NP Cardiovascular Practice Assessment:
Case-Based Q&A, Rationales Full Package.
2025/2026
1. A 58-year-old man presents with exertional chest pain relieved by
rest. His ECG is normal at rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Myocardial infarction
D. Pericarditis
Rationale: Stable angina is characterized by predictable chest pain
with exertion that is relieved by rest or nitroglycerin. Unstable angina
presents with pain at rest or increasing frequency, while MI has
persistent symptoms and ECG changes.
2. First-line therapy for a patient with hypertension and diabetes is:
A. Beta-blocker
B. ACE inhibitor or ARB
C. Thiazide diuretic
D. Calcium channel blocker
Rationale: ACE inhibitors or ARBs are preferred in patients with
diabetes due to renal protective effects and proven cardiovascular
benefit.
3. Which lipid-lowering therapy is first-line for a patient with
ASCVD?
A. Ezetimibe
B. Niacin
C. High-intensity statin
D. Bile acid sequestrant
,Rationale: High-intensity statins reduce LDL cholesterol significantly
and lower the risk of recurrent cardiovascular events in patients with
established ASCVD.
4. A patient presents with sudden onset chest pain, shortness of
breath, and diaphoresis. ECG shows ST-segment elevation in leads
II, III, and aVF. The immediate next step is:
A. Start heparin and schedule elective cath
B. Administer thrombolytics if PCI unavailable
C. Activate STEMI protocol and prepare for emergent PCI
D. Observe and repeat ECG in 6 hours
Rationale: STEMI is a medical emergency. Rapid reperfusion via PCI is
preferred; thrombolytics are considered if PCI is not available within
the recommended time frame.
5. Which of the following is a major risk factor for aortic dissection?
A. Hyperlipidemia
B. Diabetes
C. Hypertension
D. Asthma
Rationale: Chronic hypertension increases stress on the aortic wall,
predisposing to dissection.
6. Which antihypertensive is preferred in a patient with heart failure
with reduced ejection fraction (HFrEF)?
A. Dihydropyridine calcium channel blocker
B. ACE inhibitor
C. Thiazide diuretic
D. Alpha-blocker
Rationale: ACE inhibitors improve survival in HFrEF and reduce
hospitalizations; other agents may be added as indicated.
, 7. The target blood pressure for a patient with diabetes and
hypertension is:
A. <140/90 mmHg
B. <150/90 mmHg
C. <130/80 mmHg
D. <120/70 mmHg
Rationale: Current guidelines recommend a BP target of <130/80
mmHg in patients with diabetes to reduce cardiovascular risk.
8. A 65-year-old man with a history of MI is on aspirin and statin
therapy but has LDL of 120 mg/dL. Next step in management:
A. Stop statin and monitor
B. Increase aspirin dose
C. Add ezetimibe or PCSK9 inhibitor
D. Switch to a fibrate
Rationale: Patients with ASCVD who do not reach LDL goals on statin
therapy may benefit from adding non-statin agents to further reduce
LDL and cardiovascular risk.
9. A patient presents with dyspnea, orthopnea, and lower extremity
edema. BNP is elevated. Most likely diagnosis:
A. COPD exacerbation
B. Pulmonary embolism
C. Heart failure
D. Asthma
Rationale: Elevated BNP, along with classic symptoms like dyspnea,
orthopnea, and edema, suggests heart failure.
10. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of
3 should:
A. Start oral anticoagulation
, B. Take aspirin only
C. Use beta-blocker monotherapy
D. Monitor without therapy
Rationale: Oral anticoagulation is indicated in patients with AF and a
CHA₂DS₂-VASc score ≥2 in men (≥3 in women) to reduce the risk of
stroke.
11. First-line treatment for acute decompensated heart failure
with pulmonary edema is:
A. Oral ACE inhibitor
B. IV loop diuretic
C. Oral beta-blocker
D. Calcium channel blocker
Rationale: IV loop diuretics rapidly reduce volume overload and
improve symptoms in acute decompensated heart failure.
12. Which test is most sensitive for detecting myocardial
ischemia?
A. Resting ECG
B. Chest X-ray
C. Stress test (exercise or pharmacologic)
D. Echocardiogram
Rationale: Stress testing identifies ischemia by inducing myocardial
oxygen demand; resting ECG may be normal.
13. Which medication should be avoided in acute
decompensated heart failure?
A. IV loop diuretics
B. ACE inhibitors
C. Non-dihydropyridine calcium channel blockers (verapamil,
Case-Based Q&A, Rationales Full Package.
2025/2026
1. A 58-year-old man presents with exertional chest pain relieved by
rest. His ECG is normal at rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Myocardial infarction
D. Pericarditis
Rationale: Stable angina is characterized by predictable chest pain
with exertion that is relieved by rest or nitroglycerin. Unstable angina
presents with pain at rest or increasing frequency, while MI has
persistent symptoms and ECG changes.
2. First-line therapy for a patient with hypertension and diabetes is:
A. Beta-blocker
B. ACE inhibitor or ARB
C. Thiazide diuretic
D. Calcium channel blocker
Rationale: ACE inhibitors or ARBs are preferred in patients with
diabetes due to renal protective effects and proven cardiovascular
benefit.
3. Which lipid-lowering therapy is first-line for a patient with
ASCVD?
A. Ezetimibe
B. Niacin
C. High-intensity statin
D. Bile acid sequestrant
,Rationale: High-intensity statins reduce LDL cholesterol significantly
and lower the risk of recurrent cardiovascular events in patients with
established ASCVD.
4. A patient presents with sudden onset chest pain, shortness of
breath, and diaphoresis. ECG shows ST-segment elevation in leads
II, III, and aVF. The immediate next step is:
A. Start heparin and schedule elective cath
B. Administer thrombolytics if PCI unavailable
C. Activate STEMI protocol and prepare for emergent PCI
D. Observe and repeat ECG in 6 hours
Rationale: STEMI is a medical emergency. Rapid reperfusion via PCI is
preferred; thrombolytics are considered if PCI is not available within
the recommended time frame.
5. Which of the following is a major risk factor for aortic dissection?
A. Hyperlipidemia
B. Diabetes
C. Hypertension
D. Asthma
Rationale: Chronic hypertension increases stress on the aortic wall,
predisposing to dissection.
6. Which antihypertensive is preferred in a patient with heart failure
with reduced ejection fraction (HFrEF)?
A. Dihydropyridine calcium channel blocker
B. ACE inhibitor
C. Thiazide diuretic
D. Alpha-blocker
Rationale: ACE inhibitors improve survival in HFrEF and reduce
hospitalizations; other agents may be added as indicated.
, 7. The target blood pressure for a patient with diabetes and
hypertension is:
A. <140/90 mmHg
B. <150/90 mmHg
C. <130/80 mmHg
D. <120/70 mmHg
Rationale: Current guidelines recommend a BP target of <130/80
mmHg in patients with diabetes to reduce cardiovascular risk.
8. A 65-year-old man with a history of MI is on aspirin and statin
therapy but has LDL of 120 mg/dL. Next step in management:
A. Stop statin and monitor
B. Increase aspirin dose
C. Add ezetimibe or PCSK9 inhibitor
D. Switch to a fibrate
Rationale: Patients with ASCVD who do not reach LDL goals on statin
therapy may benefit from adding non-statin agents to further reduce
LDL and cardiovascular risk.
9. A patient presents with dyspnea, orthopnea, and lower extremity
edema. BNP is elevated. Most likely diagnosis:
A. COPD exacerbation
B. Pulmonary embolism
C. Heart failure
D. Asthma
Rationale: Elevated BNP, along with classic symptoms like dyspnea,
orthopnea, and edema, suggests heart failure.
10. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of
3 should:
A. Start oral anticoagulation
, B. Take aspirin only
C. Use beta-blocker monotherapy
D. Monitor without therapy
Rationale: Oral anticoagulation is indicated in patients with AF and a
CHA₂DS₂-VASc score ≥2 in men (≥3 in women) to reduce the risk of
stroke.
11. First-line treatment for acute decompensated heart failure
with pulmonary edema is:
A. Oral ACE inhibitor
B. IV loop diuretic
C. Oral beta-blocker
D. Calcium channel blocker
Rationale: IV loop diuretics rapidly reduce volume overload and
improve symptoms in acute decompensated heart failure.
12. Which test is most sensitive for detecting myocardial
ischemia?
A. Resting ECG
B. Chest X-ray
C. Stress test (exercise or pharmacologic)
D. Echocardiogram
Rationale: Stress testing identifies ischemia by inducing myocardial
oxygen demand; resting ECG may be normal.
13. Which medication should be avoided in acute
decompensated heart failure?
A. IV loop diuretics
B. ACE inhibitors
C. Non-dihydropyridine calcium channel blockers (verapamil,
