NURS 681 Virtual SIM Lab: Alex R. Kayan – Complete
Simulation Exam Latest Fall 2025/26 | West Coast
University | 130 Questions & Answers | Grade A+
Question 1
Alex R. Kayan reports chest pain that started acutely. What is the most appropriate
initial question to clarify the chief complaint?
A. “Are you having any nausea?”
B. “Can you describe the quality and location of your chest pain?”
C. “Did you take any medication at home?”
D. “Is your family history significant for heart disease?”
Answer: B. “Can you describe the quality and location of your chest pain?”
Rationale: Characterizing the pain (e.g., pressure, crushing, sharp) helps
differentiate cardiac from non-cardiac causes.
Question 2
Alex’s blood pressure is 76/65 mmHg. This finding is classified as:
A. Normal
B. Elevated
C. Hypotension
D. Hypertensive urgency
Answer: C. Hypotension
Rationale: BP <90/60 mmHg is considered hypotension and can indicate
cardiogenic shock or dehydration.
Question 3
Heart rate is 50 bpm. Which term describes this rhythm?
A. Tachycardia
B. Bradycardia
C. Normal sinus rhythm
D. Atrial fibrillation
,Answer: B. Bradycardia
Rationale: Normal adult resting HR is 60-100 bpm; <60 bpm is bradycardia.
Question 4
Alex’s respiratory rate is 22 breaths/min. This is:
A. Normal
B. Bradypnea
C. Tachypnea
D. Apnea
Answer: C. Tachypnea
Rationale: Normal RR is 12-20/min; >20/min is tachypnea, which may compensate
for metabolic acidosis or hypoxia.
Question 5
Temperature is 97°F (36.1°C). This is:
A. Febrile
B. Hypothermic
C. Within normal range
D. Hyperthermic
Answer: C. Within normal range
Rationale: Normal body temperature ranges from 97°F to 99°F.
Question 6
The patient reports being a smoker. Which additional question is most important?
A. “How many packs per day and for how many years?”
B. “Do you smoke cigarettes or cigars?”
C. “Have you tried to quit?”
D. “Does your spouse smoke?”
Answer: A. “How many packs per day and for how many years?”
Rationale: Pack-years quantify smoking history and cardiovascular risk.
,Question 7
Family history reveals father died of a heart attack. This increases Alex’s risk for:
A. Stroke
B. Coronary artery disease (CAD)
C. Diabetes
D. Chronic kidney disease
Answer: B. Coronary artery disease (CAD)
Rationale: Premature CAD in a first-degree relative is a strong risk factor.
Question 8
When asking about associated symptoms for chest pain, which must be assessed?
(Select all that apply)
A. Diaphoresis
B. Dizziness
C. Shortness of breath
D. Nausea
E. All of the above
Answer: E. All of the above
Rationale: These symptoms are common in acute coronary syndrome (ACS).
Question 9
The patient’s blood pressure and heart rate suggest possible:
A. Anxiety attack
B. Cardiogenic shock
C. Pulmonary embolism
D. Costochondritis
Answer: B. Cardiogenic shock
Rationale: Hypotension with bradycardia can result from reduced cardiac output,
e.g., acute MI.
Question 10
Which medication class should the nurse ask about during medication
reconciliation for chest pain?
, A. Antihypertensives
B. Nitrates
C. Antiplatelet agents
D. All of the above
Answer: D. All of the above
Rationale: Many cardiac medications affect hemodynamics and bleeding risk.
SECTION 2: PHYSICAL ASSESSMENT & VITAL SIGNS
INTERPRETATION
Question 11
Alex’s BP 76/65 and HR 50 would place this patient in which triage category?
A. Emergent (immediate life threat)
B. Urgent (should be seen within 30-60 min)
C. Non-urgent
D. Minor
Answer: A. Emergent (immediate life threat)
Rationale: Hypotension with bradycardia can rapidly lead to cardiac arrest.
Question 12
A 12-lead EKG is ordered. Which finding is most concerning for STEMI?
A. ST-segment elevation in two contiguous leads
B. Prolonged PR interval
C. Narrow QRS complex
D. U waves
Answer: A. ST-segment elevation in two contiguous leads
Rationale: ST elevation indicates transmural myocardial injury.
Question 13
Cardiac biomarkers (troponin) are drawn. An elevated troponin indicates:
A. Myocardial necrosis
B. Dehydration
Simulation Exam Latest Fall 2025/26 | West Coast
University | 130 Questions & Answers | Grade A+
Question 1
Alex R. Kayan reports chest pain that started acutely. What is the most appropriate
initial question to clarify the chief complaint?
A. “Are you having any nausea?”
B. “Can you describe the quality and location of your chest pain?”
C. “Did you take any medication at home?”
D. “Is your family history significant for heart disease?”
Answer: B. “Can you describe the quality and location of your chest pain?”
Rationale: Characterizing the pain (e.g., pressure, crushing, sharp) helps
differentiate cardiac from non-cardiac causes.
Question 2
Alex’s blood pressure is 76/65 mmHg. This finding is classified as:
A. Normal
B. Elevated
C. Hypotension
D. Hypertensive urgency
Answer: C. Hypotension
Rationale: BP <90/60 mmHg is considered hypotension and can indicate
cardiogenic shock or dehydration.
Question 3
Heart rate is 50 bpm. Which term describes this rhythm?
A. Tachycardia
B. Bradycardia
C. Normal sinus rhythm
D. Atrial fibrillation
,Answer: B. Bradycardia
Rationale: Normal adult resting HR is 60-100 bpm; <60 bpm is bradycardia.
Question 4
Alex’s respiratory rate is 22 breaths/min. This is:
A. Normal
B. Bradypnea
C. Tachypnea
D. Apnea
Answer: C. Tachypnea
Rationale: Normal RR is 12-20/min; >20/min is tachypnea, which may compensate
for metabolic acidosis or hypoxia.
Question 5
Temperature is 97°F (36.1°C). This is:
A. Febrile
B. Hypothermic
C. Within normal range
D. Hyperthermic
Answer: C. Within normal range
Rationale: Normal body temperature ranges from 97°F to 99°F.
Question 6
The patient reports being a smoker. Which additional question is most important?
A. “How many packs per day and for how many years?”
B. “Do you smoke cigarettes or cigars?”
C. “Have you tried to quit?”
D. “Does your spouse smoke?”
Answer: A. “How many packs per day and for how many years?”
Rationale: Pack-years quantify smoking history and cardiovascular risk.
,Question 7
Family history reveals father died of a heart attack. This increases Alex’s risk for:
A. Stroke
B. Coronary artery disease (CAD)
C. Diabetes
D. Chronic kidney disease
Answer: B. Coronary artery disease (CAD)
Rationale: Premature CAD in a first-degree relative is a strong risk factor.
Question 8
When asking about associated symptoms for chest pain, which must be assessed?
(Select all that apply)
A. Diaphoresis
B. Dizziness
C. Shortness of breath
D. Nausea
E. All of the above
Answer: E. All of the above
Rationale: These symptoms are common in acute coronary syndrome (ACS).
Question 9
The patient’s blood pressure and heart rate suggest possible:
A. Anxiety attack
B. Cardiogenic shock
C. Pulmonary embolism
D. Costochondritis
Answer: B. Cardiogenic shock
Rationale: Hypotension with bradycardia can result from reduced cardiac output,
e.g., acute MI.
Question 10
Which medication class should the nurse ask about during medication
reconciliation for chest pain?
, A. Antihypertensives
B. Nitrates
C. Antiplatelet agents
D. All of the above
Answer: D. All of the above
Rationale: Many cardiac medications affect hemodynamics and bleeding risk.
SECTION 2: PHYSICAL ASSESSMENT & VITAL SIGNS
INTERPRETATION
Question 11
Alex’s BP 76/65 and HR 50 would place this patient in which triage category?
A. Emergent (immediate life threat)
B. Urgent (should be seen within 30-60 min)
C. Non-urgent
D. Minor
Answer: A. Emergent (immediate life threat)
Rationale: Hypotension with bradycardia can rapidly lead to cardiac arrest.
Question 12
A 12-lead EKG is ordered. Which finding is most concerning for STEMI?
A. ST-segment elevation in two contiguous leads
B. Prolonged PR interval
C. Narrow QRS complex
D. U waves
Answer: A. ST-segment elevation in two contiguous leads
Rationale: ST elevation indicates transmural myocardial injury.
Question 13
Cardiac biomarkers (troponin) are drawn. An elevated troponin indicates:
A. Myocardial necrosis
B. Dehydration
