ADVANCED PRACTICE NURSING I -
EXAM 2 COMPREHENSIVE
ASSESSMENT
1. A 65-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotid arteries. Which of the
following is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Valve Prolapse
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a harsh systolic crescendo-
decrescendo murmur at the right upper sternal border that radiates to the neck.
,2. Which of the following pharmacological agents is considered first-line treatment for a 55-
year-old African American patient with newly diagnosed Stage 1 Hypertension and no
comorbidities?
A. Lisinopril
B. Losartan
C. Amlodipine
D. Metoprolol
Answer: C
Conceptual Explanation: According to JNC 8 and ACC/AHA guidelines, Calcium Channel
Blockers (CCBs) or thiazide-type diuretics are preferred first-line agents for the African
American population.
3. In patients with Heart Failure with Reduced Ejection Fraction (HFrEF), which medication
class is known to reduce mortality and should be initiated in all stable patients?
A. Loop Diuretics
B. Beta-Blockers
C. Calcium Channel Blockers
D. Digoxin
Answer: B
, Conceptual Explanation: Beta-blockers (specifically carvedilol, metoprolol succinate, or
bisoprolol) are proven to reduce mortality and morbidity in HFrEF patients.
4. A 45-year-old patient presents with a ‘ripping’ or ‘tearing’ chest pain that radiates to the
back between the scapulae. The clinician should immediately suspect:
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Conceptual Explanation: Tearing chest pain radiating to the back is a classic presentation
of aortic dissection, requiring emergent imaging.
5. A patient’s EKG shows a PR interval of 0.24 seconds with a 1:1 P to QRS ratio. What is the
interpretation?
A. First-degree AV Block
B. Second-degree AV Block Type I
C. Second-degree AV Block Type II
D. Third-degree AV Block
Answer: A
EXAM 2 COMPREHENSIVE
ASSESSMENT
1. A 65-year-old male presents with a harsh, crescendo-decrescendo systolic murmur heard
best at the right second intercostal space, radiating to the carotid arteries. Which of the
following is the most likely diagnosis?
A. Mitral Regurgitation
B. Aortic Regurgitation
C. Mitral Valve Prolapse
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a harsh systolic crescendo-
decrescendo murmur at the right upper sternal border that radiates to the neck.
,2. Which of the following pharmacological agents is considered first-line treatment for a 55-
year-old African American patient with newly diagnosed Stage 1 Hypertension and no
comorbidities?
A. Lisinopril
B. Losartan
C. Amlodipine
D. Metoprolol
Answer: C
Conceptual Explanation: According to JNC 8 and ACC/AHA guidelines, Calcium Channel
Blockers (CCBs) or thiazide-type diuretics are preferred first-line agents for the African
American population.
3. In patients with Heart Failure with Reduced Ejection Fraction (HFrEF), which medication
class is known to reduce mortality and should be initiated in all stable patients?
A. Loop Diuretics
B. Beta-Blockers
C. Calcium Channel Blockers
D. Digoxin
Answer: B
, Conceptual Explanation: Beta-blockers (specifically carvedilol, metoprolol succinate, or
bisoprolol) are proven to reduce mortality and morbidity in HFrEF patients.
4. A 45-year-old patient presents with a ‘ripping’ or ‘tearing’ chest pain that radiates to the
back between the scapulae. The clinician should immediately suspect:
A. Myocardial Infarction
B. Pulmonary Embolism
C. Aortic Dissection
D. Pneumothorax
Answer: C
Conceptual Explanation: Tearing chest pain radiating to the back is a classic presentation
of aortic dissection, requiring emergent imaging.
5. A patient’s EKG shows a PR interval of 0.24 seconds with a 1:1 P to QRS ratio. What is the
interpretation?
A. First-degree AV Block
B. Second-degree AV Block Type I
C. Second-degree AV Block Type II
D. Third-degree AV Block
Answer: A
