NR 603 CEA EXAM QUESTIONS AND
CORRECT ANSWERS WITH DETAILED
RATIONALES
Question 1
A 55-year-old male presents with crushing chest pain radiating to the left arm.
What is the first diagnostic step?
A) Echocardiogram
B) Troponin level
C) Chest X-ray
D) 12-lead ECG
Answer: D
Rationale: The 12-lead ECG should be obtained within 10 minutes of arrival
for any patient with chest pain suspicious for myocardial infarction. It allows
immediate identification of ST-elevation MI (STEMI), which requires urgent
reperfusion therapy. Troponin levels are essential but can take hours to rise,
making the ECG the priority initial test.
Question 2
Which cardiac biomarker is the most specific for myocardial infarction?
A) CK-MB
B) BNP
C) Troponin I
,D) D-dimer
Answer: C
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. CK-MB is less
specific, BNP indicates heart failure, and D-dimer is used for thromboembolic
conditions.
Question 3
A 50-year-old woman with a history of hypertension presents with dyspnea
on exertion and orthopnea. She has jugular venous distention and bilateral
crackles. What is the priority diagnosis?
A) Myocardial infarction
B) Heart failure
C) Pneumonia
D) Pulmonary embolism
Answer: B
Rationale: The combination of dyspnea on exertion, orthopnea, jugular venous
distention, and bilateral crackles is classic for heart failure. These findings
indicate fluid overload and impaired cardiac function, distinguishing heart
failure from other conditions like MI or pneumonia.
Question 4
A patient with new-onset atrial fibrillation and a CHA₂DS₂-VASc score of 4
should be treated with which of the following?
A) Aspirin 81 mg daily
B) Clopidogrel 75 mg daily
C) Warfarin or a direct oral anticoagulant
,D) No anticoagulation, only rate control
Answer: C
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high annual stroke risk
(over 4%). Current guidelines strongly recommend oral anticoagulation with
warfarin (target INR 2-3) or a DOAC such as apixaban or rivaroxaban. Aspirin
is not adequate for stroke prevention in this high-risk group.
Question 5
A 68-year-old diabetic male reports intermittent claudication in his calves
after walking one block. His ankle-brachial index is 0.65. What is the most
appropriate initial management?
A) Urgent surgical bypass
B) Supervised exercise program and smoking cessation
C) High-dose statin only
D) Antiplatelet therapy alone
Answer: B
Rationale: For stable intermittent claudication, initial management includes
supervised exercise, smoking cessation, and cardiovascular risk factor
modification. Revascularization is reserved for debilitating symptoms or
critical limb ischemia. Antiplatelet and statin therapies are adjuncts, not the
sole initial step.
Question 6
A 45-year-old female has a blood pressure of 152/96 mmHg on three separate
visits. She has no target organ damage. What is the first-line pharmacologic
agent according to JNC 8 guidelines?
A) Hydrochlorothiazide
B) Lisinopril
, C) Amlodipine
D) Metoprolol
Answer: B
Rationale: For the general non-black population, JNC 8 recommends a
thiazide, ACE inhibitor, ARB, or calcium channel blocker as initial therapy.
However, for a non-black patient without compelling indications, ACE
inhibitors like lisinopril are frequently chosen for their renal protective effects
and low side-effect profile. Thiazides are also acceptable, but ACE inhibitors
are often preferred first-line.
Question 7
Which finding on a lipid panel is the strongest independent predictor of
coronary artery disease risk?
A) Total cholesterol
B) Triglycerides
C) LDL cholesterol
D) HDL cholesterol
Answer: C
Rationale: LDL cholesterol is the primary atherogenic lipoprotein and the
strongest independent predictor of atherosclerotic cardiovascular disease.
Lowering LDL is the main target of statin therapy. HDL is protective but not as
strong a predictor, and triglycerides are a weaker independent factor.
Question 8
A 72-year-old man presents with acute onset of severe headache,
photophobia, and nuchal rigidity. His temperature is 38.9°C. What is the most
critical diagnostic test?
A) CT head without contrast
CORRECT ANSWERS WITH DETAILED
RATIONALES
Question 1
A 55-year-old male presents with crushing chest pain radiating to the left arm.
What is the first diagnostic step?
A) Echocardiogram
B) Troponin level
C) Chest X-ray
D) 12-lead ECG
Answer: D
Rationale: The 12-lead ECG should be obtained within 10 minutes of arrival
for any patient with chest pain suspicious for myocardial infarction. It allows
immediate identification of ST-elevation MI (STEMI), which requires urgent
reperfusion therapy. Troponin levels are essential but can take hours to rise,
making the ECG the priority initial test.
Question 2
Which cardiac biomarker is the most specific for myocardial infarction?
A) CK-MB
B) BNP
C) Troponin I
,D) D-dimer
Answer: C
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. CK-MB is less
specific, BNP indicates heart failure, and D-dimer is used for thromboembolic
conditions.
Question 3
A 50-year-old woman with a history of hypertension presents with dyspnea
on exertion and orthopnea. She has jugular venous distention and bilateral
crackles. What is the priority diagnosis?
A) Myocardial infarction
B) Heart failure
C) Pneumonia
D) Pulmonary embolism
Answer: B
Rationale: The combination of dyspnea on exertion, orthopnea, jugular venous
distention, and bilateral crackles is classic for heart failure. These findings
indicate fluid overload and impaired cardiac function, distinguishing heart
failure from other conditions like MI or pneumonia.
Question 4
A patient with new-onset atrial fibrillation and a CHA₂DS₂-VASc score of 4
should be treated with which of the following?
A) Aspirin 81 mg daily
B) Clopidogrel 75 mg daily
C) Warfarin or a direct oral anticoagulant
,D) No anticoagulation, only rate control
Answer: C
Rationale: A CHA₂DS₂-VASc score of 4 indicates a high annual stroke risk
(over 4%). Current guidelines strongly recommend oral anticoagulation with
warfarin (target INR 2-3) or a DOAC such as apixaban or rivaroxaban. Aspirin
is not adequate for stroke prevention in this high-risk group.
Question 5
A 68-year-old diabetic male reports intermittent claudication in his calves
after walking one block. His ankle-brachial index is 0.65. What is the most
appropriate initial management?
A) Urgent surgical bypass
B) Supervised exercise program and smoking cessation
C) High-dose statin only
D) Antiplatelet therapy alone
Answer: B
Rationale: For stable intermittent claudication, initial management includes
supervised exercise, smoking cessation, and cardiovascular risk factor
modification. Revascularization is reserved for debilitating symptoms or
critical limb ischemia. Antiplatelet and statin therapies are adjuncts, not the
sole initial step.
Question 6
A 45-year-old female has a blood pressure of 152/96 mmHg on three separate
visits. She has no target organ damage. What is the first-line pharmacologic
agent according to JNC 8 guidelines?
A) Hydrochlorothiazide
B) Lisinopril
, C) Amlodipine
D) Metoprolol
Answer: B
Rationale: For the general non-black population, JNC 8 recommends a
thiazide, ACE inhibitor, ARB, or calcium channel blocker as initial therapy.
However, for a non-black patient without compelling indications, ACE
inhibitors like lisinopril are frequently chosen for their renal protective effects
and low side-effect profile. Thiazides are also acceptable, but ACE inhibitors
are often preferred first-line.
Question 7
Which finding on a lipid panel is the strongest independent predictor of
coronary artery disease risk?
A) Total cholesterol
B) Triglycerides
C) LDL cholesterol
D) HDL cholesterol
Answer: C
Rationale: LDL cholesterol is the primary atherogenic lipoprotein and the
strongest independent predictor of atherosclerotic cardiovascular disease.
Lowering LDL is the main target of statin therapy. HDL is protective but not as
strong a predictor, and triglycerides are a weaker independent factor.
Question 8
A 72-year-old man presents with acute onset of severe headache,
photophobia, and nuchal rigidity. His temperature is 38.9°C. What is the most
critical diagnostic test?
A) CT head without contrast
