CEA Week 1 Exam Questions and Answers
1. 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: 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.
2. Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of
cold Isometric
exercise
,Ginkgo biloba: 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.
3. 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: Norvasc
Rationale
The most common side ettects 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.
4. An adult patient must maintain an International Normalized
Ratio (INR) be- tween 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:
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 ettect of warfarin. It's also important to remember that with the direct oral
anticoagulants category, vitamin K is not attected, 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 ettects 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 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.
, 5. 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: 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.
6. 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
1. 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: 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.
2. Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks
Avoidance of
cold Isometric
exercise
,Ginkgo biloba: 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.
3. 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: Norvasc
Rationale
The most common side ettects 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.
4. An adult patient must maintain an International Normalized
Ratio (INR) be- tween 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:
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 ettect of warfarin. It's also important to remember that with the direct oral
anticoagulants category, vitamin K is not attected, 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 ettects 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 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.
, 5. 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: 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.
6. 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
