NR 603 CEA PRE-DIAGNOSTIC EXAM NEWEST
2026/2027 COMPLETE ALL QUESTIONS AND
CORRECT DETAILED ANSWERS |BRAND NEW
An older adult presents with the single complaint of bilateral pitting edema. The
patient has a history of diabetes and high blood pressure and is on oral
medications. Which of the following medications is the MOST likely cause of the
patient's complaint?
Correct Answer: Amlodipine (Norvasc)
Expert Rationale
Amlodipine is a dihydropyridine calcium channel blocker that commonly causes
peripheral edema due to peripheral vasodilation and increased capillary
hydrostatic pressure. This side effect is dose-dependent and often bilateral. Other
antihypertensives such as ACE inhibitors or ARBs are less likely to cause edema.
The NP should consider reducing the dose or switching to another agent if edema
is bothersome.
DIF: Cognitive Level: Apply (Application) TOP: Pharmacological Side
Effects/Calcium Channel Blockers MSC: NCLEX: Pharmacological and Parenteral
Therapies
Your patient is complaining of paroxysmal atrial fibrillation. Which medical
procedure is commonly used to treat this condition?
Correct Answer: Cryoablation of the transition zone of the left pulmonary vein
inflow to the left atrium
,Expert Rationale
Cryoablation is a catheter-based procedure used to treat paroxysmal atrial
fibrillation by isolating the pulmonary veins, where ectopic foci often originate. A
cryoballoon is used to freeze tissue at the pulmonary vein antrum, creating lesions
that electrically isolate the veins from the left atrium. This is an effective rhythm
control strategy for patients with symptomatic paroxysmal AF refractory to
medical therapy.
DIF: Cognitive Level: Apply (Application) TOP: Atrial Fibrillation
Management/Ablation MSC: NCLEX: Physiological Integrity
As the nurse practitioner working in a primary care clinic, you have been notified
from a hospitalization that your long-term patient with a history of HFrEF with
an ejection fraction of 40% two years ago who is also not on optimal medical
therapy has been diagnosed with an MI this admission and received emergent
placement of a drug-eluting stent to the left anterior descending artery. Who
will manage this patient and what is their priority for CHF after MI?
Correct Answer: Ordering a new transthoracic echocardiogram and order a life
vest if EF is less than 35%
Expert Rationale
Following an MI, especially with reduced ejection fraction, a new echocardiogram
should be obtained to reassess left ventricular function. If the EF is ≤35%, a
wearable cardioverter-defibrillator (LifeVest) should be ordered for patients at risk
of sudden cardiac death until further evaluation for an implantable cardioverter-
defibrillator (ICD) can be performed. This is a critical step in optimizing post-MI
heart failure management.
DIF: Cognitive Level: Apply (Application) TOP: Post-MI Heart Failure Management
MSC: NCLEX: Physiological Integrity
A 65 year old woman presents for follow up. She is a smoker and HTN is now
controlled. Her mother died at age 40 from heart attack. Fasting lipids shows
cholesterol 240, HDL 30, and LDL 200. In addition to therapeutic lifestyle changes
what should the NP start?
Correct Answer: Statin drug
,Expert Rationale
This patient has very high LDL cholesterol (200 mg/dL) and multiple cardiovascular
risk factors (smoking, hypertension, family history of premature CAD). According
to the ACC/AHA cholesterol guidelines, patients with LDL ≥190 mg/dL should be
treated with high-intensity statin therapy regardless of ASCVD risk score. Lifestyle
changes alone are insufficient. The NP should initiate a high-intensity statin
(atorvastatin 40–80 mg or rosuvastatin 20–40 mg).
DIF: Cognitive Level: Apply (Application) TOP: Dyslipidemia Management/Statin
Therapy MSC: NCLEX: Pharmacological and Parenteral Therapies
An adult patient must maintain INR between 2-3. The patient goes to a clinic for
INR check and results is 1.4. What would decrease the effects of Coumadin?
Correct Answer: Broccoli
Expert Rationale
Broccoli and other green leafy vegetables are high in vitamin K, which antagonizes
the effect of warfarin (Coumadin) and can lower the INR. Patients on warfarin
should maintain a consistent intake of vitamin K-rich foods. An INR of 1.4 is
subtherapeutic and increases the risk of thrombosis. The NP should assess dietary
changes, medication interactions, and consider increasing the warfarin dose.
DIF: Cognitive Level: Apply (Application) TOP: Warfarin/Drug-Nutrient Interactions
MSC: NCLEX: Pharmacological and Parenteral Therapies
The patient admitted with crushing chest pain just converted from NSR to Brady
with elevated ST segments. What is the priority?
Correct Answer: Cath lab
Expert Rationale
ST-segment elevation with bradycardia in a patient with crushing chest pain is
consistent with an acute ST-elevation myocardial infarction (STEMI). The priority is
immediate reperfusion therapy via percutaneous coronary intervention (PCI) in
the cardiac catheterization lab. This is a time-sensitive emergency; the goal is
door-to-balloon time of ≤90 minutes.
, DIF: Cognitive Level: Apply (Application) TOP: STEMI Management/Emergency
MSC: NCLEX: Safe and Effective Care Environment
A 50 year old woman with a history of HTN presents with dyspnea on exertion
and orthopnea. She has JVD and bilateral crackles. What is their priority
diagnosis?
Correct Answer: CHF (Congestive Heart Failure)
Expert Rationale
Dyspnea on exertion, orthopnea, jugular venous distention (JVD), and bilateral
crackles are classic signs of congestive heart failure (CHF). This patient's symptoms
indicate pulmonary congestion (crackles) and right-sided pressure (JVD),
consistent with biventricular failure. The NP should evaluate with BNP,
echocardiogram, and initiate appropriate heart failure therapy.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Diagnosis MSC: NCLEX:
Physiological Integrity
65 alcoholic patient presents with a new onset of persistent palpitations and
anxiety for the past 3 days. Monitor is applied and has irregularly irregular
rhythm. Which evaluation should be performed first?
Correct Answer: Ordering a transthoracic echocardiogram
Expert Rationale
An irregularly irregular rhythm in a patient with alcohol use is consistent with
atrial fibrillation. The first evaluation should be a transthoracic echocardiogram to
assess for structural heart disease, evaluate left atrial size, and rule out valvular or
myocardial pathology. This guides further management, including rate control,
anticoagulation, and rhythm control strategies.
DIF: Cognitive Level: Apply (Application) TOP: Atrial Fibrillation/Echocardiogram
MSC: NCLEX: Physiological Integrity
Effective long term treatment of systolic heart failure with reduced ejection
fraction should include which of the following?
Correct Answer: Prescribing valsartan/sacubitril (Entresto)
2026/2027 COMPLETE ALL QUESTIONS AND
CORRECT DETAILED ANSWERS |BRAND NEW
An older adult presents with the single complaint of bilateral pitting edema. The
patient has a history of diabetes and high blood pressure and is on oral
medications. Which of the following medications is the MOST likely cause of the
patient's complaint?
Correct Answer: Amlodipine (Norvasc)
Expert Rationale
Amlodipine is a dihydropyridine calcium channel blocker that commonly causes
peripheral edema due to peripheral vasodilation and increased capillary
hydrostatic pressure. This side effect is dose-dependent and often bilateral. Other
antihypertensives such as ACE inhibitors or ARBs are less likely to cause edema.
The NP should consider reducing the dose or switching to another agent if edema
is bothersome.
DIF: Cognitive Level: Apply (Application) TOP: Pharmacological Side
Effects/Calcium Channel Blockers MSC: NCLEX: Pharmacological and Parenteral
Therapies
Your patient is complaining of paroxysmal atrial fibrillation. Which medical
procedure is commonly used to treat this condition?
Correct Answer: Cryoablation of the transition zone of the left pulmonary vein
inflow to the left atrium
,Expert Rationale
Cryoablation is a catheter-based procedure used to treat paroxysmal atrial
fibrillation by isolating the pulmonary veins, where ectopic foci often originate. A
cryoballoon is used to freeze tissue at the pulmonary vein antrum, creating lesions
that electrically isolate the veins from the left atrium. This is an effective rhythm
control strategy for patients with symptomatic paroxysmal AF refractory to
medical therapy.
DIF: Cognitive Level: Apply (Application) TOP: Atrial Fibrillation
Management/Ablation MSC: NCLEX: Physiological Integrity
As the nurse practitioner working in a primary care clinic, you have been notified
from a hospitalization that your long-term patient with a history of HFrEF with
an ejection fraction of 40% two years ago who is also not on optimal medical
therapy has been diagnosed with an MI this admission and received emergent
placement of a drug-eluting stent to the left anterior descending artery. Who
will manage this patient and what is their priority for CHF after MI?
Correct Answer: Ordering a new transthoracic echocardiogram and order a life
vest if EF is less than 35%
Expert Rationale
Following an MI, especially with reduced ejection fraction, a new echocardiogram
should be obtained to reassess left ventricular function. If the EF is ≤35%, a
wearable cardioverter-defibrillator (LifeVest) should be ordered for patients at risk
of sudden cardiac death until further evaluation for an implantable cardioverter-
defibrillator (ICD) can be performed. This is a critical step in optimizing post-MI
heart failure management.
DIF: Cognitive Level: Apply (Application) TOP: Post-MI Heart Failure Management
MSC: NCLEX: Physiological Integrity
A 65 year old woman presents for follow up. She is a smoker and HTN is now
controlled. Her mother died at age 40 from heart attack. Fasting lipids shows
cholesterol 240, HDL 30, and LDL 200. In addition to therapeutic lifestyle changes
what should the NP start?
Correct Answer: Statin drug
,Expert Rationale
This patient has very high LDL cholesterol (200 mg/dL) and multiple cardiovascular
risk factors (smoking, hypertension, family history of premature CAD). According
to the ACC/AHA cholesterol guidelines, patients with LDL ≥190 mg/dL should be
treated with high-intensity statin therapy regardless of ASCVD risk score. Lifestyle
changes alone are insufficient. The NP should initiate a high-intensity statin
(atorvastatin 40–80 mg or rosuvastatin 20–40 mg).
DIF: Cognitive Level: Apply (Application) TOP: Dyslipidemia Management/Statin
Therapy MSC: NCLEX: Pharmacological and Parenteral Therapies
An adult patient must maintain INR between 2-3. The patient goes to a clinic for
INR check and results is 1.4. What would decrease the effects of Coumadin?
Correct Answer: Broccoli
Expert Rationale
Broccoli and other green leafy vegetables are high in vitamin K, which antagonizes
the effect of warfarin (Coumadin) and can lower the INR. Patients on warfarin
should maintain a consistent intake of vitamin K-rich foods. An INR of 1.4 is
subtherapeutic and increases the risk of thrombosis. The NP should assess dietary
changes, medication interactions, and consider increasing the warfarin dose.
DIF: Cognitive Level: Apply (Application) TOP: Warfarin/Drug-Nutrient Interactions
MSC: NCLEX: Pharmacological and Parenteral Therapies
The patient admitted with crushing chest pain just converted from NSR to Brady
with elevated ST segments. What is the priority?
Correct Answer: Cath lab
Expert Rationale
ST-segment elevation with bradycardia in a patient with crushing chest pain is
consistent with an acute ST-elevation myocardial infarction (STEMI). The priority is
immediate reperfusion therapy via percutaneous coronary intervention (PCI) in
the cardiac catheterization lab. This is a time-sensitive emergency; the goal is
door-to-balloon time of ≤90 minutes.
, DIF: Cognitive Level: Apply (Application) TOP: STEMI Management/Emergency
MSC: NCLEX: Safe and Effective Care Environment
A 50 year old woman with a history of HTN presents with dyspnea on exertion
and orthopnea. She has JVD and bilateral crackles. What is their priority
diagnosis?
Correct Answer: CHF (Congestive Heart Failure)
Expert Rationale
Dyspnea on exertion, orthopnea, jugular venous distention (JVD), and bilateral
crackles are classic signs of congestive heart failure (CHF). This patient's symptoms
indicate pulmonary congestion (crackles) and right-sided pressure (JVD),
consistent with biventricular failure. The NP should evaluate with BNP,
echocardiogram, and initiate appropriate heart failure therapy.
DIF: Cognitive Level: Apply (Application) TOP: Heart Failure Diagnosis MSC: NCLEX:
Physiological Integrity
65 alcoholic patient presents with a new onset of persistent palpitations and
anxiety for the past 3 days. Monitor is applied and has irregularly irregular
rhythm. Which evaluation should be performed first?
Correct Answer: Ordering a transthoracic echocardiogram
Expert Rationale
An irregularly irregular rhythm in a patient with alcohol use is consistent with
atrial fibrillation. The first evaluation should be a transthoracic echocardiogram to
assess for structural heart disease, evaluate left atrial size, and rule out valvular or
myocardial pathology. This guides further management, including rate control,
anticoagulation, and rhythm control strategies.
DIF: Cognitive Level: Apply (Application) TOP: Atrial Fibrillation/Echocardiogram
MSC: NCLEX: Physiological Integrity
Effective long term treatment of systolic heart failure with reduced ejection
fraction should include which of the following?
Correct Answer: Prescribing valsartan/sacubitril (Entresto)
