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NR 667 WEEK 1 REVIEW: 250 QUIZ
QUESTIONS AND CORRECT ANSWERS FNP
Capstone Practicum and Intensive – Clinical
Evaluation Assessment (CEA) Preparation Latest
Update 2026 – Evidence-Based Practice
Guidelines
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–30)
1. A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and
shortness of breath. His ECG shows ST-segment elevation. What is the initial
management response?
A) Start intravenous heparin
B) Administer nitroglycerin sublingually
C) Perform immediate coronary angiography
D) Administer aspirin and call for emergency medical services
Answer: D
*Rationale: For suspected ST-segment elevation myocardial infarction (STEMI),
immediate administration of aspirin (325 mg chewed) and activation of emergency
medical services for transport to a PCI-capable hospital is the priority. Time to
reperfusion is critical. Nitroglycerin may be given if no hypotension, but EMS activation
comes first. *
2. Effective long-term treatment of systolic heart failure with reduced ejection fraction
(HFrEF) should include which of the following?
A) Prescribing valsartan/sacubitril (Entresto) unless contraindicated
B) Prescribing 500 mL fluid bolus for hypotension
C) Auscultating lung sounds for rhonchi
D) Prescribing midazolam to aid with air hunger
Answer: A
Rationale: Angiotensin receptor-neprilysin inhibition (ARNI) with valsartan/sacubitril is
considered goal-directed therapy for patients with HFrEF based on evidence from the
PARADIGM-HF trial. It reduces mortality and hospitalizations compared to ACE
inhibitors alone.
,2|Page
3. An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
A) Deep vein thrombosis
B) Acute arterial occlusion
C) Cellulitis
D) Peripheral artery disease
Answer: B
Rationale: The "six Ps" of acute arterial occlusion—pain, pallor, pulselessness, paresthesia,
paralysis, poikilothermia—along with a history of atrial fibrillation (embolic source)
suggest acute arterial embolism. This is a vascular emergency requiring immediate
surgical consultation.
4. A patient presents with bradycardia, severe nausea, and substernal pain. STEMI is
identified on EKG. Which region of the heart is most likely involved?
A) Lateral Wall
B) Anterior Wall
C) Inferior Wall
D) Septal Wall
Answer: C
Rationale: Inferior wall MI (usually right coronary artery territory) commonly presents
with bradycardia (due to vagal stimulation or SA/AV node ischemia), nausea/vomiting,
and substernal pain. Dyspepsia is common in RCA territory injury.
5. What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
A) Increase in libido
B) Reduction in cardiac output
C) Baseline reduction of blood pressure
D) Potential increase in ejection fraction
Answer: D
*Rationale: Carvedilol has been shown to improve left ventricular ejection fraction (LVEF)
in patients with HFrEF due to its beta-blocking and antioxidant properties. Unlike
metoprolol, carvedilol provides additional alpha-1 blockade, which may contribute to
reverse remodeling. *
6. The inability to fully relax the myocardium during relaxation is a trademark of which
diagnosis?
A) Systolic heart failure
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B) Diastolic dysfunction
C) Grade 2 systolic dysfunction
D) Grade 3 systolic dysfunction
Answer: B
Rationale: Diastolic dysfunction is defined by impaired ventricular relaxation and filling
during diastole, while systolic function is preserved. Patients typically have normal or
near-normal ejection fraction but elevated filling pressures.
7. A patient has been complaining of palpitations for the past week. EKG identifies atrial
fibrillation with heart rate of 122 bpm. What is your next order?
A) Administer 5 mg of warfarin
B) Order a stat transthoracic echocardiogram and prepare for inpatient evaluation
C) Apply a Holter monitor
D) Administer 150 mg of amiodarone IV bolus
Answer: B
*Rationale: New-onset atrial fibrillation with rapid ventricular response requires
evaluation for underlying structural heart disease and thrombus before rhythm or rate
control is initiated. A TTE is essential to assess ejection fraction, valvular disease, and left
atrial size. Patients with AF of unknown duration or >48 hours require anticoagulation
before cardioversion. *
8. An older adult with diabetes mellitus presents with leg cramps that worsen when
walking and subside with rest. The nurse practitioner knows that this patient needs a
workup for:
A) Deep vein thrombosis
B) Benign nocturnal leg cramps
C) Intermittent claudication
D) Popliteal aneurysm
Answer: C
*Rationale: Intermittent claudication is reproducible ischemic leg pain that occurs with
exercise and resolves within 2-5 minutes of rest. It is the classic symptom of peripheral
arterial disease (PAD), for which diabetes is a major risk factor. Ankle-brachial index
(ABI) is the initial noninvasive diagnostic test. *
9. A 65-year-old woman presents for follow-up. She is a smoker with controlled
hypertension. Her mother died at age 40 from a heart attack. Fasting lipid profile:
cholesterol 240 mg/dL, HDL 30, LDL 200. In addition to starting therapeutic lifestyle
changes, the nurse practitioner should:
, 4|Page
A) Start a statin drug
B) Start a cholesterol absorption inhibitor
C) Start low-dose aspirin
D) Start a bile acid sequestrant
Answer: A
Rationale: This patient has multiple ASCVD risk factors (active smoker, hypertension,
family history of premature coronary disease in a female first-degree relative) and is far
from LDL goal. Statin therapy provides the most aggressive lipid-lowering and mortality
benefit.
10. Which of the following is best performed to assess the risk for fall in an 88-year-old
adult?
A) PHQ-2 questionnaire
B) Get up and go test
C) Clock-drawing test
D) Global screening assessment
Answer: B
Rationale: The "Get Up and Go" test is a simple, validated screening tool for fall risk. The
patient rises from a chair, walks 10 feet, turns, returns, and sits. Difficulty or unsteadiness
indicates increased fall risk.
11. A patient with a diagnosis of peripheral arterial disease asks what is considered a non-
modifiable risk factor. Which of the following is the best Answer?
A) Smoking less cigarettes
B) Older age
C) Obesity
D) Uncontrolled hypertension
Answer: B
Rationale: Non-modifiable risk factors are those that cannot be changed by the patient:
age, sex, genetics, and family history. Modifiable risk factors include smoking,
hypertension, hyperlipidemia, diabetes, and obesity.
12. As a follow-up from hospitalization, an adult patient presents with ankle edema.
Which medication is the most likely cause?
A) Nebivolol
B) HCTZ
C) Metformin
D) Norvasc (amlodipine)
NR 667 WEEK 1 REVIEW: 250 QUIZ
QUESTIONS AND CORRECT ANSWERS FNP
Capstone Practicum and Intensive – Clinical
Evaluation Assessment (CEA) Preparation Latest
Update 2026 – Evidence-Based Practice
Guidelines
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–30)
1. A 45-year-old man presents with chest pain radiating to the left arm, diaphoresis, and
shortness of breath. His ECG shows ST-segment elevation. What is the initial
management response?
A) Start intravenous heparin
B) Administer nitroglycerin sublingually
C) Perform immediate coronary angiography
D) Administer aspirin and call for emergency medical services
Answer: D
*Rationale: For suspected ST-segment elevation myocardial infarction (STEMI),
immediate administration of aspirin (325 mg chewed) and activation of emergency
medical services for transport to a PCI-capable hospital is the priority. Time to
reperfusion is critical. Nitroglycerin may be given if no hypotension, but EMS activation
comes first. *
2. Effective long-term treatment of systolic heart failure with reduced ejection fraction
(HFrEF) should include which of the following?
A) Prescribing valsartan/sacubitril (Entresto) unless contraindicated
B) Prescribing 500 mL fluid bolus for hypotension
C) Auscultating lung sounds for rhonchi
D) Prescribing midazolam to aid with air hunger
Answer: A
Rationale: Angiotensin receptor-neprilysin inhibition (ARNI) with valsartan/sacubitril is
considered goal-directed therapy for patients with HFrEF based on evidence from the
PARADIGM-HF trial. It reduces mortality and hospitalizations compared to ACE
inhibitors alone.
,2|Page
3. An 80-year-old man with a history of atrial fibrillation presents with sudden-onset
unilateral leg pain and pallor. What is the most likely diagnosis?
A) Deep vein thrombosis
B) Acute arterial occlusion
C) Cellulitis
D) Peripheral artery disease
Answer: B
Rationale: The "six Ps" of acute arterial occlusion—pain, pallor, pulselessness, paresthesia,
paralysis, poikilothermia—along with a history of atrial fibrillation (embolic source)
suggest acute arterial embolism. This is a vascular emergency requiring immediate
surgical consultation.
4. A patient presents with bradycardia, severe nausea, and substernal pain. STEMI is
identified on EKG. Which region of the heart is most likely involved?
A) Lateral Wall
B) Anterior Wall
C) Inferior Wall
D) Septal Wall
Answer: C
Rationale: Inferior wall MI (usually right coronary artery territory) commonly presents
with bradycardia (due to vagal stimulation or SA/AV node ischemia), nausea/vomiting,
and substernal pain. Dyspepsia is common in RCA territory injury.
5. What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
A) Increase in libido
B) Reduction in cardiac output
C) Baseline reduction of blood pressure
D) Potential increase in ejection fraction
Answer: D
*Rationale: Carvedilol has been shown to improve left ventricular ejection fraction (LVEF)
in patients with HFrEF due to its beta-blocking and antioxidant properties. Unlike
metoprolol, carvedilol provides additional alpha-1 blockade, which may contribute to
reverse remodeling. *
6. The inability to fully relax the myocardium during relaxation is a trademark of which
diagnosis?
A) Systolic heart failure
,3|Page
B) Diastolic dysfunction
C) Grade 2 systolic dysfunction
D) Grade 3 systolic dysfunction
Answer: B
Rationale: Diastolic dysfunction is defined by impaired ventricular relaxation and filling
during diastole, while systolic function is preserved. Patients typically have normal or
near-normal ejection fraction but elevated filling pressures.
7. A patient has been complaining of palpitations for the past week. EKG identifies atrial
fibrillation with heart rate of 122 bpm. What is your next order?
A) Administer 5 mg of warfarin
B) Order a stat transthoracic echocardiogram and prepare for inpatient evaluation
C) Apply a Holter monitor
D) Administer 150 mg of amiodarone IV bolus
Answer: B
*Rationale: New-onset atrial fibrillation with rapid ventricular response requires
evaluation for underlying structural heart disease and thrombus before rhythm or rate
control is initiated. A TTE is essential to assess ejection fraction, valvular disease, and left
atrial size. Patients with AF of unknown duration or >48 hours require anticoagulation
before cardioversion. *
8. An older adult with diabetes mellitus presents with leg cramps that worsen when
walking and subside with rest. The nurse practitioner knows that this patient needs a
workup for:
A) Deep vein thrombosis
B) Benign nocturnal leg cramps
C) Intermittent claudication
D) Popliteal aneurysm
Answer: C
*Rationale: Intermittent claudication is reproducible ischemic leg pain that occurs with
exercise and resolves within 2-5 minutes of rest. It is the classic symptom of peripheral
arterial disease (PAD), for which diabetes is a major risk factor. Ankle-brachial index
(ABI) is the initial noninvasive diagnostic test. *
9. A 65-year-old woman presents for follow-up. She is a smoker with controlled
hypertension. Her mother died at age 40 from a heart attack. Fasting lipid profile:
cholesterol 240 mg/dL, HDL 30, LDL 200. In addition to starting therapeutic lifestyle
changes, the nurse practitioner should:
, 4|Page
A) Start a statin drug
B) Start a cholesterol absorption inhibitor
C) Start low-dose aspirin
D) Start a bile acid sequestrant
Answer: A
Rationale: This patient has multiple ASCVD risk factors (active smoker, hypertension,
family history of premature coronary disease in a female first-degree relative) and is far
from LDL goal. Statin therapy provides the most aggressive lipid-lowering and mortality
benefit.
10. Which of the following is best performed to assess the risk for fall in an 88-year-old
adult?
A) PHQ-2 questionnaire
B) Get up and go test
C) Clock-drawing test
D) Global screening assessment
Answer: B
Rationale: The "Get Up and Go" test is a simple, validated screening tool for fall risk. The
patient rises from a chair, walks 10 feet, turns, returns, and sits. Difficulty or unsteadiness
indicates increased fall risk.
11. A patient with a diagnosis of peripheral arterial disease asks what is considered a non-
modifiable risk factor. Which of the following is the best Answer?
A) Smoking less cigarettes
B) Older age
C) Obesity
D) Uncontrolled hypertension
Answer: B
Rationale: Non-modifiable risk factors are those that cannot be changed by the patient:
age, sex, genetics, and family history. Modifiable risk factors include smoking,
hypertension, hyperlipidemia, diabetes, and obesity.
12. As a follow-up from hospitalization, an adult patient presents with ankle edema.
Which medication is the most likely cause?
A) Nebivolol
B) HCTZ
C) Metformin
D) Norvasc (amlodipine)
