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NR 607 Midterm Newest Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with a 3-day history of progressive dyspnea on
exertion and orthopnea. On examination, he has jugular venous
distention, bilateral crackles up to the mid-scapulae, and 2+ pitting
edema in the lower extremities. Which of the following is the most
appropriate initial pharmacologic intervention?
A) Intravenous furosemide
B) Oral metoprolol succinate
C) Sublingual nitroglycerin
D) Intravenous digoxin
Answer: A) Intravenous furosemide.
Explanation: The patient presents with acute decompensated heart
failure with volume overload. Intravenous loop diuretics such as
furosemide are the mainstay of initial therapy to reduce preload and
relieve pulmonary congestion. While nitroglycerin may be used for
afterload reduction and symptom relief, diuresis is the priority. Beta-
,2|Page
blockers are not initiated in acute decompensation, and digoxin has a
limited role in acute settings.
2. A 55-year-old female with a history of systemic lupus erythematosus
presents with acute-onset pleuritic chest pain and shortness of breath.
An ECG shows diffuse ST-segment elevation. A transthoracic
echocardiogram reveals a small pericardial effusion without
tamponade. Which of the following is the most appropriate next step in
management?
A) High-dose oral corticosteroids
B) Colchicine and ibuprofen
C) Emergent pericardiocentesis
D) Empiric antibiotics
Answer: B) Colchicine and ibuprofen.
Explanation: This patient has acute pericarditis, likely autoimmune in
etiology. First-line treatment for acute pericarditis includes nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen combined with
colchicine, which reduces the risk of recurrence. High-dose
corticosteroids are reserved for refractory cases or specific autoimmune
conditions but are not first-line. Pericardiocentesis is indicated only if
tamponade is present.
3. A 72-year-old male with chronic kidney disease stage 3 and atrial
fibrillation is being evaluated for stroke prophylaxis. His CHA2DS2-VASc
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score is 5. Which of the following anticoagulation regimens is most
appropriate?
A) Warfarin with a target INR of 2.0 to 3.0
B) Aspirin 81 mg daily
C) Apixaban 5 mg twice daily
D) Enoxaparin 40 mg subcutaneous daily
Answer: C) Apixaban 5 mg twice daily.
Explanation: For patients with atrial fibrillation and a CHA2DS2-VASc
score of 2 or greater in men or 3 or greater in women, oral
anticoagulation is recommended. Direct oral anticoagulants (DOACs)
such as apixaban are preferred over warfarin in patients with chronic
kidney disease stage 3 due to a more favorable safety profile and fewer
drug interactions. Warfarin may be used but requires careful INR
monitoring.
4. A 45-year-old male presents with acute, severe, tearing chest pain
radiating to the back. His blood pressure is 180/110 mmHg in the right
arm and 140/90 mmHg in the left arm. Which of the following imaging
modalities is most diagnostic for his suspected condition?
A) Chest X-ray
B) Transesophageal echocardiography
C) Computed tomography angiography
D) Magnetic resonance imaging
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Answer: C) Computed tomography angiography.
Explanation: The presentation is classic for acute aortic dissection.
Computed tomography angiography (CTA) is the preferred initial
imaging modality due to its high sensitivity and specificity, rapid
acquisition, and widespread availability. Transesophageal
echocardiography is also useful but is more operator-dependent. Chest
X-ray may show a widened mediastinum but is not diagnostic. MRI is
accurate but time-consuming.
5. A 60-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) is on optimal medical therapy including an ACE
inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist.
She continues to have symptoms classified as New York Heart
Association (NYHA) class III. Which of the following medications should
be considered next to reduce mortality?
A) Digoxin
B) Ivabradine
C) Hydralazine and isosorbide dinitrate
D) Sacubitril/valsartan
Answer: D) Sacubitril/valsartan.
Explanation: Sacubitril/valsartan (an ARNI) is recommended for patients
with HFrEF who remain symptomatic despite optimal therapy with ACE
inhibitors, beta-blockers, and MRAs. It has been shown to reduce
cardiovascular mortality and heart failure hospitalizations compared to
enalapril. Ivabradine is used for heart rate control in specific patients,
NR 607 Midterm Newest Exam Preparation With
Complete Questions And Correct Answers With
Rationales Already Graded A+Brand New Version!!
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with a 3-day history of progressive dyspnea on
exertion and orthopnea. On examination, he has jugular venous
distention, bilateral crackles up to the mid-scapulae, and 2+ pitting
edema in the lower extremities. Which of the following is the most
appropriate initial pharmacologic intervention?
A) Intravenous furosemide
B) Oral metoprolol succinate
C) Sublingual nitroglycerin
D) Intravenous digoxin
Answer: A) Intravenous furosemide.
Explanation: The patient presents with acute decompensated heart
failure with volume overload. Intravenous loop diuretics such as
furosemide are the mainstay of initial therapy to reduce preload and
relieve pulmonary congestion. While nitroglycerin may be used for
afterload reduction and symptom relief, diuresis is the priority. Beta-
,2|Page
blockers are not initiated in acute decompensation, and digoxin has a
limited role in acute settings.
2. A 55-year-old female with a history of systemic lupus erythematosus
presents with acute-onset pleuritic chest pain and shortness of breath.
An ECG shows diffuse ST-segment elevation. A transthoracic
echocardiogram reveals a small pericardial effusion without
tamponade. Which of the following is the most appropriate next step in
management?
A) High-dose oral corticosteroids
B) Colchicine and ibuprofen
C) Emergent pericardiocentesis
D) Empiric antibiotics
Answer: B) Colchicine and ibuprofen.
Explanation: This patient has acute pericarditis, likely autoimmune in
etiology. First-line treatment for acute pericarditis includes nonsteroidal
anti-inflammatory drugs (NSAIDs) such as ibuprofen combined with
colchicine, which reduces the risk of recurrence. High-dose
corticosteroids are reserved for refractory cases or specific autoimmune
conditions but are not first-line. Pericardiocentesis is indicated only if
tamponade is present.
3. A 72-year-old male with chronic kidney disease stage 3 and atrial
fibrillation is being evaluated for stroke prophylaxis. His CHA2DS2-VASc
,3|Page
score is 5. Which of the following anticoagulation regimens is most
appropriate?
A) Warfarin with a target INR of 2.0 to 3.0
B) Aspirin 81 mg daily
C) Apixaban 5 mg twice daily
D) Enoxaparin 40 mg subcutaneous daily
Answer: C) Apixaban 5 mg twice daily.
Explanation: For patients with atrial fibrillation and a CHA2DS2-VASc
score of 2 or greater in men or 3 or greater in women, oral
anticoagulation is recommended. Direct oral anticoagulants (DOACs)
such as apixaban are preferred over warfarin in patients with chronic
kidney disease stage 3 due to a more favorable safety profile and fewer
drug interactions. Warfarin may be used but requires careful INR
monitoring.
4. A 45-year-old male presents with acute, severe, tearing chest pain
radiating to the back. His blood pressure is 180/110 mmHg in the right
arm and 140/90 mmHg in the left arm. Which of the following imaging
modalities is most diagnostic for his suspected condition?
A) Chest X-ray
B) Transesophageal echocardiography
C) Computed tomography angiography
D) Magnetic resonance imaging
, 4|Page
Answer: C) Computed tomography angiography.
Explanation: The presentation is classic for acute aortic dissection.
Computed tomography angiography (CTA) is the preferred initial
imaging modality due to its high sensitivity and specificity, rapid
acquisition, and widespread availability. Transesophageal
echocardiography is also useful but is more operator-dependent. Chest
X-ray may show a widened mediastinum but is not diagnostic. MRI is
accurate but time-consuming.
5. A 60-year-old female with a history of heart failure with reduced
ejection fraction (HFrEF) is on optimal medical therapy including an ACE
inhibitor, a beta-blocker, and a mineralocorticoid receptor antagonist.
She continues to have symptoms classified as New York Heart
Association (NYHA) class III. Which of the following medications should
be considered next to reduce mortality?
A) Digoxin
B) Ivabradine
C) Hydralazine and isosorbide dinitrate
D) Sacubitril/valsartan
Answer: D) Sacubitril/valsartan.
Explanation: Sacubitril/valsartan (an ARNI) is recommended for patients
with HFrEF who remain symptomatic despite optimal therapy with ACE
inhibitors, beta-blockers, and MRAs. It has been shown to reduce
cardiovascular mortality and heart failure hospitalizations compared to
enalapril. Ivabradine is used for heart rate control in specific patients,
