NR 603 CEA Exam Questions and Answers with Rationales PDF – Chamberlain College of Nursing 2026/2027 | Instant Download

NR 603 CEA Exam Questions and Answers
with Rationales
Chamberlain College of Nursing | 2026/2027
Academic Year

SECTION 1: CARDIOVASCULAR DISORDERS
Question 1
A 68-year-old male with a history of hypertension presents with acute onset of
substernal chest pressure radiating to the jaw, accompanied by diaphoresis and
nausea. ECG shows ST-segment elevation in leads V1-V4. Which intervention
should be prioritized?
A) Administer sublingual nitroglycerin
B) Obtain cardiac enzymes
C) Activate emergency response for primary PCI
D) Perform bedside echocardiogram
Answer: C) Activate emergency response for primary PCI
Rationale: ST-elevation myocardial infarction (STEMI) requires immediate
reperfusion. Primary percutaneous coronary intervention (PCI) is the gold standard
if available within 90 minutes of first medical contact. Nitroglycerin and enzymes
are secondary to the reperfusion strategy. The ECG should be obtained within 10
minutes of arrival for any patient with chest pain suspicious for myocardial
infarction .


Question 2
A 72-year-old female with heart failure with reduced ejection fraction (HFrEF)
presents with worsening dyspnea, jugular venous distension, and bilateral lower

,extremity edema. Her medications include lisinopril, carvedilol, and furosemide.
What is the most appropriate next step?
A) Increase carvedilol dose
B) Add spironolactone
C) Start digoxin
D) Replace lisinopril with losartan
Answer: B) Add spironolactone
Rationale: ACCF/AHA guidelines recommend adding a mineralocorticoid
receptor antagonist (spironolactone or eplerenone) for patients with persistent
symptoms and NYHA class II-IV HFrEF despite optimal therapy with ACE
inhibitor and beta-blocker. This combination has demonstrated mortality benefit .


Question 3
A 55-year-old man with untreated hypertension presents with severe "tearing"
chest pain radiating to the back. Blood pressure is 180/110 mmHg in right arm and
130/80 mmHg in left arm. Which diagnostic study is most definitive?
A) Chest X-ray
B) CT angiography of chest
C) Transthoracic echocardiogram
D) D-dimer assay
Answer: B) CT angiography of chest
Rationale: Acute aortic dissection is suspected based on unequal blood pressures
and tearing pain. CT angiography has >95% sensitivity and specificity for
identifying dissection flap and extent of involvement. It is the preferred imaging
modality for aortic aneurysm surveillance and dissection diagnosis .


Question 4
A patient with atrial fibrillation (AF) has a CHA₂DS₂-VASc score of 4 and HAS-
BLED score of 2. Which anticoagulation strategy is recommended?

,A) Aspirin 81 mg daily
B) Direct oral anticoagulant (apixaban)
C) Warfarin with INR 2.0-3.0
D) No anticoagulation needed
Answer: B) Direct oral anticoagulant (apixaban)
Rationale: CHA₂DS₂-VASc score ≥2 in men or ≥3 in women warrants
anticoagulation. DOACs are preferred over warfarin for non-valvular AF due to
lower bleeding risk and no need for INR monitoring. A HAS-BLED score of 2
does not contraindicate anticoagulation. Target INR for warfarin in non-valvular
AF is 2.0-3.0 .


Question 5
Which finding on cardiac auscultation is most consistent with hypertrophic
cardiomyopathy?
A) Fixed splitting of S₂
B) Harsh systolic murmur that increases with Valsalva
C) Diastolic rumble at apex
D) Continuous murmur at left sternal border
Answer: B) Harsh systolic murmur that increases with Valsalva
Rationale: Hypertrophic cardiomyopathy murmur (from LVOT obstruction)
increases with decreased preload (Valsalva, standing) and decreases with increased
preload (squatting, hand grip). Murmur is systolic, harsh, best heard at left sternal
border. Fixed splitting of S₂ is characteristic of atrial septal defect .


Question 6
A 75-year-old with aortic stenosis presents with syncope during exertion. Which
intervention is most appropriate?
A) Start carvedilol
B) Refer for surgical or transcatheter valve replacement

, C) Prescribe nitrates for chest pain k k k k




D) Recommend activity restriction only k k k




Answer: B) Refer for surgical or transcatheter valve replacement
k k k k k k k k




Rationale: Symptomatic severe aortic stenosis (dyspnea, angina, syncope) carries
k k k k k k k k




poor prognosis without valve replacement. Indications for AVR include symptoms or
k k k k k k k k k k k




LV dysfunction (EF <50%). Medical management alone is insufficient for
k k k k k k k k k k




symptomatic patients .
k k k




Question 7 k




A 60-year-old African American male with hypertension not at goal despite
k k k k k k k k k k




lifestyle modifications. According to JNC8 guidelines, which medication should be
k k k k k k k k k




considered first-line?
k k




A) Lisinopril
B) Hydrochlorothiazide
C) Amlodipine
D) Metoprolol
Answer: C) Amlodipine k k




Rationale: JNC8 guidelines recommend calcium channel blockers (e.g.,
k k k k k k k




amlodipine) as first-line therapy for hypertension in African American patients,
k k k k k k k k k




particularly dihydropyridines if lifestyle changes (e.g., DASH diet, salt restriction)
k k k k k k k k k k




fail to control blood pressure. CCBs have shown better outcomes over ACE
k k k k k k k k k k k k




inhibitors in this population .
k k k k k




Question 8 k




A patient with long-standing hypertension develops a blood pressure of 162/94
k k k k k k k k k k




mmHg despite being on lisinopril 40 mg daily and HCTZ 25 mg daily. What is the
k k k k k k k k k k k k k k k k




most appropriate next step?
k k k k




A) Add amlodipine 5 mg daily
k k k k




B) Increase lisinopril to 80 mg daily k k k k k