NR 507 CEA PREP: FULL PRACTICE EXAM
QUESTIONS AND DETAILED VERIFIED
ANSWERS LATEST
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA
view shows a left lower chest area of consolidation adjacent to the left border of the
heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view
shows this lesion absent of the window posterior to the cardiac silhouette. Which is the
most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac
margin/silhouette is obliterated by the mass, the lesion is either right middle lobe or left
upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark of which of
the following diagnoses?
Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic
dysfunction and is common in patients with thickened hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is
still elevated. Which is the BEST medication to prescribe him?
,Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be
managed with a dihydropyridine calcium channel blocker such as amlodipine (Norvasc)
as first line management therapy for hypertension not at goal with DASH and lifestyle
modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance?
CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular
luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's
timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at
times, they are not able to provide multi-axis reconstruction needed to accurately
measure the size. Transesophageal echo is not needed to accurately measure the aorta
and requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation?
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
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
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.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an
ejection fraction of 40% who is also not on optimal medical therapy has been diagnosed
with a myocardial infarction this admission and received emergent placement of a drug-
eluting stent to the left anterior descending artery. As the medical home who will
manage this patient after discharge, which medication strategy would you expect to be
a priority in the patient's care?
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable
automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due
to the increased risk of sudden cardiac death with low EF states. Since most patients
are not eligible for 90 days for an AICD in this state, optimizing their medication regimen
and repeating an echo in 2-3 months to re-evaluate for improvement in their EF is
required by most insurance companies. A baseline echo is needed at discharge to
provide a baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as presented.
Which of the following people groups represent the least risk of cardiac disease?
Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians are
at at increased risk of cardiac disease due to higher rates of hypertension, diabetes,
and obesity than Caucasians.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in
reducing ASVD risk, but for a patient who is an active smoker with premature coronary
disease history (less than age 65 for women), has hypertension and is far from an LDL
goal, this patient is most certainly a candidate for statin therapy, which represents the
most aggressive therapy option of these four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropathy, it
is only directly attributed to patients who are also diabetic and is commonly found in
non-hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are
all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on addressing all the following except?
Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable risk
factors such as age, gender, genetic/family history should not be the primary focus of
prevention.
A 33-Year-Old Woman Presents With Irregular Menstrual Cycles, Hirsutism, And
Obesity. Laboratory Tests Reveal Elevated Serum Testosterone And LH Ratio > 2:1.
What Is The Most Appropriate Initial Treatment?
Oral Contraceptives
QUESTIONS AND DETAILED VERIFIED
ANSWERS LATEST
The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA
view shows a left lower chest area of consolidation adjacent to the left border of the
heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view
shows this lesion absent of the window posterior to the cardiac silhouette. Which is the
most likely location of this area of focal consolidation?
*Left upper lobe apex
*Right middle lobe
*Left upper lobe lingula
*Left lower lobe
Left upper lobe lingula
Ratonale: Lingular consolidation is described in this question precisely. If the cardiac
margin/silhouette is obliterated by the mass, the lesion is either right middle lobe or left
upper lobe lingula.
The inability to fully relax the myocardium during relaxation is a trademark of which of
the following diagnoses?
Diastolic dysfunction
Rationale: The inability for the heart to relax is a trademark of the diagnosis of diastolic
dysfunction and is common in patients with thickened hypertrophic myocardium.
An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is
still elevated. Which is the BEST medication to prescribe him?
,Calcium channel blocker
Rationale: African American patients per JNC8 Hypertension Guidelines should be
managed with a dihydropyridine calcium channel blocker such as amlodipine (Norvasc)
as first line management therapy for hypertension not at goal with DASH and lifestyle
modifications.
Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance?
CT angiography of the chest
Rationale: CT angiography is considered the standard of care for measuring vascular
luminal dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's
timed for the pulmonary artery). Although a plain film is able to catch large aneurysms at
times, they are not able to provide multi-axis reconstruction needed to accurately
measure the size. Transesophageal echo is not needed to accurately measure the aorta
and requires the patient to undergo sedation which is unnecessary.
Which of the following medications does not cause beta 1 stimulation?
phenylephrine
Rationale: Phenylephrine only stimulates alpha 1 receptors. The remaining three all
have beta receptor activity.
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
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.
Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with an
ejection fraction of 40% who is also not on optimal medical therapy has been diagnosed
with a myocardial infarction this admission and received emergent placement of a drug-
eluting stent to the left anterior descending artery. As the medical home who will
manage this patient after discharge, which medication strategy would you expect to be
a priority in the patient's care?
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale: The patient should have a protective mechanism such as an implantable
automated cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due
to the increased risk of sudden cardiac death with low EF states. Since most patients
are not eligible for 90 days for an AICD in this state, optimizing their medication regimen
and repeating an echo in 2-3 months to re-evaluate for improvement in their EF is
required by most insurance companies. A baseline echo is needed at discharge to
provide a baseline for improvement vs their repeat echo in 2-3 months.
Dual anti-platelet therapy is required for 12 months minimum post-MI.
A Holter monitor does not provide any conceivable benefit for this patient as presented.
Which of the following people groups represent the least risk of cardiac disease?
Caucasians
Rationale: Statistically African Americans, Native Hawaiians, and American Indians are
at at increased risk of cardiac disease due to higher rates of hypertension, diabetes,
and obesity than Caucasians.
A 65-year-old woman presents for a follow-up examination. She is a smoker, and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
a statin drug.
Rationale: Bile acid sequestrants and cholesterol absorption inhibitors may be useful in
reducing ASVD risk, but for a patient who is an active smoker with premature coronary
disease history (less than age 65 for women), has hypertension and is far from an LDL
goal, this patient is most certainly a candidate for statin therapy, which represents the
most aggressive therapy option of these four listed.
Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Peripheral neuropathy
Ratioanle: Although patients with hypertension frequently have peripheral neuropathy, it
is only directly attributed to patients who are also diabetic and is commonly found in
non-hypertensive diabetic patients. Proteinuria, AV nicking, and hemorrhagic stroke are
all caused by uncontrolled hypertension.
Preventive cardiac care should focus primarily on addressing all the following except?
Genetic predisposition
Rationale: Smoking cessation, exercise, and medication compliance all represent
modifiable risk factors and should be the focus of preventive care. Non-modifiable risk
factors such as age, gender, genetic/family history should not be the primary focus of
prevention.
A 33-Year-Old Woman Presents With Irregular Menstrual Cycles, Hirsutism, And
Obesity. Laboratory Tests Reveal Elevated Serum Testosterone And LH Ratio > 2:1.
What Is The Most Appropriate Initial Treatment?
Oral Contraceptives
