NURS 5463 Test 4 practice questions
Which patient is most likely to have chronically elevated troponin levels?
A 45-year-old male with an ejection fraction of 35%.
A 64-year-old man who was being treated in the hospital for acute cholecystitis is found to be unresponsive. He was noted to be in VF and underwent chest compressions for several minutes in addition to cardioversion. The patient has return of spontaneous rhythm and vital signs. Which of the following is an important treatment for this patient?
A Percutaneous coronary angiography
For which of the following patients is a left carotid endarterectomy most indicated?
A. A 70-year-old man with transient loss of vision in the left eye that recovered after 20 minutes, and he has 75% left carotid stenosis
Which of the following statements regarding carotid artery stenting is most accurate?
A. CREST study suggests that older patients have increased combined stroke and death rates in comparison to younger patients
Which of the following does NOT need to be instituted for a patient following carotid endarterectomy?
A. Coumadin to target an INR of 2 to 3
In a patient who presents to a primary care physician with signs and symptoms of claudication secondary to peripheral arterial disease, which of the following would be an ideal initial diagnostic modality?
A. D. Ankle-brachial index
A 54-year-old woman presents to the ED requesting medication refills on her antihypertensive medications. She has been out of her medications for 2 weeks and cannot get an appointment with her private physician until next week. She normally takes atenolol and hydrochlorothiazide. Her blood pressure is 190/100. The patient has no complaints. She has been waiting for 4 hours and is in a hurry to get back to work. Which of the following is the most appropriate next step?
A. Give her a prescription for her medications, instruct her to take them immediately and have her follow-up in 48 hours.
What is the pathophysiologic mechanism by which pain occurs during classic claudication of the calf muscles?
A. Imbalance between oxygen supply and demand due to inadequate blood flow, resulting in buildup of toxic metabolites
A 63-year-old man has a 4-minute period of documented expressive aphasia that completely resolved. A workup reveals 70% left internal carotid stenosis and a 50% right internal carotid stenosis. In addition to best medical management, which of the following is the most appropriate treatment?
A. Left CEA
A 73-year-old woman is evaluated in the ED and transferred to the ICU because of chest pain of 4 hours' duration. Her medical history includes a 20-year history of hypertension and Type II diabetes mellitus. Her medications include metformin, atenolol, and ASA. On physical examination, her blood pressure is 130/84 mm Hg, and her heart rate is 87 beats/min and regular. Her jugular vein is distended to 5 cm while the patient is upright. She has a faint left carotid bruit and bibasilar crackles to one quarter up from the lung bases. A normal S1 and S2 is heard, with a grade II/VI holosystolic murmur heard best at the apex to the axilla. An electrocardiogram from six months ago was normal. The ECG was seen during the chest pain. The initial serum troponin measurement is elevated. She is now admitted to the ICU for an MI. She is free of chest pain while on IV nitroglycerin, and her vital signs are stable. Which of the fol
A. Left bundle branch block with normal sinus rhythm
In a patient with PAD, what should be the ideal LDL goal for preventing further disease progression?
A. Less than100 mg/dL
An 84-year-old woman has diabetes and congestive heart failure that is refractory to medical treatment. A right carotid bruit is detected on physical examination. A duplex study suggests a 50% to 75% right carotid stenosis. Which of the following is the most appropriate treatment?
A. Medical management
A 38-year-old man presents to the emergency department after a motor vehicle collision. After complete evaluation it is determined that he sustained a fracture of the right tibia. The patient has a history of hypertension for which he is on pharmacological treatment. The patient is writhing on the gurney in pain. His blood pressure is 210/104. The patient has no complaints except for right leg pain. Which of the following is the most appropriate next step in management?
A. Pain control and monitor the patient's blood pressure.
Which of the following symptoms would categorically suggest a diagnosis of pseudoclaudication over traditional claudication?
A. Severe back and leg pain while walking downhill but not uphill
A 67-year-old man is diagnosed with peripheral arterial disease. Modification of which of the following risk factors would be advisable for this patient?
A. Smoking cessation B. Diabetes C. Dyslipidemia D. Hypertension E. All of the above
A 68-year-old male patient is currently on the telemetry unit and receiving treatment for acute decompensated heart failure reduced ejection fraction. On day two of his admission you are called to the bedside to evaluate him for a complaint of chest pain. The patient reports a severe, dull, pressure like pain in the center of his chest with associated dyspnea. It is substernal in nature and radiates to both shoulders. He is diaphoretic and looks as though he does not feel good. He has a past medical history of diabetes mellitus type 2 and hypertension. Vitals: 99.1-95-150/100, sat is 98% on RA. He has rales in his lungs and his abdominal exam is unremarkable. Which diagnosis is most important to keep in your differentials?
Acute coronary syndrome
A 55-year-old male is evaluated during a routine examination at your cardiology practice. He has a 2-year history of non-ischemic cardiomyopathy with an ejection fraction of 35%. He denies any dyspnea and can walk 2 miles a day without symptoms. Past medical history is significant for hypertension. His current medications include lisinopril (Zestril) 40mg daily, carvedilol (Coreg) 25mg BID, and chlorthalidone (Thalitone) 25mg daily. Vitals: 98.6-65-16-160/90 mmHg. On exam there is no JVD, lungs are clear, and heart rate is regular without murmur or gallops. No edema is present. How should the AGACNP modify this patient's treatment plan?
Add amlodpine (Norvasc)
A 36-year-old, 72kg female, is intubated for a severe asthma exacerbation, and is on the following ventilator settings: Tidal volume 650ml, simultaneous intermittent mandatory ventilation (SIMV) with a rate of 14, and an Fio2 of 0.75. Her morning ABG results were: pH 7.18, PaCO2 55 mmHg, HCO3 21 mEq/L. Which order is the most appropriate in response to this ABG?
Administer 1am of sodium bicarbonate
v2-v4 ST elevation
Anterior MI LAD
v1, v2 ST elevation
Anteroseptal MI LAD
A 55-year-old man in the ICU has ACS, with 2 mm of ST elevation on the leads II, III, and aVF. The troponins are positive. The blood pressure is 130/70 mm Hg on a nitroglycerin drip at 5 μg/kg/min keeping the patient chest pain free, but ECG changes persist and only 1 mm of ST elevation is seen. There is no lower extremity edema. The patient was given ASA upon entry into the ED. What is/are the next best steps in the management of this patient?
Anticoagulation, IV β-blocker, ACE inhibitor, nitroglycerin, and alert catheterization lab
A 65-year-old man with history of diabetes presents to the Emergency Department stating he has had substernal chest pain and diaphoresis for 45 minutes. Which is the most important next step in management?
Aspirin to chew
How long post PCI should the following medications be continued? Aspirin ACE inhibitor Clopidogrel Heparin
Aspirin- Indefinitely, maintenance dose 81mg/day ACE inhibitor- Indefinitely Clopidogrel-12mos Heparin-Until PCI is completed
For which of the following patients is nonoperative management most appropriate?
B A 96-year-old man with severe dementia and a 6-cm AAA. The patient has been a long-term resident of a chronic care facility due to inability to care for himself secondary to his dementia
A 59-year-old man complains of severe chest pain that radiates to his back. His brachial pulses appear unequal between his right and left arms. He appears hemodynamically stable. On chest radiography, he has a widened mediastinum. Which of the following is the best next step?
B Obtain CT of chest with intravenous contrast.
A 45-year-old man with a past medical history of diabetes, hyperlipidemia, and hypertension has smoked one pack of cigarettes a day for the past 15 years and drinks four glasses of wine every weekend. He is found to have an AAA incidentally on CT imaging of the abdomen. Which of the following is the most important predisposing factor for the development of his AAA?
B Smoking
Which of the following is NOT an accurate description of hypothermia therapy for post-cardiac arrest patients?
B Therapeutic hypothermia has a proven effect in reducing the rate of recurrent ventricular fibrillation
A 70-year-old man with rheumatic heart disease complicated by severe mitral regurgitation presents to the emergency department for evaluation of fatigue. Which of the following physical examination findings is not characteristic of this disease?
Blowing, holosystolic murmur at the left lower sternal border that increases with inspiration
A 54-year-old man is seen at a rural ED with 1 hour of nausea and substernal chest pain radiating to his jaw. The ECG shows STEMI. PCI is not performed at this hospital and only performed at a hospital 2 1/2 hours away. Which of the following statements is most accurate?
C Administer thrombolytics, then transfer to PCI center.
A 45-year-old woman with new-onset aortic regurgitation is found to have aortic dissection of the ascending aorta and aortic arch by TEE. She is relatively asymptomatic. Which of the following is the best management?
C Surgical repair of the dissection
What type of MI is this II, III, AvF
C. Inferior
A patient's chest x-ray reveals an increased retrosternal airspace and flattened diaphragm. The AGACNP accurately interprets this as evidence of which diagnosis?
COPD
A 35-year-old woman is being seen for shortness of breath of 2 weeks' duration. She denies a history of asthma, smoking, or cough. On examination, her heart rate is 100 bpm, blood pressure is 90/60 mm Hg, and respiratory rate is 20 breaths per min. Her jugular venous pulse was noted at rest to be 2 cm above the sternal notch, increasing to 6 cm above the sternal notch with deep inspiration. Which of the following conditions does she most likely have?
Constrictive pericarditis
A 62-year-old man is evaluated for a 7-month history of progressive dyspnea and lower extremity swelling. His medical history is significant for lymphoma treated with chest irradiation 15 years ago and currently in remission. He does not smoke or drink alcohol. On physical exam, vital signs are stable. There is jugular venous distension and jugular venous engorgement with inspiration. Cardiac exam discloses a prominent early diastolic sound but no murmurs or gallops. Lung exam reveals normal breath sounds. Abdominal examination reveals ascites, and lower extremities show 3+ pitting edema. ECG shows normal sinus rhythm with nonspecific diffuse ST-T changes. Urinalysis is normal. Chest radiography shows calcifications around the heart and clear lung fields. Which of the following is the most likely diagnosis?
Constrictive pericarditis
An 88-year-old patient is sent to the ED by his nursing home in acute decompensated heart failure reduced ejection fraction. His dry weight is 71kg and current weight is 73.5kg. Heart rate is 104, respiratory rate is 30/minute, BP of 120/60 mmHg, O2 sat 89% on RA. Heart rate is regular, lungs have rales in the posterior lung fields and he is using accessory muscles. Initial labs come back and he is noted to have a creatinine of 3.0 mg/dL and a potassium of 4.5 mEq/L. Baseline creatinine is 1.5 mg/dL. Which intervention should the AGACNP do next?
Consult cardiology and nephrology
What are the most common risk factors for developing heart failure?
Coronary Heart Disease Hypertension Obesity Prediabetes and Diabetes
A 61-year-old man is found on physical examination to have an asymptomatic AAA. Ultrasound evaluation reveals that the AAA measures 4 cm in diameter. Which of the following is the best surveillance strategy for his AAA?
D Ultrasound evaluation every year
A 68-year-old man with a history of end-stage renal disease is admitted to the hospital for chest pain. On examination, a pericardial friction rub is noted. His ECG shows diffuse ST-segment elevation. Which of the following is the best definitive treatment?
Dialysis
Which of the following statements regarding out-of-hospital sudden cardiac arrest (SCA) is true?
E Therapeutic hypothermia improves neurological outcome after SCA in patients with depressed mental status after resuscitation.
In the initial evaluation of a patient with chest pain, which is the most important diagnostic test?
ECG
An 88-year-old patient is sent to the ED by his nursing home in acute decompensated heart failure reduced ejection fraction. His dry weight is 71kg and current weight is 73.5kg. Heart rate is 104, respiratory rate is 30/minute, BP of 120/60 mmHg, O2 sat 89% on RA. Heart rate is regular, lungs have rales in the posterior lung fields and he is using accessory muscles. The initial evaluation of this patient should include which tests?
EKG, troponins, BMP
Acute Coronary Syndrome may present atypically in which patient?
Elderly
Which of the following is most likely to cause restrictive cardiomyopathy?
Endomyocardial fibrosis
An AGACNP is treating a patient with a new onset of NSTEMI and an O2 sat of 94%. Which therapy is most appropriate for the AGACNP to initiate?
Enoxaparin (Lovenox) and ASA
A 102-year-old Hispanic female presents to the ED with dyspnea and weakness. Her respiratory rate is 30, O2 sat is 82% on high flow oxygen, BP is 86/60 mmHg. Labs reveal an acute kidney injury with a creatinine of 6.0, and elevated troponins consistent with an acute coronary syndrome. EKG shows inferior wall changes. CXR reveals pulmonary edema and a CT of the head shows an acute ischemic stroke. The patient is not responding. Which topic is most important to discuss with the family?
Goals of Care
Which of the following types of infection, precedes by several weeks, the development of acute rheumatic fever?
Group A beta-hemolytic streptococcal infection of the pharynx
A 48-year-old female with acute pancreatitis is in the ICU and is ventilated. Current vitals are: heart rate 116, BP 92/60 mmHg. Hemodynamics are: CVP 9 mmHg, PAP 29/18 mmHg, PCWP 14 mmHg. Ventilator settings are: Assist Control, Tidal volume 800ml, Rate 14, FiO2 0.85, PEEP 5.0 cm H2O. ABG results are: pH 7.31, PaCO2 48 mmHg, PaO2 62 mmHg. The chest x-ray shows diffuse, fluffy infiltrates. Which intervention is most appropriate for the AGACNP to complete?
Increase PEEP 7.5 cm H2O
II, III, avF ST elevation
Inferior MI RCA
A 25-year-old woman is brought to the emergency department following a motor vehicle accident. She has a heart rate of 120 bpm and a blood pressure of 85/55 mmHg. She is saturating 89% while breathing ambient air. A chest radiograph shows pulmonary edema, and an echocardiogram reveals severe mitral regurgitation. Which of the following would be contraindicated in this patient?
Initiation of phenylephrine
An 88-year-old patient is sent to the ED by his nursing home in acute decompensated heart failure reduced ejection fraction. His dry weight is 71kg and current weight is 73.5kg. Heart rate is 104, respiratory rate is 30/minute, BP of 120/60 mmHg, O2 sat 89% on RA. Heart rate is regular, lungs have rales in the posterior lung fields and he is using accessory muscles. To which level of care should this patient be admitted?
Intensive Care
Post percutaneous treatment for a STEMI the patient should be transferred to which level of care?
Intensive care
A 35-year-old man is brought into the emergency department after a knife injury to the chest. He is noted to be hypotensive with a blood pressure of 80/40 mm Hg and an elevated jugular venous pulse. Bedside ultrasound examination confirms a large cardiac effusion. While awaiting pericardiocentesis, which of the following is the most important intervention for the patient to receive?
Intravenous fluids
I, avL, v4-v6 ST elevation
Lateral LCA
A 44-year-old woman presents with worsening fatigue and dyspnea. The pertinent medical history is that she had rheumatic fever during childhood. Physical examination finds an early diastolic opening snap with a rumbling late diastolic murmur. A chest radiograph shows an enlarged left atrium. Which of the following is the most likely diagnosis?
Mitral Stenosis
During your preoperative assessment, a 28-year-old woman complains of dyspnea on exertion. Upon auscultation of her heart, you notice a mid-diastolic rumbling murmur. This murmur is most characteristic of which valvular lesion?
Mitral Stenosis
Which of the following statements is true regarding EVAR?
Most EVAR complications do not require open interventions
A 55year-old man presents to the emergency room with complaints of a severe headache, diplopia, and vomiting. His blood pressure is 210/120 upon arrival. Which of the following is the best next step?
Obtain a head CT scan, give an antihypertensive such as nicardipine, and admit to the intensive care unit.
Which of the following is a known complication associated with AAA?
Painful discoloration of the great toe
A 102-year-old Hispanic female presents to the ED with dyspnea and weakness. Her respiratory rate is 30, O2 sat is 82% on high flow oxygen, BP is 86/60 mmHg. Labs reveal an acute kidney injury with a creatinine of 6.0, and elevated troponins consistent with an acute coronary syndrome. EKG shows inferior wall changes. CXR reveals pulmonary edema and a CT of the head shows an acute CVA. Who is most important for the AGACNP consult?
Palliative Care
The same is now hospitalized, but there is a delay in initiating treatment. You are called to the bedside because he has become hypotensive with a systolic blood pressure of 85/68 mm Hg, a heart rate of 122 bpm, and pulsus paradoxus. A repeat ECG is unchanged from admission. Which of the following is the most appropriate immediate intervention?
Perform echocardiographic-guided pericardiocentesis.
A patient experiencing an asthma exacerbation is unarousable and has a decreasing respiratory rate. Which action should the AGACNP take next?
Prepare for intubation and admit to the ICU
A 57-year-old woman develops acute respiratory distress 7 days following CABG. She has a history of adenocarcinoma of the colon. She had been doing well up until this time. The physical examination reveals diminished breath sounds at the lung bases. The CXR reveals atelectasis of the left lower lobe. Which of the following is the most appropriate treatment at this time?
Provide supplemental oxygen therapy, obtain venous duplex scan of the lower extremities and CT angiography of the chest, consider empiric heparin therapy until the results of imaging studies are obtained
A 55-year-old hospitalized man develops sudden shortness of breath. He has newly diagnosed coronary artery disease that manifested as an inferior ST elevation myocardial infarction 3 days ago. Coronary angiography at presentation showed a dominant right coronary artery that was occluded in the distal segment. Percutaneous coronary intervention was unsuccessful. He had been doing well over the last few days until now. He denies chest pain. Physical examination is notable for a heart rate of 140 bpm and a blood pressure of 90/60 mmHg. He is extremely uncomfortable. Jugular venous pulsations are biphasic but elevated to approximately 14 cm above the right atrium. He exhibits labored breathing, and fine inspiratory rales are heard in both lower lung fields. The apical impulse is not displaced. Cardiac auscultation reveals a soft S1, an S3, and a new short systolic murmur heard best at the apex. Echocardiography shows sev
Ruptured posteromedial papillary muscle
A 68-year-old male patient is currently on the telemetry unit and receiving treatment for acute decompensated heart failure reduced ejection fraction. On day two of his admission you are called to the bedside to evaluate him for a complaint of chest pain. The patient reports a severe, dull, pressure like pain in the center of his chest with associated dyspnea. It is substernal in nature and radiates to both shoulders. He is diaphoretic and looks as though he does not feel good. He has a past medical history of diabetes mellitus type 2 and hypertension. Vitals: 99.1-95-150/100, sat is 98% on RA. He has rales in his lungs and his abdominal exam is unremarkable. Which diagnostic test will best help to confirm the diagnosis?
Serial Troponins
What is the most common complication of CPB machine?
Short-term memory loss
A 75-year-old man is found to have asymptomatic AF. Which of the following is the most common complication of his AF long term?
Stroke
How does diastolic heart failure (HFpEF) differ from systolic heart failure (HFrEF)? How does this affect how you treat your patient for exacerbations?
Systolic heart failure results in myocardial contraction failure. Diastolic heart failure is present when the ventricle is not able to relax completely. In this instance, contraction is normal, but filling is reduced. Diastolic HF patients are preload dependent, so diuresis should be gentle. You can cause them harm by taking off the fluid to aggressively i.e. AKI, decrease cardiac output
An 83-year-old woman with a history of hypertension presents to the emergency department with bright red blood per rectum and a blood pressure of 85/50 mm Hg. Her pulse is 160 beats per minute and irregular. An ECG confirms she is in new onset AF. Which of the following is the best treatment for this patient?
Transfusion and IV fluid
A 40-year-old patient who is being discharged home after being treated for an acute decompensated heart failure reduced ejection fraction, admits to not taking his medications or following his diet. Which response would best help the AGACNP provide anticipatory guidance?
What prevents you from taking your medications?
When a patient comes in for an acute exacerbation of a chronic heart failure, what do you need to explore?
When a patient presents with an exacerbation of an acute illness there is typically a trigger which has caused the exacerbation. The AGACNP should find the triggering event to treat it. Things which may cause an acute decompensation of chronic, stable heart failure include: ACS, thyroid disease, noncompliance with medication and diet, and medications such as diltiazem and verapamil in persons with systolic dysfunction.
When should oral beta blocker therapy be initiated for an individual with acute coronary syndrome?
Within 24 hours of onset in those who do not have signs of acute heart failure, evidence of a low output state, increased risk for cardiogenic shock, or other contraindications to beta blockade (PR interval > 0.24 or second or third-degree heart block without a pacemaker, Asthma, reactive airway disease).
A 72-year-old woman with history of HTN and non-insulin dependent diabetes mellitus is seen in the emergency department for knee pain after tripping and falling. On examination, she has an abrasion and contusion to her knee with negative x-rays. However, her heart rate is 80 beats per minute and irregular to palpation. On ECG, she is diagnosed with AF. She does not recall ever being told about this condition. Which of the following is the best initial treatment for this patient's AF?
• C Oral anticoagulation
A 53-year-old man has been undergoing dialysis for end-stage renal disease due to long-standing diabetes mellitus. He is being seen in the emergency center for progressive dyspnea on exertion. On examination, he is found to have a heart rate of 105 bpm, blood pressure of 90/60 mm Hg, and respiratory rate of 20 breaths per minute. After examination, the clinician suspects cardiac tamponade. Which of the following is the most sensitive finding in this condition?
• Drop in systolic blood pressure more than 10 mm Hg during inspiration
