NR 570 FINAL EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+ ASSURED PASS
Section 1: Cardiovascular Disorders (Questions 1-30)
1. A 68-year-old male presents with substernal chest pressure radiating to the jaw,
diaphoresis, and nausea for 2 hours. ECG shows ST-segment elevation in leads
V2-V4. What is the most appropriate next intervention?
A) Administer sublingual nitroglycerin and wait 30 minutes
B) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention
C) Administer tenecteplase immediately
D) Admit to telemetry for observation
Answer: B
Rationale: An ST-segment elevation myocardial infarction (STEMI) requires
emergent reperfusion. Primary percutaneous coronary intervention within 90
minutes of arrival is the standard of care. Fibrinolysis is used only if PCI is
unavailable within 120 minutes .
2. A 55-year-old with acute decompensated heart failure has crackles to the mid-
lungs, an S3 gallop, and oxygen saturation of 90% on room air. Blood pressure is
145/90, heart rate 110. What is the priority intervention?
A) IV furosemide 40 mg
B) IV metoprolol 5 mg
C) Oral digoxin loading
D) IV normal saline bolus
Answer: A
Rationale: An IV loop diuretic (furosemide) is the first-line treatment for acute
heart failure with volume overload and pulmonary congestion. Beta-blockers are
not given in acute decompensation .
3. A patient with atrial fibrillation with rapid ventricular response (heart rate 150)
is hemodynamically stable. Which medication is most appropriate for rate control?
A) IV amiodarone
B) IV diltiazem or IV metoprolol
C) IV digoxin as monotherapy
,D) Direct current cardioversion
Answer: B
Rationale: For hemodynamically stable atrial fibrillation with rapid ventricular
response, IV diltiazem (calcium channel blocker) or IV metoprolol (beta-blocker)
are first-line agents for rate control .
4. A 72-year-old with hypertension presents with sudden onset severe tearing chest
pain radiating to the back. Blood pressure is 180/100 in the right arm and 130/70 in
the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection classically presents with sudden, severe tearing chest
pain radiating to the back and a difference in blood pressure between arms. This is
a life-threatening emergency .
5. A patient with acute pericarditis would most likely have which ECG finding?
A) ST-segment elevation in a single lead
B) Diffuse ST-segment elevation with PR depression
C) Deep Q waves in leads II, III, and aVF
D) T-wave inversion in all leads
Answer: B
Rationale: Acute pericarditis causes diffuse ST-segment elevation (concave up)
without reciprocal changes. PR-segment depression may also be seen .
6. A patient presents with syncope and a murmur that increases with Valsalva.
What is the most likely diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Atrial septal defect
Answer: B
Rationale: The murmur of hypertrophic cardiomyopathy increases with Valsalva
(decreased preload) and decreases with squatting or handgrip (increased afterload).
Aortic stenosis radiates to the carotids .
7. A 45-year-old with sudden onset shortness of breath and hypotension. ECG
shows an S1Q3T3 pattern. What is the most likely diagnosis?
,A) Acute myocardial infarction
B) Pulmonary embolism
C) Tension pneumothorax
D) Pericardial tamponade
Answer: B
Rationale: The S1Q3T3 pattern (S wave in lead I, Q wave in lead III, inverted T
wave in lead III) is classic but not sensitive for pulmonary embolism. Massive PE
presents with hypotension and hypoxia .
8. A patient with septic shock is on a norepinephrine infusion. Blood pressure
remains 80/50. Which vasopressor should be added next?
A) Phenylephrine
B) Vasopressin
C) Dopamine
D) Epinephrine
Answer: B
Rationale: In septic shock, vasopressin (0.03 units/min) is added as a second-line
vasopressor after norepinephrine. It has a catecholamine-sparing effect .
9. A patient with acute myocardial infarction develops a new systolic murmur and
hypotension. What is the most likely complication?
A) Pericarditis
B) Ventricular septal rupture
C) Pulmonary embolism
D) Right ventricular infarction
Answer: B
Rationale: Ventricular septal rupture occurs 3-7 days post-MI, presenting with a
new harsh holosystolic murmur, thrill, and cardiogenic shock. Immediate surgical
repair is often needed .
10. A patient with unstable angina and high-risk features (ongoing chest pain,
dynamic ECG changes) should receive which treatment?
A) Outpatient stress testing
B) Discharge with aspirin and nitroglycerin
C) Urgent invasive strategy (angiography within 24 hours)
D) Oral anticoagulation with warfarin
Answer: C
Rationale: High-risk NSTEMI/unstable angina (ongoing pain, hemodynamic
instability, arrhythmias, dynamic ECG changes) warrants an urgent invasive
strategy (angiography within 24 hours) .
, 11. A patient with acute heart failure and severe hypertension (BP 190/110) is best
treated with:
A) IV furosemide alone
B) IV nitroglycerin or IV nitroprusside
C) Oral metoprolol
D) IV phenylephrine
Answer: B
Rationale: Acute heart failure with hypertension (hypertensive crisis) is managed
with IV vasodilators (nitroglycerin, nitroprusside) to reduce afterload and improve
cardiac output .
12. A patient with symptomatic bradycardia (HR 32, BP 80/50, altered mental
status) requires emergent treatment with:
A) IV atropine 0.5 mg
B) Transcutaneous pacing
C) Dopamine infusion
D) IV aminophylline
Answer: B
Rationale: Unstable bradycardia (hypotension, altered mental status, ischemic
chest pain) requires immediate transcutaneous pacing. Atropine is used while
preparing for pacing .
13. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 should
receive which anticoagulation?
A) Aspirin 81 mg daily
B) Aspirin 325 mg daily plus clopidogrel
C) Direct oral anticoagulant (apixaban, rivaroxaban, edoxaban, or warfarin)
D) No anticoagulation
Answer: C
Rationale: A CHA₂DS₂-VASc score of ≥2 in men or ≥3 in women requires oral
anticoagulation. Direct oral anticoagulants (DOACs) are preferred over warfarin
unless a mechanical valve or severe mitral stenosis is present .
14. A patient with acute lower extremity deep vein thrombosis (DVT) and no
contraindications should initially be treated with:
A) Warfarin monotherapy
B) Aspirin alone
C) Direct oral anticoagulant (rivaroxaban or apixaban) or low molecular weight
heparin followed by warfarin
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+ ASSURED PASS
Section 1: Cardiovascular Disorders (Questions 1-30)
1. A 68-year-old male presents with substernal chest pressure radiating to the jaw,
diaphoresis, and nausea for 2 hours. ECG shows ST-segment elevation in leads
V2-V4. What is the most appropriate next intervention?
A) Administer sublingual nitroglycerin and wait 30 minutes
B) Activate the cardiac catheterization lab for primary percutaneous coronary
intervention
C) Administer tenecteplase immediately
D) Admit to telemetry for observation
Answer: B
Rationale: An ST-segment elevation myocardial infarction (STEMI) requires
emergent reperfusion. Primary percutaneous coronary intervention within 90
minutes of arrival is the standard of care. Fibrinolysis is used only if PCI is
unavailable within 120 minutes .
2. A 55-year-old with acute decompensated heart failure has crackles to the mid-
lungs, an S3 gallop, and oxygen saturation of 90% on room air. Blood pressure is
145/90, heart rate 110. What is the priority intervention?
A) IV furosemide 40 mg
B) IV metoprolol 5 mg
C) Oral digoxin loading
D) IV normal saline bolus
Answer: A
Rationale: An IV loop diuretic (furosemide) is the first-line treatment for acute
heart failure with volume overload and pulmonary congestion. Beta-blockers are
not given in acute decompensation .
3. A patient with atrial fibrillation with rapid ventricular response (heart rate 150)
is hemodynamically stable. Which medication is most appropriate for rate control?
A) IV amiodarone
B) IV diltiazem or IV metoprolol
C) IV digoxin as monotherapy
,D) Direct current cardioversion
Answer: B
Rationale: For hemodynamically stable atrial fibrillation with rapid ventricular
response, IV diltiazem (calcium channel blocker) or IV metoprolol (beta-blocker)
are first-line agents for rate control .
4. A 72-year-old with hypertension presents with sudden onset severe tearing chest
pain radiating to the back. Blood pressure is 180/100 in the right arm and 130/70 in
the left arm. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C
Rationale: Aortic dissection classically presents with sudden, severe tearing chest
pain radiating to the back and a difference in blood pressure between arms. This is
a life-threatening emergency .
5. A patient with acute pericarditis would most likely have which ECG finding?
A) ST-segment elevation in a single lead
B) Diffuse ST-segment elevation with PR depression
C) Deep Q waves in leads II, III, and aVF
D) T-wave inversion in all leads
Answer: B
Rationale: Acute pericarditis causes diffuse ST-segment elevation (concave up)
without reciprocal changes. PR-segment depression may also be seen .
6. A patient presents with syncope and a murmur that increases with Valsalva.
What is the most likely diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral regurgitation
D) Atrial septal defect
Answer: B
Rationale: The murmur of hypertrophic cardiomyopathy increases with Valsalva
(decreased preload) and decreases with squatting or handgrip (increased afterload).
Aortic stenosis radiates to the carotids .
7. A 45-year-old with sudden onset shortness of breath and hypotension. ECG
shows an S1Q3T3 pattern. What is the most likely diagnosis?
,A) Acute myocardial infarction
B) Pulmonary embolism
C) Tension pneumothorax
D) Pericardial tamponade
Answer: B
Rationale: The S1Q3T3 pattern (S wave in lead I, Q wave in lead III, inverted T
wave in lead III) is classic but not sensitive for pulmonary embolism. Massive PE
presents with hypotension and hypoxia .
8. A patient with septic shock is on a norepinephrine infusion. Blood pressure
remains 80/50. Which vasopressor should be added next?
A) Phenylephrine
B) Vasopressin
C) Dopamine
D) Epinephrine
Answer: B
Rationale: In septic shock, vasopressin (0.03 units/min) is added as a second-line
vasopressor after norepinephrine. It has a catecholamine-sparing effect .
9. A patient with acute myocardial infarction develops a new systolic murmur and
hypotension. What is the most likely complication?
A) Pericarditis
B) Ventricular septal rupture
C) Pulmonary embolism
D) Right ventricular infarction
Answer: B
Rationale: Ventricular septal rupture occurs 3-7 days post-MI, presenting with a
new harsh holosystolic murmur, thrill, and cardiogenic shock. Immediate surgical
repair is often needed .
10. A patient with unstable angina and high-risk features (ongoing chest pain,
dynamic ECG changes) should receive which treatment?
A) Outpatient stress testing
B) Discharge with aspirin and nitroglycerin
C) Urgent invasive strategy (angiography within 24 hours)
D) Oral anticoagulation with warfarin
Answer: C
Rationale: High-risk NSTEMI/unstable angina (ongoing pain, hemodynamic
instability, arrhythmias, dynamic ECG changes) warrants an urgent invasive
strategy (angiography within 24 hours) .
, 11. A patient with acute heart failure and severe hypertension (BP 190/110) is best
treated with:
A) IV furosemide alone
B) IV nitroglycerin or IV nitroprusside
C) Oral metoprolol
D) IV phenylephrine
Answer: B
Rationale: Acute heart failure with hypertension (hypertensive crisis) is managed
with IV vasodilators (nitroglycerin, nitroprusside) to reduce afterload and improve
cardiac output .
12. A patient with symptomatic bradycardia (HR 32, BP 80/50, altered mental
status) requires emergent treatment with:
A) IV atropine 0.5 mg
B) Transcutaneous pacing
C) Dopamine infusion
D) IV aminophylline
Answer: B
Rationale: Unstable bradycardia (hypotension, altered mental status, ischemic
chest pain) requires immediate transcutaneous pacing. Atropine is used while
preparing for pacing .
13. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 should
receive which anticoagulation?
A) Aspirin 81 mg daily
B) Aspirin 325 mg daily plus clopidogrel
C) Direct oral anticoagulant (apixaban, rivaroxaban, edoxaban, or warfarin)
D) No anticoagulation
Answer: C
Rationale: A CHA₂DS₂-VASc score of ≥2 in men or ≥3 in women requires oral
anticoagulation. Direct oral anticoagulants (DOACs) are preferred over warfarin
unless a mechanical valve or severe mitral stenosis is present .
14. A patient with acute lower extremity deep vein thrombosis (DVT) and no
contraindications should initially be treated with:
A) Warfarin monotherapy
B) Aspirin alone
C) Direct oral anticoagulant (rivaroxaban or apixaban) or low molecular weight
heparin followed by warfarin
