CEA WEEK 1 EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS
TheA2suggestedA2InternationalA2NormalizedA2RatioA2(INR)A2rangeA2inA2aA2patientA2beingA2
treatedA2forA2atrialA2fibrillationA2is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0A2-A2Ans--A22.0-3.0A2
Rationale
RememberA2thatA2forA2internationalA2normalizedA2ratio,A2theA2patientA2isA2theirA2ownA2nor
malizationA2withA2anA2INRA2ofA21.0A2asA2theA2standardA2ofA2untreatedA2blood,A2soA2withA2a
nA2INRA2ofA22.0,A2thinkA2ofA2theA2patientA2asA2twiceA2asA2thinA2forA2theirA2bloodA2asA2theirA2
normal.A2ProtimeA2canA2alsoA2beA2usedA2toA2evaluateA2bleedingA2timeA2forA2warfarinA2pati
ents,A2butA2hasA2inA2generalA2beenA2replacedA2manyA2yearsA2agoA2byA2theA2INRA2asA2theA
2standardA2measurement,A2whereA2PTTA2(partialA2thromboplastinA2time)A2orA2Anti-
XaA2areA2moreA2usefulA2forA2evaluatingA2bleedingA2timesA2relatedA2toA2HeparinA2therapy.
NonpharmacologicA2therapyA2forA2Raynaud'sA2diseaseA2include:
UseA2ofA2hotA2soaks
AvoidanceA2ofA2cold
IsometricA2exercise
GinkgoA2bilobaA2-A2Ans--A2AvoidanceA2ofA2cold
Rationale
Raynaud'sA2diseaseA2isA2aA2peripheralA2vascularA2syndromeA2triggeredA2byA2coldA2expos
ureA2whichA2causesA2theA2patientA2toA2haveA2extremelyA2pale/
whiteA2vasoconstrictedA2digitsA2followedA2byA2aA2over-
dilatedA2vasoplegicA2responseA2causingA2purplishA2painfulA2revascularization.A2Avoidanc
eA2ofA2coldA2isA2theA2mostA2effectiveA2non-
pharmacologicA2wayA2toA2mitigateA2thisA2eventA2fromA2occurring.A2PharmacologicA2therap
yA2wouldA2includeA2theA2useA2ofA2medicationsA2suchA2asA2calciumA2channelA2blockers.
AtA2aA2followA2upA2fromA2aA2hospitalization,A2anA2adultA2patientA2presentsA2withA2ankleA2e
dema.A2WhichA2ofA2theA2followingA2medicationsA2isA2theA2mostA2likelyA2causeA2ofA2theA2ed
ema?
Metformin
HCTZ
Norvasc
NebivololA2-A2Ans--A2Norvasc
,RationaleA2
TheA2mostA2commonA2sideA2effectsA2ofA2calciumA2channelA2blockersA2includeA2constipati
onA2andA2lowerA2extremityA2edema.A2TheA2otherA2optionsA2doA2notA2haveA2anyA2relationsh
ipA2specificallyA2withA2edema,A2inA2fact,A2hydrochlorothiazideA2specificallyA2reducesA2ede
maA2viaA2diuresis.
AnA2adultA2patientA2mustA2maintainA2anA2InternationalA2NormalizedA2RatioA2(INR)A2betwe
enA22.0A2andA23.0.A2TheA2patientA2goesA2toA2aA2clinicA2forA2INRA2determination,A2andA2the
A2resultA2isA21.4.A2WhichA2ofA2theA2followingA2wouldA2likelyA2decreaseA2theA2effectsA2ofA2w
arfarinA2(Coumadin)?
RedA2meat
Grapefruit
RedA2Wine
BroccoliA2-A2Ans--A2Broccoli
Rationale
It'sA2importantA2toA2rememberA2withA2warfarinA2(Coumadin)A2therapyA2thatA2itA2isA2aA2vita
minA2KA2antagonist,A2andA2thereforeA2itA2canA2beA2counteractedA2byA2aA2patientA2whoA2isA
2eatingA2aA2dietaryA2intakeA2ofA2vitaminA2K.A2LeafyA2greenA2vegetablesA2suchA2asA2brocco
liA2andA2spinachA2areA2notoriousA2forA2increasingA2vitaminA2KA2levels,A2andA2thereforeA2in
hibitingA2theA2anticoagulationA2effectA2ofA2warfarin.A2It'sA2alsoA2importantA2toA2rememberA2
thatA2withA2theA2directA2oralA2anticoagulantsA2category,A2vitaminA2KA2isA2notA2affected,A2an
dA2thereforeA2noA2dietaryA2restrictionsA2areA2requiredA2forA2thisA2classA2ofA2medicationsA2s
uchA2asA2apixaban,A2rivaroxaban,A2andA2edoxaban,A2whichA2isA2aA2distinctA2benefitA2overA
2warfarinA2asA2notedA2above.A2Also,A2withA2warfarinA2itA2isA2importantA2toA2rememberA2tha
tA2theA2effectsA2areA2basedA2onA2theA2freeA2drug,A2notA2theA2proteinA2boundA2drugA2level,A2
soA2patientsA2whoA2haveA2considerableA2proteinA2storesA2willA2requireA2moreA2warfarinA2t
hanA2thoseA2whoA2areA2emaciatedA2orA2haveA2lowA2proteinA2levelsA2chronically.
WithA2respectA2toA2thisA2particularA2question,A2redA2wineA2andA2grapefruitA2doA2notA2haveA
2anA2effectA2ofA2loweringA2theA2INR,A2inA2fact,A2theyA2willA2raiseA2itA2byA2theirA2uniqueA2me
chanisms.A2GrapefruitA2specificallyA2causesA2warfarinA2levelsA2toA2riseA2throughA2theA2CY
PA2450A2system,A2andA2redA2wineA2causesA2theA2INRA2toA2increaseA2byA2thinningA2theA2bl
oodA2andA2andA2redA2meatA2isA2notA2likelyA2toA2haveA2aA2considerableA2impact,A2althoughA
2itA2mightA2haveA2someA2impactA2ifA2theA2proteinA2storesA2areA2otherwiseA2lowA2priorA2toA2i
nitiatingA2theA2redA2meatA2inA2theA2diet.A2BroccoliA2isA2theA2onlyA2optionA2thatA2hasA2vitami
nA2KA2andA2shouldA2beA2anA2obviousA2choiceA2forA2thisA2question.
AA250-year-
oldA2womanA2withA2aA2historyA2ofA2hypertensionA2presentsA2withA2dyspneaA2onA2exertionA
2andA2orthopnea.A2OnA2examination,A2sheA2hasA2jugularA2venousA2distentionA2andA2bilate
ralA2cracklesA2onA2lungA2auscultation.A2WhatA2isA2theA2mostA2likelyA2diagnosis?
CongestiveA2heartA2failure
PulmonaryA2embolism
,AcuteA2myocardialA2infarction
ChronicA2obstructiveA2pulmonaryA2diseaseA2-A2Ans--A2CongestiveA2HeartA2Failure
Rationale
OfA2theA2availableA2options,A2theA2mostA2accurateA2responseA2isA2congestiveA2heartA2failu
reA2asA2itA2isA2signifyingA2bothA2aA2rightA2ventricularA2backA2upA2withA2jugularA2venousA2ext
ensionA2andA2cracklesA2onA2lungA2assault,A2whichA2areA2suggestiveA2ofA2leftA2ventricularA2
backA2up.A2itA2isA2possibleA2theA2patientA2mayA2haveA2anA2acuteA2myocardialA2infarctionA2t
hatA2precipitatedA2this,A2however,A2aA2patientA2hasA2notA2describedA2that,A2ratherA2isA2onl
yA2describingA2dyspneaA2onA2exertionA2andA2orthopnea,A2whichA2bothA2speakA2toA2aA2stat
eA2ofA2fluidA2overload.A2TheA2onlyA2appropriateA2responseA2ofA2theseA2availableA2isA2cong
estiveA2heartA2failure.
AnA2olderA2adultA2femaleA2presentsA2forA2herA2annualA2examination.A2SheA2hasA2beenA2o
nA2antihypertensiveA2medicationsA2forA2overA220A2years,A2withA2goodA2control.A2Laborator
yA2valuesA2areA2withinA2normalA2ranges.A2TheA2nurseA2practitionerA2isA2concernedA2about
A2theA2patient'sA2cardiacA2healthA2risks,A2dueA2herA2toA2weightA2andA2herA2waistA2circumfer
ence.A2AccordingA2toA2theA2AHAA2guidelines,A2whichA2ofA2theA2followingA2goalsA2isA2expec
tedA2forA2thisA2patient?
PhysicalA2activityA2forA260A2minutesA2daily,A2forA2aA2minimumA2ofA26A2daysA2aA2week
PhysicalA2activityA2forA230A2minutesA2daily,A2forA2aA2minimumA2ofA25A2daysA2aA2week
PhysicalA2activityA2forA260A2minutesA2daily,A27A2daysA2aA2week
PhysicalA2activityA2forA230A2minutesA2daily,A27A2daysA2aA2weekA2-A2Ans--
A2PhysicalA2activityA2forA230A2minutesA2daily,A2forA2aA2minimumA2ofA25A2daysA2aA2week
AA275-year-
oldA2patientA2hasA2justA2beenA2dischargedA2toA2aA2nursingA2facilityA2followingA2hospitalizat
ionA2forA2anA2exacerbationA2ofA2chronicA2heartA2failure.A2TheA2patient'sA2conditionA2isA2cla
ssifiedA2asA2stageA2C,A2whichA2involvesA2knownA2structuralA2heartA2diseaseA2withA2previo
usA2orA2presentA2symptomsA2ofA2failure.A2IfA2theA2patientA2isA2adherentA2toA2currentA2clinic
alA2guidelines,A2theA2nurseA2practitionerA2whoA2isA2visitingA2canA2expectA2treatmentA2toA2in
cludeA2whichA2ofA2theA2followingA2medications?
HydrochlorothiazideA2(HCTZ),A2lisinoprilA2(Zestril),A2amlodipineA2(Norvasc)
FurosemideA2(Lasix),A2lisinoprilA2(Zestril),A2carvedilolA2(Coreg)
FurosemideA2(Lasix),A2prazosinA2(Minipress),A2propranololA2(Inderal)
HydrochlorothiazideA2(HCTZ),A2metoprololA2(Lopressor),A2losartanA2(Cozaar)A2-A2Ans--
A2FurosemideA2(Lasix),A2lisinoprilA2(Zestril),A2carvedilolA2(Coreg)
Rationale
GoalA2directedA2therapyA2forA2reducingA2chronicA2symptomsA2ofA2heartA2failure,A2andA2ho
pefullyA2improvingA2ejectionA2fractionA2inA2aA2patientA2withA2heartA2failureA2withA2reducedA
2ejectionA2fractionA2shouldA2includeA2carvedilolA2(Coreg)A2furosemideA2(Lasix)A2orA2anoth
erA2loopA2diuretic,A2andA2anA2ACEA2inhibitor/ARBA2orA2ARB/ARNIA2suchA2asA2sacubitril/
, valsartanA2(Entresto).A2CalciumA2channelA2blockersA2areA2contraindicatedA2andA2heartA2fa
ilureA2suchA2asA2amlodipineA2(Norvasc).
YourA2patientA2presentsA2withA2bradycardia,A2severeA2nausea,A2andA2substernalA2pain.A2
STEMIA2wasA2identifiedA2onA2theA2EKG.A2WhichA2regionA2ofA2theA2heartA2isA2mostA2likelyA2
involved?
LateralA2Wall
AnteriorA2Wall
InferiorA2Wall
SeptalA2WallA2-A2Ans--A2InferiorA2Wall
Rationale
TheA2inferiorA2wall,A2fedA2byA2theA2rightA2coronaryA2arteryA2isA2commonlyA2associatedA2wit
hA2theseA2symptoms.A2RememberA2rightA2equalsA2rateA2asA2itA2isA2theA2bloodA2supplyA2for
A2theA2SAA2andA2AVA2nodesA2inA2mostA2patients.A2DyspepsiaA2isA2commonA2inA2RCAA2terri
toryA2injuryA2dueA2toA2vagalA2stimulationA2notA2typicalA2ofA2otherA2areas.
WhatA2isA2theA2keyA2long-
termA2benefitA2ofA2usingA2carvedilolA2forA2patientsA2withA2coronaryA2arteryA2diseaseA2andA
2heartA2failureA2withA2reducedA2ejectionA2fractionA2(HFrEF)?
IncreaseA2inA2libido
ReductionA2inA2cardiacA2output
BaselineA2reductionA2ofA2bloodA2pressure
PotentialA2increaseA2inA2ejectionA2fractionA2-A2Ans--
A2PotentialA2increaseA2inA2ejectionA2fraction
Rationale
EFA2increaseA2isA2aA2keyA2reasonA2forA2usingA2carvedilolA2overA2metoprololA2forA2patientsA
2withA2lowA2EFA2states.A2LibidoA2unfortunatelyA2canA2beA2negativelyA2impactedA2byA2anyA2
betaA2blocker.A2CardiacA2outputA2shouldA2onlyA2improveA2withA2longA2termA2use,A2notA2de
crease,A2andA2betaA2blockersA2mayA2reduceA2bloodA2pressureA2slightly,A2butA2thatA2isA2not
A2theirA2keyA2long-
termA2benefit.A2InA2fact,A2theyA2areA2notA2evenA2consideredA2forA2routineA2anti-
hypertensiveA2managementA2perA2JNC-8A2guidelines.
YourA2patientA2presentsA2withA2pale,A2waxyA2legs,A2weakA2peripheralA2pulses,A2andA2state
sA2heA2isA2havingA2difficultyA2walkingA2greatA2distancesA2dueA2toA2theA2painA2inA2hisA2calve
s.A2TheA2mostA2appropriateA2non-
invasiveA2testA2toA2evaluateA2hisA2legA2vascularA2flowA2qualityA2isA2whichA2ofA2theA2followin
gA2exams?
ExerciseA2stressA2test
AngiogramA2ofA2theA2legA2withA2runoff
AnkleA2BrachialA2IndexA2(ABI)
CORRECT VERIFIED ANSWERS
TheA2suggestedA2InternationalA2NormalizedA2RatioA2(INR)A2rangeA2inA2aA2patientA2beingA2
treatedA2forA2atrialA2fibrillationA2is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0A2-A2Ans--A22.0-3.0A2
Rationale
RememberA2thatA2forA2internationalA2normalizedA2ratio,A2theA2patientA2isA2theirA2ownA2nor
malizationA2withA2anA2INRA2ofA21.0A2asA2theA2standardA2ofA2untreatedA2blood,A2soA2withA2a
nA2INRA2ofA22.0,A2thinkA2ofA2theA2patientA2asA2twiceA2asA2thinA2forA2theirA2bloodA2asA2theirA2
normal.A2ProtimeA2canA2alsoA2beA2usedA2toA2evaluateA2bleedingA2timeA2forA2warfarinA2pati
ents,A2butA2hasA2inA2generalA2beenA2replacedA2manyA2yearsA2agoA2byA2theA2INRA2asA2theA
2standardA2measurement,A2whereA2PTTA2(partialA2thromboplastinA2time)A2orA2Anti-
XaA2areA2moreA2usefulA2forA2evaluatingA2bleedingA2timesA2relatedA2toA2HeparinA2therapy.
NonpharmacologicA2therapyA2forA2Raynaud'sA2diseaseA2include:
UseA2ofA2hotA2soaks
AvoidanceA2ofA2cold
IsometricA2exercise
GinkgoA2bilobaA2-A2Ans--A2AvoidanceA2ofA2cold
Rationale
Raynaud'sA2diseaseA2isA2aA2peripheralA2vascularA2syndromeA2triggeredA2byA2coldA2expos
ureA2whichA2causesA2theA2patientA2toA2haveA2extremelyA2pale/
whiteA2vasoconstrictedA2digitsA2followedA2byA2aA2over-
dilatedA2vasoplegicA2responseA2causingA2purplishA2painfulA2revascularization.A2Avoidanc
eA2ofA2coldA2isA2theA2mostA2effectiveA2non-
pharmacologicA2wayA2toA2mitigateA2thisA2eventA2fromA2occurring.A2PharmacologicA2therap
yA2wouldA2includeA2theA2useA2ofA2medicationsA2suchA2asA2calciumA2channelA2blockers.
AtA2aA2followA2upA2fromA2aA2hospitalization,A2anA2adultA2patientA2presentsA2withA2ankleA2e
dema.A2WhichA2ofA2theA2followingA2medicationsA2isA2theA2mostA2likelyA2causeA2ofA2theA2ed
ema?
Metformin
HCTZ
Norvasc
NebivololA2-A2Ans--A2Norvasc
,RationaleA2
TheA2mostA2commonA2sideA2effectsA2ofA2calciumA2channelA2blockersA2includeA2constipati
onA2andA2lowerA2extremityA2edema.A2TheA2otherA2optionsA2doA2notA2haveA2anyA2relationsh
ipA2specificallyA2withA2edema,A2inA2fact,A2hydrochlorothiazideA2specificallyA2reducesA2ede
maA2viaA2diuresis.
AnA2adultA2patientA2mustA2maintainA2anA2InternationalA2NormalizedA2RatioA2(INR)A2betwe
enA22.0A2andA23.0.A2TheA2patientA2goesA2toA2aA2clinicA2forA2INRA2determination,A2andA2the
A2resultA2isA21.4.A2WhichA2ofA2theA2followingA2wouldA2likelyA2decreaseA2theA2effectsA2ofA2w
arfarinA2(Coumadin)?
RedA2meat
Grapefruit
RedA2Wine
BroccoliA2-A2Ans--A2Broccoli
Rationale
It'sA2importantA2toA2rememberA2withA2warfarinA2(Coumadin)A2therapyA2thatA2itA2isA2aA2vita
minA2KA2antagonist,A2andA2thereforeA2itA2canA2beA2counteractedA2byA2aA2patientA2whoA2isA
2eatingA2aA2dietaryA2intakeA2ofA2vitaminA2K.A2LeafyA2greenA2vegetablesA2suchA2asA2brocco
liA2andA2spinachA2areA2notoriousA2forA2increasingA2vitaminA2KA2levels,A2andA2thereforeA2in
hibitingA2theA2anticoagulationA2effectA2ofA2warfarin.A2It'sA2alsoA2importantA2toA2rememberA2
thatA2withA2theA2directA2oralA2anticoagulantsA2category,A2vitaminA2KA2isA2notA2affected,A2an
dA2thereforeA2noA2dietaryA2restrictionsA2areA2requiredA2forA2thisA2classA2ofA2medicationsA2s
uchA2asA2apixaban,A2rivaroxaban,A2andA2edoxaban,A2whichA2isA2aA2distinctA2benefitA2overA
2warfarinA2asA2notedA2above.A2Also,A2withA2warfarinA2itA2isA2importantA2toA2rememberA2tha
tA2theA2effectsA2areA2basedA2onA2theA2freeA2drug,A2notA2theA2proteinA2boundA2drugA2level,A2
soA2patientsA2whoA2haveA2considerableA2proteinA2storesA2willA2requireA2moreA2warfarinA2t
hanA2thoseA2whoA2areA2emaciatedA2orA2haveA2lowA2proteinA2levelsA2chronically.
WithA2respectA2toA2thisA2particularA2question,A2redA2wineA2andA2grapefruitA2doA2notA2haveA
2anA2effectA2ofA2loweringA2theA2INR,A2inA2fact,A2theyA2willA2raiseA2itA2byA2theirA2uniqueA2me
chanisms.A2GrapefruitA2specificallyA2causesA2warfarinA2levelsA2toA2riseA2throughA2theA2CY
PA2450A2system,A2andA2redA2wineA2causesA2theA2INRA2toA2increaseA2byA2thinningA2theA2bl
oodA2andA2andA2redA2meatA2isA2notA2likelyA2toA2haveA2aA2considerableA2impact,A2althoughA
2itA2mightA2haveA2someA2impactA2ifA2theA2proteinA2storesA2areA2otherwiseA2lowA2priorA2toA2i
nitiatingA2theA2redA2meatA2inA2theA2diet.A2BroccoliA2isA2theA2onlyA2optionA2thatA2hasA2vitami
nA2KA2andA2shouldA2beA2anA2obviousA2choiceA2forA2thisA2question.
AA250-year-
oldA2womanA2withA2aA2historyA2ofA2hypertensionA2presentsA2withA2dyspneaA2onA2exertionA
2andA2orthopnea.A2OnA2examination,A2sheA2hasA2jugularA2venousA2distentionA2andA2bilate
ralA2cracklesA2onA2lungA2auscultation.A2WhatA2isA2theA2mostA2likelyA2diagnosis?
CongestiveA2heartA2failure
PulmonaryA2embolism
,AcuteA2myocardialA2infarction
ChronicA2obstructiveA2pulmonaryA2diseaseA2-A2Ans--A2CongestiveA2HeartA2Failure
Rationale
OfA2theA2availableA2options,A2theA2mostA2accurateA2responseA2isA2congestiveA2heartA2failu
reA2asA2itA2isA2signifyingA2bothA2aA2rightA2ventricularA2backA2upA2withA2jugularA2venousA2ext
ensionA2andA2cracklesA2onA2lungA2assault,A2whichA2areA2suggestiveA2ofA2leftA2ventricularA2
backA2up.A2itA2isA2possibleA2theA2patientA2mayA2haveA2anA2acuteA2myocardialA2infarctionA2t
hatA2precipitatedA2this,A2however,A2aA2patientA2hasA2notA2describedA2that,A2ratherA2isA2onl
yA2describingA2dyspneaA2onA2exertionA2andA2orthopnea,A2whichA2bothA2speakA2toA2aA2stat
eA2ofA2fluidA2overload.A2TheA2onlyA2appropriateA2responseA2ofA2theseA2availableA2isA2cong
estiveA2heartA2failure.
AnA2olderA2adultA2femaleA2presentsA2forA2herA2annualA2examination.A2SheA2hasA2beenA2o
nA2antihypertensiveA2medicationsA2forA2overA220A2years,A2withA2goodA2control.A2Laborator
yA2valuesA2areA2withinA2normalA2ranges.A2TheA2nurseA2practitionerA2isA2concernedA2about
A2theA2patient'sA2cardiacA2healthA2risks,A2dueA2herA2toA2weightA2andA2herA2waistA2circumfer
ence.A2AccordingA2toA2theA2AHAA2guidelines,A2whichA2ofA2theA2followingA2goalsA2isA2expec
tedA2forA2thisA2patient?
PhysicalA2activityA2forA260A2minutesA2daily,A2forA2aA2minimumA2ofA26A2daysA2aA2week
PhysicalA2activityA2forA230A2minutesA2daily,A2forA2aA2minimumA2ofA25A2daysA2aA2week
PhysicalA2activityA2forA260A2minutesA2daily,A27A2daysA2aA2week
PhysicalA2activityA2forA230A2minutesA2daily,A27A2daysA2aA2weekA2-A2Ans--
A2PhysicalA2activityA2forA230A2minutesA2daily,A2forA2aA2minimumA2ofA25A2daysA2aA2week
AA275-year-
oldA2patientA2hasA2justA2beenA2dischargedA2toA2aA2nursingA2facilityA2followingA2hospitalizat
ionA2forA2anA2exacerbationA2ofA2chronicA2heartA2failure.A2TheA2patient'sA2conditionA2isA2cla
ssifiedA2asA2stageA2C,A2whichA2involvesA2knownA2structuralA2heartA2diseaseA2withA2previo
usA2orA2presentA2symptomsA2ofA2failure.A2IfA2theA2patientA2isA2adherentA2toA2currentA2clinic
alA2guidelines,A2theA2nurseA2practitionerA2whoA2isA2visitingA2canA2expectA2treatmentA2toA2in
cludeA2whichA2ofA2theA2followingA2medications?
HydrochlorothiazideA2(HCTZ),A2lisinoprilA2(Zestril),A2amlodipineA2(Norvasc)
FurosemideA2(Lasix),A2lisinoprilA2(Zestril),A2carvedilolA2(Coreg)
FurosemideA2(Lasix),A2prazosinA2(Minipress),A2propranololA2(Inderal)
HydrochlorothiazideA2(HCTZ),A2metoprololA2(Lopressor),A2losartanA2(Cozaar)A2-A2Ans--
A2FurosemideA2(Lasix),A2lisinoprilA2(Zestril),A2carvedilolA2(Coreg)
Rationale
GoalA2directedA2therapyA2forA2reducingA2chronicA2symptomsA2ofA2heartA2failure,A2andA2ho
pefullyA2improvingA2ejectionA2fractionA2inA2aA2patientA2withA2heartA2failureA2withA2reducedA
2ejectionA2fractionA2shouldA2includeA2carvedilolA2(Coreg)A2furosemideA2(Lasix)A2orA2anoth
erA2loopA2diuretic,A2andA2anA2ACEA2inhibitor/ARBA2orA2ARB/ARNIA2suchA2asA2sacubitril/
, valsartanA2(Entresto).A2CalciumA2channelA2blockersA2areA2contraindicatedA2andA2heartA2fa
ilureA2suchA2asA2amlodipineA2(Norvasc).
YourA2patientA2presentsA2withA2bradycardia,A2severeA2nausea,A2andA2substernalA2pain.A2
STEMIA2wasA2identifiedA2onA2theA2EKG.A2WhichA2regionA2ofA2theA2heartA2isA2mostA2likelyA2
involved?
LateralA2Wall
AnteriorA2Wall
InferiorA2Wall
SeptalA2WallA2-A2Ans--A2InferiorA2Wall
Rationale
TheA2inferiorA2wall,A2fedA2byA2theA2rightA2coronaryA2arteryA2isA2commonlyA2associatedA2wit
hA2theseA2symptoms.A2RememberA2rightA2equalsA2rateA2asA2itA2isA2theA2bloodA2supplyA2for
A2theA2SAA2andA2AVA2nodesA2inA2mostA2patients.A2DyspepsiaA2isA2commonA2inA2RCAA2terri
toryA2injuryA2dueA2toA2vagalA2stimulationA2notA2typicalA2ofA2otherA2areas.
WhatA2isA2theA2keyA2long-
termA2benefitA2ofA2usingA2carvedilolA2forA2patientsA2withA2coronaryA2arteryA2diseaseA2andA
2heartA2failureA2withA2reducedA2ejectionA2fractionA2(HFrEF)?
IncreaseA2inA2libido
ReductionA2inA2cardiacA2output
BaselineA2reductionA2ofA2bloodA2pressure
PotentialA2increaseA2inA2ejectionA2fractionA2-A2Ans--
A2PotentialA2increaseA2inA2ejectionA2fraction
Rationale
EFA2increaseA2isA2aA2keyA2reasonA2forA2usingA2carvedilolA2overA2metoprololA2forA2patientsA
2withA2lowA2EFA2states.A2LibidoA2unfortunatelyA2canA2beA2negativelyA2impactedA2byA2anyA2
betaA2blocker.A2CardiacA2outputA2shouldA2onlyA2improveA2withA2longA2termA2use,A2notA2de
crease,A2andA2betaA2blockersA2mayA2reduceA2bloodA2pressureA2slightly,A2butA2thatA2isA2not
A2theirA2keyA2long-
termA2benefit.A2InA2fact,A2theyA2areA2notA2evenA2consideredA2forA2routineA2anti-
hypertensiveA2managementA2perA2JNC-8A2guidelines.
YourA2patientA2presentsA2withA2pale,A2waxyA2legs,A2weakA2peripheralA2pulses,A2andA2state
sA2heA2isA2havingA2difficultyA2walkingA2greatA2distancesA2dueA2toA2theA2painA2inA2hisA2calve
s.A2TheA2mostA2appropriateA2non-
invasiveA2testA2toA2evaluateA2hisA2legA2vascularA2flowA2qualityA2isA2whichA2ofA2theA2followin
gA2exams?
ExerciseA2stressA2test
AngiogramA2ofA2theA2legA2withA2runoff
AnkleA2BrachialA2IndexA2(ABI)
