Adult-Gerontology Acute Care Nurse Practitioner Actual
Certification Review Cardiology Latest 2025 Real
Assessment Exam Graded A+ Complete Questions Fully
Solved 100% with Rationales
. A 50-year-old male patient was admitted to the hospital 7 days ago after a diagnosis of inferior
wall myocardial infarction. Today he complains of new pleuritic chest pain that is relieved by
leaning forward. The patient's physical exam was unremarkable. What is your next step in
management?
1. Echocardiograph.
2. Chest x-ray.
3. Electrocardiogram.
4. Sputum culture.
3. Electrocardiogram.
Rationale: One of the complications of myocardial infarction (MI) is pericarditis, which can happen
within a week after MI. This presents as chest pain relieved by leaning forward and is diagnosed by
diffuse ST elevation in all leads.
1. A 55-year-old male patient was admitted to the hospital after diagnosis of unstable angina; he
underwent percutaneous transcutaneous angiography 1 day ago. Now the plan for this patient is
discharge. When can this patient drive his car?
1. After 2 weeks.
2. Immediately after discharge.
3. After 1 week.
4. After 1 month.
3. After 1 week.
Rationale: The patient who underwent percutaneous coronary intervention (PCI) because of angina
symptoms can drive a car 1 week after PCI according to the latest guideline, but if he underwent
PCI because of myocardial infarction he needs at least 3 weeks to recover before driving a car.
,2. A 50-year-old female patient was admitted to the coronary care unit 3 days ago because of
inferior wall myocardial infarction. She is now discharged on clopidogrel. What is the mechanism
of action of this drug?
1. Antiinflammatory effect.
2. Inhibit cyclooxygenase pathway.
3. Glycoprotein IIB/IIIa receptor antagonist.
4. Adenosine diphosphate receptor antagonist.
4. Adenosine diphosphate receptor antagonist.
Rationale: Clopidogrel works as antagonist to the adenosine diphosphate receptor, whereas aspirin
inhibits platelet aggregation through inhibition of the cyclooxygenase pathway.
3. A 60-year-old male patient presented to the emergency department with chest pain radiating to
his left arm. On physical exam, blood pressure is 120/85 mmHg and pulse is 54 beats/min. Lung
and cardiac exams are clear. Electrocardiogram shows type 2 heart block. Which of the following
arteries is occluded?
1. Left coronary artery.
2. Right coronary artery.
3. Circumflex artery.
4. Left anterior descending.
2. Right coronary artery.
Rationale: The right coronary artery (RCA) supplies the atrioventricular (AV) node, so when the
RCA is occluded both the right ventricle and AV node will be affected, which can lead to heart
block.
4. A 66-year-old male patient with a history of hypertension and dyslipidemia was diagnosed with
myocardial infarction 1 week ago. Today he starts feeling short of breath and is having
palpitations. On physical exam, blood pressure is 110/75 mmHg and pulse is 120 beats/min and is
irregularly irregular. Cardiac exam revealed holosystolic murmur. Which is the cause of this
murmur and the patient's symptoms?
1. Aortic valve stenosis.
2. Mitral valve stenosis.
,3. Tricuspid regurgitation.
4. Mitral valve regurgitation.
4. Mitral valve regurgitation
Rationale: One of the complications of myocardial infarction is rupture of the papillary muscle,
which can lead to mitral valve regurgitation and pulmonary edema.
5. A 61-year-old male patient with a known history of hypertension visits his nurse practitioner for
routine follow-up. On physical exam, his blood pressure is 180/100 mmHg and pulse is 80
beats/min. Lung auscultation revealed bibasilar crackles. Which of the following is the pathology
for this patient?
1. Left ventricular hypertrophy.
2. Aortic valve stenosis.
3. Pulmonary hypertension.
4. Mitral valve regurgitation.
1. Left ventricular hypertrophy
Rationale: This patient has signs of left ventricular heart failure, which is a complication from
hypertension (HTN). HTN leads to left ventricular hypertrophy, leading to increased afterload, so
the lung will be congested.
6. An 80-year-old male patient with no past medical history presents to his nurse practitioner for a
routine exam. On physical exam, his blood pressure is 180/80 mmHg and pulse is 80 beats/min.
The other exams are unremarkable. Which of the following is the drug of choice for this patient?
1. Enalapril.
2. Thiazide diuretic.
3. Bisoprolol.
4. Furosemide.
2. Thiazide diuretic.
Rationale: This gentleman has isolated hypertension, which has high risk in elderly people. The
drug of choice for this patient is either a calcium channel blocker or a diuretic.
, 7. A 60-year-old woman with a history of hypertension and dyslipidemia presented to the
emergency department because of chest pain that radiated to her left arm one hour ago. She also
has nausea and diaphoresis. On physical exam, her blood pressure is 120/80 mmHg and her pulse
is 90 beats/min; otherwise her exam is unremarkable. Which of the following is most specific for
the patient's diagnosis?
1. ST elevation in electrocardiogram.
2. Change in Q wave.
3. Akinesia in echocardiograph.
4. Elevated cardiac enzymes.
2. Change in Q wave.
Rationale: The most specific change related to myocardial infarction is change of the Q wave. ST
elevation can happen with multiple diseases. Also, cardiac enzymes can increase in several
diseases.
8. A 50-year-old female patient presented with chest pain that began 30 minutes ago not relieved
by rest and associated with diaphoresis. On exam, her blood pressure is 120/80 mmHg and pulse is
120 beats/min; otherwise her exam is unremarkable. Electrocardiogram (ECG) shows ST elevation.
What is the next step of management?
1. Echocardiograph.
2. Cardiac enzymes.
3. Exercise ECG.
4. Percutaneous coronary intervention.
4. Percutaneous coronary intervention.
Rationale: The patient suffered from myocardial infarction, which is confirmed by
electrocardiogram changes. The next step in such cases according to guidelines is either
percutaneous coronary intervention PCI or thrombolysis.
9. A 60-year-old male patient with previous history of myocardial infarction (MI) 3 years ago is on
aspirin (81 mg) and enalapril. His cholesterol level is 6 mmol/L. Which of the following can reduce
the risk of a second MI?
1. Warfarin.
Certification Review Cardiology Latest 2025 Real
Assessment Exam Graded A+ Complete Questions Fully
Solved 100% with Rationales
. A 50-year-old male patient was admitted to the hospital 7 days ago after a diagnosis of inferior
wall myocardial infarction. Today he complains of new pleuritic chest pain that is relieved by
leaning forward. The patient's physical exam was unremarkable. What is your next step in
management?
1. Echocardiograph.
2. Chest x-ray.
3. Electrocardiogram.
4. Sputum culture.
3. Electrocardiogram.
Rationale: One of the complications of myocardial infarction (MI) is pericarditis, which can happen
within a week after MI. This presents as chest pain relieved by leaning forward and is diagnosed by
diffuse ST elevation in all leads.
1. A 55-year-old male patient was admitted to the hospital after diagnosis of unstable angina; he
underwent percutaneous transcutaneous angiography 1 day ago. Now the plan for this patient is
discharge. When can this patient drive his car?
1. After 2 weeks.
2. Immediately after discharge.
3. After 1 week.
4. After 1 month.
3. After 1 week.
Rationale: The patient who underwent percutaneous coronary intervention (PCI) because of angina
symptoms can drive a car 1 week after PCI according to the latest guideline, but if he underwent
PCI because of myocardial infarction he needs at least 3 weeks to recover before driving a car.
,2. A 50-year-old female patient was admitted to the coronary care unit 3 days ago because of
inferior wall myocardial infarction. She is now discharged on clopidogrel. What is the mechanism
of action of this drug?
1. Antiinflammatory effect.
2. Inhibit cyclooxygenase pathway.
3. Glycoprotein IIB/IIIa receptor antagonist.
4. Adenosine diphosphate receptor antagonist.
4. Adenosine diphosphate receptor antagonist.
Rationale: Clopidogrel works as antagonist to the adenosine diphosphate receptor, whereas aspirin
inhibits platelet aggregation through inhibition of the cyclooxygenase pathway.
3. A 60-year-old male patient presented to the emergency department with chest pain radiating to
his left arm. On physical exam, blood pressure is 120/85 mmHg and pulse is 54 beats/min. Lung
and cardiac exams are clear. Electrocardiogram shows type 2 heart block. Which of the following
arteries is occluded?
1. Left coronary artery.
2. Right coronary artery.
3. Circumflex artery.
4. Left anterior descending.
2. Right coronary artery.
Rationale: The right coronary artery (RCA) supplies the atrioventricular (AV) node, so when the
RCA is occluded both the right ventricle and AV node will be affected, which can lead to heart
block.
4. A 66-year-old male patient with a history of hypertension and dyslipidemia was diagnosed with
myocardial infarction 1 week ago. Today he starts feeling short of breath and is having
palpitations. On physical exam, blood pressure is 110/75 mmHg and pulse is 120 beats/min and is
irregularly irregular. Cardiac exam revealed holosystolic murmur. Which is the cause of this
murmur and the patient's symptoms?
1. Aortic valve stenosis.
2. Mitral valve stenosis.
,3. Tricuspid regurgitation.
4. Mitral valve regurgitation.
4. Mitral valve regurgitation
Rationale: One of the complications of myocardial infarction is rupture of the papillary muscle,
which can lead to mitral valve regurgitation and pulmonary edema.
5. A 61-year-old male patient with a known history of hypertension visits his nurse practitioner for
routine follow-up. On physical exam, his blood pressure is 180/100 mmHg and pulse is 80
beats/min. Lung auscultation revealed bibasilar crackles. Which of the following is the pathology
for this patient?
1. Left ventricular hypertrophy.
2. Aortic valve stenosis.
3. Pulmonary hypertension.
4. Mitral valve regurgitation.
1. Left ventricular hypertrophy
Rationale: This patient has signs of left ventricular heart failure, which is a complication from
hypertension (HTN). HTN leads to left ventricular hypertrophy, leading to increased afterload, so
the lung will be congested.
6. An 80-year-old male patient with no past medical history presents to his nurse practitioner for a
routine exam. On physical exam, his blood pressure is 180/80 mmHg and pulse is 80 beats/min.
The other exams are unremarkable. Which of the following is the drug of choice for this patient?
1. Enalapril.
2. Thiazide diuretic.
3. Bisoprolol.
4. Furosemide.
2. Thiazide diuretic.
Rationale: This gentleman has isolated hypertension, which has high risk in elderly people. The
drug of choice for this patient is either a calcium channel blocker or a diuretic.
, 7. A 60-year-old woman with a history of hypertension and dyslipidemia presented to the
emergency department because of chest pain that radiated to her left arm one hour ago. She also
has nausea and diaphoresis. On physical exam, her blood pressure is 120/80 mmHg and her pulse
is 90 beats/min; otherwise her exam is unremarkable. Which of the following is most specific for
the patient's diagnosis?
1. ST elevation in electrocardiogram.
2. Change in Q wave.
3. Akinesia in echocardiograph.
4. Elevated cardiac enzymes.
2. Change in Q wave.
Rationale: The most specific change related to myocardial infarction is change of the Q wave. ST
elevation can happen with multiple diseases. Also, cardiac enzymes can increase in several
diseases.
8. A 50-year-old female patient presented with chest pain that began 30 minutes ago not relieved
by rest and associated with diaphoresis. On exam, her blood pressure is 120/80 mmHg and pulse is
120 beats/min; otherwise her exam is unremarkable. Electrocardiogram (ECG) shows ST elevation.
What is the next step of management?
1. Echocardiograph.
2. Cardiac enzymes.
3. Exercise ECG.
4. Percutaneous coronary intervention.
4. Percutaneous coronary intervention.
Rationale: The patient suffered from myocardial infarction, which is confirmed by
electrocardiogram changes. The next step in such cases according to guidelines is either
percutaneous coronary intervention PCI or thrombolysis.
9. A 60-year-old male patient with previous history of myocardial infarction (MI) 3 years ago is on
aspirin (81 mg) and enalapril. His cholesterol level is 6 mmol/L. Which of the following can reduce
the risk of a second MI?
1. Warfarin.
