NR 603 CEA Midterm Exam (2026) - Advanced
Clinical Diagnosis Chamberlain University
College of Nursing Actual Questions & Answers
with Rationales
Section 1: Cardiovascular System (Questions 1-40)
1. A 58-year-old male with a history of hypertension and smoking presents to
the emergency department with substernal chest pressure that started 2
hours ago while walking. The pain radiates to his left arm and jaw, and he
reports diaphoresis and nausea. His blood pressure is 155/95 mmHg, heart
rate 110 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 for diagnosis, the ECG provides
immediate actionable information for time-sensitive interventions .
2. The 12-lead ECG shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Left circumflex artery
,C. Left anterior descending artery
D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in the anterior precordial leads (V1-
V4) indicates an anterior wall myocardial infarction, which is typically
caused by occlusion of the left anterior descending artery (LAD). The
LAD supplies a large portion of the left ventricular myocardium, and
occlusion carries significant morbidity and mortality .
3. The patient's troponin I is elevated at 3.2 ng/mL (normal <0.04 ng/mL).
According to current ACC/AHA guidelines, what is the appropriate next
step?
A. Administer aspirin and observe
B. Transfer for percutaneous coronary intervention (PCI)
C. Administer thrombolytics immediately
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. Aspirin should be given immediately, but PCI is the
preferred reperfusion strategy .
4. A 68-year-old male presents with sudden onset of severe, tearing chest
pain that radiates to his back. He has a blood pressure of 160/50 mmHg in
the right arm and 110/70 mmHg in the left arm. What is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe,
,tearing chest or back pain with a blood pressure differential between
arms. Other findings may include aortic regurgitation murmur, pulse
deficit, or neurologic deficits. This is a life-threatening emergency
requiring immediate CT angiography .
5. Which imaging study is most appropriate for diagnosing aortic dissection?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Cardiac MRI
Answer: C. CT angiography of the chest
Rationale: CT angiography of the chest is the preferred initial imaging
study for suspected aortic dissection due to its rapid acquisition, high
sensitivity and specificity (approaching 100%), and ability to assess the
entire aorta from the root to the iliac arteries .
6. A 70-year-old female presents with dyspnea on exertion, orthopnea, and
peripheral edema. On auscultation, crackles are heard at both lung bases.
What is the most appropriate initial intervention?
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. After stabilization, guideline-directed
medical therapy (GDMT) should be initiated .
7. 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 less than ordinary
activity (e.g., walking one block, climbing one flight of stairs) causes
fatigue, palpitation, or dyspnea. This classification helps guide
treatment decisions .
8. A patient with heart failure has an ejection fraction of 30%. Which
medication has demonstrated mortality benefit in heart failure with reduced
ejection fraction (HFrEF)?
A. Metoprolol tartrate
B. Carvedilol
C. Atenolol
D. Propranolol
Answer: B. 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 .
9. A 55-year-old African American male has hypertension. According to
current 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
Clinical Diagnosis Chamberlain University
College of Nursing Actual Questions & Answers
with Rationales
Section 1: Cardiovascular System (Questions 1-40)
1. A 58-year-old male with a history of hypertension and smoking presents to
the emergency department with substernal chest pressure that started 2
hours ago while walking. The pain radiates to his left arm and jaw, and he
reports diaphoresis and nausea. His blood pressure is 155/95 mmHg, heart
rate 110 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 for diagnosis, the ECG provides
immediate actionable information for time-sensitive interventions .
2. The 12-lead ECG shows ST-segment elevation in leads V1-V4. Which
coronary artery is most likely occluded?
A. Right coronary artery
B. Left circumflex artery
,C. Left anterior descending artery
D. Posterior descending artery
Answer: C. Left anterior descending artery
Rationale: ST-segment elevation in the anterior precordial leads (V1-
V4) indicates an anterior wall myocardial infarction, which is typically
caused by occlusion of the left anterior descending artery (LAD). The
LAD supplies a large portion of the left ventricular myocardium, and
occlusion carries significant morbidity and mortality .
3. The patient's troponin I is elevated at 3.2 ng/mL (normal <0.04 ng/mL).
According to current ACC/AHA guidelines, what is the appropriate next
step?
A. Administer aspirin and observe
B. Transfer for percutaneous coronary intervention (PCI)
C. Administer thrombolytics immediately
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. Aspirin should be given immediately, but PCI is the
preferred reperfusion strategy .
4. A 68-year-old male presents with sudden onset of severe, tearing chest
pain that radiates to his back. He has a blood pressure of 160/50 mmHg in
the right arm and 110/70 mmHg in the left arm. What is the most likely
diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Answer: C. Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe,
,tearing chest or back pain with a blood pressure differential between
arms. Other findings may include aortic regurgitation murmur, pulse
deficit, or neurologic deficits. This is a life-threatening emergency
requiring immediate CT angiography .
5. Which imaging study is most appropriate for diagnosing aortic dissection?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Cardiac MRI
Answer: C. CT angiography of the chest
Rationale: CT angiography of the chest is the preferred initial imaging
study for suspected aortic dissection due to its rapid acquisition, high
sensitivity and specificity (approaching 100%), and ability to assess the
entire aorta from the root to the iliac arteries .
6. A 70-year-old female presents with dyspnea on exertion, orthopnea, and
peripheral edema. On auscultation, crackles are heard at both lung bases.
What is the most appropriate initial intervention?
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. After stabilization, guideline-directed
medical therapy (GDMT) should be initiated .
7. 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 less than ordinary
activity (e.g., walking one block, climbing one flight of stairs) causes
fatigue, palpitation, or dyspnea. This classification helps guide
treatment decisions .
8. A patient with heart failure has an ejection fraction of 30%. Which
medication has demonstrated mortality benefit in heart failure with reduced
ejection fraction (HFrEF)?
A. Metoprolol tartrate
B. Carvedilol
C. Atenolol
D. Propranolol
Answer: B. 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 .
9. A 55-year-old African American male has hypertension. According to
current 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
