NURS 142 – EXAM 1 (CLASS 1 & 2) – COMPLETE
PRACTICE BANK MCQs
Cardiology (Questions 1-25)
1. A 65-year-old male with a history of hypertension and diabetes presents to
the emergency department with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mmHg in the right arm
and 140/80 mmHg in the left arm. Which of the following is the most
appropriate initial imaging study to confirm the diagnosis?
A. Transthoracic echocardiogram (TTE)
B. Computed tomography angiography (CTA) of the chest
C. Electrocardiogram (ECG)
D. Chest X-ray
Answer: B
Rationale: The presentation is classic for an acute aortic dissection. CTA of the
chest is the gold standard for diagnosis, offering high sensitivity and
specificity. TTE can be useful but is less sensitive for aortic arch involvement.
ECG is often normal or non-specific. Chest X-ray may show a widened
mediastinum but is not diagnostic.
2. A 55-year-old woman presents with progressive dyspnea on exertion and
bilateral lower extremity edema. On examination, she has jugular venous
distention, a systolic murmur at the left lower sternal border that increases
with inspiration, and hepatomegaly. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral stenosis
,C. Tricuspid regurgitation
D. Pulmonary hypertension
Answer: C
Rationale: The murmur of tricuspid regurgitation is a holosystolic murmur at
the left lower sternal border that increases with inspiration (Carvallo's sign).
The clinical findings of right-sided heart failure (JVD, hepatomegaly, edema)
support this diagnosis. Aortic stenosis presents with a systolic ejection
murmur at the right upper sternal border. Mitral stenosis is a diastolic
murmur.
3. A 72-year-old male with a history of coronary artery disease is started on a
new medication for his chronic stable angina. He reports that his chest pain
has decreased in frequency, but he now experiences frequent headaches and
facial flushing. Which medication was most likely prescribed?
A. Metoprolol
B. Amlodipine
C. Isosorbide mononitrate
D. Ranolazine
Answer: C
Rationale: Isosorbide mononitrate, a long-acting nitrate, commonly causes
headaches and facial flushing as side effects due to vasodilation. Metoprolol
can cause fatigue and bradycardia. Amlodipine can cause peripheral edema.
Ranolazine is generally better tolerated.
4. A 62-year-old man presents with acute onset of palpitations, dizziness, and
shortness of breath. His ECG shows an irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 140 bpm. What is the most
appropriate acute management strategy?
A. Immediate synchronized cardioversion
,B. Administer intravenous amiodarone
C. Rate control with intravenous diltiazem
D. Administer intravenous adenosine
Answer: C
Rationale: This ECG shows atrial fibrillation with a rapid ventricular response.
In a hemodynamically stable patient, the initial approach is rate control with a
beta-blocker or a non-dihydropyridine calcium channel blocker (like diltiazem
or verapamil). Synchronized cardioversion is for unstable patients. Adenosine
is for paroxysmal supraventricular tachycardia (PSVT).
5. A 48-year-old woman with no significant medical history presents with
recurrent episodes of palpitations. Her ECG during an episode shows a narrow
complex tachycardia at a rate of 170 bpm. Carotid sinus massage terminates
the rhythm. What is the most likely underlying mechanism?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Atrioventricular nodal reentrant tachycardia (AVNRT)
D. Atrial flutter
Answer: C
Rationale: AVNRT is a common cause of paroxysmal regular narrow-complex
tachycardia. Vagal maneuvers, such as carotid sinus massage or Valsalva, can
terminate the reentrant circuit by increasing AV node refractoriness. Atrial
fibrillation is irregularly irregular. Ventricular tachycardia is wide-complex.
6. A 58-year-old male has a history of a myocardial infarction 3 months ago.
He is now asymptomatic but is concerned about his risk of sudden cardiac
death. His ejection fraction is measured at 30%. Which of the following is the
most appropriate intervention to reduce his risk of sudden cardiac death?
A. Aspirin and clopidogrel
, B. High-dose statin therapy
C. Implantable cardioverter-defibrillator (ICD) placement
D. Cardiac rehabilitation
Answer: C
Rationale: Patients with an EF ≤ 35% at least 40 days after a myocardial
infarction are at increased risk for sudden cardiac death and should be
considered for an ICD.
7. A 65-year-old woman with hypertension is diagnosed with an abdominal
aortic aneurysm (AAA) of 5.2 cm. Which of the following is the most
appropriate management?
A. Surgical repair or endovascular aneurysm repair (EVAR)
B. Repeat ultrasound in 6 months
C. Repeat ultrasound in 1 year
D. Initiate beta-blocker therapy and monitor
Answer: A
Rationale: The threshold for repairing an AAA is typically 5.0 to 5.5 cm in
women and 5.5 cm in men. A 5.2 cm AAA in a woman exceeds this threshold
and warrants surgical intervention.
8. A 30-year-old athlete collapses during a marathon. He has a history of a
heart murmur. The paramedics find him in ventricular fibrillation. After
resuscitation, a cardiologist notes a systolic ejection murmur that increases
with Valsalva. What is the most likely underlying diagnosis?
A. Mitral valve prolapse
B. Hypertrophic cardiomyopathy (HCM)
C. Aortic stenosis
D. Pulmonary embolism
PRACTICE BANK MCQs
Cardiology (Questions 1-25)
1. A 65-year-old male with a history of hypertension and diabetes presents to
the emergency department with sudden onset of severe, tearing chest pain
radiating to his back. His blood pressure is 180/100 mmHg in the right arm
and 140/80 mmHg in the left arm. Which of the following is the most
appropriate initial imaging study to confirm the diagnosis?
A. Transthoracic echocardiogram (TTE)
B. Computed tomography angiography (CTA) of the chest
C. Electrocardiogram (ECG)
D. Chest X-ray
Answer: B
Rationale: The presentation is classic for an acute aortic dissection. CTA of the
chest is the gold standard for diagnosis, offering high sensitivity and
specificity. TTE can be useful but is less sensitive for aortic arch involvement.
ECG is often normal or non-specific. Chest X-ray may show a widened
mediastinum but is not diagnostic.
2. A 55-year-old woman presents with progressive dyspnea on exertion and
bilateral lower extremity edema. On examination, she has jugular venous
distention, a systolic murmur at the left lower sternal border that increases
with inspiration, and hepatomegaly. What is the most likely diagnosis?
A. Aortic stenosis
B. Mitral stenosis
,C. Tricuspid regurgitation
D. Pulmonary hypertension
Answer: C
Rationale: The murmur of tricuspid regurgitation is a holosystolic murmur at
the left lower sternal border that increases with inspiration (Carvallo's sign).
The clinical findings of right-sided heart failure (JVD, hepatomegaly, edema)
support this diagnosis. Aortic stenosis presents with a systolic ejection
murmur at the right upper sternal border. Mitral stenosis is a diastolic
murmur.
3. A 72-year-old male with a history of coronary artery disease is started on a
new medication for his chronic stable angina. He reports that his chest pain
has decreased in frequency, but he now experiences frequent headaches and
facial flushing. Which medication was most likely prescribed?
A. Metoprolol
B. Amlodipine
C. Isosorbide mononitrate
D. Ranolazine
Answer: C
Rationale: Isosorbide mononitrate, a long-acting nitrate, commonly causes
headaches and facial flushing as side effects due to vasodilation. Metoprolol
can cause fatigue and bradycardia. Amlodipine can cause peripheral edema.
Ranolazine is generally better tolerated.
4. A 62-year-old man presents with acute onset of palpitations, dizziness, and
shortness of breath. His ECG shows an irregularly irregular rhythm with no
discernible P waves and a ventricular rate of 140 bpm. What is the most
appropriate acute management strategy?
A. Immediate synchronized cardioversion
,B. Administer intravenous amiodarone
C. Rate control with intravenous diltiazem
D. Administer intravenous adenosine
Answer: C
Rationale: This ECG shows atrial fibrillation with a rapid ventricular response.
In a hemodynamically stable patient, the initial approach is rate control with a
beta-blocker or a non-dihydropyridine calcium channel blocker (like diltiazem
or verapamil). Synchronized cardioversion is for unstable patients. Adenosine
is for paroxysmal supraventricular tachycardia (PSVT).
5. A 48-year-old woman with no significant medical history presents with
recurrent episodes of palpitations. Her ECG during an episode shows a narrow
complex tachycardia at a rate of 170 bpm. Carotid sinus massage terminates
the rhythm. What is the most likely underlying mechanism?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Atrioventricular nodal reentrant tachycardia (AVNRT)
D. Atrial flutter
Answer: C
Rationale: AVNRT is a common cause of paroxysmal regular narrow-complex
tachycardia. Vagal maneuvers, such as carotid sinus massage or Valsalva, can
terminate the reentrant circuit by increasing AV node refractoriness. Atrial
fibrillation is irregularly irregular. Ventricular tachycardia is wide-complex.
6. A 58-year-old male has a history of a myocardial infarction 3 months ago.
He is now asymptomatic but is concerned about his risk of sudden cardiac
death. His ejection fraction is measured at 30%. Which of the following is the
most appropriate intervention to reduce his risk of sudden cardiac death?
A. Aspirin and clopidogrel
, B. High-dose statin therapy
C. Implantable cardioverter-defibrillator (ICD) placement
D. Cardiac rehabilitation
Answer: C
Rationale: Patients with an EF ≤ 35% at least 40 days after a myocardial
infarction are at increased risk for sudden cardiac death and should be
considered for an ICD.
7. A 65-year-old woman with hypertension is diagnosed with an abdominal
aortic aneurysm (AAA) of 5.2 cm. Which of the following is the most
appropriate management?
A. Surgical repair or endovascular aneurysm repair (EVAR)
B. Repeat ultrasound in 6 months
C. Repeat ultrasound in 1 year
D. Initiate beta-blocker therapy and monitor
Answer: A
Rationale: The threshold for repairing an AAA is typically 5.0 to 5.5 cm in
women and 5.5 cm in men. A 5.2 cm AAA in a woman exceeds this threshold
and warrants surgical intervention.
8. A 30-year-old athlete collapses during a marathon. He has a history of a
heart murmur. The paramedics find him in ventricular fibrillation. After
resuscitation, a cardiologist notes a systolic ejection murmur that increases
with Valsalva. What is the most likely underlying diagnosis?
A. Mitral valve prolapse
B. Hypertrophic cardiomyopathy (HCM)
C. Aortic stenosis
D. Pulmonary embolism
