NR603 FINAL EXAM REVIEW 2026 WITH
COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST
RECENT!!)
NR603 FINAL EXAM REVIEW
Advanced Clinical Diagnosis & Practice Across the Lifespan
Total Questions: 200
Format: Multiple Choice
Passing Score: 85% (170 correct)
Time Limit: 4 hours
Section 1: Cardiovascular Disorders (Questions 1–25)
1. A 58-year-old male presents with substernal chest pressure radiating to the
jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V2–V4. What
is the most appropriate immediate management?
A) Aspirin and discharge with cardiology follow-up
B) Aspirin, nitroglycerin, and transfer for percutaneous coronary
intervention (PCI)
C) Albuterol nebulizer
D) Oral anticoagulation
Answer: B
*Rationale: ST elevation in V2–V4 indicates anterior STEMI (LAD occlusion).
Immediate management includes aspirin (325 mg chewed), nitroglycerin (if
SBP >90), oxygen (if SpO2 <90%), morphine for pain, and emergent PCI
(door-to-balloon <90 minutes).*
,2. A 72-year-old woman reports episodic palpitations, dizziness, and
shortness of breath. ECG shows irregularly irregular rhythm with no P waves.
What is the most likely diagnosis?
A) Atrial flutter
B) Atrial fibrillation
C) Multifocal atrial tachycardia
D) Sinus arrhythmia
Answer: B
Rationale: Atrial fibrillation (AF) is characterized by absent P waves,
irregularly irregular ventricular response, and variable rate. CHA₂DS₂-VASc
score determines anticoagulation needs.
3. A patient with chronic heart failure (HFrEF) presents with worsening
dyspnea, jugular venous distension, and bilateral pedal edema. Which
medication class has been shown to reduce mortality in HFrEF?
A) Calcium channel blockers
B) Beta-blockers (carvedilol, metoprolol succinate)
C) Loop diuretics only
D) Alpha-blockers
Answer: B
*Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes
beta-blockers, ACE inhibitors/ARBs/ARNIs, aldosterone antagonists, and
SGLT2 inhibitors. Diuretics relieve symptoms but do not reduce mortality.*
4. A 45-year-old with hypertension and diabetes has a blood pressure of
150/92 mmHg. According to the 2017 ACC/AHA guideline, this is classified
as:
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
*Rationale: ACC/AHA: Normal <120/80; Elevated 120-129/<80; Stage 1 HTN
,130-139/80-89; Stage 2 HTN ≥140/90. This patient with diabetes should start
pharmacotherapy.*
5. A 68-year-old smoker presents with calf pain while walking that resolves
with rest. Dorsalis pedis pulses are diminished. What is the most likely
diagnosis?
A) Peripheral artery disease (PAD)
B) Deep vein thrombosis
C) Sciatica
D) Venous insufficiency
Answer: A
*Rationale: Intermittent claudication (pain with exercise, relieved by rest) is
classic for PAD. Ankle-brachial index (ABI) <0.90 confirms. Smoking
cessation and antiplatelet therapy are key.*
6. A patient with aortic stenosis may present with which triad of symptoms?
A) Syncope, dyspnea, chest pain
B) Palpitations, fever, weight loss
C) Edema, fatigue, cough
D) Headache, epistaxis, anxiety
Answer: A
Rationale: Classic triad of severe aortic stenosis: angina (chest pain), syncope
(exertional), and heart failure (dyspnea). Murmur = crescendo-decrescendo,
radiating to carotids.
7. An ECG shows a prolonged PR interval (>200 ms) with consistent
conduction of each P wave to a QRS. This is:
A) First-degree AV block
B) Second-degree Mobitz I
C) Second-degree Mobitz II
D) Third-degree AV block
Answer: A
*Rationale: First-degree AV block is PR >200 ms with 1:1 conduction. Usually
benign but can progress. No treatment needed unless symptomatic.*
, 8. A 55-year-old with acute onset of severe, tearing chest pain radiating to
the back has a blood pressure of 160/100 mmHg in the right arm and 110/70
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection presents with tearing chest pain, pulse
differential, and possible neurological deficits. Immediate management
includes beta-blockers (reduce shearing force) and surgical consultation.
9. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is
the recommended antithrombotic therapy?
A) Aspirin 81 mg daily
B) No anticoagulation
C) Oral anticoagulation (warfarin or DOAC)
D) Clopidogrel alone
Answer: C
*Rationale: CHA₂DS₂-VASc ≥2 in men or ≥3 in women indicates oral
anticoagulation (DOACs preferred over warfarin unless valvular AF or
mechanical valve).*
10. An S3 gallop is most commonly associated with:
A) Heart failure (volume overload)
B) Hypertension
C) Aortic stenosis
D) Mitral valve prolapse
Answer: A
Rationale: S3 (ventricular gallop) occurs in early diastole and indicates rapid
ventricular filling, often in HFrEF or volume overload. S4 occurs in late
diastole with stiff ventricles (hypertrophy).
COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (MOST
RECENT!!)
NR603 FINAL EXAM REVIEW
Advanced Clinical Diagnosis & Practice Across the Lifespan
Total Questions: 200
Format: Multiple Choice
Passing Score: 85% (170 correct)
Time Limit: 4 hours
Section 1: Cardiovascular Disorders (Questions 1–25)
1. A 58-year-old male presents with substernal chest pressure radiating to the
jaw, diaphoresis, and nausea. ECG shows ST elevation in leads V2–V4. What
is the most appropriate immediate management?
A) Aspirin and discharge with cardiology follow-up
B) Aspirin, nitroglycerin, and transfer for percutaneous coronary
intervention (PCI)
C) Albuterol nebulizer
D) Oral anticoagulation
Answer: B
*Rationale: ST elevation in V2–V4 indicates anterior STEMI (LAD occlusion).
Immediate management includes aspirin (325 mg chewed), nitroglycerin (if
SBP >90), oxygen (if SpO2 <90%), morphine for pain, and emergent PCI
(door-to-balloon <90 minutes).*
,2. A 72-year-old woman reports episodic palpitations, dizziness, and
shortness of breath. ECG shows irregularly irregular rhythm with no P waves.
What is the most likely diagnosis?
A) Atrial flutter
B) Atrial fibrillation
C) Multifocal atrial tachycardia
D) Sinus arrhythmia
Answer: B
Rationale: Atrial fibrillation (AF) is characterized by absent P waves,
irregularly irregular ventricular response, and variable rate. CHA₂DS₂-VASc
score determines anticoagulation needs.
3. A patient with chronic heart failure (HFrEF) presents with worsening
dyspnea, jugular venous distension, and bilateral pedal edema. Which
medication class has been shown to reduce mortality in HFrEF?
A) Calcium channel blockers
B) Beta-blockers (carvedilol, metoprolol succinate)
C) Loop diuretics only
D) Alpha-blockers
Answer: B
*Rationale: Guideline-directed medical therapy (GDMT) for HFrEF includes
beta-blockers, ACE inhibitors/ARBs/ARNIs, aldosterone antagonists, and
SGLT2 inhibitors. Diuretics relieve symptoms but do not reduce mortality.*
4. A 45-year-old with hypertension and diabetes has a blood pressure of
150/92 mmHg. According to the 2017 ACC/AHA guideline, this is classified
as:
A) Normal
B) Elevated
C) Stage 1 hypertension
D) Stage 2 hypertension
Answer: C
*Rationale: ACC/AHA: Normal <120/80; Elevated 120-129/<80; Stage 1 HTN
,130-139/80-89; Stage 2 HTN ≥140/90. This patient with diabetes should start
pharmacotherapy.*
5. A 68-year-old smoker presents with calf pain while walking that resolves
with rest. Dorsalis pedis pulses are diminished. What is the most likely
diagnosis?
A) Peripheral artery disease (PAD)
B) Deep vein thrombosis
C) Sciatica
D) Venous insufficiency
Answer: A
*Rationale: Intermittent claudication (pain with exercise, relieved by rest) is
classic for PAD. Ankle-brachial index (ABI) <0.90 confirms. Smoking
cessation and antiplatelet therapy are key.*
6. A patient with aortic stenosis may present with which triad of symptoms?
A) Syncope, dyspnea, chest pain
B) Palpitations, fever, weight loss
C) Edema, fatigue, cough
D) Headache, epistaxis, anxiety
Answer: A
Rationale: Classic triad of severe aortic stenosis: angina (chest pain), syncope
(exertional), and heart failure (dyspnea). Murmur = crescendo-decrescendo,
radiating to carotids.
7. An ECG shows a prolonged PR interval (>200 ms) with consistent
conduction of each P wave to a QRS. This is:
A) First-degree AV block
B) Second-degree Mobitz I
C) Second-degree Mobitz II
D) Third-degree AV block
Answer: A
*Rationale: First-degree AV block is PR >200 ms with 1:1 conduction. Usually
benign but can progress. No treatment needed unless symptomatic.*
, 8. A 55-year-old with acute onset of severe, tearing chest pain radiating to
the back has a blood pressure of 160/100 mmHg in the right arm and 110/70
mmHg in the left arm. What is the most likely diagnosis?
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Pericarditis
Answer: B
Rationale: Aortic dissection presents with tearing chest pain, pulse
differential, and possible neurological deficits. Immediate management
includes beta-blockers (reduce shearing force) and surgical consultation.
9. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. What is
the recommended antithrombotic therapy?
A) Aspirin 81 mg daily
B) No anticoagulation
C) Oral anticoagulation (warfarin or DOAC)
D) Clopidogrel alone
Answer: C
*Rationale: CHA₂DS₂-VASc ≥2 in men or ≥3 in women indicates oral
anticoagulation (DOACs preferred over warfarin unless valvular AF or
mechanical valve).*
10. An S3 gallop is most commonly associated with:
A) Heart failure (volume overload)
B) Hypertension
C) Aortic stenosis
D) Mitral valve prolapse
Answer: A
Rationale: S3 (ventricular gallop) occurs in early diastole and indicates rapid
ventricular filling, often in HFrEF or volume overload. S4 occurs in late
diastole with stiff ventricles (hypertrophy).
