CEA FNP Review (NR 667): 100
Practice Questions and Answer
Explanations
Part One: Cardiovascular (1–18)
1. A 67-year-old patient presents with chest pain. On physical examination, you note that
the right ventricle is located anteriorly and the left ventricle is posteriorly. Which of the
following best describes the normal flow of blood through the cardiovascular system?
A. Lungs → pulmonary arteries → left atrium → left ventricle → aorta → body tissues →
vena cava → right atrium → right ventricle → pulmonary veins → lungs
B. Lungs → pulmonary veins → left atrium → left ventricle → aorta → body tissues → vena
cava → right atrium → right ventricle → pulmonary arteries → lungs
C. Body tissues → vena cava → left atrium → left ventricle → aorta → lungs → pulmonary
veins → right atrium → right ventricle → pulmonary arteries
D. Lungs → pulmonary veins → right atrium → right ventricle → pulmonary arteries → body
tissues → vena cava → left atrium → left ventricle → aorta
Answer: B
Explanation: Oxygenated blood returns from the lungs via pulmonary veins to the left
atrium, then to the left ventricle, is pumped to the body via the aorta, and deoxygenated
blood returns via vena cava to the right atrium, then right ventricle, before being sent to the
lungs via pulmonary arteries .
2. A patient with chronic hypertension asks about the mechanism of their medication. You
explain that the RAAS system typically manages afterload. Which of the following best
describes afterload?
A. The force of myocardial contraction
B. Central fluid volume status
C. Arterial backpressure on outflow
D. The stretching of cardiac muscle fibers
Answer: C
Explanation: Afterload is defined as the arterial backpressure on outflow that the heart must
overcome to eject blood. Preload refers to central fluid volume status, and contractility
refers to the force of myocardial contraction .
3. According to JNC8 guidelines, a 65-year-old patient without diabetes or chronic kidney
disease should have a target blood pressure of:
A. <140/90
B. <150/90
,C. <130/80
D. <120/80
Answer: B
Explanation: According to JNC8 guidelines, patients age >60 years without diabetes or
chronic kidney disease should have a target blood pressure of <150/90 .
4. A 55-year-old African American patient is newly diagnosed with hypertension.
According to the guidelines discussed, which medication class should be considered as
first-line therapy?
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Loop diuretics
Answer: C
Explanation: Calcium channel blockers are first-line for African American patients with
hypertension .
5. A 58-year-old male presents with sudden onset of severe, tearing chest pain radiating to
his back. He has a history of hypertension and smokes one pack per day. His blood
pressure is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. Which
finding is most concerning for aortic dissection?
A. Equal blood pressures in both arms
B. Interarm blood pressure differential
C. Pain relieved by nitroglycerin
D. ST elevation on ECG
Answer: B
Explanation: A significant interarm blood pressure differential (>20 mmHg) is a classic
finding in aortic dissection due to compromised flow in the subclavian artery .
6. A 58-year-old male presents with new-onset substernal chest pain radiating to the left
arm, diaphoresis, and dyspnea. Troponin is elevated, and ECG shows ST elevation in the
anterior leads. What is the most appropriate immediate management?
A. Administer aspirin 325 mg, clopidogrel 600 mg loading dose, and refer for PCI
B. Start intravenous nitroglycerin and schedule a stress test in 2 days
C. Discharge with sublingual nitroglycerin
D. Obtain CT angiography to rule out pulmonary embolism
Answer: A
Explanation: The patient presents with classic STEMI. Emergent reperfusion via PCI
combined with dual antiplatelet therapy is the standard of care.
7. A 72-year-old woman with hypertension and atrial fibrillation presents with a new
systolic murmur heard best at the right upper sternal border that radiates to the carotid
arteries. She reports progressive dyspnea and fatigue. What is the most likely diagnosis?
, A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Answer: B
Explanation: Aortic stenosis produces a systolic ejection murmur at the right upper sternal
border with radiation to the carotids.
8. A 45-year-old man with uncontrolled hypertension is prescribed lisinopril. After 2
weeks, he reports a persistent dry cough. What is the most appropriate management?
A. Continue lisinopril and add dextromethorphan
B. Discontinue lisinopril and switch to an ARB
C. Reduce the lisinopril dose by half
D. Add diphenhydramine
Answer: B
Explanation: ACE inhibitor-induced dry cough occurs in approximately 5–20% of patients.
Switching to an ARB is appropriate.
9. A patient presents with crushing chest pain and ST-elevation in leads II, III, and aVF.
What is the most likely diagnosis?
A. Anterior STEMI
B. Inferior STEMI
C. NSTEMI
D. Pericarditis
Answer: B
Explanation: ST-elevation in leads II, III, and aVF corresponds to the inferior myocardial wall.
10. A 68-year-old female presents with sudden-onset confusion and right-sided weakness.
CT shows ischemic stroke. Which therapy should be considered within the first 3 hours of
symptom onset?
A. Aspirin
B. Intravenous thrombolysis
C. Heparin
D. Statin therapy
Answer: B
Explanation: IV tPA is indicated for ischemic stroke within 3–4.5 hours of symptom onset if
no contraindications exist.
11. A patient with heart failure has a potassium level of 3.1 mEq/L and is taking digoxin.
What is the priority action?
A. Administer digoxin as ordered
B. Hold digoxin and notify the provider
C. Administer potassium without holding digoxin
Practice Questions and Answer
Explanations
Part One: Cardiovascular (1–18)
1. A 67-year-old patient presents with chest pain. On physical examination, you note that
the right ventricle is located anteriorly and the left ventricle is posteriorly. Which of the
following best describes the normal flow of blood through the cardiovascular system?
A. Lungs → pulmonary arteries → left atrium → left ventricle → aorta → body tissues →
vena cava → right atrium → right ventricle → pulmonary veins → lungs
B. Lungs → pulmonary veins → left atrium → left ventricle → aorta → body tissues → vena
cava → right atrium → right ventricle → pulmonary arteries → lungs
C. Body tissues → vena cava → left atrium → left ventricle → aorta → lungs → pulmonary
veins → right atrium → right ventricle → pulmonary arteries
D. Lungs → pulmonary veins → right atrium → right ventricle → pulmonary arteries → body
tissues → vena cava → left atrium → left ventricle → aorta
Answer: B
Explanation: Oxygenated blood returns from the lungs via pulmonary veins to the left
atrium, then to the left ventricle, is pumped to the body via the aorta, and deoxygenated
blood returns via vena cava to the right atrium, then right ventricle, before being sent to the
lungs via pulmonary arteries .
2. A patient with chronic hypertension asks about the mechanism of their medication. You
explain that the RAAS system typically manages afterload. Which of the following best
describes afterload?
A. The force of myocardial contraction
B. Central fluid volume status
C. Arterial backpressure on outflow
D. The stretching of cardiac muscle fibers
Answer: C
Explanation: Afterload is defined as the arterial backpressure on outflow that the heart must
overcome to eject blood. Preload refers to central fluid volume status, and contractility
refers to the force of myocardial contraction .
3. According to JNC8 guidelines, a 65-year-old patient without diabetes or chronic kidney
disease should have a target blood pressure of:
A. <140/90
B. <150/90
,C. <130/80
D. <120/80
Answer: B
Explanation: According to JNC8 guidelines, patients age >60 years without diabetes or
chronic kidney disease should have a target blood pressure of <150/90 .
4. A 55-year-old African American patient is newly diagnosed with hypertension.
According to the guidelines discussed, which medication class should be considered as
first-line therapy?
A. ACE inhibitors
B. Beta-blockers
C. Calcium channel blockers
D. Loop diuretics
Answer: C
Explanation: Calcium channel blockers are first-line for African American patients with
hypertension .
5. A 58-year-old male presents with sudden onset of severe, tearing chest pain radiating to
his back. He has a history of hypertension and smokes one pack per day. His blood
pressure is 180/100 mmHg in the right arm and 150/90 mmHg in the left arm. Which
finding is most concerning for aortic dissection?
A. Equal blood pressures in both arms
B. Interarm blood pressure differential
C. Pain relieved by nitroglycerin
D. ST elevation on ECG
Answer: B
Explanation: A significant interarm blood pressure differential (>20 mmHg) is a classic
finding in aortic dissection due to compromised flow in the subclavian artery .
6. A 58-year-old male presents with new-onset substernal chest pain radiating to the left
arm, diaphoresis, and dyspnea. Troponin is elevated, and ECG shows ST elevation in the
anterior leads. What is the most appropriate immediate management?
A. Administer aspirin 325 mg, clopidogrel 600 mg loading dose, and refer for PCI
B. Start intravenous nitroglycerin and schedule a stress test in 2 days
C. Discharge with sublingual nitroglycerin
D. Obtain CT angiography to rule out pulmonary embolism
Answer: A
Explanation: The patient presents with classic STEMI. Emergent reperfusion via PCI
combined with dual antiplatelet therapy is the standard of care.
7. A 72-year-old woman with hypertension and atrial fibrillation presents with a new
systolic murmur heard best at the right upper sternal border that radiates to the carotid
arteries. She reports progressive dyspnea and fatigue. What is the most likely diagnosis?
, A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Pulmonary stenosis
Answer: B
Explanation: Aortic stenosis produces a systolic ejection murmur at the right upper sternal
border with radiation to the carotids.
8. A 45-year-old man with uncontrolled hypertension is prescribed lisinopril. After 2
weeks, he reports a persistent dry cough. What is the most appropriate management?
A. Continue lisinopril and add dextromethorphan
B. Discontinue lisinopril and switch to an ARB
C. Reduce the lisinopril dose by half
D. Add diphenhydramine
Answer: B
Explanation: ACE inhibitor-induced dry cough occurs in approximately 5–20% of patients.
Switching to an ARB is appropriate.
9. A patient presents with crushing chest pain and ST-elevation in leads II, III, and aVF.
What is the most likely diagnosis?
A. Anterior STEMI
B. Inferior STEMI
C. NSTEMI
D. Pericarditis
Answer: B
Explanation: ST-elevation in leads II, III, and aVF corresponds to the inferior myocardial wall.
10. A 68-year-old female presents with sudden-onset confusion and right-sided weakness.
CT shows ischemic stroke. Which therapy should be considered within the first 3 hours of
symptom onset?
A. Aspirin
B. Intravenous thrombolysis
C. Heparin
D. Statin therapy
Answer: B
Explanation: IV tPA is indicated for ischemic stroke within 3–4.5 hours of symptom onset if
no contraindications exist.
11. A patient with heart failure has a potassium level of 3.1 mEq/L and is taking digoxin.
What is the priority action?
A. Administer digoxin as ordered
B. Hold digoxin and notify the provider
C. Administer potassium without holding digoxin
