NR 511 CEA Exam
2026/2027 Updated
Version Questions And
Correct Detailed
Answers
1. During a post-hospital discharge visit, you notice your 71 year old
female patient has been diagnosed with a "new murmur" found by
the hospitalist during their recent hospitalization for CHF
exacerbation. In evaluating the patient, during which phase of the
cardiac cycle would you anticipate auscultation of a S3 or S4 heart
sound?
• Answer: Diastole
• Rationale: The patient has been diagnosed with a new murmur and
CHF exacerbation, which is typically associated with increased
blood volume and pressure in the ventricles, leading to an
increased volume of blood in the ventricles during diastole.
Therefore, auscultation of an S3 or S4 heart sound, which are heard
during diastole, is anticipated during this phase of the cardiac
cycle .
,2. The point of maximum impulse (PMI) is most often palpable in
healthy adults when positioned in the supine or left lateral decubitus
position. Which one of the following locations is most commonly
described as the PMI in a healthy adult?
• Answer: left 5th ICS, MCL
• Rationale: The PMI is most commonly palpable in the left 5th
intercostal space (ICS) and midclavicular line (MCL) because this
location corresponds to the apex of the heart, which is the area of
maximum impulse generation. In a healthy adult, the apex of the
heart is typically positioned towards the left chest wall .
3. 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
sound correlate with the electrocardiographic waves?
• Answer: Peak of the R wave
• Rationale: The S1 heart sound correlates with the Peak of the R
wave because the R wave on the EKG represents ventricular
contraction, which occurs during systole, when the heart is actively
pumping blood .
4. Michael, a 72 year old male patient who previously presented with
stable cardiac-type chest pain has underwent a stress test. He
presents today to review the stress test results, which show EKG
findings of ST segment depression during the exam in leads V3 and
V4 as well as some concurrent chest discomfort. Based on these
findings, which of the following are NOT priority medical decisions?
, • Answer: Check for thyroid dysfunction
• Rationale: The stress test results indicate ST segment depression,
which is a potential indicator of cardiac ischemia. Checking for
thyroid dysfunction is not a priority medical decision because it is
not related to the patient's current symptoms or test results .
5. A patient with chronic heart failure presents with dyspnea,
orthopnea, and peripheral edema. Which lab value best indicates
worsening heart failure?
• Answer: B-type natriuretic peptide (BNP) 600 pg/mL
• Rationale: BNP is released in response to ventricular stretch and is
a sensitive marker for heart failure severity .
6. A 65-year-old patient with hypertension is prescribed a thiazide
diuretic. Which electrolyte should be monitored closely?
• Answer: Potassium
• Rationale: Thiazides can cause hypokalemia, which increases the
risk of arrhythmias .
7. A patient is prescribed digoxin. Which sign indicates digoxin
toxicity?
• Answer: Visual disturbances (yellow halos) and nausea
• Rationale: Digoxin toxicity presents with GI symptoms and visual
changes; monitoring is critical .
8. A patient is receiving IV heparin. Which lab test is essential for
monitoring therapy?
, • Answer: aPTT
• Rationale: aPTT measures anticoagulation effect for unfractionated
heparin therapy .
9. A patient on warfarin presents with bruising and nosebleeds.
Which lab confirms supratherapeutic anticoagulation?
• Answer: INR >3.5
• Rationale: INR monitors warfarin therapy; values >3 indicate high
bleeding risk .
10. The patient with congestive heart failure with an ejection fraction
of 35% has become symptomatic with shortness of breath when
performing activities of daily living but does not have any symptoms
at rest. This is suggestive of New York Heart Association heart failure
classification?
• Answer: Class III
• Rationale: Class III heart failure is characterized by symptoms with
ordinary physical activity but not at rest .
11. Your patient has presented with a new onset rapid heart rate that
is irregularly irregular, heart rate 100, BP 120/74, R 16 non labored,
and SP02 is 99%. They state this has been going on for a week or so
intermittently, but for the last 4 days straight it hasn't stopped. Your
first priority intervention for this patient is to do which of the
following:
• Answer: Maintain rate control and anticoagulate prior to rhythm
conversion
2026/2027 Updated
Version Questions And
Correct Detailed
Answers
1. During a post-hospital discharge visit, you notice your 71 year old
female patient has been diagnosed with a "new murmur" found by
the hospitalist during their recent hospitalization for CHF
exacerbation. In evaluating the patient, during which phase of the
cardiac cycle would you anticipate auscultation of a S3 or S4 heart
sound?
• Answer: Diastole
• Rationale: The patient has been diagnosed with a new murmur and
CHF exacerbation, which is typically associated with increased
blood volume and pressure in the ventricles, leading to an
increased volume of blood in the ventricles during diastole.
Therefore, auscultation of an S3 or S4 heart sound, which are heard
during diastole, is anticipated during this phase of the cardiac
cycle .
,2. The point of maximum impulse (PMI) is most often palpable in
healthy adults when positioned in the supine or left lateral decubitus
position. Which one of the following locations is most commonly
described as the PMI in a healthy adult?
• Answer: left 5th ICS, MCL
• Rationale: The PMI is most commonly palpable in the left 5th
intercostal space (ICS) and midclavicular line (MCL) because this
location corresponds to the apex of the heart, which is the area of
maximum impulse generation. In a healthy adult, the apex of the
heart is typically positioned towards the left chest wall .
3. 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
sound correlate with the electrocardiographic waves?
• Answer: Peak of the R wave
• Rationale: The S1 heart sound correlates with the Peak of the R
wave because the R wave on the EKG represents ventricular
contraction, which occurs during systole, when the heart is actively
pumping blood .
4. Michael, a 72 year old male patient who previously presented with
stable cardiac-type chest pain has underwent a stress test. He
presents today to review the stress test results, which show EKG
findings of ST segment depression during the exam in leads V3 and
V4 as well as some concurrent chest discomfort. Based on these
findings, which of the following are NOT priority medical decisions?
, • Answer: Check for thyroid dysfunction
• Rationale: The stress test results indicate ST segment depression,
which is a potential indicator of cardiac ischemia. Checking for
thyroid dysfunction is not a priority medical decision because it is
not related to the patient's current symptoms or test results .
5. A patient with chronic heart failure presents with dyspnea,
orthopnea, and peripheral edema. Which lab value best indicates
worsening heart failure?
• Answer: B-type natriuretic peptide (BNP) 600 pg/mL
• Rationale: BNP is released in response to ventricular stretch and is
a sensitive marker for heart failure severity .
6. A 65-year-old patient with hypertension is prescribed a thiazide
diuretic. Which electrolyte should be monitored closely?
• Answer: Potassium
• Rationale: Thiazides can cause hypokalemia, which increases the
risk of arrhythmias .
7. A patient is prescribed digoxin. Which sign indicates digoxin
toxicity?
• Answer: Visual disturbances (yellow halos) and nausea
• Rationale: Digoxin toxicity presents with GI symptoms and visual
changes; monitoring is critical .
8. A patient is receiving IV heparin. Which lab test is essential for
monitoring therapy?
, • Answer: aPTT
• Rationale: aPTT measures anticoagulation effect for unfractionated
heparin therapy .
9. A patient on warfarin presents with bruising and nosebleeds.
Which lab confirms supratherapeutic anticoagulation?
• Answer: INR >3.5
• Rationale: INR monitors warfarin therapy; values >3 indicate high
bleeding risk .
10. The patient with congestive heart failure with an ejection fraction
of 35% has become symptomatic with shortness of breath when
performing activities of daily living but does not have any symptoms
at rest. This is suggestive of New York Heart Association heart failure
classification?
• Answer: Class III
• Rationale: Class III heart failure is characterized by symptoms with
ordinary physical activity but not at rest .
11. Your patient has presented with a new onset rapid heart rate that
is irregularly irregular, heart rate 100, BP 120/74, R 16 non labored,
and SP02 is 99%. They state this has been going on for a week or so
intermittently, but for the last 4 days straight it hasn't stopped. Your
first priority intervention for this patient is to do which of the
following:
• Answer: Maintain rate control and anticoagulate prior to rhythm
conversion
