NR 603 CEA (Advanced Clinical Diagnosis) – Comprehensive Exam Study Guide

NR 603 CEA (Advanced Clinical Diagnosis)
– Comprehensive Exam Study Guide

NR 603 CEA ADVANCED CLINICAL DIAGNOSIS – ULTIMATE EXAM BANK
200+ Questions with Verified Answers & Rationales
2026/2027 Edition | Chamberlain University


Exam Focus: Clinical Reasoning, Differential Diagnosis, Patient Management
Systems Covered: Cardiovascular, Respiratory, Endocrine, Neurology,
Hematology,
Renal/Urology, GI, Infectious Disease, Musculoskeletal, Dermatology,
Psychiatry




SECTION 1: CARDIOVASCULAR SYSTEM (Questions 1-35)




QUESTION 1: A 58-year-old male with hypertension presents to the ED with
substernal chest pressure radiating to his left arm, accompanied by diaphoresis
and nausea. What is the most appropriate initial diagnostic test?
A) Chest X-ray
B) 12-lead ECG
C) Cardiac troponin
D) Stress echocardiogram


Correct Answer: B) 12-lead ECG




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,Rationale: The 12-lead ECG should be obtained within 10 minutes of arrival for
any patient with chest pain suspicious for myocardial infarction. It immediately
identifies ST-elevation MI (STEMI), which requires urgent reperfusion. While
troponin is critical, the ECG provides immediate, time-sensitive information .


QUESTION 2: Which cardiac biomarker is the most specific for myocardial
infarction?
A) CK-MB
B) BNP
C) Troponin I
D) D-dimer


Correct Answer: C) Troponin I


Rationale: Cardiac troponins I and T are the most specific biomarkers for
myocardial injury. Troponin I is not normally found in the blood of healthy
individuals and rises within hours of myocardial necrosis .


QUESTION 3: A 12-lead ECG shows ST-segment elevation in leads II, III, and
aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery (LAD)
B) Left circumflex artery (LCX)
C) Right coronary artery (RCA)
D) Left main coronary artery


Correct Answer: C) Right coronary artery (RCA)


Rationale: Inferior wall myocardial infarction (ST elevation in leads II, III, aVF) is
typically caused by occlusion of the right coronary artery (RCA). The LAD
supplies the anterior wall, and the LCX supplies the lateral wall .




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,QUESTION 4: A 50-year-old woman with hypertension presents with dyspnea on
exertion and orthopnea. On exam, she has jugular venous distention (JVD) and
bilateral crackles. What is the most likely diagnosis?
A) Pulmonary embolism
B) Congestive heart failure
C) Pneumonia
D) COPD exacerbation


Correct Answer: B) Congestive heart failure


Rationale: JVD indicates right ventricular backup, while crackles indicate left
ventricular backup (pulmonary congestion). This combination of classic
findings confirms congestive heart failure .


QUESTION 5: A 72-year-old female with dyspnea, orthopnea, and peripheral
edema has crackles at both lung bases. Which medication is most appropriate
for initial management of this patient's volume overload?
A) Metoprolol
B) Furosemide
C) Lisinopril
D) Digoxin


Correct Answer: B) Furosemide


Rationale: For acute volume overload in heart failure, loop diuretics
(furosemide) are first-line to rapidly reduce preload and relieve pulmonary
congestion. Beta-blockers and ACE inhibitors are long-term therapies .


QUESTION 6: An ECG shows a heart rate of 42 bpm, regular rhythm, no P
waves, and wide QRS complexes (0.14 sec). What is the rhythm?
A) Sinus bradycardia
B) Junctional rhythm


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, C) Idioventricular rhythm
D) Atrial fibrillation with slow ventricular response


Correct Answer: C) Idioventricular rhythm


Rationale: Absence of P waves, wide QRS, and a very slow ventricular rate
(typically 20-40 bpm) indicates an idioventricular rhythm—the Purkinje fibers
acting as the pacemaker .


QUESTION 7: The point of maximum impulse (PMI) is most often palpable in
healthy adults at which location?
A) 5th intercostal space, mid-clavicular line, left side
B) 4th intercostal space, sternal border
C) 3rd intercostal space, mid-axillary line
D) Xiphoid process


Correct Answer: A) 5th intercostal space, left mid-clavicular line


Rationale: The normal PMI is located at the 5th intercostal space at the left mid-
clavicular line (apex of the heart). Displacement suggests cardiomegaly .


QUESTION 8: A 45-year-old man presents with substernal chest pain that
worsens when lying supine and improves when sitting forward. He has a low-
grade fever and a pericardial friction rub on auscultation. What is the most likely
diagnosis?
A) Acute myocardial infarction
B) Pericarditis
C) Aortic dissection
D) Pulmonary embolism


Correct Answer: B) Pericarditis



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