NSG 554 EXAM 3 STUDY GUIDE — WILKES UNIVERSITY
Nurse Practitioners in Primary Care I | 2026/2027
Update | Complete Solutions
Welcome to your Exam 3 study guide. As your professor, I expect you to not just memorize
these concepts, but to internalize the clinical reasoning behind them. The NCNP/FNP board
exams and this exam rely on your ability to sift through distractors and prioritize patient
safety. Read every rationale. Master the pearls. Let's get to work.
PART A: CARDIOLOGY & CARDIOVASCULAR DISORDERS DRILL (Questions 1–12)
1. A 45-year-old patient presents to the clinic complaining of chest pain and dyspnea on
exertion. The patient has an intermediate pre-test probability for acute coronary syndrome
(ACS). What is the most appropriate next step in diagnosis?
A) Admit for immediate cardiac catheterization
B) Order an exercise stress test
C) Obtain a resting 12-lead ECG
D) Prescribe a trial of PPIs to rule out GERD
Correct Answer: B) Order an exercise stress test
Rationale: For patients with symptoms of chest pain or dyspnea on exertion and an
intermediate risk of ACS, an exercise stress test is the correct diagnostic choice to assess for
ischemia and evaluate functional capacity. Immediate catheterization is for high-risk/STEMI. A
resting ECG is done first for acute suspicion, but the stress test evaluates the exertional
component.
High-Yield Pearl: Exercise stress testing is indicated for symptomatic patients (chest pain/DOE)
with intermediate ACS risk to evaluate for CAD and establish functional capacity.
2. A 60-year-old asymptomatic patient with no history of cardiac disease or revascularization
requests an exercise stress test for a "routine cardiac checkup." What is your response?
,A) Order the test to provide reassurance
B) Decline the test, as it is not indicated for asymptomatic patients without a history of
revascularization
C) Order a pharmacologic stress test instead
D) Order a coronary CT angiogram instead
Correct Answer: B) Decline the test, as it is not indicated for asymptomatic patients without a
history of revascularization
Rationale: Exercise stress testing is specifically contraindicated for the detection of ischemia in
asymptomatic patients who lack a history of prior revascularization. It yields false positives
and does not improve outcomes in this population.
High-Yield Pearl: Do NOT use an exercise stress test for asymptomatic patients without a
history of revascularization.
3. A patient arrives at the emergency department with crushing substernal chest pain
radiating to the left jaw. What is the mandatory time frame for obtaining a 12-lead ECG?
A) Within 30 minutes of arrival
B) Within 10 minutes of arrival
C) Within 45 minutes of arrival
D) Within 20 minutes of arrival
Correct Answer: B) Within 10 minutes of arrival
Rationale: For any patient with symptoms suggestive of ACS, the 12-lead ECG must be
obtained and interpreted within 10 minutes of arrival to identify ST-segment elevation
(STEMI) or other acute ischemic changes.
High-Yield Pearl: The 10-minute ECG rule is an absolute standard of care for acute chest pain.
4. The initial 12-lead ECG for a patient with chest pain is non-diagnostic. What is the next
mandatory step in the ACS workup?
A) Discharge with follow-up in 1 week
B) Obtain cardiac biomarkers (high-sensitivity troponin)
, C) Order a CT angiogram of the chest
D) Administer thrombolytics
Correct Answer: B) Obtain cardiac biomarkers (high-sensitivity troponin)
Rationale: If the ECG is non-diagnostic, high-sensitivity cardiac troponin (hs-cTn) is the
preferred biomarker to rule out myocardial injury.
High-Yield Pearl: Non-diagnostic ECG = immediate next step is troponin.
5. A patient's ECG reveals ST-segment elevation in contiguous leads. The patient is diagnosed
with a STEMI. What is the immediate required action?
A) Start beta-blockers
B) Activate the emergency response system for immediate reperfusion (PCI or fibrinolysis)
C) Schedule an outpatient stress test
D) Repeat the ECG in 1 hour
Correct Answer: B) Activate the emergency response system for immediate reperfusion (PCI
or fibrinolysis)
Rationale: ST-segment elevation requires immediate reperfusion therapy, either via
percutaneous coronary intervention (PCI) or fibrinolysis. Time is muscle.
High-Yield Pearl: STEMI = Activate the cath lab immediately.
6. Which patient meets the criteria for "premature" family history of coronary artery disease
(CAD)?
A) Brother diagnosed with CAD at age 65
B) Mother diagnosed with CAD at age 68
C) Father diagnosed with CAD at age 48
D) Sister diagnosed with CAD at age 70
Correct Answer: C) Father diagnosed with CAD at age 48
Rationale: Premature CAD in a first-degree relative is defined as occurring in a male < 55 years
old or a female < 65 years old.
Nurse Practitioners in Primary Care I | 2026/2027
Update | Complete Solutions
Welcome to your Exam 3 study guide. As your professor, I expect you to not just memorize
these concepts, but to internalize the clinical reasoning behind them. The NCNP/FNP board
exams and this exam rely on your ability to sift through distractors and prioritize patient
safety. Read every rationale. Master the pearls. Let's get to work.
PART A: CARDIOLOGY & CARDIOVASCULAR DISORDERS DRILL (Questions 1–12)
1. A 45-year-old patient presents to the clinic complaining of chest pain and dyspnea on
exertion. The patient has an intermediate pre-test probability for acute coronary syndrome
(ACS). What is the most appropriate next step in diagnosis?
A) Admit for immediate cardiac catheterization
B) Order an exercise stress test
C) Obtain a resting 12-lead ECG
D) Prescribe a trial of PPIs to rule out GERD
Correct Answer: B) Order an exercise stress test
Rationale: For patients with symptoms of chest pain or dyspnea on exertion and an
intermediate risk of ACS, an exercise stress test is the correct diagnostic choice to assess for
ischemia and evaluate functional capacity. Immediate catheterization is for high-risk/STEMI. A
resting ECG is done first for acute suspicion, but the stress test evaluates the exertional
component.
High-Yield Pearl: Exercise stress testing is indicated for symptomatic patients (chest pain/DOE)
with intermediate ACS risk to evaluate for CAD and establish functional capacity.
2. A 60-year-old asymptomatic patient with no history of cardiac disease or revascularization
requests an exercise stress test for a "routine cardiac checkup." What is your response?
,A) Order the test to provide reassurance
B) Decline the test, as it is not indicated for asymptomatic patients without a history of
revascularization
C) Order a pharmacologic stress test instead
D) Order a coronary CT angiogram instead
Correct Answer: B) Decline the test, as it is not indicated for asymptomatic patients without a
history of revascularization
Rationale: Exercise stress testing is specifically contraindicated for the detection of ischemia in
asymptomatic patients who lack a history of prior revascularization. It yields false positives
and does not improve outcomes in this population.
High-Yield Pearl: Do NOT use an exercise stress test for asymptomatic patients without a
history of revascularization.
3. A patient arrives at the emergency department with crushing substernal chest pain
radiating to the left jaw. What is the mandatory time frame for obtaining a 12-lead ECG?
A) Within 30 minutes of arrival
B) Within 10 minutes of arrival
C) Within 45 minutes of arrival
D) Within 20 minutes of arrival
Correct Answer: B) Within 10 minutes of arrival
Rationale: For any patient with symptoms suggestive of ACS, the 12-lead ECG must be
obtained and interpreted within 10 minutes of arrival to identify ST-segment elevation
(STEMI) or other acute ischemic changes.
High-Yield Pearl: The 10-minute ECG rule is an absolute standard of care for acute chest pain.
4. The initial 12-lead ECG for a patient with chest pain is non-diagnostic. What is the next
mandatory step in the ACS workup?
A) Discharge with follow-up in 1 week
B) Obtain cardiac biomarkers (high-sensitivity troponin)
, C) Order a CT angiogram of the chest
D) Administer thrombolytics
Correct Answer: B) Obtain cardiac biomarkers (high-sensitivity troponin)
Rationale: If the ECG is non-diagnostic, high-sensitivity cardiac troponin (hs-cTn) is the
preferred biomarker to rule out myocardial injury.
High-Yield Pearl: Non-diagnostic ECG = immediate next step is troponin.
5. A patient's ECG reveals ST-segment elevation in contiguous leads. The patient is diagnosed
with a STEMI. What is the immediate required action?
A) Start beta-blockers
B) Activate the emergency response system for immediate reperfusion (PCI or fibrinolysis)
C) Schedule an outpatient stress test
D) Repeat the ECG in 1 hour
Correct Answer: B) Activate the emergency response system for immediate reperfusion (PCI
or fibrinolysis)
Rationale: ST-segment elevation requires immediate reperfusion therapy, either via
percutaneous coronary intervention (PCI) or fibrinolysis. Time is muscle.
High-Yield Pearl: STEMI = Activate the cath lab immediately.
6. Which patient meets the criteria for "premature" family history of coronary artery disease
(CAD)?
A) Brother diagnosed with CAD at age 65
B) Mother diagnosed with CAD at age 68
C) Father diagnosed with CAD at age 48
D) Sister diagnosed with CAD at age 70
Correct Answer: C) Father diagnosed with CAD at age 48
Rationale: Premature CAD in a first-degree relative is defined as occurring in a male < 55 years
old or a female < 65 years old.
