NR 603 CEA Final Exam (2026) - Advanced Clinical
Diagnosis Chamberlain University College of NursingActual
Questions & Answers with Rationales
Section 1: Cardiovascular System (Questions 1-40)
1. The primary purpose of clinical evaluation in the advanced practice setting
is:
A. To collect data for billing
B. To diagnose and manage patient conditions
C. To fulfill regulatory requirements
D. To provide documentation for research
Answer: B. To diagnose and manage patient conditions
Rationale: The primary purpose of clinical evaluation is to
systematically assess patients to formulate accurate diagnoses and
develop appropriate management plans. While documentation and
billing are necessary aspects of practice, they are secondary to the core
function of patient care .
2. A 55-year-old male presents with crushing chest pain radiating to the left
arm. What is the first diagnostic step?
A. Echocardiogram
B. Troponin level
C. Chest X-ray
D. 12-lead ECG
Answer: D. 12-lead ECG
Rationale: The 12-lead ECG should be obtained within 10 minutes of
arrival for any patient with chest pain suspicious for myocardial
infarction. It allows immediate identification of ST-elevation MI
(STEMI), which requires urgent reperfusion therapy .
,3. Which of the following is the most specific cardiac biomarker for
myocardial infarction?
A. CK-MB
B. BNP
C. Troponin I
D. D-dimer
Answer: C. Troponin I
Rationale: 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 .
4. A 60-year-old male with chest pain has ECG showing ST-elevation in
anterior leads. Troponin I is 2.5 ng/mL (normal <0.04). What diagnostic
criterion confirms STEMI, and what is initial therapy per AHA/ACC 2023?
A. EKG + troponin; aspirin + heparin
B. Troponin only; beta-blocker
C. EKG alone; thrombolytics
D. Pain history; nitroglycerin
Answer: A. EKG + troponin; aspirin + heparin
Rationale: STEMI diagnosis requires new ST-elevation ≥1 mm in ≥2
contiguous leads plus elevated troponin indicating myocyte necrosis.
AHA/ACC 2023 guidelines mandate immediate reperfusion with PCI,
plus aspirin 325 mg and heparin for anticoagulation .
5. According to JNC 8 guidelines, hypertension in African American patients
is best treated with:
A. ACE inhibitors
B. ARBs
C. Thiazide diuretics or calcium channel blockers
D. Beta-blockers
Answer: C. Thiazide diuretics or calcium channel blockers
Rationale: JNC 8 guidelines recommend thiazide diuretics or calcium
,channel blockers as first-line therapy for hypertension in African
American patients due to better outcomes and reduced risk of
angioedema compared to ACE inhibitors .
6. A patient with heart failure and EF <35% after myocardial infarction is at
increased risk for:
A. Stroke
B. Sudden cardiac death
C. Renal failure
D. Liver cirrhosis
Answer: B. Sudden cardiac death
Rationale: Patients with EF <35% after MI have significantly increased
risk of sudden cardiac death due to ventricular arrhythmias. An
implantable cardioverter-defibrillator (ICD) is recommended for
primary prevention in these patients .
7. Which of the following symptoms is consistent with left-sided heart
failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Hepatomegaly
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure leads to pulmonary congestion due
to increased pressure in the pulmonary circulation. This results in
crackles (rales) on auscultation, dyspnea, and orthopnea. Peripheral
edema and JVD are signs of right-sided heart failure .
8. The New York Heart Association (NYHA) Class III heart failure is
characterized by:
A. No limitation of physical activity
B. Slight limitation; symptoms with ordinary activity
C. Marked limitation; symptoms with less than ordinary activity
D. Severe limitation; symptoms at rest
, Answer: C. Marked limitation; symptoms with less than ordinary
activity
Rationale: NYHA Class III is defined as marked limitation of physical
activity. Patients are comfortable at rest but less than ordinary activity
causes fatigue, palpitation, or dyspnea. This classification helps guide
treatment decisions .
9. Which beta-blocker is preferred for heart failure with reduced ejection
fraction (HFrEF)?
A. Metoprolol tartrate
B. Atenolol
C. Carvedilol
D. Propranolol
Answer: C. Carvedilol
Rationale: Carvedilol is a non-selective beta-blocker with additional
alpha-1 blocking properties, which reduces afterload. It has
demonstrated mortality benefit in HFrEF and is FDA-approved for this
indication. Metoprolol succinate (not tartrate) is also approved .
10. A patient with heart failure and preserved ejection fraction (HFpEF) has
an EF of:
A. Less than 40%
B. 40-50%
C. Greater than 50%
D. Any value with symptoms
Answer: C. Greater than 50%
Rationale: HFpEF (diastolic heart failure) is defined by signs and
symptoms of heart failure with left ventricular ejection fraction ≥50%.
Diagnosis requires evidence of diastolic dysfunction on
echocardiography .
11. The most appropriate initial imaging for suspected aortic aneurysm
surveillance is:
A. Chest X-ray
Diagnosis Chamberlain University College of NursingActual
Questions & Answers with Rationales
Section 1: Cardiovascular System (Questions 1-40)
1. The primary purpose of clinical evaluation in the advanced practice setting
is:
A. To collect data for billing
B. To diagnose and manage patient conditions
C. To fulfill regulatory requirements
D. To provide documentation for research
Answer: B. To diagnose and manage patient conditions
Rationale: The primary purpose of clinical evaluation is to
systematically assess patients to formulate accurate diagnoses and
develop appropriate management plans. While documentation and
billing are necessary aspects of practice, they are secondary to the core
function of patient care .
2. A 55-year-old male presents with crushing chest pain radiating to the left
arm. What is the first diagnostic step?
A. Echocardiogram
B. Troponin level
C. Chest X-ray
D. 12-lead ECG
Answer: D. 12-lead ECG
Rationale: The 12-lead ECG should be obtained within 10 minutes of
arrival for any patient with chest pain suspicious for myocardial
infarction. It allows immediate identification of ST-elevation MI
(STEMI), which requires urgent reperfusion therapy .
,3. Which of the following is the most specific cardiac biomarker for
myocardial infarction?
A. CK-MB
B. BNP
C. Troponin I
D. D-dimer
Answer: C. Troponin I
Rationale: 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 .
4. A 60-year-old male with chest pain has ECG showing ST-elevation in
anterior leads. Troponin I is 2.5 ng/mL (normal <0.04). What diagnostic
criterion confirms STEMI, and what is initial therapy per AHA/ACC 2023?
A. EKG + troponin; aspirin + heparin
B. Troponin only; beta-blocker
C. EKG alone; thrombolytics
D. Pain history; nitroglycerin
Answer: A. EKG + troponin; aspirin + heparin
Rationale: STEMI diagnosis requires new ST-elevation ≥1 mm in ≥2
contiguous leads plus elevated troponin indicating myocyte necrosis.
AHA/ACC 2023 guidelines mandate immediate reperfusion with PCI,
plus aspirin 325 mg and heparin for anticoagulation .
5. According to JNC 8 guidelines, hypertension in African American patients
is best treated with:
A. ACE inhibitors
B. ARBs
C. Thiazide diuretics or calcium channel blockers
D. Beta-blockers
Answer: C. Thiazide diuretics or calcium channel blockers
Rationale: JNC 8 guidelines recommend thiazide diuretics or calcium
,channel blockers as first-line therapy for hypertension in African
American patients due to better outcomes and reduced risk of
angioedema compared to ACE inhibitors .
6. A patient with heart failure and EF <35% after myocardial infarction is at
increased risk for:
A. Stroke
B. Sudden cardiac death
C. Renal failure
D. Liver cirrhosis
Answer: B. Sudden cardiac death
Rationale: Patients with EF <35% after MI have significantly increased
risk of sudden cardiac death due to ventricular arrhythmias. An
implantable cardioverter-defibrillator (ICD) is recommended for
primary prevention in these patients .
7. Which of the following symptoms is consistent with left-sided heart
failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Hepatomegaly
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure leads to pulmonary congestion due
to increased pressure in the pulmonary circulation. This results in
crackles (rales) on auscultation, dyspnea, and orthopnea. Peripheral
edema and JVD are signs of right-sided heart failure .
8. The New York Heart Association (NYHA) Class III heart failure is
characterized by:
A. No limitation of physical activity
B. Slight limitation; symptoms with ordinary activity
C. Marked limitation; symptoms with less than ordinary activity
D. Severe limitation; symptoms at rest
, Answer: C. Marked limitation; symptoms with less than ordinary
activity
Rationale: NYHA Class III is defined as marked limitation of physical
activity. Patients are comfortable at rest but less than ordinary activity
causes fatigue, palpitation, or dyspnea. This classification helps guide
treatment decisions .
9. Which beta-blocker is preferred for heart failure with reduced ejection
fraction (HFrEF)?
A. Metoprolol tartrate
B. Atenolol
C. Carvedilol
D. Propranolol
Answer: C. Carvedilol
Rationale: Carvedilol is a non-selective beta-blocker with additional
alpha-1 blocking properties, which reduces afterload. It has
demonstrated mortality benefit in HFrEF and is FDA-approved for this
indication. Metoprolol succinate (not tartrate) is also approved .
10. A patient with heart failure and preserved ejection fraction (HFpEF) has
an EF of:
A. Less than 40%
B. 40-50%
C. Greater than 50%
D. Any value with symptoms
Answer: C. Greater than 50%
Rationale: HFpEF (diastolic heart failure) is defined by signs and
symptoms of heart failure with left ventricular ejection fraction ≥50%.
Diagnosis requires evidence of diastolic dysfunction on
echocardiography .
11. The most appropriate initial imaging for suspected aortic aneurysm
surveillance is:
A. Chest X-ray
