NR 661-Cardiovascular (2022 with complete solution Graded A+)

A patient has had poorly controlled hypertension for more than 10 years. Indicate the most likely position of his point of maximal impulse (PMI) a. 5th intercostal space (ICS) midclavicular line (MCL) b. 8th ICS MCL c. 5th ICS, left of MCL d. 6th ICS, right of MCL - ANSWER c. 5th ICS, left of MCL Valve most commonly involved in chronic rheumatic heart disease is the: a. aortic b. mitral c. pulmonic d. tricuspid - ANSWER b. mitral A 50 year old patient with Hypertension has taken hydrochlorozide 25 mg daily for the past 4 weeks. How should the nurse practitioner proceed? BP-155/95; 145/90 a. wait 4 weeks before making a dosage change b. increase the hydrochlorothiazide to 50mg daily c. add a drug from another class to the daily 25 mg hydrochlorothiazide d. stop the hydrochlorothiazide and start a drug from a different class - ANSWER c. add a drug from another class to the daily 25 mg hydrochlorothiazide Which choice below would be the best choice for an 80-year old patient whose blood pressure is 172/72 a. chlorthalidone b. amlodipine c. monopril d. acebutolol - ANSWER b. amlodipine The diagnosis of mitral valve prolapse can be confirmed by: a. physical examination b. electrocardiography c. echocardiography d. chest xray - ANSWER c. echocardiography A patient taking candesartan for treatment for hypertension should avoid a. strenuous exercise b. potassium supplements c. protein rich meals d. grapefruit juice - ANSWER b. potassium supplements According to the National Heart, Lung and Blood institute, which characteristic listed below is a coronary disease (CHD) risk equivelant; that is, which risk factor places the patient at a CHD risk similar to a history of CHD a. Hypertension b. cigarette smoking c. male age 45 years d. Diabetes Mellitus - ANSWER d. Diabetes Mellitus Classic symptoms of deep vein thrombosis (DVT) include: a. swelling, pain, redness b. calf complaints, pain with walking, history of exercise c. swelling, pain, discoloration in lower extremity d. warmth, edema and relief of pain with walking - ANSWER c. swelling, pain, discoloration in lower extremity Which mitral valve disorder results from redundancy of the mitral valve's leaflets?? a. acute mitral regurgitation b. chronic mitral regurgitation c. mitral valve prolapse d. mitral stenosis - ANSWER c. mitral valve prolapse Tables are used for determination of maximum blood pressure values for adolescents. How are blood pressure values established for adolescents? a. height percentile, body mass index and gender b. gender and age c. height percentile, gender and age d. body mass index and gender - ANSWER c. height percentile, gender and age The correlation between blood pressure and age greater than 60 years is that as age increases: a. diastolic blood pressure increases b. systolic blood pressure decreases c. blood pressure remains about the same d. diastolic blood pressure decreases - ANSWER d. diastolic blood pressure decreases An 80 year old female who is otherwise well has the following blood pressure readings. How should she be managed? 160/70; 175/68; 171/71; 163/63 a. thiazide diruetic b. ace inhibitor c. calcium channel blocker d. angiotensin receptor blocker - ANSWER c. calcium channel blocker Which choice below characterizes a patient who has aortic regurgitation? a. long asymptomatic period followed by exercise intolerance then dyspnea at rest b. an acute onset of shortness of breath in the fifth or sixth decade c. dyspnea on exertion for a long period of time before sudden cardiac death d. a long asymptomatic period with sudden death usually during exercise - ANSWER a. long asymptomatic period followed by exercise intolerance then dyspnea at rest How often should lipids be screened in patients who are 65 years and older if they have lipid disorders or cardiovascular risk factors a. annually b. every other year c. every 3 years d. every 5 years - ANSWER a. annually Risk assessment for dyslipidemia should begin at a. 2 years b. 6 years c. 18 years d. 21 years - ANSWER a. 2 years In older adults, the three most common ailments are: a. hearing loss, vision loss, hypertension b. hearing loss, hypertension, arthritis c. depression, vision loss, hypertension d. arthritis, hearing loss, depression - ANSWER b. hearing loss, hypertension, arthritis A 75 year old patient with longstanding hypertension takes a combined ACE inhibitor/thiazide diruetic and amlodipine daily. Today his diastolic blood pressure and heart rate is elevated. He has developed dyspnea on exertion and peripheral edema over the past several days. These symptoms likely demonstrate: a. primary renal dysfunction b. development of heart failure c. renal insufficiency d. dietary indiscretion - ANSWER b. development of heart failure Mr. Diagle is an 80 year old patient who takes warfarin for chronic afib. The NP should: INR 6.0 a. stop the warfarin for the next two days and repeat the INR on day 3 b. admit to the hospital immediately c. administer vitamin K and repeat INR tomorrow d. stop warfarin for one week and recheck INR - ANSWER a. stop the warfarin for the next two days and repeat the INR on day 3 A 42 year old hypertensive patient was given a thiazide diruetic 4 weeks ago for treatment of primary hypertension. On his return visit today, he reports feeling weak and tired. What should the NP consider to evaluate the weakness and fatigue? a. glucose level b. potassium level c. cbc d. tsh - ANSWER b. potassium level The NP is caring for an independent 74 year old female who had acute coronary syndrome (ACS) about 6 weeks ago. what medications should be part of her regimen unless there is a contraindication? a. ASA and beta blocker b. ACE and betablocker c. ACE, ASA and beta blocker d. ACE, ASA, beta blocker and statin - ANSWER d. ACE, ASA, beta blocker and statin Which hypertensive is most likely to have adverse blood pressure effects from excessive sodium consumption? a. 21 year old Asian American Male b. 35 year old menstruating female c. 55 year old post menopausal female d. 70 year old african american male - ANSWER d. 70 year old african american male An 87 year old has a history of symptomatic heart failure. He presents today with lower extremity edema and mild shortness of breath with exertion. In addition to a diruetic for volume overload, what other medication should he receive today? a. ACE inhibitor b. Beta Blocker c. Calcium Channel blocker d. oxygen - ANSWER a. ACE inhibitor A 76 year old patient who is very active has elevated cholesterol and LDL's. He had been treated for hypertension for 10 years with near normal blood pressures. What is the current recommendation for managing his lipids? a. no treatment should take place since his age exceeds 75 years b. he should be treated with an aspirin only c. he should be treated with a statin d. the benefits of treating this patient do not exceed the risk of using a statin or aspirin - ANSWER c. he should be treated with a statin A patient who has mitral valve prolapse (MVP) reports chest pain and frequent arrhythmias. In the absence of other underlying cardiac abnormalies, the drug of choice to treat her symptoms is: a. lisinopril b. metoprolol c. Amlodipine d. Chlorthalidone - ANSWER b. metoprolol A patient taking atorvastatin for newly diagnosed dyslipidemia complains of fatigue, weakness and muscle aches in his lower back, arms and legs for the past three days. It has not improved with rest. How should this be evaluated? a. stop the atorvastatin immediately b. check liver enzymes first c. order a CPK level d. ask about nighttime muscle cramps - ANSWER a. stop the atorvastatin immediately A 75 year old patient who has aortic stenosis wants to know what symptoms indicate worsening of his stenosis. The NP replies: a. palpitations and weakness b. ventricular arrythmias c. shortness of breath and syncope d. fatigue and exercise intolerance - ANSWER c. shortness of breath and syncope The most common indicator of end-organ damage in adolescents with hypertension is: a. left ventricular hypertrophy b. seizure c. renal dysfunction d. renal artery damage - ANSWER a. left ventricular hypertrophy A characteristic of an ACE inhibitor-induced cough is that it: a. is mildly productive b. is worse at nighttime c. usually begins within 2 weeks of starting therapy d. is more common in men - ANSWER c. usually begins within 2 weeks of starting therapy Which infant feeding behavior is least likely related to congenital