reduce preload/afterload and cardiac
remodeling, while Beta-Blockers reduce heart rate and
myocardial contractility. Together, they form standard long-term
therapy to improve outcomes in cardiovascular disease.
Question 5
Which acute complication represents the most immediate life-
threatening risk following prolonged myocardial ischemia due to
cholesterol buildup and coronary artery occlusion?
• A. Stable Angina
• B. Acute Coronary Syndrome / Myocardial Infarction
• C. Peripheral Artery Disease
• D. Rheumatic Heart Disease
Correct Answer: B
Rationale: Progressive buildup of atherosclerotic plaque
restricts blood flow to the myocardium. When plaque rupture or
severe narrowing severely minimizes blood flow, it triggers
Acute Coronary Syndrome (ACS) and Acute Myocardial
Infarction (MI).
Question 6
A patient is brought to the emergency department after
experiencing unremitting retrosternal chest pain for over 40
minutes that did not respond to rest or nitroglycerin. Ischemic
injury is suspected. At what duration of prolonged myocardial
EXAM PREP 2026/2027 | VERIFIED
Q&A | CHAMBERLAIN UNIVERSITY
Question 1
A 58-year-old patient presents to the clinic with complaints of
severe, squeezing chest tightness that radiates down his left arm
and into his jaw. The chest pain occurs primarily during
exertional activities and subsides within 5 minutes of rest.
Which underlying pathophysiological mechanism best accounts
for this patient's clinical presentation?
• A. Irreversible necrosis of the subendocardial tissue
• B. Transient myocardial ischemia resulting from an
imbalance in oxygen supply and demand
• C. Rupture of a vulnerable plaque leading to complete
coronary arterial thrombosis
• D. Inflammation of the pericardial sac causing friction
between the parietal and visceral layers
Correct Answer: B
Rationale: Angina pectoris occurs when localized tissue
ischemia develops due to a temporary imbalance between
myocardial oxygen demand and supply. Unlike myocardial
infarction, this ischemia is transient and reversible with rest or
nitrates before myocardial cell death occurs.
,Question 2
A primary care nurse practitioner is evaluating a patient
experiencing an acute episode of stable angina. The provider
decides to administer sublingual Nitroglycerin. What is the
primary mechanism by which Nitroglycerin relieves chest pain?
• A. Increasing cardiac contractility to enhance stroke
volume
• B. Selectively blocking beta-1 adrenergic receptors to
decrease myocardial oxygen consumption
• C. Systemic venodilation resulting in reduced preload and
decreased cardiac workload
• D. Direct inhibition of the sodium-potassium ATPase pump
in myocardial cells
Correct Answer: C
Rationale: Nitroglycerin relaxes vascular smooth muscle,
predominantly producing venous dilation. This reduces venous
return (preload), which lowers ventricular wall tension and
cardiac workload, thereby reducing myocardial oxygen demand.
Question 3
A patient experiencing stable angina is prescribed sublingual
Nitroglycerin. What is the correct dosing schedule and
maximum limit for this medication during an acute attack before
seeking emergency care?
, • A. 0.3–0.6 mg every 5 minutes, up to a maximum of 3
doses
• B. 0.3–0.6 mg every 10 minutes, up to a maximum of 5
doses
• C. 1.0 mg every 3 minutes, up to a maximum of 2 doses
• D. 0.3 mg every 15 minutes, up to a maximum of 4 doses
Correct Answer: A
Rationale: Sublingual Nitroglycerin should be administered at
0.3–0.6 mg every 5 minutes as needed. If chest pain is not
relieved after a maximum of 3 doses (over a 15-minute
window), emergency medical services should be contacted
immediately.
Question 4
A patient with a history of hypertension and stable angina is
being evaluated for long-term pharmacological management to
reduce cardiac workload and prevent cardiovascular remodeling.
Which long-term combination of medication classes is
recommended?
• A. Loop diuretics and Calcium Channel Blockers
• B. ACE Inhibitors and Beta-Blockers
• C. Direct Thrombin Inhibitors and NSAIDs
• D. Antiarrhythmics and HCN Channel Blockers
Correct Answer: B
, Rationale: ACE inhibitors reduce preload/afterload and cardiac
remodeling, while Beta-Blockers reduce heart rate and
myocardial contractility. Together, they form standard long-term
therapy to improve outcomes in cardiovascular disease.
Question 5
Which acute complication represents the most immediate life-
threatening risk following prolonged myocardial ischemia due to
cholesterol buildup and coronary artery occlusion?
• A. Stable Angina
• B. Acute Coronary Syndrome / Myocardial Infarction
• C. Peripheral Artery Disease
• D. Rheumatic Heart Disease
Correct Answer: B
Rationale: Progressive buildup of atherosclerotic plaque
restricts blood flow to the myocardium. When plaque rupture or
severe narrowing severely minimizes blood flow, it triggers
Acute Coronary Syndrome (ACS) and Acute Myocardial
Infarction (MI).
Question 6
A patient is brought to the emergency department after
experiencing unremitting retrosternal chest pain for over 40
minutes that did not respond to rest or nitroglycerin. Ischemic
injury is suspected. At what duration of prolonged myocardial
