TEST BANK
— Primary
Care: The Art
and Science of
Advanced
PracticeNursin
g (6th Edition)
,SECTION 1: CARDIOVASCULAR DISORDERS
Q1. A 58-year-old male presents with exertional chest pressure relieved by rest. His ECG is normal. What
is the most appropriate initial diagnostic test?
A. Coronary angiography
B. Exercise stress test
C. Troponin level
D. Echocardiogram
Correct Answer: B
Explanation: Stable angina is characterized by predictable chest pain with exertion that resolves with
rest. The initial diagnostic approach is an exercise stress test to provoke ischemia and assess functional
capacity. Coronary angiography is reserved for high-risk patients or those with positive stress tests.
Troponin is used for acute coronary syndrome, not chronic stable angina. Echocardiogram evaluates
structural abnormalities but does not assess for inducible ischemia.
Q2. A 72-year-old female with HFrEF (EF 30%) is started on a medication to reduce mortality. Which is
first-line?
A. Digoxin
B. Furosemide
C. Carvedilol
D. Amlodipine
Correct Answer: C
Explanation: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF by
reversing adverse remodeling. Digoxin reduces hospitalizations but not mortality. Furosemide provides
symptom relief but does not improve survival. Amlodipine is not indicated for HFrEF.
,Q3. A 65-year-old male presents with sudden tearing chest pain radiating to the back and a 20 mmHg
blood pressure differential between arms. What is the most likely diagnosis?
A. Acute MI
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Explanation: Tearing chest pain radiating to the back with interarm blood pressure differential is classic
for aortic dissection. Acute MI presents with crushing pain and ECG changes. Pulmonary embolism
causes pleuritic pain and dyspnea. Pericarditis causes positional pain and a friction rub.
Q4. A 60-year-old female with atrial fibrillation requires stroke prophylaxis. What is the most appropriate
anticoagulation?
A. Aspirin 81 mg
B. Warfarin with INR 2–3
C. Clopidogrel
D. Dipyridamole
Correct Answer: B
Explanation: Warfarin (or a DOAC) is recommended for stroke prevention in atrial fibrillation. Aspirin is
less effective and not recommended for high-risk patients. Clopidogrel and dipyridamole are antiplatelet
agents used for arterial disease, not AF.
, Q5. A 52-year-old male presents with intermittent claudication. ABI is 0.7. What is the initial
management?
A. Aspirin and exercise therapy
B. Revascularization
C. Amputation
D. Bed rest
Correct Answer: A
Explanation: An ABI of 0.7 indicates moderate PAD. Initial management includes antiplatelet therapy
and supervised exercise. Revascularization is for disabling claudication or critical limb ischemia.
Amputation is for non-salvageable limbs.
Q6. A 70-year-old female presents with palpitations and lightheadedness. ECG shows regular narrow-
complex tachycardia at 180 bpm. What is the initial management?
A. Adenosine
B. Amiodarone
C. Synchronized cardioversion
D. Vagal maneuvers
Correct Answer: D
Explanation: For stable SVT, vagal maneuvers (Valsalva, carotid sinus massage) are first-line.
Adenosine is used if vagal maneuvers fail. Synchronized cardioversion is for unstable SVT. Amiodarone
is for ventricular arrhythmias.
— Primary
Care: The Art
and Science of
Advanced
PracticeNursin
g (6th Edition)
,SECTION 1: CARDIOVASCULAR DISORDERS
Q1. A 58-year-old male presents with exertional chest pressure relieved by rest. His ECG is normal. What
is the most appropriate initial diagnostic test?
A. Coronary angiography
B. Exercise stress test
C. Troponin level
D. Echocardiogram
Correct Answer: B
Explanation: Stable angina is characterized by predictable chest pain with exertion that resolves with
rest. The initial diagnostic approach is an exercise stress test to provoke ischemia and assess functional
capacity. Coronary angiography is reserved for high-risk patients or those with positive stress tests.
Troponin is used for acute coronary syndrome, not chronic stable angina. Echocardiogram evaluates
structural abnormalities but does not assess for inducible ischemia.
Q2. A 72-year-old female with HFrEF (EF 30%) is started on a medication to reduce mortality. Which is
first-line?
A. Digoxin
B. Furosemide
C. Carvedilol
D. Amlodipine
Correct Answer: C
Explanation: Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce mortality in HFrEF by
reversing adverse remodeling. Digoxin reduces hospitalizations but not mortality. Furosemide provides
symptom relief but does not improve survival. Amlodipine is not indicated for HFrEF.
,Q3. A 65-year-old male presents with sudden tearing chest pain radiating to the back and a 20 mmHg
blood pressure differential between arms. What is the most likely diagnosis?
A. Acute MI
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Correct Answer: B
Explanation: Tearing chest pain radiating to the back with interarm blood pressure differential is classic
for aortic dissection. Acute MI presents with crushing pain and ECG changes. Pulmonary embolism
causes pleuritic pain and dyspnea. Pericarditis causes positional pain and a friction rub.
Q4. A 60-year-old female with atrial fibrillation requires stroke prophylaxis. What is the most appropriate
anticoagulation?
A. Aspirin 81 mg
B. Warfarin with INR 2–3
C. Clopidogrel
D. Dipyridamole
Correct Answer: B
Explanation: Warfarin (or a DOAC) is recommended for stroke prevention in atrial fibrillation. Aspirin is
less effective and not recommended for high-risk patients. Clopidogrel and dipyridamole are antiplatelet
agents used for arterial disease, not AF.
, Q5. A 52-year-old male presents with intermittent claudication. ABI is 0.7. What is the initial
management?
A. Aspirin and exercise therapy
B. Revascularization
C. Amputation
D. Bed rest
Correct Answer: A
Explanation: An ABI of 0.7 indicates moderate PAD. Initial management includes antiplatelet therapy
and supervised exercise. Revascularization is for disabling claudication or critical limb ischemia.
Amputation is for non-salvageable limbs.
Q6. A 70-year-old female presents with palpitations and lightheadedness. ECG shows regular narrow-
complex tachycardia at 180 bpm. What is the initial management?
A. Adenosine
B. Amiodarone
C. Synchronized cardioversion
D. Vagal maneuvers
Correct Answer: D
Explanation: For stable SVT, vagal maneuvers (Valsalva, carotid sinus massage) are first-line.
Adenosine is used if vagal maneuvers fail. Synchronized cardioversion is for unstable SVT. Amiodarone
is for ventricular arrhythmias.
