CEA WEEK 1 EXAM QUESTIONS AND
ANSWERS
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=-=ans-✔✔2.0-3.0=
Rationale
Remember=that=for=international=normalized=ratio,=the=patient=is=their=own=normalizatio
n=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=u
sed=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=thro
mboplastin=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=-=ans-✔✔Avoidance=of=cold
Rationale
Raynaud's=disease=is=a=peripheral=vascular=syndrome=triggered=by=cold=exposure=whi
ch=causes=the=patient=to=have=extremely=pale/
white=vasoconstricted=digits=followed=by=a=over-
dilated=vasoplegic=response=causing=purplish=painful=revascularization.=Avoidance=of=c
old=is=the=most=effective=non-
pharmacologic=way=to=mitigate=this=event=from=occurring.=Pharmacologic=therapy=woul
d=include=the=use=of=medications=such=as=calcium=channel=blockers.
,At=a=follow=up=from=a=hospitalization,=an=adult=patient=presents=with=ankle=edema.=Wh
ich=of=the=following=medications=is=the=most=likely=cause=of=the=edema?
Metformin
HCTZ
Norvasc
Nebivolol=-=ans-✔✔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=wi
th=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.=Whi
ch=of=the=following=would=likely=decrease=the=effects=of=warfarin=(Coumadin)?
Red=meat
Grapefruit
Red=Wine
Broccoli=-=ans-✔✔Broccoli
Rationale
It's=important=to=remember=with=warfarin=(Coumadin)=therapy=that=it=is=a=vitamin=K=ant
agonist,=and=therefore=it=can=be=counteracted=by=a=patient=who=is=eating=a=dietary=int
ake=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=cate
gory,=vitamin=K=is=not=affected,=and=therefore=no=dietary=restrictions=are=required=for=t
his=class=of=medications=such=as=apixaban,=rivaroxaban,=and=edoxaban,=which=is=a=di
stinct=benefit=over=warfarin=as=noted=above.=Also,=with=warfarin=it=is=important=to=reme
mber=that=the=effects=are=based=on=the=free=drug,=not=the=protein=bound=drug=level,=s
o=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=win
e=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=store
s=are=otherwise=low=prior=to=initiating=the=red=meat=in=the=diet.=Broccoli=is=the=only=opt
ion=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=orth
,opnea.=On=examination,=she=has=jugular=venous=distention=and=bilateral=crackles=on=l
ung=auscultation.=What=is=the=most=likely=diagnosis?
Congestive=heart=failure
Pulmonary=embolism
Acute=myocardial=infarction
Chronic=obstructive=pulmonary=disease=-=ans-✔✔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=crackl
es=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=p
atient=has=not=described=that,=rather=is=only=describing=dyspnea=on=exertion=and=ortho
pnea,=which=both=speak=to=a=state=of=fluid=overload.=The=only=appropriate=response=o
f=these=available=is=congestive=heart=failure.
An=older=adult=female=presents=for=her=annual=examination.=She=has=been=on=antihyp
ertensive=medications=for=over=20=years,=with=good=control.=Laboratory=values=are=wit
hin=normal=ranges.=The=nurse=practitioner=is=concerned=about=the=patient's=cardiac=he
alth=risks,=due=her=to=weight=and=her=waist=circumference.=According=to=the=AHA=guid
elines,=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=-=ans-
✔✔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=practition
er=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)=-=ans-
✔✔Furosemide=(Lasix),=lisinopril=(Zestril),=carvedilol=(Coreg)
Rationale
Goal=directed=therapy=for=reducing=chronic=symptoms=of=heart=failure,=and=hopefully=i
mproving=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=s
uch=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?
Lateral=Wall
Anterior=Wall
Inferior=Wall
Septal=Wall=-=ans-✔✔Inferior=Wall
Rationale
The=inferior=wall,=fed=by=the=right=coronary=artery=is=commonly=associated=with=these=
symptoms.=Remember=right=equals=rate=as=it=is=the=blood=supply=for=the=SA=and=AV=
nodes=in=most=patients.=Dyspepsia=is=common=in=RCA=territory=injury=due=to=vagal=sti
mulation=not=typical=of=other=areas.
What=is=the=key=long-
term=benefit=of=using=carvedilol=for=patients=with=coronary=artery=disease=and=heart=fai
lure=with=reduced=ejection=fraction=(HFrEF)?
Increase=in=libido
Reduction=in=cardiac=output
Baseline=reduction=of=blood=pressure
Potential=increase=in=ejection=fraction=-=ans-✔✔Potential=increase=in=ejection=fraction
Rationale
EF=increase=is=a=key=reason=for=using=carvedilol=over=metoprolol=for=patients=with=low
=EF=states.=Libido=unfortunately=can=be=negatively=impacted=by=any=beta=blocker.=Car
diac=output=should=only=improve=with=long=term=use,=not=decrease,=and=beta=blockers
=may=reduce=blood=pressure=slightly,=but=that=is=not=their=key=long-
term=benefit.=In=fact,=they=are=not=even=considered=for=routine=anti-
hypertensive=management=per=JNC-8=guidelines.
Your=patient=presents=with=pale,=waxy=legs,=weak=peripheral=pulses,=and=states=he=is=
having=difficulty=walking=great=distances=due=to=the=pain=in=his=calves.=The=most=appr
opriate=non-
invasive=test=to=evaluate=his=leg=vascular=flow=quality=is=which=of=the=following=exams
?
Exercise=stress=test
Angiogram=of=the=leg=with=runoff
Ankle=Brachial=Index=(ABI)
Bilateral=popliteal=blood=pressures=-=ans-✔✔Ankle=Brachial=Index=(ABI)
ANSWERS
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=-=ans-✔✔2.0-3.0=
Rationale
Remember=that=for=international=normalized=ratio,=the=patient=is=their=own=normalizatio
n=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=u
sed=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=thro
mboplastin=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=-=ans-✔✔Avoidance=of=cold
Rationale
Raynaud's=disease=is=a=peripheral=vascular=syndrome=triggered=by=cold=exposure=whi
ch=causes=the=patient=to=have=extremely=pale/
white=vasoconstricted=digits=followed=by=a=over-
dilated=vasoplegic=response=causing=purplish=painful=revascularization.=Avoidance=of=c
old=is=the=most=effective=non-
pharmacologic=way=to=mitigate=this=event=from=occurring.=Pharmacologic=therapy=woul
d=include=the=use=of=medications=such=as=calcium=channel=blockers.
,At=a=follow=up=from=a=hospitalization,=an=adult=patient=presents=with=ankle=edema.=Wh
ich=of=the=following=medications=is=the=most=likely=cause=of=the=edema?
Metformin
HCTZ
Norvasc
Nebivolol=-=ans-✔✔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=wi
th=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.=Whi
ch=of=the=following=would=likely=decrease=the=effects=of=warfarin=(Coumadin)?
Red=meat
Grapefruit
Red=Wine
Broccoli=-=ans-✔✔Broccoli
Rationale
It's=important=to=remember=with=warfarin=(Coumadin)=therapy=that=it=is=a=vitamin=K=ant
agonist,=and=therefore=it=can=be=counteracted=by=a=patient=who=is=eating=a=dietary=int
ake=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=cate
gory,=vitamin=K=is=not=affected,=and=therefore=no=dietary=restrictions=are=required=for=t
his=class=of=medications=such=as=apixaban,=rivaroxaban,=and=edoxaban,=which=is=a=di
stinct=benefit=over=warfarin=as=noted=above.=Also,=with=warfarin=it=is=important=to=reme
mber=that=the=effects=are=based=on=the=free=drug,=not=the=protein=bound=drug=level,=s
o=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=win
e=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=store
s=are=otherwise=low=prior=to=initiating=the=red=meat=in=the=diet.=Broccoli=is=the=only=opt
ion=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=orth
,opnea.=On=examination,=she=has=jugular=venous=distention=and=bilateral=crackles=on=l
ung=auscultation.=What=is=the=most=likely=diagnosis?
Congestive=heart=failure
Pulmonary=embolism
Acute=myocardial=infarction
Chronic=obstructive=pulmonary=disease=-=ans-✔✔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=crackl
es=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=p
atient=has=not=described=that,=rather=is=only=describing=dyspnea=on=exertion=and=ortho
pnea,=which=both=speak=to=a=state=of=fluid=overload.=The=only=appropriate=response=o
f=these=available=is=congestive=heart=failure.
An=older=adult=female=presents=for=her=annual=examination.=She=has=been=on=antihyp
ertensive=medications=for=over=20=years,=with=good=control.=Laboratory=values=are=wit
hin=normal=ranges.=The=nurse=practitioner=is=concerned=about=the=patient's=cardiac=he
alth=risks,=due=her=to=weight=and=her=waist=circumference.=According=to=the=AHA=guid
elines,=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=-=ans-
✔✔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=practition
er=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)=-=ans-
✔✔Furosemide=(Lasix),=lisinopril=(Zestril),=carvedilol=(Coreg)
Rationale
Goal=directed=therapy=for=reducing=chronic=symptoms=of=heart=failure,=and=hopefully=i
mproving=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=s
uch=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?
Lateral=Wall
Anterior=Wall
Inferior=Wall
Septal=Wall=-=ans-✔✔Inferior=Wall
Rationale
The=inferior=wall,=fed=by=the=right=coronary=artery=is=commonly=associated=with=these=
symptoms.=Remember=right=equals=rate=as=it=is=the=blood=supply=for=the=SA=and=AV=
nodes=in=most=patients.=Dyspepsia=is=common=in=RCA=territory=injury=due=to=vagal=sti
mulation=not=typical=of=other=areas.
What=is=the=key=long-
term=benefit=of=using=carvedilol=for=patients=with=coronary=artery=disease=and=heart=fai
lure=with=reduced=ejection=fraction=(HFrEF)?
Increase=in=libido
Reduction=in=cardiac=output
Baseline=reduction=of=blood=pressure
Potential=increase=in=ejection=fraction=-=ans-✔✔Potential=increase=in=ejection=fraction
Rationale
EF=increase=is=a=key=reason=for=using=carvedilol=over=metoprolol=for=patients=with=low
=EF=states.=Libido=unfortunately=can=be=negatively=impacted=by=any=beta=blocker.=Car
diac=output=should=only=improve=with=long=term=use,=not=decrease,=and=beta=blockers
=may=reduce=blood=pressure=slightly,=but=that=is=not=their=key=long-
term=benefit.=In=fact,=they=are=not=even=considered=for=routine=anti-
hypertensive=management=per=JNC-8=guidelines.
Your=patient=presents=with=pale,=waxy=legs,=weak=peripheral=pulses,=and=states=he=is=
having=difficulty=walking=great=distances=due=to=the=pain=in=his=calves.=The=most=appr
opriate=non-
invasive=test=to=evaluate=his=leg=vascular=flow=quality=is=which=of=the=following=exams
?
Exercise=stress=test
Angiogram=of=the=leg=with=runoff
Ankle=Brachial=Index=(ABI)
Bilateral=popliteal=blood=pressures=-=ans-✔✔Ankle=Brachial=Index=(ABI)
