NR 603 Advanced Clinical Diagnosis
and Practice Across the Lifespan
Week 3 Case Discussion: Cardiovascular
Comprehensive Examination
Spring 2026/2027 Complete Solution
115 Questions with Detailed Rationales
115
Multiple Choice Questions
with Comprehensive Clinical Rationales
Chamberlain University MSN Curriculum
Aligned with 2026 ACC/AHA Clinical Practice Guidelines
Graduate Nursing Education - Advanced Practice Nursing
,NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
NR 603 Advanced Clinical Diagnosis and Practice
Across the Lifespan
Week 3 Case Discussion: Cardiovascular
Comprehensive Examination with Detailed Rationales
Chamberlain University MSN Curriculum - Spring 2026/2027
Aligned with 2026 ACC/AHA Clinical Practice Guidelines
Examination Overview
This comprehensive 115-question examination covers cardiovascular assessment, diagnostic reasoning, and
clinical management for advanced practice nursing. The exam is organized into eight sections reflecting the
major cardiovascular disorder categories aligned with the NR 603 Week 3 Case Discussion content and the
2026 ACC/AHA clinical practice guidelines. Each question includes a detailed rationale with advanced practice
nursing-specific reasoning, evidence-based clinical guideline references, and pharmacological mechanism
explanations.
Cognitive Level Distribution
Questions are distributed across cognitive levels: approximately 30% recall (knowledge of pathophysiology and
pharmacology), 50% application (clinical decision-making in patient scenarios), and 20% analysis (complex
differential diagnosis and synthesis of clinical data). Approximately 80% of questions are scenario-based,
reflecting advanced practice nursing case discussion format.
Section Overview
Q1-15: Section 1: Cardiovascular Assessment and Diagnostic Reasoning (History, Physical Exam, & Risk
Stratification)
Q16-30: Section 2: Hypertension (Classification, Pathophysiology, Secondary Causes, & Management)
Q31-48: Section 3: Coronary Artery Disease and Acute Coronary Syndromes (Stable Angina, UA, NSTEMI, &
STEMI)
Q49-66: Section 4: Heart Failure (HFrEF, HFpEF, Pathophysiology, & Guideline-Directed Medical Therapy)
Q67-80: Section 5: Dysrhythmias and Conduction Disorders (AFib, Atrial Flutter, SVT, & Heart Blocks)
Q81-94: Section 6: Valvular, Pericardial, and Vascular Disorders (Valvular Disease, Pericarditis, PAD, &
DVT)
Q95-108: Section 7: Cardiovascular Pharmacotherapeutics (Antihypertensives, Antiplatelets, Anticoagulants,
& Statins)
Q109-115: Section 8: Case Discussion Application and Clinical Reasoning (Differential Diagnosis, Patient
Education, & Documentation)
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 2
,NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
Answer Format
Each question is presented with four options (A-D) and one correct answer. The correct answer is identified
with the marker [CORRECT] and bold formatting. A detailed rationale explains both why the correct answer is
right and why the distractors are wrong, with reference to pathophysiological mechanisms, diagnostic test
interpretation, pharmacological actions, and current evidence-based practice standards.
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 3
, NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
Section 1: Cardiovascular Assessment and Diagnostic Reasoning (History, Physical
Exam, & Risk Stratification) | Q1-15 questions
Q1. A 58-year-old male presents to the primary care clinic describing substernal chest pressure that
occurs with brisk walking uphill and resolves within 5 minutes of rest. The pain occasionally radiates to
his left jaw and is associated with diaphoresis. Using the OLD CARTS mnemonic, which feature most
strongly supports a cardiac (ischemic) origin for the pain versus a non-cardiac etiology such as GERD
or musculoskeletal pain?
A. Brief, sharp, stabbing pain lasting less than 10 seconds that worsens with deep inspiration
B. Pain reliably reproduced by palpation of the chest wall and relieved by changing position
C. Pressure-type discomfort that is precipitated by exertion and relieved by rest or nitroglycerin
[CORRECT]
D. Burning retrosternal pain occurring 30 minutes after a large meal while lying supine
Correct Answer: C
Rationale: Classic stable angina is characterized by substernal pressure or heaviness that is precipitated by
exertion or stress and relieved by rest or nitroglycerin within 5-10 minutes. This predictable exertion-relief
pattern reflects a fixed atherosclerotic coronary lesion causing supply-demand mismatch. Brief sharp
stabbing pain (A) suggests pleural or musculoskeletal etiology. Reproducible pain with palpation (B)
indicates musculoskeletal origin. Postprandial burning while supine (D) is the classic presentation of
GERD. Recognizing these distinctive features is essential for accurate triage of chest pain and preventing
both missed ACS and unnecessary cardiac workups.
Q2. A 67-year-old female with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF, EF 30%) presents with progressive dyspnea. She reports awakening at night gasping
for air and using three pillows to sleep comfortably. Which combination of symptoms is she describing,
and what underlying pathophysiologic mechanism best explains them?
A. Platypnea and orthodeoxia due to intracardiac shunting with positional hypoxemia
B. Paroxysmal nocturnal dyspnea and orthopnea due to nocturnal redistribution of venous return to a
failing left ventricle [CORRECT]
C. Trepopnea and orthopnea due to right-sided pleural effusion worsened by lateral decubitus position
D. Dyspnea on exertion and platypnea due to deconditioning and chronic obstructive pulmonary disease
Correct Answer: B
Rationale: Paroxysmal nocturnal dyspnea (PND) and orthopnea are hallmarks of left-sided heart failure.
When supine, venous return from the lower extremities increases by approximately 500-1000 mL,
augmenting preload in a left ventricle that cannot accommodate the additional volume due to systolic or
diastolic dysfunction. The resulting acute pulmonary venous congestion produces interstitial and alveolar
edema, waking the patient with air hunger 1-3 hours after sleep onset. Platypnea/orthodeoxia (A) describes
dyspnea worsened by upright position, classically from a right-to-left intracardiac shunt such as a patent
foramen ovale. Trepopnea (C) is positional dyspnea associated with unilateral pleural effusion or
pericardial disease. Choice D incorrectly attributes symptoms to deconditioning and COPD without
addressing the nocturnal orthopnea pattern.
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 4
and Practice Across the Lifespan
Week 3 Case Discussion: Cardiovascular
Comprehensive Examination
Spring 2026/2027 Complete Solution
115 Questions with Detailed Rationales
115
Multiple Choice Questions
with Comprehensive Clinical Rationales
Chamberlain University MSN Curriculum
Aligned with 2026 ACC/AHA Clinical Practice Guidelines
Graduate Nursing Education - Advanced Practice Nursing
,NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
NR 603 Advanced Clinical Diagnosis and Practice
Across the Lifespan
Week 3 Case Discussion: Cardiovascular
Comprehensive Examination with Detailed Rationales
Chamberlain University MSN Curriculum - Spring 2026/2027
Aligned with 2026 ACC/AHA Clinical Practice Guidelines
Examination Overview
This comprehensive 115-question examination covers cardiovascular assessment, diagnostic reasoning, and
clinical management for advanced practice nursing. The exam is organized into eight sections reflecting the
major cardiovascular disorder categories aligned with the NR 603 Week 3 Case Discussion content and the
2026 ACC/AHA clinical practice guidelines. Each question includes a detailed rationale with advanced practice
nursing-specific reasoning, evidence-based clinical guideline references, and pharmacological mechanism
explanations.
Cognitive Level Distribution
Questions are distributed across cognitive levels: approximately 30% recall (knowledge of pathophysiology and
pharmacology), 50% application (clinical decision-making in patient scenarios), and 20% analysis (complex
differential diagnosis and synthesis of clinical data). Approximately 80% of questions are scenario-based,
reflecting advanced practice nursing case discussion format.
Section Overview
Q1-15: Section 1: Cardiovascular Assessment and Diagnostic Reasoning (History, Physical Exam, & Risk
Stratification)
Q16-30: Section 2: Hypertension (Classification, Pathophysiology, Secondary Causes, & Management)
Q31-48: Section 3: Coronary Artery Disease and Acute Coronary Syndromes (Stable Angina, UA, NSTEMI, &
STEMI)
Q49-66: Section 4: Heart Failure (HFrEF, HFpEF, Pathophysiology, & Guideline-Directed Medical Therapy)
Q67-80: Section 5: Dysrhythmias and Conduction Disorders (AFib, Atrial Flutter, SVT, & Heart Blocks)
Q81-94: Section 6: Valvular, Pericardial, and Vascular Disorders (Valvular Disease, Pericarditis, PAD, &
DVT)
Q95-108: Section 7: Cardiovascular Pharmacotherapeutics (Antihypertensives, Antiplatelets, Anticoagulants,
& Statins)
Q109-115: Section 8: Case Discussion Application and Clinical Reasoning (Differential Diagnosis, Patient
Education, & Documentation)
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 2
,NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
Answer Format
Each question is presented with four options (A-D) and one correct answer. The correct answer is identified
with the marker [CORRECT] and bold formatting. A detailed rationale explains both why the correct answer is
right and why the distractors are wrong, with reference to pathophysiological mechanisms, diagnostic test
interpretation, pharmacological actions, and current evidence-based practice standards.
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 3
, NR 603 Week 3 Case Discussion: Cardiovascular Spring 2026/2027 - Complete Solution
Section 1: Cardiovascular Assessment and Diagnostic Reasoning (History, Physical
Exam, & Risk Stratification) | Q1-15 questions
Q1. A 58-year-old male presents to the primary care clinic describing substernal chest pressure that
occurs with brisk walking uphill and resolves within 5 minutes of rest. The pain occasionally radiates to
his left jaw and is associated with diaphoresis. Using the OLD CARTS mnemonic, which feature most
strongly supports a cardiac (ischemic) origin for the pain versus a non-cardiac etiology such as GERD
or musculoskeletal pain?
A. Brief, sharp, stabbing pain lasting less than 10 seconds that worsens with deep inspiration
B. Pain reliably reproduced by palpation of the chest wall and relieved by changing position
C. Pressure-type discomfort that is precipitated by exertion and relieved by rest or nitroglycerin
[CORRECT]
D. Burning retrosternal pain occurring 30 minutes after a large meal while lying supine
Correct Answer: C
Rationale: Classic stable angina is characterized by substernal pressure or heaviness that is precipitated by
exertion or stress and relieved by rest or nitroglycerin within 5-10 minutes. This predictable exertion-relief
pattern reflects a fixed atherosclerotic coronary lesion causing supply-demand mismatch. Brief sharp
stabbing pain (A) suggests pleural or musculoskeletal etiology. Reproducible pain with palpation (B)
indicates musculoskeletal origin. Postprandial burning while supine (D) is the classic presentation of
GERD. Recognizing these distinctive features is essential for accurate triage of chest pain and preventing
both missed ACS and unnecessary cardiac workups.
Q2. A 67-year-old female with a history of hypertension and heart failure with reduced ejection
fraction (HFrEF, EF 30%) presents with progressive dyspnea. She reports awakening at night gasping
for air and using three pillows to sleep comfortably. Which combination of symptoms is she describing,
and what underlying pathophysiologic mechanism best explains them?
A. Platypnea and orthodeoxia due to intracardiac shunting with positional hypoxemia
B. Paroxysmal nocturnal dyspnea and orthopnea due to nocturnal redistribution of venous return to a
failing left ventricle [CORRECT]
C. Trepopnea and orthopnea due to right-sided pleural effusion worsened by lateral decubitus position
D. Dyspnea on exertion and platypnea due to deconditioning and chronic obstructive pulmonary disease
Correct Answer: B
Rationale: Paroxysmal nocturnal dyspnea (PND) and orthopnea are hallmarks of left-sided heart failure.
When supine, venous return from the lower extremities increases by approximately 500-1000 mL,
augmenting preload in a left ventricle that cannot accommodate the additional volume due to systolic or
diastolic dysfunction. The resulting acute pulmonary venous congestion produces interstitial and alveolar
edema, waking the patient with air hunger 1-3 hours after sleep onset. Platypnea/orthodeoxia (A) describes
dyspnea worsened by upright position, classically from a right-to-left intracardiac shunt such as a patent
foramen ovale. Trepopnea (C) is positional dyspnea associated with unilateral pleural effusion or
pericardial disease. Choice D incorrectly attributes symptoms to deconditioning and COPD without
addressing the nocturnal orthopnea pattern.
Chamberlain University - MSN Program 115 Questions with Comprehensive Rationales Page 4
