NSG 6440 – Advanced Nursing Predictor Review 2025–
2026 High-level critical thinking, advanced assessment,
and clinical application concepts.
Cardiology (15 Questions)
1. A 68-year-old patient with a history of hypertension presents with sudden, "tearing" back
pain. On assessment, you note a blood pressure of 180/110 mmHg in the right arm and
150/95 mmHg in the left arm. The most immediate initial action is to:
A. Administer IV morphine for pain.
B. Order an immediate chest X-ray.
C. Obtain an urgent CT angiogram of the aorta. ✓
D. Start a nitroprusside drip to lower the systolic BP to 120 mmHg.
2. A patient with stable angina is started on Metoprolol. The patient education should
emphasize:
A. "Take this medication only when you feel chest pain."
B. "Rise slowly from a sitting or lying position to prevent dizziness." ✓
C. "Avoid eating bananas and other high-potassium foods."
D. "This drug will replace your need for nitroglycerin."
3. The most specific laboratory marker for diagnosing a non-ST-elevation myocardial infarction
(NSTEMI) is:
A. Creatine Kinase (CK)
B. C-Reactive Protein (CRP)
C. Troponin I or T ✓
D. Myoglobin
4. A 55-year-old diabetic male has an ankle-brachial index (ABI) of 0.6. This result indicates:
A. Normal peripheral circulation
B. Mild Peripheral Artery Disease (PAD)
C. Moderate to Severe PAD ✓
D. Venous insufficiency
5. The primary goal of therapy for a patient with Heart Failure with Reduced Ejection Fraction
(HFrEF) is to:
A. Increase cardiac contractility with inotropes.
B. Block neurohormonal activation (RAAS, SNS). ✓
,C. Maintain a high preload to support stroke volume.
D. Use diuretics as the sole long-term management.
6. On cardiac auscultation, you hear a mid-diastolic rumble best heard at the apex with the
bell of the stethoscope. This is characteristic of:
A. Aortic stenosis
B. Mitral stenosis ✓
C. Tricuspid regurgitation
D. Pericardial friction rub
7. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 should be managed with:
A. Aspirin 81 mg daily
B. No anticoagulation, risk is low
C. Oral anticoagulation (e.g., Apixaban) ✓
D. Clopidogrel
8. The first-line treatment for a stable, symptomatic patient with Wolff-Parkinson-White
(WPW) syndrome is:
A. Metoprolol
B. Digoxin
C. Amiodarone
D. Catheter Ablation ✓
9. You suspect cardiac tamponade in a patient post-cardiac surgery. The classic triad of
findings is:
A. Fever, murmur, and elevated white count.
B. Hypotension, JVD, and muffled heart sounds. ✓
C. Hypertension, bradycardia, and irregular pulse.
D. Chest pain, fever, and pericardial friction rub.
10. When prescribing a statin for secondary prevention in a patient with known CAD, the
target LDL-C reduction is:
A. At least 10%
B. At least 25%
C. At least 50% ✓
D. No specific target, just any reduction
11. A patient presents with acute pulmonary edema. The most appropriate initial vasodilator
in a hypertensive patient is:
A. Lisinopril
,B. Nitroprusside
C. Intravenous Nitroglycerin ✓
D. Hydralazine
12. The EKG finding of "coved" ST-segment elevation in V1-V3 is associated with:
A. Acute anterior MI
B. Brugada Syndrome ✓
C. Hypertrophic Cardiomyopathy
D. Long QT Syndrome
13. For a patient with hypertrophic cardiomyopathy (HCM), which medication is
contraindicated?
A. Furosemide
B. Digoxin ✓
C. Metoprolol
D. Verapamil (though beta-blockers are first line, verapamil is sometimes used with caution.
Digoxin is contraindicated due to its inotropic effects).
14. The most common cause of right-sided heart failure is:
A. Mitral valve regurgitation
B. Left-sided heart failure ✓
C. Primary pulmonary hypertension
D. Constrictive pericarditis
15. A "paradoxical" blood pressure (a decrease in systolic BP by more than 10 mmHg during
inspiration) is a sign of:
A. Aortic dissection
B. Cardiac tamponade ✓
C. Pulmonary embolism
D. Abdominal aortic aneurysm
Pulmonology (12 Questions)
16. A patient with COPD and chronic hypoxemia (PaO2 55 mmHg) requires long-term oxygen
therapy. The goal of this therapy is to maintain an O2 saturation of at least:
A. 80%
B. 88%
C. 90% ✓
D. 95%
, 17. The gold standard diagnostic test for confirming a diagnosis of pulmonary embolism is:
A. D-dimer
B. Ventilation-Perfusion (V/Q) Scan
C. CT Pulmonary Angiography (CTPA) ✓
D. Chest X-ray
18. A patient with suspected asthma has a normal spirometry. The best next step to confirm
the diagnosis is:
A. Chest CT scan
B. Bronchoprovocation testing ✓
C. Trial of oral corticosteroids
D. Arterial Blood Gas
19. In a patient with community-acquired pneumonia (CAP) who has no comorbidities and
has not recently taken antibiotics, the most likely pathogen is:
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Streptococcus pneumoniae ✓
D. Mycoplasma pneumoniae
20. A "box-car" appearance on a chest X-ray is suggestive of:
A. Pulmonary edema
B. Pneumothorax
C. Severe COPD / Hyperinflation ✓
D. Lobar pneumonia
21. The most appropriate initial treatment for a symptomatic primary spontaneous
pneumothorax is:
A. Observation
B. Needle Aspiration ✓
C. Chest Tube Insertion
D. Thoracic Surgery
22. A patient with sarcoidosis would most likely present with which of the following findings?
A. Eosinophilia
B. Hypercalcemia ✓
C. Hypogammaglobulinemia
D. Thrombocytosis
2026 High-level critical thinking, advanced assessment,
and clinical application concepts.
Cardiology (15 Questions)
1. A 68-year-old patient with a history of hypertension presents with sudden, "tearing" back
pain. On assessment, you note a blood pressure of 180/110 mmHg in the right arm and
150/95 mmHg in the left arm. The most immediate initial action is to:
A. Administer IV morphine for pain.
B. Order an immediate chest X-ray.
C. Obtain an urgent CT angiogram of the aorta. ✓
D. Start a nitroprusside drip to lower the systolic BP to 120 mmHg.
2. A patient with stable angina is started on Metoprolol. The patient education should
emphasize:
A. "Take this medication only when you feel chest pain."
B. "Rise slowly from a sitting or lying position to prevent dizziness." ✓
C. "Avoid eating bananas and other high-potassium foods."
D. "This drug will replace your need for nitroglycerin."
3. The most specific laboratory marker for diagnosing a non-ST-elevation myocardial infarction
(NSTEMI) is:
A. Creatine Kinase (CK)
B. C-Reactive Protein (CRP)
C. Troponin I or T ✓
D. Myoglobin
4. A 55-year-old diabetic male has an ankle-brachial index (ABI) of 0.6. This result indicates:
A. Normal peripheral circulation
B. Mild Peripheral Artery Disease (PAD)
C. Moderate to Severe PAD ✓
D. Venous insufficiency
5. The primary goal of therapy for a patient with Heart Failure with Reduced Ejection Fraction
(HFrEF) is to:
A. Increase cardiac contractility with inotropes.
B. Block neurohormonal activation (RAAS, SNS). ✓
,C. Maintain a high preload to support stroke volume.
D. Use diuretics as the sole long-term management.
6. On cardiac auscultation, you hear a mid-diastolic rumble best heard at the apex with the
bell of the stethoscope. This is characteristic of:
A. Aortic stenosis
B. Mitral stenosis ✓
C. Tricuspid regurgitation
D. Pericardial friction rub
7. A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 4 should be managed with:
A. Aspirin 81 mg daily
B. No anticoagulation, risk is low
C. Oral anticoagulation (e.g., Apixaban) ✓
D. Clopidogrel
8. The first-line treatment for a stable, symptomatic patient with Wolff-Parkinson-White
(WPW) syndrome is:
A. Metoprolol
B. Digoxin
C. Amiodarone
D. Catheter Ablation ✓
9. You suspect cardiac tamponade in a patient post-cardiac surgery. The classic triad of
findings is:
A. Fever, murmur, and elevated white count.
B. Hypotension, JVD, and muffled heart sounds. ✓
C. Hypertension, bradycardia, and irregular pulse.
D. Chest pain, fever, and pericardial friction rub.
10. When prescribing a statin for secondary prevention in a patient with known CAD, the
target LDL-C reduction is:
A. At least 10%
B. At least 25%
C. At least 50% ✓
D. No specific target, just any reduction
11. A patient presents with acute pulmonary edema. The most appropriate initial vasodilator
in a hypertensive patient is:
A. Lisinopril
,B. Nitroprusside
C. Intravenous Nitroglycerin ✓
D. Hydralazine
12. The EKG finding of "coved" ST-segment elevation in V1-V3 is associated with:
A. Acute anterior MI
B. Brugada Syndrome ✓
C. Hypertrophic Cardiomyopathy
D. Long QT Syndrome
13. For a patient with hypertrophic cardiomyopathy (HCM), which medication is
contraindicated?
A. Furosemide
B. Digoxin ✓
C. Metoprolol
D. Verapamil (though beta-blockers are first line, verapamil is sometimes used with caution.
Digoxin is contraindicated due to its inotropic effects).
14. The most common cause of right-sided heart failure is:
A. Mitral valve regurgitation
B. Left-sided heart failure ✓
C. Primary pulmonary hypertension
D. Constrictive pericarditis
15. A "paradoxical" blood pressure (a decrease in systolic BP by more than 10 mmHg during
inspiration) is a sign of:
A. Aortic dissection
B. Cardiac tamponade ✓
C. Pulmonary embolism
D. Abdominal aortic aneurysm
Pulmonology (12 Questions)
16. A patient with COPD and chronic hypoxemia (PaO2 55 mmHg) requires long-term oxygen
therapy. The goal of this therapy is to maintain an O2 saturation of at least:
A. 80%
B. 88%
C. 90% ✓
D. 95%
, 17. The gold standard diagnostic test for confirming a diagnosis of pulmonary embolism is:
A. D-dimer
B. Ventilation-Perfusion (V/Q) Scan
C. CT Pulmonary Angiography (CTPA) ✓
D. Chest X-ray
18. A patient with suspected asthma has a normal spirometry. The best next step to confirm
the diagnosis is:
A. Chest CT scan
B. Bronchoprovocation testing ✓
C. Trial of oral corticosteroids
D. Arterial Blood Gas
19. In a patient with community-acquired pneumonia (CAP) who has no comorbidities and
has not recently taken antibiotics, the most likely pathogen is:
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Streptococcus pneumoniae ✓
D. Mycoplasma pneumoniae
20. A "box-car" appearance on a chest X-ray is suggestive of:
A. Pulmonary edema
B. Pneumothorax
C. Severe COPD / Hyperinflation ✓
D. Lobar pneumonia
21. The most appropriate initial treatment for a symptomatic primary spontaneous
pneumothorax is:
A. Observation
B. Needle Aspiration ✓
C. Chest Tube Insertion
D. Thoracic Surgery
22. A patient with sarcoidosis would most likely present with which of the following findings?
A. Eosinophilia
B. Hypercalcemia ✓
C. Hypogammaglobulinemia
D. Thrombocytosis
