NRNP 6566 Advanced Care of Adults in Acute Settings I –
Final Comprehensive Examination
Academic Year 2026/2027 – Walden University
CARDIAC
1. A 68-year-old male with a history of hypertension presents with substernal chest
pressure radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. Which of the following is the priority intervention?
• A. Administer sublingual nitroglycerin
• B. Obtain a chest X-ray
• C. Initiate immediate reperfusion therapy (PCI or fibrinolysis)
• D. Administer morphine sulfate for pain
2. Which of the following ECG findings is most characteristic of acute pericarditis?
• A. ST-segment depression in leads V1–V3
• B. Diffuse ST-segment elevation with PR-segment depression
• C. Pathologic Q waves in leads II, III, aVF
• D. Tall, peaked T waves
3. A 72-year-old female with heart failure presents with dyspnea, orthopnea, and
bilateral crackles on auscultation. Her ejection fraction is 35%. Which medication
, class has been shown to reduce mortality in heart failure with reduced ejection
fraction (HFrEF)?
• A. Calcium channel blockers
• B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
• C. Thiazide diuretics
• D. Direct vasodilators alone
4. Which of the following is a contraindication to the use of fibrinolytic therapy in
acute ST-elevation myocardial infarction (STEMI)?
• A. Age > 75 years
• B. Prior intracranial hemorrhage at any time
• C. Systolic blood pressure > 180 mmHg
• D. History of diabetes mellitus
5. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the
following is the most appropriate anticoagulation strategy?
• A. Aspirin 81 mg daily
• B. Aspirin plus clopidogrel
• C. Oral anticoagulant (warfarin or direct oral anticoagulant)
• D. No anticoagulation needed
6. In a patient with unstable angina, which of the following findings on cardiac
troponin would be expected?
• A. Elevated troponin above the 99th percentile upper reference limit
• B. Normal troponin levels
• C. Troponin elevation with a rising and falling pattern
,• D. Troponin I > 10 times the upper limit of normal
7. A 65-year-old male with aortic stenosis presents with syncope during exertion. The
most likely cause of syncope in this patient is:
• A. Hypovolemia
• B. Fixed cardiac output obstruction limiting cerebral perfusion
• C. Vasovagal response
• D. Arrhythmia
8. Which of the following medications is first-line therapy for rate control in acute
atrial fibrillation with rapid ventricular response in a hemodynamically stable patient?
• A. Amiodarone
• B. Diltiazem
• C. Digoxin
• D. Lidocaine
9. A patient with acute decompensated heart failure presents with pulmonary edema.
Which of the following is the most appropriate initial diuretic therapy?
• A. Hydrochlorothiazide 50 mg PO
• B. Spironolactone 25 mg PO
• C. Furosemide IV
• D. Metolazone 5 mg PO
10. Which of the following ECG changes is most specific for hyperkalemia?
• A. Prolonged PR interval
• B. Peaked, narrow-based T waves
, • C. Wide QRS complex
• D. ST-segment elevation
11. A 58-year-old male with a history of myocardial infarction presents with a new
systolic murmur heard best at the apex, radiating to the axilla. Which of the following
is the most likely diagnosis?
• A. Aortic stenosis
• B. Mitral regurgitation (papillary muscle dysfunction)
• C. Ventricular septal defect
• D. Tricuspid regurgitation
12. What is the target INR range for a patient with a mechanical mitral valve
prosthesis?
• A. 1.5–2.0
• B. 2.0–2.5
• C. *2.5–3.5*
• D. 3.5–4.5
13. In which of the following conditions would a paradoxical (reverse) splitting of S₂
be most commonly heard?
• A. Pulmonary hypertension
• B. Aortic stenosis
• C. Atrial septal defect
• D. Right bundle branch block
14. A patient with acute coronary syndrome is started on dual antiplatelet therapy.
Which of the following is the most common adverse effect of this therapy?
Final Comprehensive Examination
Academic Year 2026/2027 – Walden University
CARDIAC
1. A 68-year-old male with a history of hypertension presents with substernal chest
pressure radiating to the left arm, diaphoresis, and nausea. ECG shows ST-segment
elevation in leads V1–V4. Which of the following is the priority intervention?
• A. Administer sublingual nitroglycerin
• B. Obtain a chest X-ray
• C. Initiate immediate reperfusion therapy (PCI or fibrinolysis)
• D. Administer morphine sulfate for pain
2. Which of the following ECG findings is most characteristic of acute pericarditis?
• A. ST-segment depression in leads V1–V3
• B. Diffuse ST-segment elevation with PR-segment depression
• C. Pathologic Q waves in leads II, III, aVF
• D. Tall, peaked T waves
3. A 72-year-old female with heart failure presents with dyspnea, orthopnea, and
bilateral crackles on auscultation. Her ejection fraction is 35%. Which medication
, class has been shown to reduce mortality in heart failure with reduced ejection
fraction (HFrEF)?
• A. Calcium channel blockers
• B. Beta-blockers (e.g., carvedilol, metoprolol succinate)
• C. Thiazide diuretics
• D. Direct vasodilators alone
4. Which of the following is a contraindication to the use of fibrinolytic therapy in
acute ST-elevation myocardial infarction (STEMI)?
• A. Age > 75 years
• B. Prior intracranial hemorrhage at any time
• C. Systolic blood pressure > 180 mmHg
• D. History of diabetes mellitus
5. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the
following is the most appropriate anticoagulation strategy?
• A. Aspirin 81 mg daily
• B. Aspirin plus clopidogrel
• C. Oral anticoagulant (warfarin or direct oral anticoagulant)
• D. No anticoagulation needed
6. In a patient with unstable angina, which of the following findings on cardiac
troponin would be expected?
• A. Elevated troponin above the 99th percentile upper reference limit
• B. Normal troponin levels
• C. Troponin elevation with a rising and falling pattern
,• D. Troponin I > 10 times the upper limit of normal
7. A 65-year-old male with aortic stenosis presents with syncope during exertion. The
most likely cause of syncope in this patient is:
• A. Hypovolemia
• B. Fixed cardiac output obstruction limiting cerebral perfusion
• C. Vasovagal response
• D. Arrhythmia
8. Which of the following medications is first-line therapy for rate control in acute
atrial fibrillation with rapid ventricular response in a hemodynamically stable patient?
• A. Amiodarone
• B. Diltiazem
• C. Digoxin
• D. Lidocaine
9. A patient with acute decompensated heart failure presents with pulmonary edema.
Which of the following is the most appropriate initial diuretic therapy?
• A. Hydrochlorothiazide 50 mg PO
• B. Spironolactone 25 mg PO
• C. Furosemide IV
• D. Metolazone 5 mg PO
10. Which of the following ECG changes is most specific for hyperkalemia?
• A. Prolonged PR interval
• B. Peaked, narrow-based T waves
, • C. Wide QRS complex
• D. ST-segment elevation
11. A 58-year-old male with a history of myocardial infarction presents with a new
systolic murmur heard best at the apex, radiating to the axilla. Which of the following
is the most likely diagnosis?
• A. Aortic stenosis
• B. Mitral regurgitation (papillary muscle dysfunction)
• C. Ventricular septal defect
• D. Tricuspid regurgitation
12. What is the target INR range for a patient with a mechanical mitral valve
prosthesis?
• A. 1.5–2.0
• B. 2.0–2.5
• C. *2.5–3.5*
• D. 3.5–4.5
13. In which of the following conditions would a paradoxical (reverse) splitting of S₂
be most commonly heard?
• A. Pulmonary hypertension
• B. Aortic stenosis
• C. Atrial septal defect
• D. Right bundle branch block
14. A patient with acute coronary syndrome is started on dual antiplatelet therapy.
Which of the following is the most common adverse effect of this therapy?
