Cardiovascular Problems

Which of the following conditions does not place a patient at risk for a deep venous thrombosis (DVT)? 1. Hypertension. 2. Pregnancy. 3. Atrial fibrillation. 4. Recent total knee replacement.

1. Hypertension.

A 75-year-old male with a history of myocardial infarction presents to your primary care office with complaints of progressive dyspnea, crackles on physical exam, and cough. The patient is a current smoker with a 60-pack-year history. He has a history of echocardiogram showing an ejection fraction of 50. His electrocardiogram (EKG) is normal and his chest x-ray shows an increased cardiac silhouette, small bilateral pleural effusions, and increased pulmonary vasculature. Which disease process is the patient experiencing? 1. Heart failure—left ventricular failure (LVF) subset. 2. Heart failure—right ventricular failure (RVF) subset. 3. Chronic obstructive pulmonary disease (COPD). 4. Pulmonary embolism.

1. Heart failure—left ventricular failure (LVF) subset.

A 60-year-old male presents to your primary care office after being discharged from the hospital. He was at a Christmas work party and started to notice heart palpitations. He was drinking alcohol at the party. He went to the emergency department, where he was admitted. His electrocardiogram (EKG) showed tachycardia, with a normal ST segment, and he did not have any obvious P waves. The patient has not felt any palpitations since that one incident, which was 2 weeks ago. If he were sent home on Coumadin for blood thinning, at what level should you try to keep his international normalized ratio (INR)? 1. 2.0 to 3.0. 2. 2.5 to 3.5. 3. The patient's INR doesn't have to be checked unless he is having palpitations. 4. The patient can discontinue his Coumadin and start Eliquis 5 mg daily instead.

. 1. 2.0 to 3.0.

When a client is getting ready for a cardiac catheterization, which question is essential to ask? 1. "Are you allergic to shellfish?" 2. "Have you ever had a catheterization before?" 3. "Have you completed an advance directive?" 4. "What current medications are you on?"

1. "Are you allergic to shellfish?"

Jeremiah has been on lipid-lowering therapy (statins) for 2 years. He is new to your practice. He says, "I haven't had my liver function tests in a while to check if my cholesterol medication is causing a problem." What do you tell him? 1. "You've been tolerating the medication well—we no longer need to monitor this." 2. "Oh, yes, we check liver function tests every six months when you're on statins." 3. "We'll order LFTs before your next visit." 4. "We better stop your medication until we get the results."

1. "You've been tolerating the medication well—we no longer need to monitor this.

Which of the following patients should not be started on medication to decrease their cholesterol? 1. A healthy 30-year-old male with low-density lipoprotein (LDL) cholesterol of 120. 2. A 45-year-old male with type 2 diabetes and low-density lipoprotein (LDL) cholesterol of 108. 3. A 50-year-old male with a history of heart attack and recent open heart surgery and low-density lipoprotein (LDL) of 110. 4. A 55-year-old male with a history of type 2 diabetes and stroke and low-density lipoprotein (LDL) of 105.

1. A healthy 30-year-old male with low-density lipoprotein (LDL) cholesterol of 120.

A 70-year-old female presents to your urgent care clinic with chest pain for 24 hours, progressive dyspnea, and fatigue and is found to have elevated troponins and an electrocardiogram (EKG) with ST elevations. Which of the following is not a recommended treatment? 1. Administration of fibrinolytics stat. 2. Nitroglycerin sublingual and morphine. 3. Aspirin 325 mg chewable with administration of oxygen. 4. Admission for immediate cardiac catheterization.

1. Administration of fibrinolytics stat.

An 85-year-old male presents to the urgent care clinic with a history of syncopal episode without a history of head injury. On cardiac auscultation, the patient has a harsh systolic murmur at the second intercostal space, with radiation of the murmur to the carotids. What type of murmur does the patient have? 1. Aortic stenosis. 2. Aortic regurgitation. 3. Mitral stenosis. 4. Mitral valve prolapse (MVP).

1. Aortic stenosis.

Antibiotic prophylaxis for dental procedures is not necessary for which of the following diagnoses? 1. Aortic stenosis. 2. History of infective endocarditis. 3. Prosthetic heart valve replacement. 4. Rheumatic heart disease

1. Aortic stenosis.

To determine the presence of target organ damage (TOD) and other risk factors in a client with hypertension, basic diagnostic tests that should be ordered include: 1. Chest x-ray, electrocardiogram, urinalysis, complete blood count, chemistry profile, lipid profile, and thyroid-stimulating hormone (TSH) level. 2. Renal arteriogram. 3. Plasma renin activity and 24-hour urinary sodium. 4. Echocardiogram.

1. Chest x-ray, electrocardiogram, urinalysis, complete blood count, chemistry profile, lipid profile, and thyroid-stimulating hormone (TSH) level.

A 55-year-old patient has just recovered in the hospital from a heart attack, for which he underwent cardiac catheterization and required coronary stenting. Which of the following medications should not be initiated? 1. Coumadin 5 mg daily to maintain international normalized ratio (INR) between 2 and 3. 2. Aspirin 81 mg. 3. Metoprolol 25 mg. 4. Clopidogrel 75 mg.

1. Coumadin 5 mg daily to maintain international normalized ratio (INR) between 2 and 3.

A 70-year-old patient presents to your office following an acute hospital stay for atrial fibrillation. The patient has the following past medical and surgical history: diabetes, hypertension, gout, rheumatoid arthritis, hyperlipidemia, and multiple joint replacements. Which of the following medications is appropriate for their outpatient deep venous thrombosis (DVT) prophylaxis? 1. Coumadin 5 mg daily. 2. Lovenox 40 mg subcutaneously daily. 3. No medication is necessary. 4. Heparin 5000 international units subcutaneously daily.

1. Coumadin 5 mg daily.

When performing a cardiac assessment, where is the most essential site for assessing edema? 1. Dependent areas. 2. Periorbital areas. 3. Upper extremities. 4. Cerebral edema.

1. Dependent areas.

Ted, age 18, is to have a cardiac screening examination to determine if he can play college basketball. The diagnostic test of choice for detecting hypertrophic cardiomyopathy or idiopathic left ventricular hypertrophy is a(n): 1. Echocardiogram. 2. Electrocardiogram. 3. Arteriogram. 4. Stress test.

1. Echocardiogram.

Which of the following is not a risk factor for coronary artery disease? 1. Female sex with use of oral contraceptives. 2. Male gender. 3. Smoking. 4. Family history of coronary artery disease.

1. Female sex with use of oral contraceptives.

Which of the following statements concerning auscultation of the typical murmur associated with aortic stenosis is true? 1. It is a harsh, crescendo-decrescendo ejection-type murmur that often radiates to the carotid arteries. 2. It is a diastolic murmur. 3. It is best heard at the apex of the heart. 4. The loudness of the murmur reflects the severity of the lesion.

1. It is a harsh, crescendo-decrescendo ejection-type murmur that often radiates to the carotid arteries.

Which of the following statements is true of mitral regurgitation? 1. It may be noted as a holosystolic murmur. 2. It is caused by stiff leaflets that limit flow from the left atrium to the left ventricle. 3. It occurs only as a result of congenital malformation of the mitral valve, which inhibits contact and closure of the cusps. 4. It results in a prolonged PR interval on electrocardiogram.

1. It may be noted as a holosystolic murmur.

Sarah, who is postmenopausal, has controlled asthma and hypertension that is effectively treated with medication, and she smokes cigarettes. She has a low-density lipoprotein (LDL) cholesterol level of 170 mg/dL and a high-density lipoprotein (HDL) cholesterol level of 40 mg/dL. To reduce Sarah's risk of a coronary event, the treatment plan would focus on: 1. Lowering her LDL cholesterol level. 2. Lowering her HDL cholesterol level. 3. Aggressively treating and controlling her hypertension and asthma. 4. Getting Sarah to stop smoking.

1. Lowering her LDL cholesterol level.

Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you begin your examination, you know that it: 1. May present with complaints of only coldness or paresthesia of the extremity. 2. May present as the only disease. 3. Always occurs in the lower extremities. 4. Will result in an extremity that appears blue.

1. May present with complaints of only coldness or paresthesia of the extremity.

Jessica is pregnant and is being seen for the first time. She states that her blood pressure (BP) has been high for a long time, but she never wanted to take medication for it. Today her BP is 172/98, her lungs are clear, and she has no pedal or ankle edema. What medication would you most likely order? 1. Methyldopa. 2. Atenolol. 3. Nifedipine. 4. Clonidine.

1. Methyldopa.

A 16-year-old with a history of anxiety presents with her mother to your primary care office complaining of intermittent palpitations. They occur randomly every couple of days and are not made worse with exercise. The patient is healthy and takes only Prozac for anxiety and an oral contraceptive. On physical exam, a midsystolic click is heard. It is louder when lying in a supine position and heard best at the apex of the heart. What condition does the patient have? 1. Mitral valve prolapse. 2. Hypertrophic cardiomyopathy (HCM). 3. Aortic regurgitation. 4. Mitral regurgitation.

1. Mitral valve prolapse.

Greg, age 68, has just been given a diagnosis of congestive heart failure (CHF). Which of his medications should be discontinued? 1. Nifedipine (Procardia XL) for long-term management of his chronic stable angina. 2. Hydrochlorothiazide (HydroDIURIL) for his hypertension. 3. Enalapril (Vasotec) for his hypertension. 4. Butalbital for his headaches.

1. Nifedipine (Procardia XL) for long-term management of his chronic stable angina.

A 65-year-old obese, diabetic female presents to your urgent care clinic complaining of 2 days of progressively worsening epigastric pain, fatigue, nausea, and dizziness. Her vitals are as follows: temperature (T) 98.8°F, pulse (P) 110, pulse oximetry 93%, blood pressure (BP) 160/100. The patient has a family history of diabetes, breast cancer, paternal heart attack, hypertension, and hyperlipidemia. Her complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis show a patient with stage 2 chronic kidney disease (CKD) and a glucose of 150. The patient has no diarrhea and no other gastrointestinal symptoms. How would you proceed next? 1. Order a rapid troponin test and electrocardiogram (EKG). 2. Discharge to home with reassurance and close follow-up with her primary care provider (PCP). 3. Initiate intravenous (IV) fluids and IV Zofran for the patient's symptoms. 4. Give the patient insulin.

1. Order a rapid troponin test and electrocardiogram (EKG).

Larry, age 66, is a smoker with hypertension and hyperlipidemia. He is 6 months post myocardial infarction (MI). To prevent reinfarction, the most important behavior change he can make is to: 1. Quit smoking. 2. Maintain aggressive hypertension therapy. 3. Stick to a low-fat, low-sodium diet. 4. Continue with his exercise program.

1. Quit smoking.

Which of the following is a relative contraindication for initiation of metoprolol? 1. Resting heart rate of 45. 2. History of erectile dysfunction. 3. History of angioedema from angiotensin-converting enzyme (ACE) inhibitors. 4. Blood pressure of 140/90.

1. Resting heart rate of 45.

Which cardiac marker would be best for identifying if a patient has had any cardiac damage over the past 4 days? 1. Troponin. 2. Creatine kinase MB (CK-MB). 3. C-reactive protein (CRP). 4. Myoglobin.

1. Troponin.

What is the most important question to ask when a client presents with chest pain? 1. "What were you doing at the time of onset of chest pain?" 2. "What was the time of the onset of pain?" 3. "Are you a smoker?" 4. "When was the last time you had blood work done?"

2. "What was the time of the onset of pain?"

Charles has chronic ischemic heart disease and is taking a beta blocker, which results in: 1. An increase in high-density lipoprotein cholesterol. 2. A reduced heart rate. 3. A decreased diastolic filling time. 4. An increase in oxygen demand.

2. A reduced heart rate.

Nathan, age 63, comes for his annual physical. He has a history of mild hypertension and hyperlipidemia that he has not been successful in treating with diet and weight loss. His only complaint is a problem with impotence. On physical examination, you note a palpable, pulsatile abdominal mass in the umbilical region; a bruit above the umbilical region; and diminished femoral pulses. You suspect: 1. Renal artery stenosis. 2. An abdominal aortic aneurysm. 3. A cardiac tumor. 4. A thoracic aortic aneurysm.

2. An abdominal aortic aneurysm.

Janice, age 64, arrives at the office this morning without an appointment. She appears quite anxious and pale and is complaining of an intermittent aching across her sternum and into her jaw and left arm that started about an hour ago and woke her out of a sound sleep. She took an antacid and acetaminophen, but they did not seem to help. Her blood pressure is 160/90, and her heart rate is 98. An electrocardiogram (ECG) shows normal sinus rhythm with 2-mm ST-segment elevations in leads II, III, and aVF. What do you suspect? 1. An acute anterior wall myocardial infarction (MI). 2. An acute inferior wall myocardial infarction (MI). 3. Severe gastroesophageal reflux. 4. An anxiety attack.

2. An acute inferior wall myocardial infarction (MI).

Mary, age 50, has cardiovascular disease but has a low-density lipoprotein (LDL) cholesterol level of less than 100 mg/dL. She is slightly overweight. What is crucial to do for her today? 1. Stress the need for her to begin Therapeutic Lifestyle Changes (TLC). 2. Begin Mary on a statin. 3. Do an angiogram to see if there is any further cardiovascular damage. 4. Do a stress test to determine if she can begin an exercise program.

2. Begin Mary on a statin.

Marvin, age 56, is a smoker with diabetes mellitus. He has just been diagnosed as hypertensive. Which of the following drugs has the potential to cause the development of bronchial asthma and inhibit gluconeogenesis? 1. Angiotensin-converting enzyme (ACE) inhibitors. 2. Beta blockers. 3. Calcium channel blockers. 4. Diuretics.

2. Beta blockers.

Headache, flushing, tachycardia, and peripheral edema are adverse effects associated with which class of antihypertensive agents? 1. Beta blockers. 2. Calcium channel blockers. 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Diuretics.

2. Calcium channel blockers.

Martin, age 56, has hypertension and has been taking antihypertensive medication for about 10 years. He has been very stable. You have not seen him in about 6 months. His examination today should specifically: 1. Include only a blood pressure measurement with the client seated comfortably. 2. Include a funduscopic examination. 3. Be a focused examination limited to the respiratory and cardiovascular systems. 4. Include a discussion of weaning him off his medication.

2. Include a funduscopic examination.

Signs of right-sided heart failure include: 1. A low cardiac output. 2. Indications of fluid retention. 3. Dyspnea. 4. Elevated pulmonary venous pressure.

2. Indications of fluid retention.

When auscultating an adult client's heart, you note a short, high-frequency click (opening snap) after S2 (second heart sound) during the beginning of diastole. What could this indicate? 1. Aortic regurgitation. 2. Mitral stenosis. 3. Mitral regurgitation. 4. Nothing; this is normal.

2. Mitral stenosis.

Impaired blood flow to the extremities is caused by which of the following common disorders? 1. Raynaud disease. 2. Peripheral vascular disease. 3. Polycythemia. 4. Buerger disease.

2. Peripheral vascular disease.

Clinical findings associated with aortic regurgitation include: 1. Pulsus paradoxus. 2. Water hammer pulses. 3. Pulsus alternans. 4. Weak, thready pulses.

2. Water hammer pulses.

When teaching a client with a new diagnosis of aortic stenosis, which of the following statements made by him leads you to believe he needs more teaching? 1. "I no longer need antibiotic prophylaxis to prevent endocarditis prior to dental work." 2. "You told me I still need aggressive treatment of my hypertension." 3. "I'll continue the use of the diuretics and nitrates my previous doctor gave me." 4. "I'll have a yearly Doppler echocardiography to evaluate the progression of the valve lesion."

3. "I'll continue the use of the diuretics and nitrates my previous doctor gave me."

When teaching a client with a new diagnosis of aortic stenosis, which of the following statements made by him leads you to believe he needs more teaching? 1. "I no longer need antibiotic prophylaxis to prevent endocarditis prior to dental work." 2. "You told me I still need aggressive treatment of my hypertension." 3. "I'll continue the use of the diuretics and nitrates my previous doctor gave me."4. "I'll have a yearly Doppler echocardiography to evaluate the progression of the valve lesion."

3. "I'll continue the use of the diuretics and nitrates my previous doctor gave me."

Which drugs are used to lower blood pressure in a client with coexisting benign prostatic hyperplasia? 1. Beta blockers. 2. Angiotensin-converting enzyme (ACE) inhibitors. 3. Alpha-adrenergic blockers. 4. Calcium channel blockers.

3. Alpha-adrenergic blockers.

A 55-year-old African American man with newly diagnosed hypertension presents to your primary care clinic for medication management. Today his blood pressure reads 145/95. He denies headache, blurred vision, chest pain, and shortness of breath. Which medication would you start him on? 1. Catapres. 2. Hydralazine. 3. Amlodipine. 4. Metoprolol.

3. Amlodipine.

Mr. Michaels has a long-standing cardiac problem. His electrocardiogram rhythm strip is shown [above/below]. Which medication should he be taking to prevent a pulmonary or cerebral problem? 1. An angiotensin-converting enzyme (ACE) inhibitor, such as enalapril (Vasotec). 2. An antiarrhythmic agent, such as procainamide (Procan SR). 3. An anticoagulant, such as warfarin, dabigatran, apixaban, or rivaroxaban. 4. An anticonvulsant, such as phenytoin (Dilantin).

3. An anticoagulant, such as warfarin, dabigatran, apixaban, or rivaroxaban.

Cough, loss of taste, and rash are adverse effects associated with which class of antihypertensive agents? 1. Diuretics. 2. Beta blockers. 3. Angiotensin-converting enzyme (ACE) inhibitors. 4. Calcium channel blockers.

3. Angiotensin-converting enzyme (ACE) inhibitors.

Dana has ischemic arterial ulcers. What is your first priority when counseling her? 1. Tell her that increasing coffee intake will stimulate heart rate and circulation. 2. Tell her to decrease water intake slightly to improve blood viscosity. 3. Tell her to reduce risk factors to improve tissue perfusion. 4. Tell her to begin an intense aerobics program.

3. Tell her to reduce risk factors to improve tissue perfusion.

Terry, a 42-year-old black man who just moved into the area, comes into the clinic for a new client visit. He brings his medical records from his previous health care provider; the records show a blood pressure of 140/104 mm Hg on 2 separate occasions. Recent laboratory tests (complete blood count, chemistry profile, urinalysis, and thyroid-stimulating hormone) are normal. A recent electrocardiogram shows normal sinus rhythm with left ventricular hypertrophy. He denies any medical problems and tells you he has never been diagnosed with hypertension. He is not taking any medications, does not smoke, and drinks about 2 beers a day. He is currently unemployed. His blood pressure today is 150/110 mm Hg. Your next step would be to: 1. Obtain plasma and urine catecholamine measurements. 2. Have him keep a food diary for 1 week and then return for a repeat blood pressure reading. 3. Begin drug therapy with chlorthalidone 25 mg. 4. Start him on metoprolol 100 mg twice a day.

3. Begin drug therapy with chlorthalidone 25 mg.

George, a 59-year-old African American man, has just been diagnosed with hypertension (HTN). His A1C is 5.8%. Which of the following classifications of medications would you start him on? 1. Angiotensin-converting enzyme (ACE) inhibitor with a thiazide-type diuretic. 2. Angiotensin receptor blocker (ARB) with a thiazide-type diuretic. 3. Calcium channel blocker (CCB) with a thiazide-type diuretic. 4. Beta blocker (BB) with a thiazide-type diuretic.

3. Calcium channel blocker (CCB) with a thiazide-type diuretic.

Sheila, age 78, presents with a chief complaint of waking up during the night coughing. You examine her and find an S3 heart sound, pulmonary crackles (rales) that do not clear with coughing, and peripheral edema. What do you suspect? 1. Asthma. 2. Nocturnal allergies. 3. Heart failure. 4. Valvular disease.

3. Heart failure.

Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Her electrocardiogram (ECG) shows some changes. Your next action would be to: 1. Start aspirin therapy and schedule an exercise stress test at the client's convenience. 2. Initiate lipid-lowering agents. 3. Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate. 4. Prescribe a Holter monitor and start her on a beta blocker.

3. Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate.

Jim, age 72, has a history of type 2 diabetes mellitus that has been controlled with diet. He has come for a routine examination and reports feeling more tired than usual. On his electrocardiogram (ECG), you notice Q waves in leads II and III, and he is in atrial fibrillation, which was not present on his previous ECGs. What do you do? 1. Immediately hospitalize Jim, order a cardiology consultation, start intravenous administration of an anticoagulant and nitrates, and run serial cardiac enzyme tests. 2. Do nothing because you know the normal progression of type 2 diabetes in older adults includes ECG changes as a result of neuropathy, which involves the transmission of electrical impulses. 3. Initiate aspirin therapy and refer Jim to a cardiologist for evaluation of occult ischemic heart disease and left ventricular function as soon as possible. 4. Initiate lipid-lowering therapy because Jim may have had an acute myocardial infarction.

3. Initiate aspirin therapy and refer Jim to a cardiologist for evaluation of occult ischemic heart disease and left ventricular function as soon as possible.

Clients with Prinzmetal angina frequently have a history of Raynaud disease and which other disorder? 1. Syncope. 2. Insomnia. 3. Migraine headaches. 4. Leg cramps.

3. Migraine headaches.

Mort is hypertensive, and you need to add a second antihypertensive agent to his medication regimen. Which of the following factors influences your choice of using an alpha blocker as the second antihypertensive medication? 1. Mort is African American. 2. Mort has congestive heart failure. 3. Mort has benign prostatic hyperplasia (BPH). 4. Mort has frequent migraine headaches.

3. Mort has benign prostatic hyperplasia (BPH).

Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue over the past 6 months. She has been trying to lose weight, has been on a walking exercise program for over a year, and had taken the fenfluramine-phentermine (fen-phen) combination many years ago but stopped when its adverse effects were reported. Your examination reveals a grade 2/6 systolic murmur along the apex. What do you do? 1. Obtain pulmonary function tests. 2. Instruct the client about other exercise activities that may not produce these symptoms. 3. Refer the client to a cardiologist for an echocardiogram and cardiovascular workup. 4. Start endocarditis prophylaxis.

3. Refer the client to a cardiologist for an echocardiogram and cardiovascular workup.

When teaching a client with hypertension about restricting dietary sodium, you would include which of the following instructions? 1. Sodium restriction can cause serious adverse effects. 2. Diets with markedly reduced intake of sodium may be associated with other beneficial effects beyond blood pressure control. 3. Seventy-five percent of sodium intake is derived from processed food. 4. A goal of 3 g of sodium chloride or 1.2 g of sodium per day is easily achievable.

3. Seventy-five percent of sodium intake is derived from processed food.

An active 68-year-old man under your care has known acquired valvular aortic stenosis and mitral regurgitation. He also has a history of infectious endocarditis. He has recently been told he needs elective replacement of his aortic valve. When he comes in, you discover that he has 10 remaining teeth that are in poor repair. Your recommendation would be to: 1. Defer any further dental work until his valve replacement is completed. 2. Instruct the client to have dental extraction done cautiously, having no more than 2 teeth removed per visit. 3. Suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis. 4. Coordinate with his cardiac and oral surgeons to have the tooth extraction and valve replacement done at the same time to reduce the risk of anesthetic complications.

3. Suggest that he consult with his oral surgeon about removing all the teeth at once and receiving appropriate antibiotic prophylaxis

A newly discharged outpatient surgery client, age 65, presents with insidious onset of edema and dusky blue discoloration of the head and upper extremities. You know it is a medical emergency and suspect which of the following? 1. Evolving cerebral infarction. 2. Impending myocardial infarction. 3. Superior vena cava syndrome. 4. Temporal arteritis.

3. Superior vena cava syndrome.

Harry has been on antihypertensive therapy with a single agent for 1 month, but his readings are still too high. What do you tell him? 1. "Let's give it a 3-month trial. If your BP is still too high after that, we'll make some changes." 2. "You must continue to follow the DASH diet, which will make a difference." 3. "You must exercise for at least 30 minutes most days of the week." 4. "We must increase the dosage of that drug now or add a second drug."

4. "We must increase the dosage of that drug now or add a second drug."

Which is the LAST step you would consider taking in a client with long-term chronic ischemic heart disease? 1. Use of aspirin. 2. Use of beta blockers, calcium channel blockers, and nitrates. 3. Risk factor and lifestyle modification. 4. A coronary angiogram.

4. A coronary angiogram.

Some older adults develop postural hypotension with hypertensive drug therapy. What is included in your teaching with these individuals? 1. To prevent this problem from recurring, drug therapy will be discontinued as soon as their blood pressure stabilizes. 2. Slight dehydration will prevent postural hypotension from occurring. 3. Clients should sleep in a high Fowler position to prevent this from happening. 4. Clients should be taught to sit on the edge of the bed before standing.

4. Clients should be taught to sit on the edge of the bed before standing.

Which of the following antihypertensive agents would most likely produce a rebound hypertensive crisis following its abrupt withdrawal? 1. Doxazosin (Cardura). 2. Lisinopril (Prinivil). 3. Losartan (Cozaar). 4. Clonidine (Catapres).

4. Clonidine (Catapres).

our postmyocardial infarction (PMI) client is allergic to acetylsalicylic acid, or aspirin (ASA). Which drug should he be on indefinitely? 1. Coumadin. 2. Heparin. 3. Pentoxifylline (Trental). 4. Clopidogrel (Plavix).

4. Clopidogrel (Plavix).

Rona, age 69, has hypertension (HTN), drinks 1 glass of white wine per day, and is slightly overweight. She asks you if making changes in her life at this age will make any difference. You tell her that lifestyle modifications for the control of HTN: 1. Are not as effective in older adults because HTN is an inevitable consequence of aging. 2. Require a marked reduction in weight and a very limited choice of foods to achieve any benefit. 3. Should include at least 3 glasses of red wine every day because red wine improves levels of high-density lipoprotein cholesterol, a known cardiovascular risk factor, which may be worsened by HTN. 4. May lower elevated blood pressure, and reduce the number and dosage of antihypertensive medications needed to manage the condition.

4. May lower elevated blood pressure, and reduce the number and dosage of antihypertensive medications needed to manage the condition.

Rick, age 35, is modifying his diet to try to lose weight, but after 3 months, he has not lost any weight even though he has complied with his diet plan. A follow-up lipid profile reveals the following: total cholesterol 238 mg/dL, triglycerides 100 mg/dL, high-density lipoprotein (HDL) cholesterol 28 mg/dL, and low-density lipoprotein (LDL) cholesterol 190 mg/dL. What would you recommend? 1. Continuing the diet plan for another month. 2. Starting an exercise program with a goal of uninterrupted aerobic exercise for 30 minutes per day, aiming for 5 days per week. 3. Stopping his diet plan and trying another. 4. Starting statin drug therapy.

4. Starting statin drug therapy.

Harry, age 54, comes to your office with waxing and waning ischemic symptoms over a period of days and weeks, an increase in angina while at rest, and transient ST changes on his electrocardiogram. This presentation leads you to believe that he is experiencing: 1. A brain attack—stroke, ie, cerebrovascular accident (CVA). 2. A myocardial infarction. 3. Stable angina. 4. Unstable angina.

4. Unstable angina.

You are starting Jill, age 61, on a statin, as she had a stroke recently and has peripheral vascular disease (PVD). Which is your drug of choice? 1. Atorvastatin. 2. Pravastatin. 3. Lovastatin. 4. Simvastatin.

Atorvastatin.