NR 545 CERTIFICATION SCRIPT 2026 QUESTIONS WITH
SOLUTIONS GRADED A+
● Chest Pain AKA Angina Patho. Answer: Patho: Chest pain associated with decreased
blood flow or ischemia to the myocardial tissue.
● Chest pain PA. Answer: Physical Assessment: chest heaviness Pressure Squeezing
Fullness Pain radiates to left shoulder, arm, or jaw. Elevation of blood pressure during attack
● Chest pain Pharm. Answer: Pharm: Nitroglycerin- relaxes and widens blood vessels
Dosing: 0.3-0.6mg every 5 minutes for max of 3 doses Long-term treatment to consider: ACE
Inhibitors & Beta-Blockers
● Chest pain risks. Answer: Risks and complications: Acute Coronary Syndrome
● Myocardial Infarction. Answer: blood flow to the heart is minimized. Buildup of cholesterol
● MI Patho. Answer: imbalance between myocardial oxygen supply and demand Prolonged
for greater than 30 minutes can lead to cardiac tissue death.
● MI PA. Answer: Pain at rest Not relieved with nitro Lightheaded Impending doom Nausea
Diaphoresis Wheezing
● MI Dx. Answer: Troponins elevated, often stay elevated for one week after infarction. EKG-
ST elevation or new left bundle branch block
● Atherosclerosis. Answer: when blood vessels that carry oxygen to organs and tissues is
restricted. Hardening of vessels from buildup of fats, cholesterol in the artery walls Happens
gradually. Formed plaque can break off and burst, triggering a blood clot.
● Atherosclerosis patho. Answer: inflammatory process that begins with damage to the
endothelium often result of HTN, smoking, high cholesterol, or other risk factors. Fatty streak
to fibrous plaque and then complicated lesion
● Atherosclerosis PA. Answer: modifiable risk factors Fluid retention Fatigue Neck vein
distension Edema Calf pain
● Atherosclerosis Dx. Answer: Dx: Stress tests Chest Xray EKG Ankle-Brachial Index to
assess blood pressure in the extremities.
, ● Atherosclerosis Pharm. Answer: Pharm: Antiplatelets (Aspirin) Statins- reduce
inflammation. ACE Inhibitor- relax blood pressure and reduce work and pressure on heart.
Can be treated with lifestyle management.
● Heart Failure. Answer: complex clinical syndrome that results from structural or functional
impairment of ventricular or ejection of blood, which in turn leads to the cardinal clinical
symptoms of dyspnea and fatigue, edema, and rales.
● Heart Failure PA. Answer: Pre-existing conditions such as diabetes, liver failure, renal
disease, anemia. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND),
nocturnal angina, Cheyne-Stokes respirations (ask families or caretaker) Fatigue, lethargy,
decreased functional capacityPatient takes medications as directed, observing, and adhering
to dietary requirements. Alcohol or tobacco use History of rheumatic heart disease or Chaga's
disease Discomfort when laying down. Hypertension Tachycardia
● HF Dx. Answer: CBC, electrolytes, BUN, serum creatinine, hepatic enzymes, and a
urinalysis to screen for diabetes mellitus Fasting lipid panel and TSH B-type natriuretic
peptide (BNP) and N-Terminal pro-BNP (NT-proBNP) are released from a failing heart and a
sensitive marker for the presence of HF Newer markers, soluble ST-2, and galectin-3 are
used to determine the prognosis of HF patients Chest Xray to show the size and shape of the
heart, as well as pulmonary vasculature Electrocardiogram 12-lead; assess for cardiac
rhythm, and if LV hypertrophy is present, prior MI, QRS width. A normal ECG can exclude any
LV systolic dysfunction. Echocardiogram two-dimensional (2-D) assessment of LV size and
function, as well as valvular function or dysfunction and wall motion abnormalities (indicative
of prior MI damage). With Doppler can also assess RV size and pulmonary pressures for
evaluation and management of cor-pulmonale. MRI is the gold standard for assessing LV
mass and volume
● HF Pharm. Answer: Pharm: First line pharmacological management of heart failure is as
follows: Asymptomatic Treatment: Ace Inhibitor - Venous/Arterial vasodilation - Drug/Dosing:
Enalapril 2.5mg three times a day Angiotensin II Receptor Blocker - Venous/Arterial
vasodilation - Drug/Dosing: Losartan 25-40mg per day Symptomatic Treatment: Beta
Blockers - Blocks receptors of adrenergic nervous system - Drug/Dosing: Coreg 6.25-25mg
twice a day HCN Channel Blockers - Blocks Hyperpolarization-Activated Cyclic
Nucleotide-Gated Channel (HCN) in SA node to decrease heart rate - Drug/Dosing: Corlanor
5mg twice a day for two weeks, then 5mg per day Diuretics - Inhibits sodium chloride
reabsorption - Drug/Dosing: HCTZ 12.5-50mg per day - Drug/Dosing: Lasix 20-80mg per day
Antiarrhythmics - Inhibits sodium-potassium ATPase - Drug/Dosing: Digitalis 3.4-5.1mcg/kg
per day Nonpharm: Salt restriction to 2gm/day Considerations: Avoid NSAIDs, antiarrhythmic
drugs, calcium channel blockers Restrict fluid to 2L/day
SOLUTIONS GRADED A+
● Chest Pain AKA Angina Patho. Answer: Patho: Chest pain associated with decreased
blood flow or ischemia to the myocardial tissue.
● Chest pain PA. Answer: Physical Assessment: chest heaviness Pressure Squeezing
Fullness Pain radiates to left shoulder, arm, or jaw. Elevation of blood pressure during attack
● Chest pain Pharm. Answer: Pharm: Nitroglycerin- relaxes and widens blood vessels
Dosing: 0.3-0.6mg every 5 minutes for max of 3 doses Long-term treatment to consider: ACE
Inhibitors & Beta-Blockers
● Chest pain risks. Answer: Risks and complications: Acute Coronary Syndrome
● Myocardial Infarction. Answer: blood flow to the heart is minimized. Buildup of cholesterol
● MI Patho. Answer: imbalance between myocardial oxygen supply and demand Prolonged
for greater than 30 minutes can lead to cardiac tissue death.
● MI PA. Answer: Pain at rest Not relieved with nitro Lightheaded Impending doom Nausea
Diaphoresis Wheezing
● MI Dx. Answer: Troponins elevated, often stay elevated for one week after infarction. EKG-
ST elevation or new left bundle branch block
● Atherosclerosis. Answer: when blood vessels that carry oxygen to organs and tissues is
restricted. Hardening of vessels from buildup of fats, cholesterol in the artery walls Happens
gradually. Formed plaque can break off and burst, triggering a blood clot.
● Atherosclerosis patho. Answer: inflammatory process that begins with damage to the
endothelium often result of HTN, smoking, high cholesterol, or other risk factors. Fatty streak
to fibrous plaque and then complicated lesion
● Atherosclerosis PA. Answer: modifiable risk factors Fluid retention Fatigue Neck vein
distension Edema Calf pain
● Atherosclerosis Dx. Answer: Dx: Stress tests Chest Xray EKG Ankle-Brachial Index to
assess blood pressure in the extremities.
, ● Atherosclerosis Pharm. Answer: Pharm: Antiplatelets (Aspirin) Statins- reduce
inflammation. ACE Inhibitor- relax blood pressure and reduce work and pressure on heart.
Can be treated with lifestyle management.
● Heart Failure. Answer: complex clinical syndrome that results from structural or functional
impairment of ventricular or ejection of blood, which in turn leads to the cardinal clinical
symptoms of dyspnea and fatigue, edema, and rales.
● Heart Failure PA. Answer: Pre-existing conditions such as diabetes, liver failure, renal
disease, anemia. Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea (PND),
nocturnal angina, Cheyne-Stokes respirations (ask families or caretaker) Fatigue, lethargy,
decreased functional capacityPatient takes medications as directed, observing, and adhering
to dietary requirements. Alcohol or tobacco use History of rheumatic heart disease or Chaga's
disease Discomfort when laying down. Hypertension Tachycardia
● HF Dx. Answer: CBC, electrolytes, BUN, serum creatinine, hepatic enzymes, and a
urinalysis to screen for diabetes mellitus Fasting lipid panel and TSH B-type natriuretic
peptide (BNP) and N-Terminal pro-BNP (NT-proBNP) are released from a failing heart and a
sensitive marker for the presence of HF Newer markers, soluble ST-2, and galectin-3 are
used to determine the prognosis of HF patients Chest Xray to show the size and shape of the
heart, as well as pulmonary vasculature Electrocardiogram 12-lead; assess for cardiac
rhythm, and if LV hypertrophy is present, prior MI, QRS width. A normal ECG can exclude any
LV systolic dysfunction. Echocardiogram two-dimensional (2-D) assessment of LV size and
function, as well as valvular function or dysfunction and wall motion abnormalities (indicative
of prior MI damage). With Doppler can also assess RV size and pulmonary pressures for
evaluation and management of cor-pulmonale. MRI is the gold standard for assessing LV
mass and volume
● HF Pharm. Answer: Pharm: First line pharmacological management of heart failure is as
follows: Asymptomatic Treatment: Ace Inhibitor - Venous/Arterial vasodilation - Drug/Dosing:
Enalapril 2.5mg three times a day Angiotensin II Receptor Blocker - Venous/Arterial
vasodilation - Drug/Dosing: Losartan 25-40mg per day Symptomatic Treatment: Beta
Blockers - Blocks receptors of adrenergic nervous system - Drug/Dosing: Coreg 6.25-25mg
twice a day HCN Channel Blockers - Blocks Hyperpolarization-Activated Cyclic
Nucleotide-Gated Channel (HCN) in SA node to decrease heart rate - Drug/Dosing: Corlanor
5mg twice a day for two weeks, then 5mg per day Diuretics - Inhibits sodium chloride
reabsorption - Drug/Dosing: HCTZ 12.5-50mg per day - Drug/Dosing: Lasix 20-80mg per day
Antiarrhythmics - Inhibits sodium-potassium ATPase - Drug/Dosing: Digitalis 3.4-5.1mcg/kg
per day Nonpharm: Salt restriction to 2gm/day Considerations: Avoid NSAIDs, antiarrhythmic
drugs, calcium channel blockers Restrict fluid to 2L/day
