NR 603 Week 4 APEA Predictor Exam
Review Questions and Answers
INSTRUCTIONS
● This comprehensive review guide contains practice questions for the
NR 603 Week 4 APEA Predictor Exam
● Questions are formatted as multiple choice
● Each question includes the correct answer and a detailed rationale
● Topics include: cardiovascular, endocrine, respiratory, infectious
disease, pharmacology, and advanced practice nursing concepts
SECTION 1: CARDIOVASCULAR KNOWLEDGE DOMAIN
Question 1
A 28-year-old patient presents with a grade 3 systolic murmur. Which
specific murmur characteristic necessitates an immediate referral to
cardiology?
A) A murmur that decreases with Valsalva
B) A fixed split S2
C) An early systolic click
D) Split S2 during inspiration
Answer: B) A fixed split S2
,Rationale: A fixed split S2 does not change with respiration and indicates
an underlying structural pathology, such as an atrial septal defect (ASD),
pulmonic stenosis, or mitral regurgitation. Normal physiological splits
disappear during expiration.
Question 2
Which class of medications is strictly contraindicated for a patient
diagnosed with heart failure with reduced ejection fraction (HFrEF) due to
its potential to worsen the condition?
A) ACE inhibitors
B) Beta-blockers
C) Non-dihydropyridine calcium channel blockers (e.g., Verapamil)
D) Loop diuretics
Answer: C) Non-dihydropyridine calcium channel blockers (e.g., Verapamil)
Rationale: Verapamil and Diltiazem exert negative inotropic effects that can
severely depress myocardial contractility, directly worsening heart failure.
Guideline-directed medical therapy mandates ACE inhibitors, beta-blockers,
and diuretics.
Question 3
A 75-year-old patient diagnosed with aortic stenosis asks what key
symptoms signal severe progression of the disease. The NP should
educate the patient on which classic triad?
A) Hemoptysis, claudication, and edema
B) Angina, syncope, and heart failure (dyspnea)
, C) Palpitations, bradycardia, and orthostatic hypotension
D) Headache, blurred vision, and tinnitus
Answer: B) Angina, syncope, and heart failure (dyspnea)
Rationale: The classic triad of worsening aortic stenosis includes angina
(increased myocardial oxygen demand), syncope (exertional drop in
cerebral perfusion), and dyspnea/heart failure (retrograde pulmonary
congestion).
Question 4
A patient with stage 3 chronic kidney disease (CKD) presents with an
elevated serum potassium level of 6.2 mEq/L. Which ECG finding is the
earliest indication of hyperkalemia?
A) Prominent U waves
B) Prolonged QT interval
C) Tall, peaked T waves
D) ST-segment depression
Answer: C) Tall, peaked T waves
Rationale: The earliest electrical manifestation of hyperkalemia is the
presence of narrow, tall, peaked T waves. Progressive elevation leads to PR
prolongation, QRS widening, and eventually a sine-wave pattern.
Question 5
A 45-year-old female presents with persistent blood pressure readings
averaging 148/94 mmHg despite lifestyle changes. Lab work reveals a
Review Questions and Answers
INSTRUCTIONS
● This comprehensive review guide contains practice questions for the
NR 603 Week 4 APEA Predictor Exam
● Questions are formatted as multiple choice
● Each question includes the correct answer and a detailed rationale
● Topics include: cardiovascular, endocrine, respiratory, infectious
disease, pharmacology, and advanced practice nursing concepts
SECTION 1: CARDIOVASCULAR KNOWLEDGE DOMAIN
Question 1
A 28-year-old patient presents with a grade 3 systolic murmur. Which
specific murmur characteristic necessitates an immediate referral to
cardiology?
A) A murmur that decreases with Valsalva
B) A fixed split S2
C) An early systolic click
D) Split S2 during inspiration
Answer: B) A fixed split S2
,Rationale: A fixed split S2 does not change with respiration and indicates
an underlying structural pathology, such as an atrial septal defect (ASD),
pulmonic stenosis, or mitral regurgitation. Normal physiological splits
disappear during expiration.
Question 2
Which class of medications is strictly contraindicated for a patient
diagnosed with heart failure with reduced ejection fraction (HFrEF) due to
its potential to worsen the condition?
A) ACE inhibitors
B) Beta-blockers
C) Non-dihydropyridine calcium channel blockers (e.g., Verapamil)
D) Loop diuretics
Answer: C) Non-dihydropyridine calcium channel blockers (e.g., Verapamil)
Rationale: Verapamil and Diltiazem exert negative inotropic effects that can
severely depress myocardial contractility, directly worsening heart failure.
Guideline-directed medical therapy mandates ACE inhibitors, beta-blockers,
and diuretics.
Question 3
A 75-year-old patient diagnosed with aortic stenosis asks what key
symptoms signal severe progression of the disease. The NP should
educate the patient on which classic triad?
A) Hemoptysis, claudication, and edema
B) Angina, syncope, and heart failure (dyspnea)
, C) Palpitations, bradycardia, and orthostatic hypotension
D) Headache, blurred vision, and tinnitus
Answer: B) Angina, syncope, and heart failure (dyspnea)
Rationale: The classic triad of worsening aortic stenosis includes angina
(increased myocardial oxygen demand), syncope (exertional drop in
cerebral perfusion), and dyspnea/heart failure (retrograde pulmonary
congestion).
Question 4
A patient with stage 3 chronic kidney disease (CKD) presents with an
elevated serum potassium level of 6.2 mEq/L. Which ECG finding is the
earliest indication of hyperkalemia?
A) Prominent U waves
B) Prolonged QT interval
C) Tall, peaked T waves
D) ST-segment depression
Answer: C) Tall, peaked T waves
Rationale: The earliest electrical manifestation of hyperkalemia is the
presence of narrow, tall, peaked T waves. Progressive elevation leads to PR
prolongation, QRS widening, and eventually a sine-wave pattern.
Question 5
A 45-year-old female presents with persistent blood pressure readings
averaging 148/94 mmHg despite lifestyle changes. Lab work reveals a
