The Ultimate Acute Care NP Board
Exam Prep: 150 High-Yield Questions
with Rationales
Cardiology
1. A 68-year-old male with a history of HTN and DM presents with
sudden onset substernal chest pain radiating to his jaw. ECG shows
3mm ST elevations in V1-V4. What is the immediate priority?
A. Obtain a Troponin
B. Give Morphine
C. Arrange for emergent PCI
D. Start a Heparin drip
Answer: C. STEMI requires immediate reperfusion. PCI is preferred if
available within 90 minutes of first medical contact. Do not wait for
troponin to rise.
2. A 72-year-old female presents with acute pulmonary edema. BP is
160/90, HR 110. What is the first-line pharmacological intervention?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Nitroglycerin
Answer: B. Furosemide is first-line for acute pulmonary edema to reduce
preload. Nitroglycerin is also used for preload/afterload reduction but
diuretics are standard initial therapy in fluid overload.
,3. A 65-year-old with heart failure has a BP of 85/50, HR 120, and is
cool/clammy. What is the most appropriate initial vasopressor?
A. Dobutamine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
Answer: B. Norepinephrine is the vasopressor of choice in cardiogenic
shock with hypotension because it increases SVR without excessive
tachycardia.
4. Which ECG finding is most specific for pericarditis?
A. ST depression
B. Wide QRS
C. PR segment depression
D. Pathologic Q waves
Answer: C. Widespread ST elevation is classic, but PR segment depression
is highly specific for pericarditis.
5. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4.
What is the appropriate antithrombotic therapy?
A. Aspirin 81 mg
B. Clopidogrel
C. Warfarin or DOAC
D. No therapy
Answer: C. Score ≥2 in men or ≥3 in women indicates high risk for stroke;
oral anticoagulation is indicated.
6. A 60-year-old with a history of HFrEF (EF 25%) is on Lisinopril,
Carvedilol, and Spironolactone. Which additional medication has been
shown to reduce mortality?
A. Digoxin
B. Hydralazine
,C. Sacubitril/Valsartan
D. Diltiazem
Answer: C. Sacubitril/Valsartan (ARNI) is superior to ACE inhibitors in
reducing mortality in HFrEF.
7. A patient has a heart rate of 180, regular, narrow complex. What is
the best initial treatment if the patient is stable?
A. Immediate cardioversion
B. Adenosine 6 mg IV push
C. Amiodarone 150 mg IV
D. Lidocaine
Answer: B. Adenosine is first-line for stable narrow-complex SVT.
8. A 55-year-old is 2 days post-MI and develops a harsh holosystolic
murmur at the apex radiating to the axilla. What is the most likely
diagnosis?
A. Ventricular septal defect
B. Papillary muscle rupture
C. Acute pericarditis
D. Free wall rupture
Answer: B. Acute mitral regurgitation due to papillary muscle rupture is a
mechanical complication of MI, presenting with a holosystolic murmur and
sudden pulmonary edema.
9. A patient with a pacemaker presents with hiccups and muscle
twitching. What is the likely cause?
A. Lead perforation
B. Failure to capture
C. Pacemaker syndrome
D. Diaphragmatic pacing
Answer: D. This is likely phrenic nerve stimulation due to lead placement
near the diaphragm.
, 10. What is the target LDL level for a patient with a history of ASCVD?
A. < 100 mg/dL
B. < 70 mg/dL
C. < 130 mg/dL
D. < 55 mg/dL
Answer: B. < 70 mg/dL is the target for very high-risk patients (ASCVD);
some guidelines now recommend < 55 mg/dL for extreme risk.
Pulmonology
11. A patient with COPD presents with increased sputum purulence
and dyspnea. CXR shows no infiltrate. What is the most appropriate
treatment?
A. Levofloxacin
B. Doxycycline
C. Prednisone
D. Bronchodilators and Antibiotics
Answer: D. Acute exacerbation of COPD with purulent sputum requires
antibiotics (Doxycycline or Macrolide) plus systemic corticosteroids and
bronchodilators.
12. A 45-year-old post-op day 3 develops sudden pleuritic chest pain
and hemoptysis. What is the gold standard diagnostic test?
A. V/Q scan
B. D-dimer
C. CTA Chest
D. Spiral CT
Answer: C. CT Pulmonary Angiography (CTA) is the gold standard for
diagnosing PE.
Exam Prep: 150 High-Yield Questions
with Rationales
Cardiology
1. A 68-year-old male with a history of HTN and DM presents with
sudden onset substernal chest pain radiating to his jaw. ECG shows
3mm ST elevations in V1-V4. What is the immediate priority?
A. Obtain a Troponin
B. Give Morphine
C. Arrange for emergent PCI
D. Start a Heparin drip
Answer: C. STEMI requires immediate reperfusion. PCI is preferred if
available within 90 minutes of first medical contact. Do not wait for
troponin to rise.
2. A 72-year-old female presents with acute pulmonary edema. BP is
160/90, HR 110. What is the first-line pharmacological intervention?
A. Metoprolol
B. Furosemide
C. Digoxin
D. Nitroglycerin
Answer: B. Furosemide is first-line for acute pulmonary edema to reduce
preload. Nitroglycerin is also used for preload/afterload reduction but
diuretics are standard initial therapy in fluid overload.
,3. A 65-year-old with heart failure has a BP of 85/50, HR 120, and is
cool/clammy. What is the most appropriate initial vasopressor?
A. Dobutamine
B. Norepinephrine
C. Dopamine
D. Phenylephrine
Answer: B. Norepinephrine is the vasopressor of choice in cardiogenic
shock with hypotension because it increases SVR without excessive
tachycardia.
4. Which ECG finding is most specific for pericarditis?
A. ST depression
B. Wide QRS
C. PR segment depression
D. Pathologic Q waves
Answer: C. Widespread ST elevation is classic, but PR segment depression
is highly specific for pericarditis.
5. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4.
What is the appropriate antithrombotic therapy?
A. Aspirin 81 mg
B. Clopidogrel
C. Warfarin or DOAC
D. No therapy
Answer: C. Score ≥2 in men or ≥3 in women indicates high risk for stroke;
oral anticoagulation is indicated.
6. A 60-year-old with a history of HFrEF (EF 25%) is on Lisinopril,
Carvedilol, and Spironolactone. Which additional medication has been
shown to reduce mortality?
A. Digoxin
B. Hydralazine
,C. Sacubitril/Valsartan
D. Diltiazem
Answer: C. Sacubitril/Valsartan (ARNI) is superior to ACE inhibitors in
reducing mortality in HFrEF.
7. A patient has a heart rate of 180, regular, narrow complex. What is
the best initial treatment if the patient is stable?
A. Immediate cardioversion
B. Adenosine 6 mg IV push
C. Amiodarone 150 mg IV
D. Lidocaine
Answer: B. Adenosine is first-line for stable narrow-complex SVT.
8. A 55-year-old is 2 days post-MI and develops a harsh holosystolic
murmur at the apex radiating to the axilla. What is the most likely
diagnosis?
A. Ventricular septal defect
B. Papillary muscle rupture
C. Acute pericarditis
D. Free wall rupture
Answer: B. Acute mitral regurgitation due to papillary muscle rupture is a
mechanical complication of MI, presenting with a holosystolic murmur and
sudden pulmonary edema.
9. A patient with a pacemaker presents with hiccups and muscle
twitching. What is the likely cause?
A. Lead perforation
B. Failure to capture
C. Pacemaker syndrome
D. Diaphragmatic pacing
Answer: D. This is likely phrenic nerve stimulation due to lead placement
near the diaphragm.
, 10. What is the target LDL level for a patient with a history of ASCVD?
A. < 100 mg/dL
B. < 70 mg/dL
C. < 130 mg/dL
D. < 55 mg/dL
Answer: B. < 70 mg/dL is the target for very high-risk patients (ASCVD);
some guidelines now recommend < 55 mg/dL for extreme risk.
Pulmonology
11. A patient with COPD presents with increased sputum purulence
and dyspnea. CXR shows no infiltrate. What is the most appropriate
treatment?
A. Levofloxacin
B. Doxycycline
C. Prednisone
D. Bronchodilators and Antibiotics
Answer: D. Acute exacerbation of COPD with purulent sputum requires
antibiotics (Doxycycline or Macrolide) plus systemic corticosteroids and
bronchodilators.
12. A 45-year-old post-op day 3 develops sudden pleuritic chest pain
and hemoptysis. What is the gold standard diagnostic test?
A. V/Q scan
B. D-dimer
C. CTA Chest
D. Spiral CT
Answer: C. CT Pulmonary Angiography (CTA) is the gold standard for
diagnosing PE.
