NR 603 CEA Exam Prep 2026: 200 Practice Questions & Detailed
Answers | Final Exam Complete Study Guide with Rationales
Question 1
A 62yearold male with hypertension and diabetes mellitus type 2 presents with a blood pressure of
168/96 mmHg despite adhering to lifestyle modifications for the past 6 months. He is currently
prescribed lisinopril 20 mg daily. What is the most appropriate next step in his management?
A. Increase the lisinopril dose to 40 mg daily.
B. Add a thiazide diuretic.
C. Add a betablocker.
D. Switch to an angiotensin II receptor blocker (ARB).
Correct Answer: B. Add a thiazide diuretic.
Explanation: For uncontrolled hypertension in a patient already on an ACE inhibitor (lisinopril), current
guidelines recommend adding a thiazide diuretic or a calcium channel blocker (CCB) before switching
medication classes. Combination therapy is more effective than monotherapy and targets
complementary pathways. Increasing the ACE inhibitor dose may not provide additional benefit. Adding
a betablocker is not a firstline step unless there is a compelling indication like heart failure. Switching to
an ARB is unlikely to provide better blood pressure control as ARBs and ACE inhibitors have similar
efficacy.
Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) should be prescribed which of the
following evidencebased, guidelinedirected therapies? (Select all that apply)
A. ACE inhibitor
B. Betablocker
C. NSAIDs for arthritis pain
D. Aldosterone antagonist
Correct Answers: A, B, D.
Explanation: Guidelinedirected medical therapy (GDMT) for HFrEF includes ACE inhibitors (or ARBs),
betablockers, and aldosterone antagonists (mineralocorticoid receptor antagonists). Nonsteroidal
antiinflammatory drugs (NSAIDs) are contraindicated in HFrEF because they can worsen heart failure by
causing sodium and water retention, decreasing renal perfusion, and increasing systemic vascular
resistance.
,Question 3
A 58yearold male with a history of hypertension presents to the emergency department with crushing
substernal chest pain radiating to his left arm, accompanied by diaphoresis and nausea. What is the
most appropriate initial diagnostic test?
A. Chest Xray
B. 12lead ECG
C. Cardiac troponin level
D. Stress echocardiogram
Correct Answer: B. 12lead ECG.
Explanation: The 12lead ECG should be obtained within 10 minutes of arrival for any patient with chest
pain suspicious for myocardial infarction. It allows immediate identification of STelevation myocardial
infarction (STEMI), which requires urgent reperfusion therapy. While troponin is critical for diagnosis,
the ECG provides immediate, timesensitive information about the need for emergent intervention.
Question 4
A patient presents with crushing chest pain. ECG shows STsegment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery (LAD)
B. Left circumflex artery (LCX)
C. Right coronary artery (RCA)
D. Left main coronary artery
Correct Answer: C. Right coronary artery (RCA).
Explanation: Inferior wall myocardial infarction, which presents with ST elevation in leads II, III, and aVF,
is typically caused by occlusion of the right coronary artery (RCA). Occlusion of the LAD leads to anterior
wall MI (leads V1–V4), the LCX causes lateral wall MI (leads I, aVL, V5–V6), and left main occlusion
causes a widespread anterior and lateral pattern.
Question 5
A patient presents with a blood pressure of 220/120 mmHg, severe headache, blurred vision, and
confusion. What is the most appropriate next step?
A. Start oral amlodipine and schedule followup in 2 weeks.
,B. Admit to the hospital for intravenous antihypertensive therapy.
C. Instruct the patient to rest and recheck blood pressure in 1 hour.
D. Administer sublingual nifedipine.
Correct Answer: B. Admit to the hospital for intravenous antihypertensive therapy.
Explanation: This patient has hypertensive emergency, defined as severely elevated blood pressure
(>180/120 mmHg) with acute target organ dysfunction (headache, blurred vision, confusion).
Hypertensive emergency requires immediate blood pressure reduction with intravenous
antihypertensive agents in a monitored setting. Oral agents and sublingual nifedipine are
contraindicated due to the risk of rapid, uncontrolled BP lowering.
Question 6
A patient with a known ascending aortic aneurysm of 4.5 cm is being followed serially. What imaging
study is considered the standard of care for surveillance?
A. Chest Xray
B. CT angiography of the chest
C. Transthoracic echocardiogram
D. Abdominal ultrasound
Correct Answer: B. CT angiography of the chest.
Explanation: CT angiography is the standard imaging modality for surveillance of thoracic aortic
aneurysms because it provides precise measurements, allows for detection of changes in size and
morphology, and can visualize the entire aorta. Chest Xray is insensitive for aneurysm sizing,
transthoracic echocardiogram has limitations for visualizing the entire thoracic aorta, and abdominal
ultrasound is not adequate for thoracic aorta evaluation.
Question 7
Which cardiac biomarker is the most specific for myocardial infarction?
A. Creatine kinaseMB (CKMB)
B. Btype natriuretic peptide (BNP)
C. Troponin I
D. Ddimer
Correct Answer: C. Troponin I.
, Explanation: Cardiac troponins I and T are the most specific biomarkers for myocardial injury. Troponin I
is not normally found in the blood of healthy individuals and rises within 3–4 hours of myocardial
necrosis. CKMB is less specific as it can be elevated by skeletal muscle injury, BNP indicates heart failure,
and Ddimer is used for thromboembolism.
Question 8
A 65yearold patient presents with progressive fatigue and shortness of breath on exertion. Physical
examination reveals jugular venous distension, crackles at both lung bases, and 2+ pitting edema in the
lower extremities. Which condition is most likely?
A. COPD exacerbation
B. Leftsided heart failure only
C. Rightsided heart failure only
D. Biventricular heart failure
Correct Answer: D. Biventricular heart failure.
Explanation: The patient has signs of both left ventricular failure (crackles, dyspnea) and right ventricular
failure (jugular venous distension, peripheral edema). This combination of findings is characteristic of
biventricular heart failure. Isolated leftsided heart failure may eventually lead to rightsided failure, but
the presence of both sets of signs suggests biventricular involvement.
Question 9
A 75yearold man involved in a motor vehicle accident strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. Physical examination reveals
weakness of his upper extremities that is greater than in his lower extremities. What type of spinal cord
injury does this patient most likely have?
A. Anterior cord syndrome
B. Central cord syndrome
C. BrownSéquard syndrome
D. Complete cord transection
Correct Answer: B. Central cord syndrome.
Explanation: Central cord syndrome involves loss of motor function that is more severe in the upper
extremities than in the lower extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. This pattern results from injury to the central part of the
spinal cord, often from hyperextension injury in older adults.
Answers | Final Exam Complete Study Guide with Rationales
Question 1
A 62yearold male with hypertension and diabetes mellitus type 2 presents with a blood pressure of
168/96 mmHg despite adhering to lifestyle modifications for the past 6 months. He is currently
prescribed lisinopril 20 mg daily. What is the most appropriate next step in his management?
A. Increase the lisinopril dose to 40 mg daily.
B. Add a thiazide diuretic.
C. Add a betablocker.
D. Switch to an angiotensin II receptor blocker (ARB).
Correct Answer: B. Add a thiazide diuretic.
Explanation: For uncontrolled hypertension in a patient already on an ACE inhibitor (lisinopril), current
guidelines recommend adding a thiazide diuretic or a calcium channel blocker (CCB) before switching
medication classes. Combination therapy is more effective than monotherapy and targets
complementary pathways. Increasing the ACE inhibitor dose may not provide additional benefit. Adding
a betablocker is not a firstline step unless there is a compelling indication like heart failure. Switching to
an ARB is unlikely to provide better blood pressure control as ARBs and ACE inhibitors have similar
efficacy.
Question 2
A patient with heart failure with reduced ejection fraction (HFrEF) should be prescribed which of the
following evidencebased, guidelinedirected therapies? (Select all that apply)
A. ACE inhibitor
B. Betablocker
C. NSAIDs for arthritis pain
D. Aldosterone antagonist
Correct Answers: A, B, D.
Explanation: Guidelinedirected medical therapy (GDMT) for HFrEF includes ACE inhibitors (or ARBs),
betablockers, and aldosterone antagonists (mineralocorticoid receptor antagonists). Nonsteroidal
antiinflammatory drugs (NSAIDs) are contraindicated in HFrEF because they can worsen heart failure by
causing sodium and water retention, decreasing renal perfusion, and increasing systemic vascular
resistance.
,Question 3
A 58yearold male with a history of hypertension presents to the emergency department with crushing
substernal chest pain radiating to his left arm, accompanied by diaphoresis and nausea. What is the
most appropriate initial diagnostic test?
A. Chest Xray
B. 12lead ECG
C. Cardiac troponin level
D. Stress echocardiogram
Correct Answer: B. 12lead ECG.
Explanation: The 12lead ECG should be obtained within 10 minutes of arrival for any patient with chest
pain suspicious for myocardial infarction. It allows immediate identification of STelevation myocardial
infarction (STEMI), which requires urgent reperfusion therapy. While troponin is critical for diagnosis,
the ECG provides immediate, timesensitive information about the need for emergent intervention.
Question 4
A patient presents with crushing chest pain. ECG shows STsegment elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?
A. Left anterior descending artery (LAD)
B. Left circumflex artery (LCX)
C. Right coronary artery (RCA)
D. Left main coronary artery
Correct Answer: C. Right coronary artery (RCA).
Explanation: Inferior wall myocardial infarction, which presents with ST elevation in leads II, III, and aVF,
is typically caused by occlusion of the right coronary artery (RCA). Occlusion of the LAD leads to anterior
wall MI (leads V1–V4), the LCX causes lateral wall MI (leads I, aVL, V5–V6), and left main occlusion
causes a widespread anterior and lateral pattern.
Question 5
A patient presents with a blood pressure of 220/120 mmHg, severe headache, blurred vision, and
confusion. What is the most appropriate next step?
A. Start oral amlodipine and schedule followup in 2 weeks.
,B. Admit to the hospital for intravenous antihypertensive therapy.
C. Instruct the patient to rest and recheck blood pressure in 1 hour.
D. Administer sublingual nifedipine.
Correct Answer: B. Admit to the hospital for intravenous antihypertensive therapy.
Explanation: This patient has hypertensive emergency, defined as severely elevated blood pressure
(>180/120 mmHg) with acute target organ dysfunction (headache, blurred vision, confusion).
Hypertensive emergency requires immediate blood pressure reduction with intravenous
antihypertensive agents in a monitored setting. Oral agents and sublingual nifedipine are
contraindicated due to the risk of rapid, uncontrolled BP lowering.
Question 6
A patient with a known ascending aortic aneurysm of 4.5 cm is being followed serially. What imaging
study is considered the standard of care for surveillance?
A. Chest Xray
B. CT angiography of the chest
C. Transthoracic echocardiogram
D. Abdominal ultrasound
Correct Answer: B. CT angiography of the chest.
Explanation: CT angiography is the standard imaging modality for surveillance of thoracic aortic
aneurysms because it provides precise measurements, allows for detection of changes in size and
morphology, and can visualize the entire aorta. Chest Xray is insensitive for aneurysm sizing,
transthoracic echocardiogram has limitations for visualizing the entire thoracic aorta, and abdominal
ultrasound is not adequate for thoracic aorta evaluation.
Question 7
Which cardiac biomarker is the most specific for myocardial infarction?
A. Creatine kinaseMB (CKMB)
B. Btype natriuretic peptide (BNP)
C. Troponin I
D. Ddimer
Correct Answer: C. Troponin I.
, Explanation: Cardiac troponins I and T are the most specific biomarkers for myocardial injury. Troponin I
is not normally found in the blood of healthy individuals and rises within 3–4 hours of myocardial
necrosis. CKMB is less specific as it can be elevated by skeletal muscle injury, BNP indicates heart failure,
and Ddimer is used for thromboembolism.
Question 8
A 65yearold patient presents with progressive fatigue and shortness of breath on exertion. Physical
examination reveals jugular venous distension, crackles at both lung bases, and 2+ pitting edema in the
lower extremities. Which condition is most likely?
A. COPD exacerbation
B. Leftsided heart failure only
C. Rightsided heart failure only
D. Biventricular heart failure
Correct Answer: D. Biventricular heart failure.
Explanation: The patient has signs of both left ventricular failure (crackles, dyspnea) and right ventricular
failure (jugular venous distension, peripheral edema). This combination of findings is characteristic of
biventricular heart failure. Isolated leftsided heart failure may eventually lead to rightsided failure, but
the presence of both sets of signs suggests biventricular involvement.
Question 9
A 75yearold man involved in a motor vehicle accident strikes his forehead on the windshield. He
complains of neck pain and severe burning in his shoulders and arms. Physical examination reveals
weakness of his upper extremities that is greater than in his lower extremities. What type of spinal cord
injury does this patient most likely have?
A. Anterior cord syndrome
B. Central cord syndrome
C. BrownSéquard syndrome
D. Complete cord transection
Correct Answer: B. Central cord syndrome.
Explanation: Central cord syndrome involves loss of motor function that is more severe in the upper
extremities than in the lower extremities, and is more severe in the hands. There is typically
hyperesthesia over the shoulders and arms. This pattern results from injury to the central part of the
spinal cord, often from hyperextension injury in older adults.
