NR 667 / NR667 VISE Study Guide | 100% Correct
Questions & Verified Answers for Guaranteed A-
Level Results
The suggested International Normalized Ratio (INR) range in a patient being treated for atrial fibrillation
is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0 - answ✔️💜💜✔️-2.0-3.0
Rationale
Remember that for international normalized ratio, the patient is their own normalization with an INR of
1.0 as the standard of untreated blood, so with an INR of 2.0, think of the patient as twice as thin for
their blood as their normal. Protime can also be used to evaluate bleeding time for warfarin patients,
but has in general been replaced many years ago by the INR as the standard measurement, where PTT
(partial thromboplastin time) or Anti-Xa are more useful for evaluating bleeding times related to Heparin
therapy.
Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of cold
,Isometric exercise
Ginkgo biloba - answ✔️💜💜✔️-Avoidance of cold
Rationale
Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure which causes the
patient to have extremely pale/white vasoconstricted digits followed by a over-dilated vasoplegic
response causing purplish painful revascularization. Avoidance of cold is the most effective non-
pharmacologic way to mitigate this event from occurring. Pharmacologic therapy would include the use
of medications such as calcium channel blockers.
At a follow up from a hospitalization, an adult patient presents with ankle edema. Which of the
following medications is the most likely cause of the edema?
Metformin
HCTZ
Norvasc
Nebivolol - answ✔️💜💜✔️-Norvasc
Rationale
The most common side effects of calcium channel blockers include constipation and lower extremity
edema. The other options do not have any relationship specifically with edema, in fact,
hydrochlorothiazide specifically reduces edema via diuresis.
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The
patient goes to a clinic for INR determination, and the result is 1.4. Which of the following would likely
decrease the effects of warfarin (Coumadin)?
Red meat
Grapefruit
Red Wine
Broccoli - answ✔️💜💜✔️-Broccoli
,Rationale
It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and
therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green
vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore
inhibiting the anticoagulation effect of warfarin. It's also important to remember that with the direct
oral anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required
for this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit
over warfarin as noted above. Also, with warfarin it is important to remember that the effects are based
on the free drug, not the protein bound drug level, so patients who have considerable protein stores will
require more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of lowering the
INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels
to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and
and red meat is not likely to have a considerable impact, although it might have some impact if the
protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option
that has vitamin K and should be an obvious choice for this question.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea.
On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is
the most likely diagnosis?
Congestive heart failure
Pulmonary embolism
Acute myocardial infarction
Chronic obstructive pulmonary disease - answ✔️💜💜✔️-Congestive Heart Failure
Rationale
Of the available options, the most accurate response is congestive heart failure as it is signifying both a
right ventricular back up with jugular venous extension and crackles on lung assault, which are
suggestive of left ventricular back up. it is possible the patient may have an acute myocardial infarction
that precipitated this, however, a patient has not described that, rather is only describing dyspnea on
exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate response of
these available is congestive heart failure.
, An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient's cardiac health risks, due her to weight and her waist
circumference. According to the AHA guidelines, which of the following goals is expected for this
patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week
Physical activity for 30 minutes daily, 7 days a week - answ✔️💜💜✔️-Physical activity for 30 minutes
daily, for a minimum of 5 days a week
A 75-year-old patient has just been discharged to a nursing facility following hospitalization for an
exacerbation of chronic heart failure. The patient's condition is classified as stage C, which involves
known structural heart disease with previous or present symptoms of failure. If the patient is adherent
to current clinical guidelines, the nurse practitioner who is visiting can expect treatment to include
which of the following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Furosemide (Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar) - answ✔️💜💜✔️-Furosemide
(Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale
Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully improving ejection
fraction in a patient with heart failure with reduced ejection fraction should include carvedilol (Coreg)
furosemide (Lasix) or another loop diuretic, and an ACE inhibitor/ARB or ARB/ARNI such as
sacubitril/valsartan (Entresto). Calcium channel blockers are contraindicated and heart failure such as
amlodipine (Norvasc).
Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the
EKG. Which region of the heart is most likely involved?
Questions & Verified Answers for Guaranteed A-
Level Results
The suggested International Normalized Ratio (INR) range in a patient being treated for atrial fibrillation
is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0 - answ✔️💜💜✔️-2.0-3.0
Rationale
Remember that for international normalized ratio, the patient is their own normalization with an INR of
1.0 as the standard of untreated blood, so with an INR of 2.0, think of the patient as twice as thin for
their blood as their normal. Protime can also be used to evaluate bleeding time for warfarin patients,
but has in general been replaced many years ago by the INR as the standard measurement, where PTT
(partial thromboplastin time) or Anti-Xa are more useful for evaluating bleeding times related to Heparin
therapy.
Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of cold
,Isometric exercise
Ginkgo biloba - answ✔️💜💜✔️-Avoidance of cold
Rationale
Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure which causes the
patient to have extremely pale/white vasoconstricted digits followed by a over-dilated vasoplegic
response causing purplish painful revascularization. Avoidance of cold is the most effective non-
pharmacologic way to mitigate this event from occurring. Pharmacologic therapy would include the use
of medications such as calcium channel blockers.
At a follow up from a hospitalization, an adult patient presents with ankle edema. Which of the
following medications is the most likely cause of the edema?
Metformin
HCTZ
Norvasc
Nebivolol - answ✔️💜💜✔️-Norvasc
Rationale
The most common side effects of calcium channel blockers include constipation and lower extremity
edema. The other options do not have any relationship specifically with edema, in fact,
hydrochlorothiazide specifically reduces edema via diuresis.
An adult patient must maintain an International Normalized Ratio (INR) between 2.0 and 3.0. The
patient goes to a clinic for INR determination, and the result is 1.4. Which of the following would likely
decrease the effects of warfarin (Coumadin)?
Red meat
Grapefruit
Red Wine
Broccoli - answ✔️💜💜✔️-Broccoli
,Rationale
It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K antagonist, and
therefore it can be counteracted by a patient who is eating a dietary intake of vitamin K. Leafy green
vegetables such as broccoli and spinach are notorious for increasing vitamin K levels, and therefore
inhibiting the anticoagulation effect of warfarin. It's also important to remember that with the direct
oral anticoagulants category, vitamin K is not affected, and therefore no dietary restrictions are required
for this class of medications such as apixaban, rivaroxaban, and edoxaban, which is a distinct benefit
over warfarin as noted above. Also, with warfarin it is important to remember that the effects are based
on the free drug, not the protein bound drug level, so patients who have considerable protein stores will
require more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of lowering the
INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically causes warfarin levels
to rise through the CYP 450 system, and red wine causes the INR to increase by thinning the blood and
and red meat is not likely to have a considerable impact, although it might have some impact if the
protein stores are otherwise low prior to initiating the red meat in the diet. Broccoli is the only option
that has vitamin K and should be an obvious choice for this question.
A 50-year-old woman with a history of hypertension presents with dyspnea on exertion and orthopnea.
On examination, she has jugular venous distention and bilateral crackles on lung auscultation. What is
the most likely diagnosis?
Congestive heart failure
Pulmonary embolism
Acute myocardial infarction
Chronic obstructive pulmonary disease - answ✔️💜💜✔️-Congestive Heart Failure
Rationale
Of the available options, the most accurate response is congestive heart failure as it is signifying both a
right ventricular back up with jugular venous extension and crackles on lung assault, which are
suggestive of left ventricular back up. it is possible the patient may have an acute myocardial infarction
that precipitated this, however, a patient has not described that, rather is only describing dyspnea on
exertion and orthopnea, which both speak to a state of fluid overload. The only appropriate response of
these available is congestive heart failure.
, An older adult female presents for her annual examination. She has been on antihypertensive
medications for over 20 years, with good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient's cardiac health risks, due her to weight and her waist
circumference. According to the AHA guidelines, which of the following goals is expected for this
patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week
Physical activity for 30 minutes daily, 7 days a week - answ✔️💜💜✔️-Physical activity for 30 minutes
daily, for a minimum of 5 days a week
A 75-year-old patient has just been discharged to a nursing facility following hospitalization for an
exacerbation of chronic heart failure. The patient's condition is classified as stage C, which involves
known structural heart disease with previous or present symptoms of failure. If the patient is adherent
to current clinical guidelines, the nurse practitioner who is visiting can expect treatment to include
which of the following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Furosemide (Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar) - answ✔️💜💜✔️-Furosemide
(Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale
Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully improving ejection
fraction in a patient with heart failure with reduced ejection fraction should include carvedilol (Coreg)
furosemide (Lasix) or another loop diuretic, and an ACE inhibitor/ARB or ARB/ARNI such as
sacubitril/valsartan (Entresto). Calcium channel blockers are contraindicated and heart failure such as
amlodipine (Norvasc).
Your patient presents with bradycardia, severe nausea, and substernal pain. STEMI was identified on the
EKG. Which region of the heart is most likely involved?
