NSG 554 EXAM 3 – NURSE PRACTITIONERS
IN PRIMARY CARE I350 MULTIPLECHOICE
PRACTICE QUESTIONS WITH ANSWERS AND
RATIONALES
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–50)
Question 1
A 55yearold male presents with new onset exertional chest pain. Which
diagnostic test is the initial choice for assessing CAD in a patient with an
intermediate risk for ACS?
A) Coronary Angiography
B) Exercise Stress Test
C) Resting ECG only
D) Cardiac MRI
Answer: B
Rationale: Exercise stress testing is the preferred initial noninvasive test for
symptomatic patients with intermediate risk and a normal baseline ECG.
Coronary angiography is invasive and reserved for highrisk or positive stress
test results. Resting ECG alone is insufficient for diagnosing ischemia. Cardiac
MRI is not firstline.
,Question 2
Which ECG finding indicates a "positive" exercise stress test for inducible
ischemia?
A) Horizontal or downsloping STsegment depression
B) Twave inversion in Lead II
C) Sinus tachycardia at 150 bpm
D) Occasional PVCs
Answer: A
Rationale: STsegment depression that is horizontal or downsloping is the
classic diagnostic indicator of myocardial ischemia during stress testing.
Twave inversions, sinus tachycardia, and occasional PVCs can occur during
exercise but are not diagnostic of ischemia.
Question 3
A 60yearold man reports bilateral lower extremity edema, worsening dyspnea
on exertion, and a 5pound weight gain over one week. He has a known history
of HFrEF. Which finding would be most concerning for acute decompensation
requiring urgent intervention?
A) Trace pedal edema improved with elevation
B) New orthopnea and paroxysmal nocturnal dyspnea
C) Stable weight compared to last visit
D) Mild fatigue after a long walk
,Answer: B
Rationale: New orthopnea and paroxysmal nocturnal dyspnea (PND) are
hallmark symptoms of worsening pulmonary congestion in heart failure and
suggest acute decompensation requiring urgent evaluation. Trace edema that
improves with elevation and stable weight are reassuring findings. Mild
exertional fatigue is nonspecific.
Question 4
Which lipid panel result would most strongly indicate a need to screen for
familial hypercholesterolemia in a 30yearold patient?
A) LDL of 110 mg/dL with normal triglycerides
B) LDL of 220 mg/dL with family history of premature CAD
C) HDL of 65 mg/dL
D) Triglycerides of 140 mg/dL
Answer: B
Rationale: An LDL ≥190 mg/dL in a young adult, particularly with a family
history of premature coronary artery disease, raises strong suspicion for
familial hypercholesterolemia.
Question 5
A 72yearold man with a 5year history of angina and type 2 DM collapses while
playing golf. Paramedics arrive in 10 minutes. What is the most appropriate
initial intervention?
, A) Administer sublingual nitroglycerin
B) Start CPR immediately
C) Obtain a 12lead ECG
D) Check blood glucose
Answer: C
Rationale: In a patient with known CAD who collapses, obtaining a 12lead ECG
to assess for acute MI is the priority. While CPR may be needed if pulseless,
ECG assessment guides definitive management.
Question 6
A patient with chronic heart failure presents with worsening dyspnea,
orthopnea, and peripheral edema. Which medication class is most appropriate
for firstline management of fluid overload?
A) Betablockers
B) ACE inhibitors
C) Loop diuretics
D) Calcium channel blockers
Answer: C
Rationale: Loop diuretics are the mainstay for managing fluid overload in
heart failure, providing rapid symptom relief through diuresis. Betablockers
and ACE inhibitors are chronic management agents. Calcium channel blockers
may worsen heart failure.
IN PRIMARY CARE I350 MULTIPLECHOICE
PRACTICE QUESTIONS WITH ANSWERS AND
RATIONALES
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–50)
Question 1
A 55yearold male presents with new onset exertional chest pain. Which
diagnostic test is the initial choice for assessing CAD in a patient with an
intermediate risk for ACS?
A) Coronary Angiography
B) Exercise Stress Test
C) Resting ECG only
D) Cardiac MRI
Answer: B
Rationale: Exercise stress testing is the preferred initial noninvasive test for
symptomatic patients with intermediate risk and a normal baseline ECG.
Coronary angiography is invasive and reserved for highrisk or positive stress
test results. Resting ECG alone is insufficient for diagnosing ischemia. Cardiac
MRI is not firstline.
,Question 2
Which ECG finding indicates a "positive" exercise stress test for inducible
ischemia?
A) Horizontal or downsloping STsegment depression
B) Twave inversion in Lead II
C) Sinus tachycardia at 150 bpm
D) Occasional PVCs
Answer: A
Rationale: STsegment depression that is horizontal or downsloping is the
classic diagnostic indicator of myocardial ischemia during stress testing.
Twave inversions, sinus tachycardia, and occasional PVCs can occur during
exercise but are not diagnostic of ischemia.
Question 3
A 60yearold man reports bilateral lower extremity edema, worsening dyspnea
on exertion, and a 5pound weight gain over one week. He has a known history
of HFrEF. Which finding would be most concerning for acute decompensation
requiring urgent intervention?
A) Trace pedal edema improved with elevation
B) New orthopnea and paroxysmal nocturnal dyspnea
C) Stable weight compared to last visit
D) Mild fatigue after a long walk
,Answer: B
Rationale: New orthopnea and paroxysmal nocturnal dyspnea (PND) are
hallmark symptoms of worsening pulmonary congestion in heart failure and
suggest acute decompensation requiring urgent evaluation. Trace edema that
improves with elevation and stable weight are reassuring findings. Mild
exertional fatigue is nonspecific.
Question 4
Which lipid panel result would most strongly indicate a need to screen for
familial hypercholesterolemia in a 30yearold patient?
A) LDL of 110 mg/dL with normal triglycerides
B) LDL of 220 mg/dL with family history of premature CAD
C) HDL of 65 mg/dL
D) Triglycerides of 140 mg/dL
Answer: B
Rationale: An LDL ≥190 mg/dL in a young adult, particularly with a family
history of premature coronary artery disease, raises strong suspicion for
familial hypercholesterolemia.
Question 5
A 72yearold man with a 5year history of angina and type 2 DM collapses while
playing golf. Paramedics arrive in 10 minutes. What is the most appropriate
initial intervention?
, A) Administer sublingual nitroglycerin
B) Start CPR immediately
C) Obtain a 12lead ECG
D) Check blood glucose
Answer: C
Rationale: In a patient with known CAD who collapses, obtaining a 12lead ECG
to assess for acute MI is the priority. While CPR may be needed if pulseless,
ECG assessment guides definitive management.
Question 6
A patient with chronic heart failure presents with worsening dyspnea,
orthopnea, and peripheral edema. Which medication class is most appropriate
for firstline management of fluid overload?
A) Betablockers
B) ACE inhibitors
C) Loop diuretics
D) Calcium channel blockers
Answer: C
Rationale: Loop diuretics are the mainstay for managing fluid overload in
heart failure, providing rapid symptom relief through diuresis. Betablockers
and ACE inhibitors are chronic management agents. Calcium channel blockers
may worsen heart failure.
