COMLEX-USA Level 3 Exam
Practice Questions And
Correct Answers (Verified
Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1.
A 67-year-old man with hypertension and hyperlipidemia presents
with 45 minutes of substernal chest pressure radiating to his left
arm. ECG shows ST-segment elevations in leads II, III, and aVF. He is
hypotensive, has clear lungs, and jugular venous distention. Which
intervention is most appropriate?
A. IV furosemide
B. Sublingual nitroglycerin
C. IV normal saline
D. IV metoprolol
E. Emergent pericardiocentesis
Answer: C. IV normal saline
The presentation suggests an inferior myocardial infarction with right
ventricular involvement. RV infarction causes preload dependence, so
cautious IV fluid administration is appropriate. Nitrates and diuretics
can worsen hypotension.
2.
,A 72-year-old woman with atrial fibrillation has a ventricular rate of
155/min, BP 78/45 mm Hg, chest discomfort, and altered mental
status. What is the next step?
A. IV metoprolol
B. IV diltiazem
C. IV amiodarone
D. Synchronized cardioversion
E. Oral apixaban
Answer: D. Synchronized cardioversion
Hemodynamically unstable atrial fibrillation requires immediate
synchronized cardioversion. Rate-control medications should not
delay cardioversion in an unstable patient.
3.
A 64-year-old man develops sudden dyspnea and pleuritic chest pain
5 days after hip replacement. He is tachycardic and hypoxemic. CT
angiography demonstrates a large pulmonary embolus. BP is 82/48
mm Hg. What is the preferred treatment?
A. Aspirin
B. IV unfractionated heparin alone
C. Systemic thrombolysis
D. Warfarin alone
E. Observation
Answer: C. Systemic thrombolysis
Massive pulmonary embolism with hypotension is high-risk PE. Unless
contraindicated, systemic thrombolysis is indicated to rapidly reduce
pulmonary vascular obstruction.
4.
,A patient taking lisinopril develops potassium of 6.9 mEq/L and ECG
changes with peaked T waves. What should be administered first?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide
D. Insulin alone
E. Sodium bicarbonate alone
Answer: B. IV calcium gluconate
IV calcium stabilizes the cardiac membrane and is the immediate
treatment for life-threatening hyperkalemia with ECG abnormalities.
It does not lower serum potassium but prevents fatal arrhythmias.
5.
A 58-year-old man presents with severe headache, confusion, BP
230/130 mm Hg, and papilledema. Which treatment is most
appropriate?
A. Oral hydrochlorothiazide
B. IV nicardipine
C. Sublingual nifedipine
D. Oral lisinopril
E. No treatment until repeat BP
Answer: B. IV nicardipine
Severe hypertension with acute target-organ injury constitutes
hypertensive emergency. Controlled reduction with an IV titratable
agent such as nicardipine is appropriate.
6.
, A 70-year-old man with heart failure with reduced ejection fraction
presents with worsening dyspnea, pulmonary edema, and peripheral
edema. Which medication provides rapid symptomatic relief?
A. Digoxin
B. IV loop diuretic
C. Oral spironolactone
D. Sacubitril/valsartan
E. Empagliflozin
Answer: B. IV loop diuretic
Acute decompensated heart failure with volume overload is treated
initially with IV loop diuretics to rapidly reduce congestion.
7.
A 45-year-old woman has exertional chest pain relieved by rest. ECG
is normal at rest. She has an intermediate pretest probability of
coronary artery disease. Which is an appropriate initial diagnostic
test?
A. Coronary angiography in every case
B. Exercise stress testing
C. Endomyocardial biopsy
D. D-dimer
E. Holter monitoring
Answer: B. Exercise stress testing
In a patient with stable exertional symptoms and intermediate
probability of CAD who can exercise and has an interpretable ECG,
exercise-based ischemic evaluation is reasonable.
8.
Practice Questions And
Correct Answers (Verified
Answers) Plus Rationale 2026
Q&A| Instant Download Pdf
1.
A 67-year-old man with hypertension and hyperlipidemia presents
with 45 minutes of substernal chest pressure radiating to his left
arm. ECG shows ST-segment elevations in leads II, III, and aVF. He is
hypotensive, has clear lungs, and jugular venous distention. Which
intervention is most appropriate?
A. IV furosemide
B. Sublingual nitroglycerin
C. IV normal saline
D. IV metoprolol
E. Emergent pericardiocentesis
Answer: C. IV normal saline
The presentation suggests an inferior myocardial infarction with right
ventricular involvement. RV infarction causes preload dependence, so
cautious IV fluid administration is appropriate. Nitrates and diuretics
can worsen hypotension.
2.
,A 72-year-old woman with atrial fibrillation has a ventricular rate of
155/min, BP 78/45 mm Hg, chest discomfort, and altered mental
status. What is the next step?
A. IV metoprolol
B. IV diltiazem
C. IV amiodarone
D. Synchronized cardioversion
E. Oral apixaban
Answer: D. Synchronized cardioversion
Hemodynamically unstable atrial fibrillation requires immediate
synchronized cardioversion. Rate-control medications should not
delay cardioversion in an unstable patient.
3.
A 64-year-old man develops sudden dyspnea and pleuritic chest pain
5 days after hip replacement. He is tachycardic and hypoxemic. CT
angiography demonstrates a large pulmonary embolus. BP is 82/48
mm Hg. What is the preferred treatment?
A. Aspirin
B. IV unfractionated heparin alone
C. Systemic thrombolysis
D. Warfarin alone
E. Observation
Answer: C. Systemic thrombolysis
Massive pulmonary embolism with hypotension is high-risk PE. Unless
contraindicated, systemic thrombolysis is indicated to rapidly reduce
pulmonary vascular obstruction.
4.
,A patient taking lisinopril develops potassium of 6.9 mEq/L and ECG
changes with peaked T waves. What should be administered first?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. IV furosemide
D. Insulin alone
E. Sodium bicarbonate alone
Answer: B. IV calcium gluconate
IV calcium stabilizes the cardiac membrane and is the immediate
treatment for life-threatening hyperkalemia with ECG abnormalities.
It does not lower serum potassium but prevents fatal arrhythmias.
5.
A 58-year-old man presents with severe headache, confusion, BP
230/130 mm Hg, and papilledema. Which treatment is most
appropriate?
A. Oral hydrochlorothiazide
B. IV nicardipine
C. Sublingual nifedipine
D. Oral lisinopril
E. No treatment until repeat BP
Answer: B. IV nicardipine
Severe hypertension with acute target-organ injury constitutes
hypertensive emergency. Controlled reduction with an IV titratable
agent such as nicardipine is appropriate.
6.
, A 70-year-old man with heart failure with reduced ejection fraction
presents with worsening dyspnea, pulmonary edema, and peripheral
edema. Which medication provides rapid symptomatic relief?
A. Digoxin
B. IV loop diuretic
C. Oral spironolactone
D. Sacubitril/valsartan
E. Empagliflozin
Answer: B. IV loop diuretic
Acute decompensated heart failure with volume overload is treated
initially with IV loop diuretics to rapidly reduce congestion.
7.
A 45-year-old woman has exertional chest pain relieved by rest. ECG
is normal at rest. She has an intermediate pretest probability of
coronary artery disease. Which is an appropriate initial diagnostic
test?
A. Coronary angiography in every case
B. Exercise stress testing
C. Endomyocardial biopsy
D. D-dimer
E. Holter monitoring
Answer: B. Exercise stress testing
In a patient with stable exertional symptoms and intermediate
probability of CAD who can exercise and has an interpretable ECG,
exercise-based ischemic evaluation is reasonable.
8.
