{"id":128323,"date":"2023-02-14T00:00:00","date_gmt":"2023-02-14T00:00:00","guid":{"rendered":"https:\/\/nursingstudybay.com\/2023\/02\/14\/nr507-week-3-quiz-2016-4\/"},"modified":"2023-02-14T00:00:00","modified_gmt":"2023-02-14T00:00:00","slug":"nr507-week-3-quiz-2016-4","status":"publish","type":"post","link":"https:\/\/www.studyproessays.com\/help\/nr507-week-3-quiz-2016-4\/","title":{"rendered":"Nr507 week 3 quiz 2016"},"content":{"rendered":"

<\/p>\n

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Question<\/span><\/p>\n

Question 1<\/span>.<\/span><\/a>1<\/span>.<\/span><\/a>\u00a0A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician<\/span>.<\/span><\/a>\u00a0As part of the patient’s diagnostic workup, the nurse practitioner conducting the intake assessment has ordered a Holter monitor for 24 hours<\/span>.<\/span><\/a>\u00a0Which of the following statements best captures an aspect of Holter monitoring? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity<\/span>.<\/span><\/a><\/p>\n

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies<\/span>.<\/span><\/a><\/p>\n

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording<\/span>.<\/span><\/a><\/p>\n

Holter monitors are normally set to record electrical activity of the heart at least once per hour<\/span>.<\/span><\/a><\/p>\n

Question 2<\/span>.<\/span><\/a>2<\/span>.<\/span><\/a>\u00a0As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart<\/span>.<\/span><\/a>\u00a0Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Echocardiogram, PET scan, ECG<\/span><\/p>\n

Ambulatory ECG, cardiac MRI, echocardiogram<\/span><\/p>\n

Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy<\/span><\/p>\n

Cardiac catheterization, cardiac CT, exercise stress testing<\/span><\/p>\n

Question 3<\/span>.<\/span><\/a>3<\/span>.<\/span><\/a>\u00a0An 81-year-old female patient of a long-term care facility has a history of congestive heart failure<\/span>.<\/span><\/a>\u00a0The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention<\/span>.<\/span><\/a>\u00a0Why is jugular venous distention a useful indicator for the assessment of the patient’s condition? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest<\/span>.<\/span><\/a><\/p>\n

Blood backs up into the jugular vein because there are no valves at the point of entry into the heart<\/span>.<\/span><\/a><\/p>\n

Peripheral dilation is associated with decreased stroke volume and ejection fraction<\/span>.<\/span><\/a><\/p>\n

Heart valves are not capable of preventing backflow in cases of atrial congestion<\/span>.<\/span><\/a><\/p>\n

Question 4<\/span>.<\/span><\/a>4<\/span>.<\/span><\/a>\u00a0A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right<\/span>.<\/span><\/a>\u00a0In addition, her femoral pulses are weak bilaterally<\/span>.<\/span><\/a>\u00a0Which of the following possibilities would her care provider be most likely to suspect? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Pheochromocytoma<\/span><\/p>\n

Essential hypertension<\/span><\/p>\n

Coarctation of the aorta<\/span><\/p>\n

An adrenocortical disorder<\/span><\/p>\n

Question 5<\/span>.<\/span><\/a>5<\/span>.<\/span><\/a>\u00a0A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was \u201cso fast I couldn’t even count it<\/span>.<\/span><\/a>\u201d The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team<\/span>.<\/span><\/a>\u00a0Which of the following points should underlie an explanation to the mother? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

The child is experiencing a reentry rhythm in his right atrium<\/span>.<\/span><\/a><\/p>\n

The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions<\/span>.<\/span><\/a><\/p>\n

The child is likely to have a normal ECG apart from the rapid heart rate<\/span>.<\/span><\/a><\/p>\n

The boy’s atria are experiencing abnormal sympathetic stimulation<\/span>.<\/span><\/a><\/p>\n

Question 6<\/span>.<\/span><\/a>6<\/span>.<\/span><\/a>\u00a0A 66-year-old patient’s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart<\/span>.<\/span><\/a>\u00a0What is this patient’s most likely diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Mitral valve regurgitation<\/span><\/p>\n

Aortic valve stenosis<\/span><\/p>\n

Mitral valve stenosis<\/span><\/p>\n

Aortic valve regurgitation<\/span><\/p>\n

Question 7<\/span>.<\/span><\/a>7<\/span>.<\/span><\/a>\u00a0A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks<\/span>.<\/span><\/a>\u00a0His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened<\/span>.<\/span><\/a>\u00a0What would his care provider’s preliminary diagnosis and anticipated treatment most likely be?(Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Acute arterial occlusion that will be treated with angioplasty<\/span><\/p>\n

Raynaud disease that will require antiplatelet medications<\/span><\/p>\n

Atherosclerotic occlusive disease necessitating thrombolytic therapy<\/span><\/p>\n

Giant cell temporal arteritis that will be treated with corticosteroids<\/span><\/p>\n

Question 8<\/span>.<\/span><\/a>8<\/span>.<\/span><\/a>\u00a0A patient in the intensive care unit has a blood pressure of 87\/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness<\/span>.<\/span><\/a>\u00a0The patient also has arterial and venous dilation and a decrease in systemic vascular resistance<\/span>.<\/span><\/a>\u00a0What is this patient’s most likely diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Hypovolemic shock<\/span><\/p>\n

Septic shock<\/span><\/p>\n

Neurogenic shock<\/span><\/p>\n

Obstructive shock<\/span><\/p>\n

Question 9<\/span>.<\/span><\/a>9<\/span>.<\/span><\/a>\u00a0A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations<\/span>.<\/span><\/a>A resting electrocardiogram reveals sinus bradycardia and she is\u00a0 suspected of having sick sinus syndrome<\/span>.<\/span><\/a>\u00a0Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Signal-averaged ECG<\/span><\/p>\n

Exercise stress testing<\/span><\/p>\n

Electrophysiologic study<\/span><\/p>\n

Holter monitoring<\/span><\/p>\n

Question 10<\/span>.<\/span><\/a>10<\/span>.<\/span><\/a>\u00a0A nurse practitioner is providing care for several patients on a medical unit of a hospital<\/span>.<\/span><\/a>\u00a0In which of the following patient situations would the nurse practitioner be most likely to rule out hypertension as a contributing factor? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A 61-year-old man who has a heart valve infection and recurrent fever<\/span><\/p>\n

An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness<\/span><\/p>\n

A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week<\/span><\/p>\n

A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance<\/span><\/p>\n

Question 11<\/span>.<\/span><\/a>11<\/span>.<\/span><\/a>\u00a0A patient is experiencing impaired circulation secondary to increased systemic arterial pressure<\/span>.<\/span><\/a>\u00a0Which of the following statements is the most relevant phenomenon?(Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Increased preload due to vascular resistance<\/span><\/p>\n

High afterload because of backpressure against the left ventricle<\/span><\/p>\n

Impaired contractility due to aortic resistance<\/span><\/p>\n

Systolic impairment because of arterial stenosis<\/span><\/p>\n

Question 12<\/span>.<\/span><\/a>12<\/span>.<\/span><\/a>\u00a0A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction<\/span>.<\/span><\/a>\u00a0Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort<\/span><\/p>\n

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin<\/span><\/p>\n

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw<\/span><\/p>\n

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest<\/span><\/p>\n

Question 13<\/span>.<\/span><\/a>13<\/span>.<\/span><\/a>\u00a0A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation<\/span>.<\/span><\/a>\u00a0Her blood pressure is 154\/110 mm Hg and she has proteinuria<\/span>.<\/span><\/a>\u00a0What other labs should be ordered for her? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Plasma angiotensin I and II and renin<\/span><\/p>\n

Urinary sodium and potassium<\/span><\/p>\n

Platelet count, serum creatinine, and liver enzymes<\/span><\/p>\n

Urinary catecholamines and metabolites<\/span><\/p>\n

Question 14<\/span>.<\/span><\/a>14<\/span>.<\/span><\/a>\u00a0An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests<\/span>.<\/span><\/a>\u00a0What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology<\/span>.<\/span><\/a><\/p>\n

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure<\/span>.<\/span><\/a><\/p>\n

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia<\/span>.<\/span><\/a><\/p>\n

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects<\/span>.<\/span><\/a><\/p>\n

Question 15<\/span>.<\/span><\/a>15<\/span>.<\/span><\/a>\u00a0The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft<\/span>.<\/span><\/a>\u00a0Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cYour blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cOnly around one quarter of your blood is in your heart at any given time<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cBlood pressure and blood volume roughly mimic one another at any given location in the circulatory system<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cLeft-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Question 16<\/span>.<\/span><\/a>16<\/span>.<\/span><\/a>\u00a0A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner<\/span>.<\/span><\/a>\u00a0The patient’s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation<\/span>.<\/span><\/a><\/p>\n

Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system<\/span>.<\/span><\/a><\/p>\n

Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction<\/span>.<\/span><\/a><\/p>\n

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption<\/span>.<\/span><\/a><\/p>\n

Question 17<\/span>.<\/span><\/a>17<\/span>.<\/span><\/a>\u00a0A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle<\/span>.<\/span><\/a> What immediate treatments are likely to most benefit the man?\u00a0 (Points : 0<\/span>.<\/span><\/a>4) <\/span><\/p>\n

Resolution of compensatory pulmonary edema and heart arrhythmias<\/span><\/p>\n

Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility<\/span><\/p>\n

Infusion of normal saline of Ringer lactate to maintain the vascular space<\/span><\/p>\n

Administration of oxygen and epinephrine to promote perfusion<\/span><\/p>\n

Question 18<\/span>.<\/span><\/a>18<\/span>.<\/span><\/a>\u00a0A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction<\/span>.<\/span><\/a>\u00a0Which of the following assessment findings is inconsistent with his diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

His resting blood pressure is normally in the range of 150\/90 and an echocardiogram indicates his ejection fraction is 30%<\/span>.<\/span><\/a><\/p>\n

His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute<\/span>.<\/span><\/a><\/p>\n

He is presently volume overloaded following several days of intravenous fluid replacement<\/span>.<\/span><\/a><\/p>\n

Ventricular dilation and wall tension are significantly lower than normal<\/span>.<\/span><\/a><\/p>\n

Question 19<\/span>.<\/span><\/a>19<\/span>.<\/span><\/a>\u00a0A 68-year-old male complains to his nurse practitioner that when he tests his blood pressure using a machine at his pharmacy, his heart rate is nearly always very low<\/span>.<\/span><\/a>\u00a0At other times, he feels that his heart is racing, and it also seems to pause at times<\/span>.<\/span><\/a>\u00a0The man has also occasionally had lightheadedness and a recent syncopal episode<\/span>.<\/span><\/a>\u00a0What is this patient’s most likely diagnosis and the phenomenon underlying it? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Sick sinus syndrome as a result of a disease of his sinus node and atrial or junctional arrhythmias<\/span><\/p>\n

Ventricular arrhythmia as a result of alternating vagal and sympathetic stimulation<\/span><\/p>\n

Torsades de pointes as a result of disease of the bundle of His<\/span><\/p>\n

Premature atrial contractions that vacillate between tachycardic and bradycardic episodes as a consequence of an infectious process<\/span><\/p>\n

Question 20<\/span>.<\/span><\/a>20<\/span>.<\/span><\/a>\u00a0An autopsy is being performed on a 44-year-old female who died unexpectedly of heart failure<\/span>.<\/span><\/a>\u00a0Which of the following components of the pathologist’s report is most suggestive of a possible history of poorly controlled blood pressure? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cScarring of urethra suggestive of recurrent urinary tract infections is evident<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cBilateral renal hypertrophy noted<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cVessel wall changes suggestive of venous stasis are evident<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cArterial sclerosis of subcortical brain regions noted<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Question 21<\/span>.<\/span><\/a>21<\/span>.<\/span><\/a>\u00a0During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment<\/span>.<\/span><\/a>\u00a0The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms<\/span>.<\/span><\/a>Which of the following aspects of the pathophysiology of aneurysms would underlie the\u00a0 explanation the nurse provides? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Aneurysms are commonly a result of poorly controlled diabetes mellitus<\/span>.<\/span><\/a><\/p>\n

Hypertension is a frequent modifiable contributor to aneurysms<\/span>.<\/span><\/a><\/p>\n

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures<\/span>.<\/span><\/a><\/p>\n

Aneurysms can normally be resolved with lifestyle and diet modifications<\/span>.<\/span><\/a><\/p>\n

Question 22<\/span>.<\/span><\/a>22<\/span>.<\/span><\/a>\u00a0A patient has suffered damage to his pericardium following a motor vehicle accident<\/span>.<\/span><\/a>\u00a0Which of the following consequences should the nurse practitioner be most likely to rule out? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Impaired physical restraint of the left ventricule<\/span><\/p>\n

Increased friction during the contraction\/relaxation cycle<\/span><\/p>\n

Reduced protection from infectious organisms<\/span><\/p>\n

Impaired regulation of myocardial contraction<\/span><\/p>\n

Question 23<\/span>.<\/span><\/a>23<\/span>.<\/span><\/a>\u00a0A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol<\/span>.<\/span><\/a>\u00a0Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cRemember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low danger to your health<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cHaving high cholesterol increases your risk of developing diabetes and irregular heart rate<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cSmoking and being overweight increases your risk of primary hypercholesterolemia<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cYour family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Question 24<\/span>.<\/span><\/a>24<\/span>.<\/span><\/a>\u00a0An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure<\/span>.<\/span><\/a>\u00a0Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

An increase in preload via the Frank-Starling mechanism<\/span><\/p>\n

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine<\/span><\/p>\n

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)<\/span><\/p>\n

AV node pacemaking activity and vagal nerve suppression<\/span><\/p>\n

Question 25<\/span>.<\/span><\/a>25<\/span>.<\/span><\/a>\u00a0A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner<\/span>.<\/span><\/a>\u00a0Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Hyperlipidemia is a consequence of diet and lifestyle rather than genetics<\/span>.<\/span><\/a><\/p>\n

HDL cholesterol is often characterized as being beneficial to health<\/span>.<\/span><\/a><\/p>\n

Cholesterol is a metabolic waste product that the liver is responsible for clearing<\/span>.<\/span><\/a><\/p>\n

The goal of medical treatment is to eliminate cholesterol from the vascular system<\/span>.<\/span><\/a><\/p>\n

1<\/span>.<\/span><\/a>\u00a0A nurse practitioner is teaching a student NP about the physiologic basis for damage to the circulatory and neurological systems that can accompany hypotension<\/span>.<\/span><\/a>\u00a0Which of the following responses by the student would warrant correction by the nurse practitioner? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cAs vessel wall thickness increases, tension decreases<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cSmaller blood vessels require more pressure to overcome wall tension<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cThe smaller the vessel radius, the greater the pressure needed to keep it open<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cTension and vessel thickness increase proportionately<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Question 2<\/span>.<\/span><\/a>2<\/span>.<\/span><\/a>\u00a0A 31-year-old woman with a congenital heart defect reports episodes of lightheadedness and syncope, with occasional palpitations<\/span>.<\/span><\/a>A resting electrocardiogram reveals sinus bradycardia and she is\u00a0 suspected of having sick sinus syndrome<\/span>.<\/span><\/a>\u00a0Which of the following diagnostic methods is the best choice to investigate the suspicion? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Signal-averaged ECG<\/span><\/p>\n

Exercise stress testing<\/span><\/p>\n

Electrophysiologic study<\/span><\/p>\n

Holter monitoring<\/span><\/p>\n

Question 3<\/span>.<\/span><\/a>3<\/span>.<\/span><\/a>\u00a0Which of the following assessment findings in a newly admitted 30-year-old male patient would be most likely to cause his nurse practitioner to suspect polyarteritis nodosa? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

The man’s blood work indicates polycythemia (elevated red cells levels) and leukocytosis (elevated white cells)<\/span>.<\/span><\/a><\/p>\n

The man’s blood pressure is 178\/102 and he has abnormal liver function tests<\/span>.<\/span><\/a><\/p>\n

The man is acutely short of breath and his oxygen saturation is 87%<\/span>.<\/span><\/a><\/p>\n

The man’s temperature is 101<\/span>.<\/span><\/a>9\u00b0F and he is diaphoretic (heavily sweating)<\/span>.<\/span><\/a><\/p>\n

Question 4<\/span>.<\/span><\/a>4<\/span>.<\/span><\/a>\u00a0An 81-year-old male resident of a long-term care facility has a long-standing diagnosis of heart failure<\/span>.<\/span><\/a>\u00a0Which of the following short-term and longer-term compensatory mechanisms is least likely to decrease the symptoms of his heart failure? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

An increase in preload via the Frank-Starling mechanism<\/span><\/p>\n

Sympathetic stimulation and increased serum levels of epinephrine and norepinephrine<\/span><\/p>\n

Activation of the renin-angiotensin-aldosterone (RAA) system and secretion of brain natriuretic peptide (BNP)<\/span><\/p>\n

AV node pacemaking activity and vagal nerve suppression<\/span><\/p>\n

Question 5<\/span>.<\/span><\/a>5<\/span>.<\/span><\/a>\u00a0A nurse practitioner is instructing a group of older adults about the risks associated with high cholesterol<\/span>.<\/span><\/a>\u00a0Which of the following teaching points should the participants try to integrate into their lifestyle after the teaching session? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cRemember, the ‘H’ in HDL and the ‘L’ in LDL correspond to high danger and low danger to your health<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cHaving high cholesterol increases your risk of developing diabetes and irregular heart rate<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cSmoking and being overweight increases your risk of primary hypercholesterolemia<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cYour family history of hypercholesterolemia is important, but there are things you can do to compensate for a high inherited risk<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Question 6<\/span>.<\/span><\/a>6<\/span>.<\/span><\/a>\u00a0A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his nurse practitioner<\/span>.<\/span><\/a>\u00a0Which of the following aspects of hyperlipidemia would the nurse practitioner most likely take into account when teaching the patient? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Hyperlipidemia is a consequence of diet and lifestyle rather than genetics<\/span>.<\/span><\/a><\/p>\n

HDL cholesterol is often characterized as being beneficial to health<\/span>.<\/span><\/a><\/p>\n

Cholesterol is a metabolic waste product that the liver is responsible for clearing<\/span>.<\/span><\/a><\/p>\n

The goal of medical treatment is to eliminate cholesterol from the vascular system<\/span>.<\/span><\/a><\/p>\n

Question 7<\/span>.<\/span><\/a>7<\/span>.<\/span><\/a>\u00a0A number of patients have presented to the emergency department in the last 24 hours with complaints that are preliminarily indicative of myocardial infarction<\/span>.<\/span><\/a>\u00a0Which of the following patients is least likely to have an ST-segment myocardial infarction (STEMI)? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort<\/span><\/p>\n

A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin<\/span><\/p>\n

A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw<\/span><\/p>\n

A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest<\/span><\/p>\n

Question 8<\/span>.<\/span><\/a>8<\/span>.<\/span><\/a>\u00a0A patient in the intensive care unit has a blood pressure of 87\/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness<\/span>.<\/span><\/a>\u00a0The patient also has arterial and venous dilation and a decrease in systemic vascular resistance<\/span>.<\/span><\/a>\u00a0What is this patient’s most likely diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Hypovolemic shock<\/span><\/p>\n

Septic shock<\/span><\/p>\n

Neurogenic shock<\/span><\/p>\n

Obstructive shock<\/span><\/p>\n

Question 9<\/span>.<\/span><\/a>9<\/span>.<\/span><\/a>\u00a0A formerly normotensive woman, pregnant for the first time, develops hypertension and headaches at 26 weeks’ gestation<\/span>.<\/span><\/a>\u00a0Her blood pressure is 154\/110 mm Hg and she has proteinuria<\/span>.<\/span><\/a>\u00a0What other labs should be ordered for her? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Plasma angiotensin I and II and renin<\/span><\/p>\n

Urinary sodium and potassium<\/span><\/p>\n

Platelet count, serum creatinine, and liver enzymes<\/span><\/p>\n

Urinary catecholamines and metabolites<\/span><\/p>\n

Question 10<\/span>.<\/span><\/a>10<\/span>.<\/span><\/a>\u00a0An older adult female patient has presented with a new onset of shortness of breath, and the patient’s nurse practitioner has ordered measurement of her BNP levels along with other diagnostic tests<\/span>.<\/span><\/a>\u00a0What is the most accurate rationale for the nurse practitioner’s choice of blood work? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

BNP is released as a compensatory mechanism during heart failure and measuring it can help differentiate the patient’s dyspnea from a respiratory pathology<\/span>.<\/span><\/a><\/p>\n

BNP is an indirect indicator of the effectiveness of the RAA system in compensating for heart failure<\/span>.<\/span><\/a><\/p>\n

BNP levels correlate with the patient’s risk of developing cognitive deficits secondary to heart failure and consequent brain hypoxia<\/span>.<\/span><\/a><\/p>\n

BNP becomes elevated in cases of cardiac asthma, Cheyne-Stokes respirations, and acute pulmonary edema, and measurement can gauge the severity of pulmonary effects<\/span>.<\/span><\/a><\/p>\n

Question 11<\/span>.<\/span><\/a>11<\/span>.<\/span><\/a>\u00a0A nurse practitioner has ordered the measurement of a cardiac patient’s electrolyte levels as part of the patient’s morning blood work<\/span>.<\/span><\/a>\u00a0Which of the following statements best captures the importance of potassium in the normal electrical function of the patient’s heart? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation<\/span>.<\/span><\/a><\/p>\n

Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells<\/span>.<\/span><\/a><\/p>\n

The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions<\/span>.<\/span><\/a><\/p>\n

The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential<\/span>.<\/span><\/a><\/p>\n

Question 12<\/span>.<\/span><\/a>12<\/span>.<\/span><\/a>\u00a0A 70-year-old male patient presents to the emergency department complaining of pain in his calf that is exacerbated when he walks<\/span>.<\/span><\/a>\u00a0His pedal and popliteal pulses are faintly palpable and his leg distal to the pain is noticeably reddened<\/span>.<\/span><\/a>\u00a0What would his care provider’s preliminary diagnosis and anticipated treatment most likely be? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Acute arterial occlusion that will be treated with angioplasty<\/span><\/p>\n

Raynaud disease that will require antiplatelet medications<\/span><\/p>\n

Atherosclerotic occlusive disease necessitating thrombolytic therapy<\/span><\/p>\n

Giant cell temporal arteritis that will be treated with corticosteroids<\/span><\/p>\n

Question 13<\/span>.<\/span><\/a>13<\/span>.<\/span><\/a>\u00a0Which of the following situations related to the transition from fetal to perinatal circulation would be most likely to necessitate medical intervention? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Pressure in the pulmonary circulation and the right side of the infant’s heart fall markedly<\/span>.<\/span><\/a><\/p>\n

Alveolar oxygen tension increases, causing reversal of pulmonary vasoconstriction of the fetal arteries<\/span>.<\/span><\/a><\/p>\n

Systemic vascular resistance and left ventricular pressure are both increasing<\/span>.<\/span><\/a><\/p>\n

Pulmonary vascular resistance, related to muscle regression in the pulmonary arteries, rises over the course of the infant’s first week<\/span>.<\/span><\/a><\/p>\n

Question 14<\/span>.<\/span><\/a>14<\/span>.<\/span><\/a>\u00a0In which of the following patient situations would a nurse practitioner be most justified in preliminarily ruling out pericarditis as a contributing pathology to the patient’s health problems? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A 61-year-old man whose ECG was characterized by widespread T wave inversions on admission but whose T waves have recently normalized<\/span><\/p>\n

A 77-year-old with diminished S3 and S4 sounds, an irregular heart rate, and a history of atrial fibrillation<\/span><\/p>\n

A 56-year-old obese man who is complaining of chest pain that is exacerbated by deep inspiration and is radiating to his neck and scapular ridge<\/span><\/p>\n

A 60-year-old woman whose admission blood work indicates elevated white cells, erythrocyte sedimentation rate, and C-reactive protein levels<\/span><\/p>\n

Question 15<\/span>.<\/span><\/a>15<\/span>.<\/span><\/a>\u00a0During a routine physical examination of a 66-year-old woman, her nurse practitioner notes a pulsating abdominal mass and refers the woman for further treatment<\/span>.<\/span><\/a>\u00a0The nurse practitioner is explaining the diagnosis to the patient, who is unfamiliar with aneurysms<\/span>.<\/span><\/a>Which of the following aspects of the pathophysiology of aneurysms would underlie the\u00a0 explanation the nurse provides? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Aneurysms are commonly a result of poorly controlled diabetes mellitus<\/span>.<\/span><\/a><\/p>\n

Hypertension is a frequent modifiable contributor to aneurysms<\/span>.<\/span><\/a><\/p>\n

Individuals with an aneurysm are normally asymptomatic until the aneurysm ruptures<\/span>.<\/span><\/a><\/p>\n

Aneurysms can normally be resolved with lifestyle and diet modifications<\/span>.<\/span><\/a><\/p>\n

Question 16<\/span>.<\/span><\/a>16<\/span>.<\/span><\/a>\u00a0A patient is experiencing impaired circulation secondary to increased systemic arterial pressure<\/span>.<\/span><\/a>\u00a0Which of the following statements is the most relevant phenomenon?(Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Increased preload due to vascular resistance<\/span><\/p>\n

High afterload because of backpressure against the left ventricle<\/span><\/p>\n

Impaired contractility due to aortic resistance<\/span><\/p>\n

Systolic impairment because of arterial stenosis<\/span><\/p>\n

Question 17<\/span>.<\/span><\/a>17<\/span>.<\/span><\/a>\u00a0A 66-year-old patient’s echocardiogram reveals a hypertrophied left ventricle, normal chamber volume, and a normal ejection fraction from the heart<\/span>.<\/span><\/a>\u00a0What is this patient’s most likely diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Mitral valve regurgitation<\/span><\/p>\n

Aortic valve stenosis<\/span><\/p>\n

Mitral valve stenosis<\/span><\/p>\n

Aortic valve regurgitation<\/span><\/p>\n

Question 18<\/span>.<\/span><\/a>18<\/span>.<\/span><\/a>\u00a0A physical assessment of a 28-year-old female patient indicates that her blood pressure in her legs is lower than that in her arms and that her brachial pulse is weaker in her left arm than in her right<\/span>.<\/span><\/a>\u00a0In addition, her femoral pulses are weak bilaterally<\/span>.<\/span><\/a>\u00a0Which of the following possibilities would her care provider be most likely to suspect? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Pheochromocytoma<\/span><\/p>\n

Essential hypertension<\/span><\/p>\n

Coarctation of the aorta<\/span><\/p>\n

An adrenocortical disorder<\/span><\/p>\n

Question 19<\/span>.<\/span><\/a>19<\/span>.<\/span><\/a>\u00a0A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiology group by her family physician<\/span>.<\/span><\/a>As part of the patient’s diagnostic workup, the nurse practitioner\u00a0 conducting the intake assessment has ordered a Holter monitor for 24 hours<\/span>.<\/span><\/a>Which of the following statements best captures an aspect of Holter monitoring? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity<\/span>.<\/span><\/a><\/p>\n

The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies<\/span>.<\/span><\/a><\/p>\n

Accurate interpretation of the results requires correlating the findings with the activity that the woman was doing at the time of recording<\/span>.<\/span><\/a><\/p>\n

Holter monitors are normally set to record electrical activity of the heart at least once per hour<\/span>.<\/span><\/a><\/p>\n

Question 20<\/span>.<\/span><\/a>20<\/span>.<\/span><\/a>\u00a0An 81-year-old female patient of a long-term care facility has a history of congestive heart failure<\/span>.<\/span><\/a>\u00a0The nurse practitioner caring for the patient has positioned her sitting up at an angle in bed and is observing her jugular venous distention<\/span>.<\/span><\/a>\u00a0Why is jugular venous distention a useful indicator for the assessment of the patient’s condition? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest<\/span>.<\/span><\/a><\/p>\n

Blood backs up into the jugular vein because there are no valves at the point of entry into the heart<\/span>.<\/span><\/a><\/p>\n

Peripheral dilation is associated with decreased stroke volume and ejection fraction<\/span>.<\/span><\/a><\/p>\n

Heart valves are not capable of preventing backflow in cases of atrial congestion<\/span>.<\/span><\/a><\/p>\n

Question 21<\/span>.<\/span><\/a>21<\/span>.<\/span><\/a>\u00a0As part of the diagnostic workup for a male patient with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements, and imaging of his heart<\/span>.<\/span><\/a>\u00a0Which of the following series of tests is most likely to provide the needed data for his diagnosis and care? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

Echocardiogram, PET scan, ECG<\/span><\/p>\n

Ambulatory ECG, cardiac MRI, echocardiogram<\/span><\/p>\n

Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy<\/span><\/p>\n

Cardiac catheterization, cardiac CT, exercise stress testing<\/span><\/p>\n

Question 22<\/span>.<\/span><\/a>22<\/span>.<\/span><\/a>\u00a0A 6-year-old boy has been brought to the emergency department by ambulance after his mother discovered that his heart rate was \u201cso fast I couldn’t even count it<\/span>.<\/span><\/a>\u201d The child was determined to be in atrial flutter and his mother is seeking an explanation from the health care team<\/span>.<\/span><\/a>\u00a0Which of the following points should underlie an explanation to the mother? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

The child is experiencing a reentry rhythm in his right atrium<\/span>.<\/span><\/a><\/p>\n

The resolution of the problem is dependent on spontaneous recovery and is resistant to pacing interventions<\/span>.<\/span><\/a><\/p>\n

The child is likely to have a normal ECG apart from the rapid heart rate<\/span>.<\/span><\/a><\/p>\n

The boy’s atria are experiencing abnormal sympathetic stimulation<\/span>.<\/span><\/a><\/p>\n

Question 23<\/span>.<\/span><\/a>23<\/span>.<\/span><\/a>\u00a0A 66-year-old obese man with a diagnosis of ischemic heart disease has been diagnosed with heart failure that his care team has characterized as attributable to systolic dysfunction<\/span>.<\/span><\/a>\u00a0Which of the following assessment findings is inconsistent with his diagnosis? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

His resting blood pressure is normally in the range of 150\/90 and an echocardiogram indicates his ejection fraction is 30%<\/span>.<\/span><\/a><\/p>\n

His end-diastolic volume is higher than normal and his resting heart rate is regular and 82 beats per minute<\/span>.<\/span><\/a><\/p>\n

He is presently volume overloaded following several days of intravenous fluid replacement<\/span>.<\/span><\/a><\/p>\n

Ventricular dilation and wall tension are significantly lower than normal<\/span>.<\/span><\/a><\/p>\n

Question 24<\/span>.<\/span><\/a>24<\/span>.<\/span><\/a>\u00a0A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his nurse practitioner<\/span>.<\/span><\/a>\u00a0The patient’s nurse practitioner would anticipate that which of the following phenomena is most likely occurring? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation<\/span>.<\/span><\/a><\/p>\n

Epinephrine from his adrenal gland is initiating the renin-angiotensin-aldosterone system<\/span>.<\/span><\/a><\/p>\n

Vasopressin is exerting an effect on his chemoreceptors and baroreceptors, resulting in vasoconstriction<\/span>.<\/span><\/a><\/p>\n

The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption<\/span>.<\/span><\/a><\/p>\n

Question 25<\/span>.<\/span><\/a>25<\/span>.<\/span><\/a>\u00a0The nurse practitioner for a cardiology practice is responsible for providing presurgical teaching for patients who are about to undergo a coronary artery bypass graft<\/span>.<\/span><\/a>\u00a0Which of the following teaching points best conveys an aspect of the human circulatory system? (Points : 0<\/span>.<\/span><\/a>4)<\/span><\/p>\n

\u201cYour blood pressure varies widely between arteries and veins, and between pulmonary and systemic circulation<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cOnly around one quarter of your blood is in your heart at any given time<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cBlood pressure and blood volume roughly mimic one another at any given location in the circulatory system<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

\u201cLeft-sided and right-sided pumping action at each beat of the heart must equal each other to ensure adequate blood distribution<\/span>.<\/span><\/a>\u201d<\/span><\/p>\n

Winland-Brown, J<\/span>.<\/span><\/a>E<\/span>.<\/span><\/a>\u00a0and Dunphy, L<\/span>.<\/span><\/a>M<\/span>.<\/span><\/a>\u00a0(2013)<\/span>.<\/span><\/a>\u00a0Adult-Gerontology and Family Nurse Practitioner Certification Examination: Review Questions and Strategies<\/span>.<\/span><\/a><\/p>\n

Codina Leik, M<\/span>.<\/span><\/a>T<\/span>.<\/span><\/a>\u00a0(2013)<\/span>.<\/span><\/a>\u00a0Adult-Gerotonolgy Nurse Practitioner Certification Intensive Review: Fast Facts and Practice Questions<\/span>.<\/span><\/a>\u00a02ND Ed<\/span>.<\/span><\/a><\/p>\n

\u00a0<\/p>\n

\u00a0<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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