Clinical Cardiovascular Management NP Test
Bank – 150 Questions, Full Solutions And
Rationale
2025/2026
1. A 62-year-old male presents with chest pain radiating to the left
arm. His ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Circumflex
C. Right coronary artery
D. Left main
C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior myocardial infarction, most commonly caused by occlusion of
the right coronary artery.
2. Which medication is first-line therapy for heart failure with
reduced ejection fraction (HFrEF)?
A. Verapamil
B. Lisinopril
C. Diltiazem
D. Metoprolol
B. Lisinopril
Rationale: ACE inhibitors, such as lisinopril, are first-line therapy for
HFrEF due to their mortality benefit and ability to reduce afterload.
3. A patient with hypertension has persistently elevated BP despite
three antihypertensive medications, including a diuretic. What is
the next step?
, A. Increase diuretic dose
B. Add a fourth antihypertensive
C. Evaluate for secondary hypertension
D. Discontinue one medication
C. Evaluate for secondary hypertension
Rationale: Resistant hypertension warrants evaluation for secondary
causes such as renal artery stenosis, primary aldosteronism, or
endocrine disorders.
4. Which lipid-lowering therapy is most effective in reducing LDL
cholesterol?
A. Ezetimibe
B. Statins
C. Fibrates
D. Niacin
B. Statins
Rationale: Statins are first-line therapy for hyperlipidemia due to their
potent LDL-lowering effect and cardiovascular risk reduction.
5. A 70-year-old male with a history of atrial fibrillation is started on
warfarin. Which lab should be monitored to ensure therapeutic
anticoagulation?
A. PT/INR
B. aPTT
C. CBC
D. Platelet count
A. PT/INR
Rationale: Warfarin anticoagulation is monitored using the INR
(international normalized ratio), with a target of 2.0–3.0 for atrial
fibrillation.
, 6. Which antihypertensive class is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
D. Nifedipine
C. ACE inhibitors
Rationale: ACE inhibitors are teratogenic and contraindicated during
pregnancy due to the risk of fetal renal damage.
7. A patient presents with sudden-onset, severe chest pain radiating
to the back. Blood pressure is 180/100 mmHg. What is the most
likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: Sudden, severe, tearing chest pain radiating to the back
with hypertension is classic for aortic dissection.
8. Which medication is recommended for rate control in atrial
fibrillation in a patient with heart failure with reduced ejection
fraction?
A. Diltiazem
B. Metoprolol succinate
C. Verapamil
D. Digoxin
B. Metoprolol succinate
Rationale: Beta-blockers like metoprolol succinate are preferred for
, rate control in AF with HFrEF because calcium channel blockers
(diltiazem, verapamil) are contraindicated.
9. A patient with peripheral arterial disease reports calf pain when
walking that improves with rest. What is the primary
management?
A. Anticoagulation
B. Smoking cessation and exercise
C. Immediate revascularization
D. ACE inhibitors
B. Smoking cessation and exercise
Rationale: Lifestyle modification, including supervised exercise and
smoking cessation, is first-line therapy for PAD to improve symptoms
and cardiovascular risk.
10. Which biomarker is most specific for myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
B. Troponin I
Rationale: Cardiac troponins are highly specific and sensitive markers
for myocardial injury and are preferred for diagnosing acute
myocardial infarction.
11. A patient with chronic stable angina is prescribed nitrates.
What is a major counseling point?
A. Avoid taking with beta-blockers
B. Take daily to prevent angina
C. Use as needed for acute symptoms and avoid concomitant
Bank – 150 Questions, Full Solutions And
Rationale
2025/2026
1. A 62-year-old male presents with chest pain radiating to the left
arm. His ECG shows ST-segment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending
B. Circumflex
C. Right coronary artery
D. Left main
C. Right coronary artery
Rationale: ST-segment elevation in leads II, III, and aVF indicates an
inferior myocardial infarction, most commonly caused by occlusion of
the right coronary artery.
2. Which medication is first-line therapy for heart failure with
reduced ejection fraction (HFrEF)?
A. Verapamil
B. Lisinopril
C. Diltiazem
D. Metoprolol
B. Lisinopril
Rationale: ACE inhibitors, such as lisinopril, are first-line therapy for
HFrEF due to their mortality benefit and ability to reduce afterload.
3. A patient with hypertension has persistently elevated BP despite
three antihypertensive medications, including a diuretic. What is
the next step?
, A. Increase diuretic dose
B. Add a fourth antihypertensive
C. Evaluate for secondary hypertension
D. Discontinue one medication
C. Evaluate for secondary hypertension
Rationale: Resistant hypertension warrants evaluation for secondary
causes such as renal artery stenosis, primary aldosteronism, or
endocrine disorders.
4. Which lipid-lowering therapy is most effective in reducing LDL
cholesterol?
A. Ezetimibe
B. Statins
C. Fibrates
D. Niacin
B. Statins
Rationale: Statins are first-line therapy for hyperlipidemia due to their
potent LDL-lowering effect and cardiovascular risk reduction.
5. A 70-year-old male with a history of atrial fibrillation is started on
warfarin. Which lab should be monitored to ensure therapeutic
anticoagulation?
A. PT/INR
B. aPTT
C. CBC
D. Platelet count
A. PT/INR
Rationale: Warfarin anticoagulation is monitored using the INR
(international normalized ratio), with a target of 2.0–3.0 for atrial
fibrillation.
, 6. Which antihypertensive class is contraindicated in pregnancy?
A. Methyldopa
B. Labetalol
C. ACE inhibitors
D. Nifedipine
C. ACE inhibitors
Rationale: ACE inhibitors are teratogenic and contraindicated during
pregnancy due to the risk of fetal renal damage.
7. A patient presents with sudden-onset, severe chest pain radiating
to the back. Blood pressure is 180/100 mmHg. What is the most
likely diagnosis?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection
Rationale: Sudden, severe, tearing chest pain radiating to the back
with hypertension is classic for aortic dissection.
8. Which medication is recommended for rate control in atrial
fibrillation in a patient with heart failure with reduced ejection
fraction?
A. Diltiazem
B. Metoprolol succinate
C. Verapamil
D. Digoxin
B. Metoprolol succinate
Rationale: Beta-blockers like metoprolol succinate are preferred for
, rate control in AF with HFrEF because calcium channel blockers
(diltiazem, verapamil) are contraindicated.
9. A patient with peripheral arterial disease reports calf pain when
walking that improves with rest. What is the primary
management?
A. Anticoagulation
B. Smoking cessation and exercise
C. Immediate revascularization
D. ACE inhibitors
B. Smoking cessation and exercise
Rationale: Lifestyle modification, including supervised exercise and
smoking cessation, is first-line therapy for PAD to improve symptoms
and cardiovascular risk.
10. Which biomarker is most specific for myocardial injury?
A. CK-MB
B. Troponin I
C. Myoglobin
D. BNP
B. Troponin I
Rationale: Cardiac troponins are highly specific and sensitive markers
for myocardial injury and are preferred for diagnosing acute
myocardial infarction.
11. A patient with chronic stable angina is prescribed nitrates.
What is a major counseling point?
A. Avoid taking with beta-blockers
B. Take daily to prevent angina
C. Use as needed for acute symptoms and avoid concomitant
