Week 3 Full Length Practice Exam
Attempt History
Attempt Time Score
LATEST Attempt 1 180 minutes 122 out of 150
Score for this quiz: 122 out of 150
Submitted Jan 26 at 2:45pm
This attempt took 180 minutes.
Question 1
pts
An older adult with diabetes mellitus presents with leg cramps. She states
that the cramps as worst when walking to the supermarket. If she stops to
rest, the pain subsides. The nurse practitioner knows that this patient needs
a workup for:
Popliteal aneurism
Intermittent claudication
Deep vein thrombosis
Benign nocturnal leg
cramps
Question 2
pts
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?
Inferior Wall
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
stimulation not typical of other areas.
,Question 3
pts
Recommendation for lipid check in adolescent with type 1 DM?
1 year
Remember than with pediatric patients with diabetes, the easiest way to
remember the evaluation schedule is to perform lipid checks is with annual
physicals.
Question 4
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-
onset unilateral leg pain and pallor. What is the most likely diagnosis?
Deep vein thrombosis
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 5
pts
An adult patient recently placed on angiotensin-converting enzyme (ACE)
inhibitor for hypertension returns with a report of a dry, persistent cough. On
examination, no indication of a respiratory problem is noted. Which of the
following is the most appropriate intervention?
Switch to an angiotensin II receptor blocker
Obtain a chest X-ray with posterior-anterior and lateral views
Continue the ACE inhibitor and prescribe a mild antitussive
,Continue the current treatment regimen
Question 6
pts
A 65 year old alcoholic patient presents with a new onset of persistent
palpitations and anxiety for the past 3 days. Your monitor is applied and an
irregularly irregular rhythm is noted. Which of the following evaluations
should be performed first in your treatment?
Ordering a BNP and Vitamin D level
Prescribing amiodarone 150mg IV bolus
Ordering a transthoracic echocardiogram
After 48-72 hrs of atrial fibrillation, the presence of thrombus must be excluded
before any rhythm-modifying intervention. Transthoracic echo is the gold standard
for a quick look for any clot burden, most likely found in the left atrial appendage.
Amiodarone is likely to convert the patient to a sinus rhythm and needs to be done
only after determining no evidence of thrombus is present. BNP and vitamin D are
inconsequential in the treatment of A-fib (TSH, serum K, and magnesium would be
valuable). Bilateral radial pulse checks are not assessed for a-fib, but rather for
patients with concern for aortic dissection and/or vascular blockage (subclavian
stenosis, thoracic outlet syndrome, etc)
Palpating pulses bilaterally to identify unilateral pulse deficit
Question 7
pts
A 70-year-old man with a history of atrial fibrillation presents with sudden-
onset left- sided weakness and slurred speech. What is the most likely
diagnosis?
Seizure
Transient ischemic attack (TIA)
, Myocardial infarction (MI)
Stroke
The patient with a history of atrial fibrillation for over 48 hours without
anticoagulation is at risk of an embolic stroke, secondary to mobilization of a
thrombus (90% of which occur in the left atrial appendage). A patient
exhibiting signs of a stroke such as unilateral weakness and slurred speech,
in addition to being evaluated for stroke with cranial imaging to rule out a
hemorrhagic etiology, should also be evaluated for a cardiac etiology as
noted above with an echocardiogram.
Question 8
pts
What is the key long-term benefit of using carvedilol for patients with
coronary artery disease and heart failure with reduced ejection fraction
(HFrEF)?
Reduction in cardiac output
Increase in libido
Baseline reduction of blood pressure
Potential increase in ejection fraction
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.
Cardiac 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.
Question 9
pts
Attempt History
Attempt Time Score
LATEST Attempt 1 180 minutes 122 out of 150
Score for this quiz: 122 out of 150
Submitted Jan 26 at 2:45pm
This attempt took 180 minutes.
Question 1
pts
An older adult with diabetes mellitus presents with leg cramps. She states
that the cramps as worst when walking to the supermarket. If she stops to
rest, the pain subsides. The nurse practitioner knows that this patient needs
a workup for:
Popliteal aneurism
Intermittent claudication
Deep vein thrombosis
Benign nocturnal leg
cramps
Question 2
pts
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?
Inferior Wall
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
stimulation not typical of other areas.
,Question 3
pts
Recommendation for lipid check in adolescent with type 1 DM?
1 year
Remember than with pediatric patients with diabetes, the easiest way to
remember the evaluation schedule is to perform lipid checks is with annual
physicals.
Question 4
pts
An 80-year-old man with a history of atrial fibrillation presents with sudden-
onset unilateral leg pain and pallor. What is the most likely diagnosis?
Deep vein thrombosis
Acute arterial occlusion
Cellulitis
Peripheral artery disease
Question 5
pts
An adult patient recently placed on angiotensin-converting enzyme (ACE)
inhibitor for hypertension returns with a report of a dry, persistent cough. On
examination, no indication of a respiratory problem is noted. Which of the
following is the most appropriate intervention?
Switch to an angiotensin II receptor blocker
Obtain a chest X-ray with posterior-anterior and lateral views
Continue the ACE inhibitor and prescribe a mild antitussive
,Continue the current treatment regimen
Question 6
pts
A 65 year old alcoholic patient presents with a new onset of persistent
palpitations and anxiety for the past 3 days. Your monitor is applied and an
irregularly irregular rhythm is noted. Which of the following evaluations
should be performed first in your treatment?
Ordering a BNP and Vitamin D level
Prescribing amiodarone 150mg IV bolus
Ordering a transthoracic echocardiogram
After 48-72 hrs of atrial fibrillation, the presence of thrombus must be excluded
before any rhythm-modifying intervention. Transthoracic echo is the gold standard
for a quick look for any clot burden, most likely found in the left atrial appendage.
Amiodarone is likely to convert the patient to a sinus rhythm and needs to be done
only after determining no evidence of thrombus is present. BNP and vitamin D are
inconsequential in the treatment of A-fib (TSH, serum K, and magnesium would be
valuable). Bilateral radial pulse checks are not assessed for a-fib, but rather for
patients with concern for aortic dissection and/or vascular blockage (subclavian
stenosis, thoracic outlet syndrome, etc)
Palpating pulses bilaterally to identify unilateral pulse deficit
Question 7
pts
A 70-year-old man with a history of atrial fibrillation presents with sudden-
onset left- sided weakness and slurred speech. What is the most likely
diagnosis?
Seizure
Transient ischemic attack (TIA)
, Myocardial infarction (MI)
Stroke
The patient with a history of atrial fibrillation for over 48 hours without
anticoagulation is at risk of an embolic stroke, secondary to mobilization of a
thrombus (90% of which occur in the left atrial appendage). A patient
exhibiting signs of a stroke such as unilateral weakness and slurred speech,
in addition to being evaluated for stroke with cranial imaging to rule out a
hemorrhagic etiology, should also be evaluated for a cardiac etiology as
noted above with an echocardiogram.
Question 8
pts
What is the key long-term benefit of using carvedilol for patients with
coronary artery disease and heart failure with reduced ejection fraction
(HFrEF)?
Reduction in cardiac output
Increase in libido
Baseline reduction of blood pressure
Potential increase in ejection fraction
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.
Cardiac 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.
Question 9
pts
