W2 NR571- midterm study set cardio UPDATED ACTUAL Questions and
CORRECT Answers
Jasper, a young and otherwise healthy patient has just CORRECT: Rivaroxaban (Xarelto)
been diagnosed with an acute distal DVT of the left
popliteal vein. The Well's score categorizes her at low risk Rationale: Patients at low risk for complications can effectively be managed in the
for complications. Which of the following is the first-line outpatient setting. These include patients who are young, with no comorbidities,
treatment for acute DVT? and who are reliable to maintain follow-up visits. Direct-acting oral anticoagulants
are recommended for the treatment of stable DVT, due to its efficacy and safety
A. Warfarin (Coumadin) profile.
B. Low Molecular Weight Heparin
C. Aspirin
D. Rivaroxaban (Xarelto)
Jacinda, a 52-year-old, presents to the emergency CORRECT: Current chemotherapy
department with complaints of acute pain in the right calf
that started 4-5 days ago with progressive worsening. Rationale: Malignancy is a risk factor for DVT and since Jacinda is receiving
Physical examination reveals that the right calf is warm, chemotherapy, malignancy can be assumed. A laceration in the days before the
tender, red, and has moderate pitting edema. The left leg start of leg pain would strongly support cellulitis. Previous admission for
appears normal. The NP strongly suspects cellulitis based pneumonia without complication does not increase a person's risk for VTE. While
on the patient's history, however, VTE is also a concern. hormone replacement should raise the NP's suspicion for VTE, there is no
Which of the following findings from Jacinda's history indication that the patient is being treated with HRT for asymptomatic menopause.
should increase the NP's suspicion for DVT?
A. Current chemotherapy
B. Minor laceration to the affected leg 7 days ago
C. Hospital admission for community-acquired
pneumonia 1 year ago without complication
D. Menopause without symptoms or pharmacological
treatment
, Eleanor, a 39-year-old, presents to the emergency CORRECT: Administer enoxaparin (Lovenox)
department for severe pain and swelling in her left calf
that began yesterday. Significant history includes the Rationale: Since the likelihood of DVT increases in patients with multiple risk
following: a 20-pack-year smoking; breast cancer factors, the Wells DVT score should be used to evaluate patients with suspected
(completed chemotherapy 4 months ago); and travel 1st-time acute DVT. The tool stratifies patients according to pretest probability
from Europe (8-hour flight) within days before pain onset. (0=low, 1-2=moderate, > 3=high) for clot and is helpful when used in combination
She takes no medications, has no known medication with other diagnostic tests in clinical decision-making. Eleanor's history, symptoms,
allergies, and no previous VTE history. She denies fever, and exam findings are consistent with DVT and probability is high (>3 risk factors).
chest pain, and shortness of breath. Physical exam Suspicion is low for PE because she has no respiratory symptoms, therefore, V/Q
reveals severe, unilateral left lower extremity swelling (8 scanning is not necessary at this time.
cm greater than the non-affected side) with pitting Since the patient's history and clinical findings are consistent with DVT, and Wells
edema, and exquisite localized tenderness along the score shows high probability, treatment should be initiated before diagnostic
popliteal region. Vital signs are within normal limits. testing is performed, unless contraindicated. Direct-acting anticoagulation is the
Which of the following is the appropriate next step? 1st line treatment but is not an option in this scenario. Warfarin can be used but
takes 5-7 days to reach a therapeutic level and must be administered with LMWH
A. Start warfarin (Coumadin) and adjust to target INR of until the goal is reached.
2.0-3.0
B. Order a left lower extremity compression ultrasound
C. Obtain a ventilation-perfusion scan (V/Q)
D. Administer enoxaparin (Lovenox)
Differential Dx for VTE include but are not limited to :
cellulitis
injury
baker's cyst
superficial thrombophlebitis.
what are the 3 categories according to hypercoagulability, vascular damage, and venous stasis.
pathophysiological states for VTE risk factors
What are the risk factors for VTE in hypercoagulability? Hereditary & non-hereditary coagulopathies
Autoimmune disorders (SLE, RA, hyperthyroidism, IBD, etc.)
Estrogen (OCPs, HRT, etc.)
What are the risk factors for VTE in vascular damage? Smoking
Atherosclerotic plaque
Prolonged elevated BP
Femoral line catheterization
Surgery
What are the risk factors for VTE in venous stasis? Prolonged immobility or hospitalization
Obesity
Paralysis of lower extremities
Pregnancy & until 12 wks. postpartum
Malignancy & chemotherapy
Clinical presentation of DVT unilateral pain, swelling, or redness to the affected extremity
may exhibit warmth, erythema, edema, and tenderness in the affected extremity
CORRECT Answers
Jasper, a young and otherwise healthy patient has just CORRECT: Rivaroxaban (Xarelto)
been diagnosed with an acute distal DVT of the left
popliteal vein. The Well's score categorizes her at low risk Rationale: Patients at low risk for complications can effectively be managed in the
for complications. Which of the following is the first-line outpatient setting. These include patients who are young, with no comorbidities,
treatment for acute DVT? and who are reliable to maintain follow-up visits. Direct-acting oral anticoagulants
are recommended for the treatment of stable DVT, due to its efficacy and safety
A. Warfarin (Coumadin) profile.
B. Low Molecular Weight Heparin
C. Aspirin
D. Rivaroxaban (Xarelto)
Jacinda, a 52-year-old, presents to the emergency CORRECT: Current chemotherapy
department with complaints of acute pain in the right calf
that started 4-5 days ago with progressive worsening. Rationale: Malignancy is a risk factor for DVT and since Jacinda is receiving
Physical examination reveals that the right calf is warm, chemotherapy, malignancy can be assumed. A laceration in the days before the
tender, red, and has moderate pitting edema. The left leg start of leg pain would strongly support cellulitis. Previous admission for
appears normal. The NP strongly suspects cellulitis based pneumonia without complication does not increase a person's risk for VTE. While
on the patient's history, however, VTE is also a concern. hormone replacement should raise the NP's suspicion for VTE, there is no
Which of the following findings from Jacinda's history indication that the patient is being treated with HRT for asymptomatic menopause.
should increase the NP's suspicion for DVT?
A. Current chemotherapy
B. Minor laceration to the affected leg 7 days ago
C. Hospital admission for community-acquired
pneumonia 1 year ago without complication
D. Menopause without symptoms or pharmacological
treatment
, Eleanor, a 39-year-old, presents to the emergency CORRECT: Administer enoxaparin (Lovenox)
department for severe pain and swelling in her left calf
that began yesterday. Significant history includes the Rationale: Since the likelihood of DVT increases in patients with multiple risk
following: a 20-pack-year smoking; breast cancer factors, the Wells DVT score should be used to evaluate patients with suspected
(completed chemotherapy 4 months ago); and travel 1st-time acute DVT. The tool stratifies patients according to pretest probability
from Europe (8-hour flight) within days before pain onset. (0=low, 1-2=moderate, > 3=high) for clot and is helpful when used in combination
She takes no medications, has no known medication with other diagnostic tests in clinical decision-making. Eleanor's history, symptoms,
allergies, and no previous VTE history. She denies fever, and exam findings are consistent with DVT and probability is high (>3 risk factors).
chest pain, and shortness of breath. Physical exam Suspicion is low for PE because she has no respiratory symptoms, therefore, V/Q
reveals severe, unilateral left lower extremity swelling (8 scanning is not necessary at this time.
cm greater than the non-affected side) with pitting Since the patient's history and clinical findings are consistent with DVT, and Wells
edema, and exquisite localized tenderness along the score shows high probability, treatment should be initiated before diagnostic
popliteal region. Vital signs are within normal limits. testing is performed, unless contraindicated. Direct-acting anticoagulation is the
Which of the following is the appropriate next step? 1st line treatment but is not an option in this scenario. Warfarin can be used but
takes 5-7 days to reach a therapeutic level and must be administered with LMWH
A. Start warfarin (Coumadin) and adjust to target INR of until the goal is reached.
2.0-3.0
B. Order a left lower extremity compression ultrasound
C. Obtain a ventilation-perfusion scan (V/Q)
D. Administer enoxaparin (Lovenox)
Differential Dx for VTE include but are not limited to :
cellulitis
injury
baker's cyst
superficial thrombophlebitis.
what are the 3 categories according to hypercoagulability, vascular damage, and venous stasis.
pathophysiological states for VTE risk factors
What are the risk factors for VTE in hypercoagulability? Hereditary & non-hereditary coagulopathies
Autoimmune disorders (SLE, RA, hyperthyroidism, IBD, etc.)
Estrogen (OCPs, HRT, etc.)
What are the risk factors for VTE in vascular damage? Smoking
Atherosclerotic plaque
Prolonged elevated BP
Femoral line catheterization
Surgery
What are the risk factors for VTE in venous stasis? Prolonged immobility or hospitalization
Obesity
Paralysis of lower extremities
Pregnancy & until 12 wks. postpartum
Malignancy & chemotherapy
Clinical presentation of DVT unilateral pain, swelling, or redness to the affected extremity
may exhibit warmth, erythema, edema, and tenderness in the affected extremity
