NR 603 CEA Midterm Exam - Advanced Clinical Diagnosis 2026/2027
Chamberlain
1. A 65-year-old African American male is newly diagnosed with stage 1
hypertension. He has no history of diabetes or chronic kidney disease. Which
class of medication is recommended as first-line therapy?
A. Calcium channel blocker
B. Beta-blocker
C. ACE inhibitor
D. Angiotensin II receptor blocker
Answer: A
Rationale: According to JNC 8 and ACC/AHA guidelines, thiazide-type diuretics or calcium
channel blockers are recommended as initial therapy for the general Black population with
hypertension.
2. Which diagnostic test is considered the gold standard for diagnosing Heart
Failure with preserved Ejection Fraction (HFpEF)?
A. Chest X-ray
B. B-type Natriuretic Peptide (BNP)
C. Electrocardiogram
D. Echocardiogram
Answer: D
Rationale: The echocardiogram is essential to assess ejection fraction, diastolic function,
and structural heart changes to confirm HFpEF.
,3. A 45-year-old patient presents with a mid-systolic click followed by a late
systolic murmur at the apex. This is most characteristic of:
A. Aortic Stenosis
B. Mitral Valve Prolapse
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
Rationale: Mitral Valve Prolapse typically presents with a mid-systolic click and a possible
late systolic murmur.
4. Which of the following CHA2DS2-VASc scores in a male patient with Atrial
Fibrillation suggests that oral anticoagulation should be initiated?
A. 0
B. 1
C. 2 or greater
D. Only if the patient is over 75
Answer: C
Rationale: A CHA2DS2-VASc score of 2 or greater in men (or 3 or greater in women)
warrants oral anticoagulation to reduce stroke risk.
5. A patient with a history of peripheral artery disease (PAD) has an Ankle-
Brachial Index (ABI) of 0.65. How is this interpreted?
A. Mild to moderate PAD
B. Normal arterial flow
C. Severe PAD
D. Non-compressible vessels
Answer: A
Rationale: An ABI between 0.41 and 0.90 indicates mild to moderate peripheral artery
disease.
, 6. In the management of stable angina, which medication is used for the
immediate relief of chest pain?
A. Amlodipine
B. Lisinopril
C. Sublingual Nitroglycerin
D. Atorvastatin
Answer: C
Rationale: Sublingual nitroglycerin provides rapid vasodilation to alleviate acute anginal
symptoms.
7. According to the GINA guidelines, what is the preferred rescue medication for
adults with mild asthma?
A. Short-acting beta-agonist (SABA) alone
B. Long-acting beta-agonist (LABA) alone
C. Oral corticosteroids
D. Low-dose inhaled corticosteroid (ICS)-formoterol as needed
Answer: D
Rationale: Current GINA guidelines recommend as-needed low-dose ICS-formoterol as the
preferred reliever to reduce the risk of severe exacerbations.
8. A 60-year-old smoker presents with chronic cough and exertional dyspnea.
Spirometry reveals an FEV1/FVC ratio of 0.62. This confirms:
A. Restrictive lung disease
B. Obstructive lung disease (COPD)
C. Normal lung function for age
D. Acute bronchitis
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 is the diagnostic hallmark
of airflow limitation in COPD.
Chamberlain
1. A 65-year-old African American male is newly diagnosed with stage 1
hypertension. He has no history of diabetes or chronic kidney disease. Which
class of medication is recommended as first-line therapy?
A. Calcium channel blocker
B. Beta-blocker
C. ACE inhibitor
D. Angiotensin II receptor blocker
Answer: A
Rationale: According to JNC 8 and ACC/AHA guidelines, thiazide-type diuretics or calcium
channel blockers are recommended as initial therapy for the general Black population with
hypertension.
2. Which diagnostic test is considered the gold standard for diagnosing Heart
Failure with preserved Ejection Fraction (HFpEF)?
A. Chest X-ray
B. B-type Natriuretic Peptide (BNP)
C. Electrocardiogram
D. Echocardiogram
Answer: D
Rationale: The echocardiogram is essential to assess ejection fraction, diastolic function,
and structural heart changes to confirm HFpEF.
,3. A 45-year-old patient presents with a mid-systolic click followed by a late
systolic murmur at the apex. This is most characteristic of:
A. Aortic Stenosis
B. Mitral Valve Prolapse
C. Mitral Stenosis
D. Aortic Regurgitation
Answer: B
Rationale: Mitral Valve Prolapse typically presents with a mid-systolic click and a possible
late systolic murmur.
4. Which of the following CHA2DS2-VASc scores in a male patient with Atrial
Fibrillation suggests that oral anticoagulation should be initiated?
A. 0
B. 1
C. 2 or greater
D. Only if the patient is over 75
Answer: C
Rationale: A CHA2DS2-VASc score of 2 or greater in men (or 3 or greater in women)
warrants oral anticoagulation to reduce stroke risk.
5. A patient with a history of peripheral artery disease (PAD) has an Ankle-
Brachial Index (ABI) of 0.65. How is this interpreted?
A. Mild to moderate PAD
B. Normal arterial flow
C. Severe PAD
D. Non-compressible vessels
Answer: A
Rationale: An ABI between 0.41 and 0.90 indicates mild to moderate peripheral artery
disease.
, 6. In the management of stable angina, which medication is used for the
immediate relief of chest pain?
A. Amlodipine
B. Lisinopril
C. Sublingual Nitroglycerin
D. Atorvastatin
Answer: C
Rationale: Sublingual nitroglycerin provides rapid vasodilation to alleviate acute anginal
symptoms.
7. According to the GINA guidelines, what is the preferred rescue medication for
adults with mild asthma?
A. Short-acting beta-agonist (SABA) alone
B. Long-acting beta-agonist (LABA) alone
C. Oral corticosteroids
D. Low-dose inhaled corticosteroid (ICS)-formoterol as needed
Answer: D
Rationale: Current GINA guidelines recommend as-needed low-dose ICS-formoterol as the
preferred reliever to reduce the risk of severe exacerbations.
8. A 60-year-old smoker presents with chronic cough and exertional dyspnea.
Spirometry reveals an FEV1/FVC ratio of 0.62. This confirms:
A. Restrictive lung disease
B. Obstructive lung disease (COPD)
C. Normal lung function for age
D. Acute bronchitis
Answer: B
Rationale: A post-bronchodilator FEV1/FVC ratio less than 0.70 is the diagnostic hallmark
of airflow limitation in COPD.
