6531 NRNP Combined midterm and final
Walden University:
A health care provider in a clinic finds a patient in a room, unresponsive and pale.
Which sign should be used to identify the need to initiate cardiopulmonary resuscitation
(CPR)?
Evaluation of peripheral perfusion and level of consciousness
Obtaining a history of previous myocardial infarction
Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - ANSWERAssessment of gasping
breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic
hypertension reports blurred vision and shortness of breath. The provider notes a blood
pressure of 185/115. What is the recommended action for this patient?
Increase the dose of the thiazide medication
Add a beta blocker to the patient's regimen
Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - ANSWERAdmit to the hospital for evaluation and
treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause of
these symptoms?
Atrial fibrillation
Anemia
Extrasystole
Paroxysmal attacks - ANSWERAtrial fibrillation
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left
sternal border. The provider determines that the murmur decreases in intensity when
the patient changes from standing to squatting and increases in intensity with the
Valsalva maneuver. Which cause will the provider suspect for this murmur?
Aortic stenosis
Tricuspid regurgitation
Hypertrophic cardiomyopathy
Mitral valve prolapse - ANSWERHypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute ST-segment
elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary
intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
,Give the patient an oral beta blocker
Transfer to the PCI-capable institution
Administer heparin
Initiate fibrinolytic treatment - ANSWERInitiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic
cardiovascular disease are those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - ANSWERprevious myocardial
infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only
relieves after sitting for 30 minutes or more. What the does provider suspect as the
cause for these symptoms?
Buerger's disease
Cauda equina syndrome
Diabetic neuropathy
Peripheral arterial disease - ANSWERCauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.)
Oral contraceptives
Isometic excercises
NSAIDS
Sleep apnea
Increased salt intake - ANSWEROral contraceptives
NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health
maintenance exam, the provider notes an apical systolic murmur and a midsystolic click
on auscultation. The patient denies chest pain, syncope, or palpitations. What will the
provider do?
Reassure the patient that these findings are expected
Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - ANSWERConsult
with cardiology to determine appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an exam,
the provider notes a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease
,Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - ANSWERUS of the mass to determine size
A patient is brought to an emergency department with symptoms of acute ST-segment
elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary
intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
Give the patient an oral beta blocker
Initiate fibrinolytic treatment
Administer heparin
Transfer to the PCI-capable institution - ANSWERInitiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient
denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not
take any medications. What will the provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - ANSWEROrder urinalysis, CBC, BUN and creatinine
A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram
reveals partial obstruction in lower extremity arteries. What will the provider recommend
to help with relief of symptoms in this patient?
Statin therapy with clopidogrel
Walking to the point of pain each day
Daily aspirin therapy to prevent clotting
Walking slowly for 15 to 20 minutes twice daily - ANSWERWalking to the point of pain
each day
An adult patient reports frequent episodes of syncope and lightheadedness. The
provider notes a heart rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down
Evaluate the patient's orthostatic vital signs
Reassure the patient that the symptoms are non-cardiac in origin - ANSWEREvaluate
the patient's orthostatic vital signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest
outside of a hospital setting because most victims have which arrhythmia?
Atrial flutter
Ventricular fibrillation
Atrial fibrillation
Ventricular tachycardia - ANSWERVentricular fibrillation
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac
monitor shows a heart rate of 225 beats per minute. The provider notifies transport to
, take the child to the child emergency department. What initial intervention may be
attempted in the clinic?
Administration of intravenous adenosine
Using a vagal maneuver or carotid massage
Providing a loading dose of digoxin
Giving a beta blocker - ANSWERUsing a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that
apply.)
Using a ratio of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - ANSWERUsing a ratio
of 2 rescue breaths to 30 compressions
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not
relieved by rest. The provider administers a nitroglycerin tablet which does not relieve
the discomfort. What is the next action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist
Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - ANSWERGive the patient a beta blocker
medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has
poorly-controlled hypertension, and decompensated heart failure. What is the
recommendation for treatment for this patient?
No intervention is necessary for this patient
Immediate open surgical repair of the aneurysm
Endovascular stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - ANSWERSerial ultrasonographic
surveillance of the aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum calcium
are consistent with a diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia -
ANSWERInappropriate secretion of PTH along with hypercalcemia
Walden University:
A health care provider in a clinic finds a patient in a room, unresponsive and pale.
Which sign should be used to identify the need to initiate cardiopulmonary resuscitation
(CPR)?
Evaluation of peripheral perfusion and level of consciousness
Obtaining a history of previous myocardial infarction
Determination of pulselessness or bradycardia
Assessment of gasping breaths or not breathing - ANSWERAssessment of gasping
breaths or not breathing
An African-American patient who is being treated with a thiazide diuretic for chronic
hypertension reports blurred vision and shortness of breath. The provider notes a blood
pressure of 185/115. What is the recommended action for this patient?
Increase the dose of the thiazide medication
Add a beta blocker to the patient's regimen
Admit to the hospital for evaluation and treatment
Prescribe a calcium channel blocker - ANSWERAdmit to the hospital for evaluation and
treatment
A patient reports sustained, irregular heart palpitations. What is the most likely cause of
these symptoms?
Atrial fibrillation
Anemia
Extrasystole
Paroxysmal attacks - ANSWERAtrial fibrillation
A patient has a cardiac murmur that peaks in midsystole and is best heard along the left
sternal border. The provider determines that the murmur decreases in intensity when
the patient changes from standing to squatting and increases in intensity with the
Valsalva maneuver. Which cause will the provider suspect for this murmur?
Aortic stenosis
Tricuspid regurgitation
Hypertrophic cardiomyopathy
Mitral valve prolapse - ANSWERHypertrophic cardiomyopathy
A patient is brought to an emergency department with symptoms of acute ST-segment
elevation MI (STEMI). The nearest hospital that can perform percutaneous coronary
intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
,Give the patient an oral beta blocker
Transfer to the PCI-capable institution
Administer heparin
Initiate fibrinolytic treatment - ANSWERInitiate fibrinolytic treatment
Patients who meet the criteria for statin therapy to help prevent atherosclerotic
cardiovascular disease are those with a history of (Select all that apply.)
previous myocardial infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
diabetes and an LDL between 40 and 70 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
a 10 year risk score of 5% and an LDL of 165 mg/dL. - ANSWERprevious myocardial
infarction.
a low-density lipoprotein (LDL) level >190 mg/dL.
a 10 year risk score of 8% with an LDL of 80 mg/dL.
A 75-year-old patient reports pain and a feeling of tiredness in both legs that only
relieves after sitting for 30 minutes or more. What the does provider suspect as the
cause for these symptoms?
Buerger's disease
Cauda equina syndrome
Diabetic neuropathy
Peripheral arterial disease - ANSWERCauda equina syndrome
Which are causes of secondary hypertension? (Select all that apply.)
Oral contraceptives
Isometic excercises
NSAIDS
Sleep apnea
Increased salt intake - ANSWEROral contraceptives
NSAIDS
Sleep apnea
A young female patient has known mitral valve prolapse. During a routine health
maintenance exam, the provider notes an apical systolic murmur and a midsystolic click
on auscultation. The patient denies chest pain, syncope, or palpitations. What will the
provider do?
Reassure the patient that these findings are expected
Continue to monitor the patient every 3 years
Admit the patient to the hospital for evaluation and treatment
Consult with cardiology to determine appropriate diagnostic tests - ANSWERConsult
with cardiology to determine appropriate diagnostic tests
A patient reports abdominal and back pain with anorexia and nausea. During an exam,
the provider notes a pulsatile abdominal mass. What is the initial action?
Scheduling an MRI to evaluate for aortic disease
,Immediate referral to a thoracic surgeon
US of the mass to determine size
Ordering CT angiography - ANSWERUS of the mass to determine size
A patient is brought to an emergency department with symptoms of acute ST-segment
elevations MI (STEMI). The nearest hospital that can perform percutaneous coronary
intervention (PCI) is 3 hours away. What is the initial treatment for this patient?
Give the patient an oral beta blocker
Initiate fibrinolytic treatment
Administer heparin
Transfer to the PCI-capable institution - ANSWERInitiate fibrinolytic treatment
A 55-year-old patient has a blood pressure of 138/85 on three occasions. The patient
denies headaches, palpitations, snoring, muscle weakness, and nocturia and does not
take any medications. What will the provider do next to evaluate this patient?
Continue to monitor blood pressure at each health maintenance visit
Assess serum cortisol levels
Order urinalysis, CBC, BUN and creatinine
Refer to specialist for sleep study - ANSWEROrder urinalysis, CBC, BUN and creatinine
A patient is diagnosed with PAD and elects to not have angioplasty after an angiogram
reveals partial obstruction in lower extremity arteries. What will the provider recommend
to help with relief of symptoms in this patient?
Statin therapy with clopidogrel
Walking to the point of pain each day
Daily aspirin therapy to prevent clotting
Walking slowly for 15 to 20 minutes twice daily - ANSWERWalking to the point of pain
each day
An adult patient reports frequent episodes of syncope and lightheadedness. The
provider notes a heart rate of 70 beats per minute. What will the provider do next?
Order an electrocardiogram and exercise stress test
Monitor the patient's heart rate while the patient is bearing down
Evaluate the patient's orthostatic vital signs
Reassure the patient that the symptoms are non-cardiac in origin - ANSWEREvaluate
the patient's orthostatic vital signs
The AHA recommends early CPR and AED use for adult victims of cardiac arrest
outside of a hospital setting because most victims have which arrhythmia?
Atrial flutter
Ventricular fibrillation
Atrial fibrillation
Ventricular tachycardia - ANSWERVentricular fibrillation
A child with a history of asthma is brought to the clinic with a rapid heart rate. A cardiac
monitor shows a heart rate of 225 beats per minute. The provider notifies transport to
, take the child to the child emergency department. What initial intervention may be
attempted in the clinic?
Administration of intravenous adenosine
Using a vagal maneuver or carotid massage
Providing a loading dose of digoxin
Giving a beta blocker - ANSWERUsing a vagal maneuver or carotid massage
Current American Heart Association (AHA) recommendations include: (Select all that
apply.)
Using a ratio of 2 rescue breaths to 30 compressions
A compression depth of 1.5 inches or more on an adult
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
Rescue breaths given during 2 seconds to allow full chest rise - ANSWERUsing a ratio
of 2 rescue breaths to 30 compressions
A rate of 100 compressions per minute at a minimum
Untrained rescuers giving compressions without breaths
A patient reports recurrent chest pain that occurs regardless of activity and is not
relieved by rest. The provider administers a nitroglycerin tablet which does not relieve
the discomfort. What is the next action?
Prescribe a calcium channel blocker medication
Start aspirin therapy and refer the patient to a cardiologist
Give the patient a beta blocker medication
Administer a second nitroglycerin tablet - ANSWERGive the patient a beta blocker
medication
A 70-year-old male patient has an aortic aneurysm measuring 5.0 cm. The patient has
poorly-controlled hypertension, and decompensated heart failure. What is the
recommendation for treatment for this patient?
No intervention is necessary for this patient
Immediate open surgical repair of the aneurysm
Endovascular stent grafting of the aneurysm
Serial ultrasonographic surveillance of the aneurysm - ANSWERSerial ultrasonographic
surveillance of the aneurysm
Which laboratory values representing parathyroid hormone (PTH) and serum calcium
are consistent with a diagnosis of primary hyperparathyroidism?
Appropriately increased PTH and low or normal serum calcium
Inappropriate secretion of PTH along with hypercalcemia
Appropriately high PTH along with hypocalcemia
Prolonged inappropriate secretion of PTH with subsequent hypercalcemia -
ANSWERInappropriate secretion of PTH along with hypercalcemia
