NR667 CEA FINAL EXAM (2026/2027)
Certified Nurse Practitioner (FNP)
Practice Questions
Verified Answers & Clinical Rationales
Topic 1: Cardiovascular Disorders (Questions 1-25)
Q1. The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a
pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would
the S1 heart sounds correlate with the electrocardiographic waves?
A) At the end of the T wave
B) At the start of the T wave
C) Peak of the R wave
D) At the start of the P wave
Answer: C
Rationale: S1 heart sounds correlate with the peak of the R wave on EKG, representing
ventricular contraction and closure of the AV valves .
Q2. Michael, a 72-year-old male patient who previously presented with stable cardiac-type chest
pain, has undergone a stress test. He presents today to review the results, which show EKG
findings of ST segment depression during the exam in leads V3 and V4 as well as concurrent
chest discomfort. Based on these findings, which of the following are NOT priority medical
decisions?
A) Prescribe metoprolol (Lopressor) 12.5mg PO BID
B) Prescribe aspirin 81mg PO daily
C) Refer to cardiology for angiography
D) Check for thyroid dysfunction
Answer: D
,Rationale: ST depression during stress testing with concurrent chest pain indicates ischemia,
requiring anti-ischemic therapy (beta-blocker, aspirin) and likely angiography. Thyroid
dysfunction is not a priority in this acute cardiac context .
Q3. Your patient presents with a new onset rapid heart rate that is irregularly irregular, heart rate
100, BP 120/74, respiration 16 non-labored and an SpO2 is 99%. They state this has been
going on for a week intermittently, but for the past four days straight it hasn't stopped. Your first
priority intervention for this patient is:
A) Ask about their family cardiac history
B) Maintain rate control and anticoagulation prior to rhythm conversion
C) Notify EMS for emergency room evaluation
D) Treat with vagal maneuvers for suspected SVT
Answer: B
Rationale: New onset atrial fibrillation with duration >48 hours requires rate control and
anticoagulation before attempting rhythm conversion to prevent thromboembolic events .
Q4. A patient presents with acute tearing chest pain radiating to the back. BP is 160/100 in the
right arm and 100/70 in the left arm. What is the most likely diagnosis?
A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection presents with tearing pain and pulse/blood pressure differentials
between arms. This is a hypertensive emergency requiring immediate CT angiography .
Q5. A 65-year-old male reports substernal chest pressure when walking up stairs. It resolves
with 5 minutes of rest. What type of angina is this?
A) Unstable angina
B) Stable angina
C) Variant angina
D) Microvascular angina
Answer: B
Rationale: Stable angina is reproducible with exertion (fixed stenosis) and resolves quickly with
rest. Unstable angina occurs at rest or with minimal exertion .
Q6. Which ECG finding is most consistent with an acute ST-elevation myocardial infarction
(STEMI)?
A) ST-segment depression in V2-V4
B) ST-segment elevation in two contiguous leads
C) Deep Q waves in lead III
,D) Peaked T waves
Answer: B
Rationale: ST elevation in contiguous leads (e.g., V3-V4) indicates acute injury and transmural
infarction requiring immediate reperfusion .
Q7. A patient with chronic heart failure presents with acute dyspnea, JVD, and crackles in all
lung fields. Which class of medication is most appropriate for acute decongestion?
A) Beta-blocker
B) ACE Inhibitor
C) IV Loop Diuretic (Furosemide)
D) Digoxin
Answer: C
Rationale: In acute decompensated heart failure with fluid overload, IV loop diuretics are
first-line for rapid decongestion .
Q8. Melissa, your 56-year-old Caucasian female patient, presents with a health history of
hypertension, migraines, hyperlipidemia, seasonal depression and obesity. After the visit she
calls your office and states she has been experiencing considerable lower extremity edema and
constipation since starting her new medicines. Which agent is most likely the common cause of
these side effects?
A) Aspirin 81 mg daily
B) Atorvastatin 40 mg daily
C) Lisinopril 20 mg daily
D) Amlodipine (Norvasc) 10 mg daily
Answer: D
Rationale: Amlodipine (Norvasc), a dihydropyridine calcium channel blocker, commonly causes
peripheral edema (from vasodilation) and constipation .
Q9. Marvin, your 47-year-old African American patient with severe COPD and coronary artery
disease, has been complaining of shortness of breath and wheezing after initiation of a new
medicine for his CAD management. Given his health history, which agent is considered the
safest beta blocker for his CAD management?
A) Propranolol
B) Metoprolol (Lopressor)
C) Atenolol
D) Carvedilol
Answer: B
Rationale: Beta-1 selective blockers (metoprolol, atenolol) are preferred in patients with COPD
as they have less bronchospasm risk compared to non-selective beta-blockers .
, Q10. Your 72-year-old female patient with history of coronary artery bypass graft and porcine
bioprosthetic aortic valve replacement (7 years ago) complains of near syncope when standing,
worsening over 6 months. Your workup should include evaluation of which potential
complication?
A) Bioprosthetic valve thrombosis
B) Bioprosthetic aortic valve stenosis
C) Prosthetic valve endocarditis
D) Coronary graft failure
Answer: B
Rationale: Bioprosthetic valves can degenerate over time (typically 10-15 years). Syncope with
position change may indicate progressive aortic stenosis from valve degeneration .
Q11. During a post-hospital discharge visit, you notice a 71-year-old female patient has a "new
murmur" found by the hospitalist. In evaluating the patient, during which phase of the cardiac
cycle would you anticipate auscultation of S3 or S4 sounds?
A) S3 in systole, S4 in diastole
B) Both in systole
C) Both in diastole
D) S3 in diastole, S4 in diastole
Answer: D
Rationale: S3 and S4 are both diastolic filling sounds. S3 occurs in early diastole (ventricular
gallop), S4 in late diastole (atrial gallop) .
Q12. A patient on warfarin for atrial fibrillation has an INR of 1.2. What is the most likely dietary
cause?
A) Grapefruit juice
B) High intake of green leafy vegetables (Vitamin K)
C) Red wine
D) Garlic supplements
Answer: B
Rationale: Vitamin K antagonizes warfarin. Large amounts of broccoli, spinach, or kale lower the
INR .
Q13. According to the updated hypertension guidelines, what is the target blood pressure for a
patient with diabetes?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B
Certified Nurse Practitioner (FNP)
Practice Questions
Verified Answers & Clinical Rationales
Topic 1: Cardiovascular Disorders (Questions 1-25)
Q1. The nurse practitioner assessing the patient with a rapid cardiac rhythm may assess for a
pulse deficit by auscultating the patient's heart while watching the EKG rhythm. Where would
the S1 heart sounds correlate with the electrocardiographic waves?
A) At the end of the T wave
B) At the start of the T wave
C) Peak of the R wave
D) At the start of the P wave
Answer: C
Rationale: S1 heart sounds correlate with the peak of the R wave on EKG, representing
ventricular contraction and closure of the AV valves .
Q2. Michael, a 72-year-old male patient who previously presented with stable cardiac-type chest
pain, has undergone a stress test. He presents today to review the results, which show EKG
findings of ST segment depression during the exam in leads V3 and V4 as well as concurrent
chest discomfort. Based on these findings, which of the following are NOT priority medical
decisions?
A) Prescribe metoprolol (Lopressor) 12.5mg PO BID
B) Prescribe aspirin 81mg PO daily
C) Refer to cardiology for angiography
D) Check for thyroid dysfunction
Answer: D
,Rationale: ST depression during stress testing with concurrent chest pain indicates ischemia,
requiring anti-ischemic therapy (beta-blocker, aspirin) and likely angiography. Thyroid
dysfunction is not a priority in this acute cardiac context .
Q3. Your patient presents with a new onset rapid heart rate that is irregularly irregular, heart rate
100, BP 120/74, respiration 16 non-labored and an SpO2 is 99%. They state this has been
going on for a week intermittently, but for the past four days straight it hasn't stopped. Your first
priority intervention for this patient is:
A) Ask about their family cardiac history
B) Maintain rate control and anticoagulation prior to rhythm conversion
C) Notify EMS for emergency room evaluation
D) Treat with vagal maneuvers for suspected SVT
Answer: B
Rationale: New onset atrial fibrillation with duration >48 hours requires rate control and
anticoagulation before attempting rhythm conversion to prevent thromboembolic events .
Q4. A patient presents with acute tearing chest pain radiating to the back. BP is 160/100 in the
right arm and 100/70 in the left arm. What is the most likely diagnosis?
A) Myocardial Infarction
B) Aortic Dissection
C) Pulmonary Embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection presents with tearing pain and pulse/blood pressure differentials
between arms. This is a hypertensive emergency requiring immediate CT angiography .
Q5. A 65-year-old male reports substernal chest pressure when walking up stairs. It resolves
with 5 minutes of rest. What type of angina is this?
A) Unstable angina
B) Stable angina
C) Variant angina
D) Microvascular angina
Answer: B
Rationale: Stable angina is reproducible with exertion (fixed stenosis) and resolves quickly with
rest. Unstable angina occurs at rest or with minimal exertion .
Q6. Which ECG finding is most consistent with an acute ST-elevation myocardial infarction
(STEMI)?
A) ST-segment depression in V2-V4
B) ST-segment elevation in two contiguous leads
C) Deep Q waves in lead III
,D) Peaked T waves
Answer: B
Rationale: ST elevation in contiguous leads (e.g., V3-V4) indicates acute injury and transmural
infarction requiring immediate reperfusion .
Q7. A patient with chronic heart failure presents with acute dyspnea, JVD, and crackles in all
lung fields. Which class of medication is most appropriate for acute decongestion?
A) Beta-blocker
B) ACE Inhibitor
C) IV Loop Diuretic (Furosemide)
D) Digoxin
Answer: C
Rationale: In acute decompensated heart failure with fluid overload, IV loop diuretics are
first-line for rapid decongestion .
Q8. Melissa, your 56-year-old Caucasian female patient, presents with a health history of
hypertension, migraines, hyperlipidemia, seasonal depression and obesity. After the visit she
calls your office and states she has been experiencing considerable lower extremity edema and
constipation since starting her new medicines. Which agent is most likely the common cause of
these side effects?
A) Aspirin 81 mg daily
B) Atorvastatin 40 mg daily
C) Lisinopril 20 mg daily
D) Amlodipine (Norvasc) 10 mg daily
Answer: D
Rationale: Amlodipine (Norvasc), a dihydropyridine calcium channel blocker, commonly causes
peripheral edema (from vasodilation) and constipation .
Q9. Marvin, your 47-year-old African American patient with severe COPD and coronary artery
disease, has been complaining of shortness of breath and wheezing after initiation of a new
medicine for his CAD management. Given his health history, which agent is considered the
safest beta blocker for his CAD management?
A) Propranolol
B) Metoprolol (Lopressor)
C) Atenolol
D) Carvedilol
Answer: B
Rationale: Beta-1 selective blockers (metoprolol, atenolol) are preferred in patients with COPD
as they have less bronchospasm risk compared to non-selective beta-blockers .
, Q10. Your 72-year-old female patient with history of coronary artery bypass graft and porcine
bioprosthetic aortic valve replacement (7 years ago) complains of near syncope when standing,
worsening over 6 months. Your workup should include evaluation of which potential
complication?
A) Bioprosthetic valve thrombosis
B) Bioprosthetic aortic valve stenosis
C) Prosthetic valve endocarditis
D) Coronary graft failure
Answer: B
Rationale: Bioprosthetic valves can degenerate over time (typically 10-15 years). Syncope with
position change may indicate progressive aortic stenosis from valve degeneration .
Q11. During a post-hospital discharge visit, you notice a 71-year-old female patient has a "new
murmur" found by the hospitalist. In evaluating the patient, during which phase of the cardiac
cycle would you anticipate auscultation of S3 or S4 sounds?
A) S3 in systole, S4 in diastole
B) Both in systole
C) Both in diastole
D) S3 in diastole, S4 in diastole
Answer: D
Rationale: S3 and S4 are both diastolic filling sounds. S3 occurs in early diastole (ventricular
gallop), S4 in late diastole (atrial gallop) .
Q12. A patient on warfarin for atrial fibrillation has an INR of 1.2. What is the most likely dietary
cause?
A) Grapefruit juice
B) High intake of green leafy vegetables (Vitamin K)
C) Red wine
D) Garlic supplements
Answer: B
Rationale: Vitamin K antagonizes warfarin. Large amounts of broccoli, spinach, or kale lower the
INR .
Q13. According to the updated hypertension guidelines, what is the target blood pressure for a
patient with diabetes?
A) <120/80 mmHg
B) <130/80 mmHg
C) <140/90 mmHg
D) <150/90 mmHg
Answer: B
