NR 603 CEA Final Exam (2026) - Advanced Clinical
Diagnosis Chamberlain University College of Nursing
Complete A+ Guide with Rationales
Section 1: Cardiovascular System (Questions 1-35)
1. A 58-year-old male presents with substernal chest pressure that started 2
hours ago while walking. The pain radiates to his left arm and is associated
with diaphoresis and nausea. His blood pressure is 150/90 mmHg, heart rate
102 bpm. What is the most appropriate initial diagnostic test?
A. Chest X-ray
B. 12-lead ECG
C. Cardiac troponin
D. Stress echocardiogram
Answer: B. 12-lead ECG
Rationale: For any patient presenting with symptoms suggestive of acute
coronary syndrome (ACS), a 12-lead ECG should be obtained within 10
minutes of arrival. The ECG can identify ST-elevation myocardial infarction
(STEMI) requiring immediate reperfusion therapy. While troponin is
important, the ECG provides immediate actionable information .
2. A 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction (ST elevation in leads II, III,
aVF) is typically caused by occlusion of the right coronary artery (RCA). The
RCA supplies the inferior wall of the left ventricle and the right ventricle .
,3. A patient with chest pain has ECG findings consistent with acute
myocardial infarction. Troponin I is 2.5 ng/mL (normal <0.04 ng/mL).
According to the 2024 ACC/AHA guidelines, what is the appropriate next
step?
A. Administer aspirin and observe
B. Transfer for percutaneous coronary intervention (PCI)
C. Administer thrombolytics
D. Perform stress testing
Answer: B. Transfer for percutaneous coronary intervention (PCI)
Rationale: For patients with STEMI, the ACC/AHA guidelines recommend
immediate reperfusion with primary PCI within 90 minutes of first medical
contact. If PCI cannot be performed within 120 minutes, fibrinolytic therapy
should be administered .
4. Which of the following findings is most specific for pericarditis?
A. ST-segment elevation in all leads except aVR and V1
B. Pathologic Q waves
C. Deep T-wave inversions
D. Prolonged QT interval
Answer: A. ST-segment elevation in all leads except aVR and V1
Rationale: Acute pericarditis typically presents with diffuse ST-segment
elevation (concave upward) in most leads, with reciprocal ST depression in
aVR and V1. PR-segment depression may also be seen. This pattern reflects
subepicardial inflammation .
5. A 72-year-old female presents with dyspnea on exertion, orthopnea, and
peripheral edema. On auscultation, crackles are heard at both lung bases.
Which medication is most appropriate for initial management of this
patient's volume overload?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
,Answer: B. Furosemide
Rationale: The patient is presenting with signs and symptoms of acute
decompensated heart failure, including pulmonary congestion (crackles,
dyspnea) and peripheral edema. Loop diuretics such as furosemide are the
mainstay of initial treatment to reduce volume overload and relieve
symptoms .
6. The New York Heart Association (NYHA) Class III heart failure is
characterized by:
A. No limitation of physical activity
B. Slight limitation; ordinary activity causes symptoms
C. Marked limitation; less than ordinary activity causes symptoms
D. Symptoms at rest
Answer: C. Marked limitation; less than ordinary activity causes symptoms
Rationale: NYHA Class III indicates marked limitation of physical activity.
Patients are comfortable at rest, but minimal activity (e.g., walking one
block, climbing one flight of stairs) causes fatigue, palpitation, or dyspnea.
This classification helps guide treatment decisions .
7. Which beta-blocker is FDA-approved for heart failure with reduced
ejection fraction (HFrEF) and has demonstrated mortality benefit?
A. Metoprolol tartrate
B. Atenolol
C. Carvedilol
D. Propranolol
Answer: C. Carvedilol
Rationale: Carvedilol, along with metoprolol succinate (not tartrate) and
bisoprolol, is FDA-approved for HFrEF and has demonstrated mortality
benefit in clinical trials. Carvedilol has additional alpha-1 blocking properties
that provide vasodilation .
8. A patient with heart failure has an ejection fraction of 30%. According to
the 2024 ACC/AHA guidelines, which medication class has the strongest
evidence for reducing mortality?
, A. Calcium channel blockers
B. Digoxin
C. Hydralazine and isosorbide dinitrate
D. Beta-blockers and ACE inhibitors
Answer: D. Beta-blockers and ACE inhibitors
Rationale: For HFrEF (EF ≤40%), guideline-directed medical therapy
includes beta-blockers and ACE inhibitors (or ARBs/ARNIs) as foundational
therapies with proven mortality benefit. ARNI (sacubitril/valsartan) is
preferred over ACE inhibitors in appropriate patients .
9. A 65-year-old male with hypertension, diabetes, and a 20-year smoking
history presents for routine examination. His blood pressure is 145/90
mmHg. According to the 2024 ACC/AHA hypertension guidelines, what is
his blood pressure classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: According to the ACC/AHA guidelines, stage 1 hypertension is
defined as systolic BP 130-139 mmHg OR diastolic BP 80-89 mmHg. This
patient with cardiovascular risk factors (diabetes, smoking) would be
recommended for pharmacologic therapy .
10. A 55-year-old African American male has hypertension. According to the
2024 hypertension guidelines, which class of medication is recommended as
first-line therapy for this patient?
A. ACE inhibitor
B. Angiotensin receptor blocker
C. Thiazide diuretic or calcium channel blocker
D. Beta-blocker
Answer: C. Thiazide diuretic or calcium channel blocker
Rationale: In African American patients, thiazide diuretics and calcium
Diagnosis Chamberlain University College of Nursing
Complete A+ Guide with Rationales
Section 1: Cardiovascular System (Questions 1-35)
1. A 58-year-old male presents with substernal chest pressure that started 2
hours ago while walking. The pain radiates to his left arm and is associated
with diaphoresis and nausea. His blood pressure is 150/90 mmHg, heart rate
102 bpm. What is the most appropriate initial diagnostic test?
A. Chest X-ray
B. 12-lead ECG
C. Cardiac troponin
D. Stress echocardiogram
Answer: B. 12-lead ECG
Rationale: For any patient presenting with symptoms suggestive of acute
coronary syndrome (ACS), a 12-lead ECG should be obtained within 10
minutes of arrival. The ECG can identify ST-elevation myocardial infarction
(STEMI) requiring immediate reperfusion therapy. While troponin is
important, the ECG provides immediate actionable information .
2. A 12-lead ECG shows ST-segment elevation in leads II, III, and aVF. Which
coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C. Right coronary artery
Rationale: Inferior wall myocardial infarction (ST elevation in leads II, III,
aVF) is typically caused by occlusion of the right coronary artery (RCA). The
RCA supplies the inferior wall of the left ventricle and the right ventricle .
,3. A patient with chest pain has ECG findings consistent with acute
myocardial infarction. Troponin I is 2.5 ng/mL (normal <0.04 ng/mL).
According to the 2024 ACC/AHA guidelines, what is the appropriate next
step?
A. Administer aspirin and observe
B. Transfer for percutaneous coronary intervention (PCI)
C. Administer thrombolytics
D. Perform stress testing
Answer: B. Transfer for percutaneous coronary intervention (PCI)
Rationale: For patients with STEMI, the ACC/AHA guidelines recommend
immediate reperfusion with primary PCI within 90 minutes of first medical
contact. If PCI cannot be performed within 120 minutes, fibrinolytic therapy
should be administered .
4. Which of the following findings is most specific for pericarditis?
A. ST-segment elevation in all leads except aVR and V1
B. Pathologic Q waves
C. Deep T-wave inversions
D. Prolonged QT interval
Answer: A. ST-segment elevation in all leads except aVR and V1
Rationale: Acute pericarditis typically presents with diffuse ST-segment
elevation (concave upward) in most leads, with reciprocal ST depression in
aVR and V1. PR-segment depression may also be seen. This pattern reflects
subepicardial inflammation .
5. A 72-year-old female presents with dyspnea on exertion, orthopnea, and
peripheral edema. On auscultation, crackles are heard at both lung bases.
Which medication is most appropriate for initial management of this
patient's volume overload?
A. Metoprolol
B. Furosemide
C. Lisinopril
D. Digoxin
,Answer: B. Furosemide
Rationale: The patient is presenting with signs and symptoms of acute
decompensated heart failure, including pulmonary congestion (crackles,
dyspnea) and peripheral edema. Loop diuretics such as furosemide are the
mainstay of initial treatment to reduce volume overload and relieve
symptoms .
6. The New York Heart Association (NYHA) Class III heart failure is
characterized by:
A. No limitation of physical activity
B. Slight limitation; ordinary activity causes symptoms
C. Marked limitation; less than ordinary activity causes symptoms
D. Symptoms at rest
Answer: C. Marked limitation; less than ordinary activity causes symptoms
Rationale: NYHA Class III indicates marked limitation of physical activity.
Patients are comfortable at rest, but minimal activity (e.g., walking one
block, climbing one flight of stairs) causes fatigue, palpitation, or dyspnea.
This classification helps guide treatment decisions .
7. Which beta-blocker is FDA-approved for heart failure with reduced
ejection fraction (HFrEF) and has demonstrated mortality benefit?
A. Metoprolol tartrate
B. Atenolol
C. Carvedilol
D. Propranolol
Answer: C. Carvedilol
Rationale: Carvedilol, along with metoprolol succinate (not tartrate) and
bisoprolol, is FDA-approved for HFrEF and has demonstrated mortality
benefit in clinical trials. Carvedilol has additional alpha-1 blocking properties
that provide vasodilation .
8. A patient with heart failure has an ejection fraction of 30%. According to
the 2024 ACC/AHA guidelines, which medication class has the strongest
evidence for reducing mortality?
, A. Calcium channel blockers
B. Digoxin
C. Hydralazine and isosorbide dinitrate
D. Beta-blockers and ACE inhibitors
Answer: D. Beta-blockers and ACE inhibitors
Rationale: For HFrEF (EF ≤40%), guideline-directed medical therapy
includes beta-blockers and ACE inhibitors (or ARBs/ARNIs) as foundational
therapies with proven mortality benefit. ARNI (sacubitril/valsartan) is
preferred over ACE inhibitors in appropriate patients .
9. A 65-year-old male with hypertension, diabetes, and a 20-year smoking
history presents for routine examination. His blood pressure is 145/90
mmHg. According to the 2024 ACC/AHA hypertension guidelines, what is
his blood pressure classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: According to the ACC/AHA guidelines, stage 1 hypertension is
defined as systolic BP 130-139 mmHg OR diastolic BP 80-89 mmHg. This
patient with cardiovascular risk factors (diabetes, smoking) would be
recommended for pharmacologic therapy .
10. A 55-year-old African American male has hypertension. According to the
2024 hypertension guidelines, which class of medication is recommended as
first-line therapy for this patient?
A. ACE inhibitor
B. Angiotensin receptor blocker
C. Thiazide diuretic or calcium channel blocker
D. Beta-blocker
Answer: C. Thiazide diuretic or calcium channel blocker
Rationale: In African American patients, thiazide diuretics and calcium
