FNP III 2026 Cardiac Conditions Second Exam Complete Review Guide

FNP III 2026 Cardiac
Conditions Second
Exam Complete
Review Guide

,Pro BNP lab - correct answer Common labs in the primary care are:
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ProBNP (pro brain natriuretic peptide aka CHF peptide) - it is identified in the brain but released
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from cardiac ventricles; indicates ventricle stretching; could be used to differentiate between
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cardiac or pulmonary induced SOB; if there is a newly elevated proBNP order ECHO, if this is
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chronic then consider adjusting or changing diuretics. i i i i i i




Digoxin Lab Testing - correct answer Digoxin - therapeutic level 0.5-0.9 (especially for HF
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patients); toxicity when >2. If at toxic level hold med and consider possible hospitalization. Lots i i i i i i i i i i i i i i i




of drug interactions (amio, loop diuretics, macrolide abx); Drug is good for a. Fib as it
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suppresses the AV node; also good for mild-mod HF. Draw labs at least 8 hours after last dose i i i i i i i i i i i i i i i i i i




of med given. Recheck 3-7 days after dose change
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What labs do we not draw in the primary care setting? - correct answer Cardiac enzymes are
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not normally completed in primary care d/t long turnaround time - send to ER!:CK-MB (creatine
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kinase MB), cardiac-specific troponin I i i i i




Anticoagulation Labs: - correct answer Anticoagulation medications and monitoring: NOAC i i i i i i i i i i




(new oral anticoagulants) - Rivaroxaban, apixaban, dabigatran are good for DVT, atrial fib.,
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venous thrombo emboli, PE i i i




Warfarin when compared NOACs is cheap, but the disadvantages are that it requires bridging,
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frequent monitoring, it has a long half life and there are many drug interactions
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Vitamin K is antidote; advise patients to ingest same amount consistently; therapeutic INR = 2-
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3

Lipid Panel: - correct answer Lipid panel typically done annually, but can be more frequent if
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medication doses are changes or there are new comorbid diagnoses i i i i i i i i i




CRP - correct answer CRP - nonspecific inflammatory marker that is produced in the live; good
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for determining carotid atherosclerosis
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D-Dimer - correct answer D-dimer - determines PE/DVT; if negative - r/u PE and DVT; if
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elevated do CT of chest to check for PE and US for DVTs; pregnancy can cause this number to
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be elevated, so don't check this number in pregnant women.
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Cardiac Diagnostic Studies - correct answer Diagnositcs: i i i i i i i




EKG - use preop, when there's dig toxicity or electrolyte abnormalities
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ECHO - murmurs, CP, HF - non-invasive, no prep necessary prior to this test
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Exercise treadmill - not common in PC i i i i i i




Stress ECHO - used preop, and when there's CP/SOB - determines exercise tolerance with
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the presence of abnormal wall mvt; a positive test indicates need for cardiac referral
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Myocardial perfusion imaging i i




Holter monitoring - Use if palpitations or syncope are present; typically worn 24h-14 days (if
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longer than that then consider an event recorder)
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, Sinus Tachycardia: - correct answer By definition, sinus tachycardia is a heart rate that is
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greater than 100 beats per minute. As a primary care provider, it's important to focus on what is
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driving the sinus tachycardia. i i i




Situations where you may see sinus tachycardia: - correct answer Heart failure, COPD i i i i i i i i i i i i i




exacerbation, pulmonary embolism, hyperthyroidism, fevers or infection, and anxiety are just i i i i i i i i i i i




a few clinical situations, to name a few, where sinus tachycardia. would be present.
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Once the cause is identified, you should treat the condition, and the tachycardia should get
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better. However, if it does not after the suspected underlying cause is identified, you may need
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to send the patient to cardiology for referral.
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Sinus Bradycardia: - correct answer This is confirmed when an EKG demonstrates a heart rate
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of 60 beats per minute or less. If a patient has sinus bradycardia. and is asymptomatic, this
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should not be alarming to you as a provider, but it should be concerning. Is there a positive
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cause for this as a healthy adult, for example, who exercises regularly? If that's the situation,
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then we know that that is not necessarily something that needs to be warranted for further
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evaluation or treatment. i i




If it's not a healthy individual that exercises on a routine basis, and they do demonstrate
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bradycardia, the next step would be review medications or other sources excluded as a cause, i i i i i i i i i i i i i i i




such as the ones that are listed here on this slide for differentials for brady arrhythmias.
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Possible Causes of Sinus Bradycardia (abnormal): - correct answer Ischemia or infarction, i i i i i i i i i i i i




neurological conditions, metabolic or endocrine or environmental situations, such as i i i i i i i i i i




electrolyte disturbances, infections, or toxic agents. All of those things, we need to think about i i i i i i i i i i i i i i i




when we're dealing with someone who has sinus bradycardia.
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Treatment of Bradycardia - correct answer Dependent upon the cause, once we identify what i i i i i i i i i i i i i i




that is, then we can treat the underlying cause and see if the bradycardia gets better. In the
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primary care setting, you should be concerned if the patient is symptomatic. These symptoms i i i i i i i i i i i i i i




may include dizziness, lightheadedness, reported episodes of syncope or chest pain, or if the
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patient has had any new medications that have been initiated that may have driven the sinus
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bradycardia. If that's the case-- the patient is symptomatic and hemodynamically unstable-- i i i i i i i i i i i i




911 needs to be summoned, and the patient needs to report to the emergency department
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immediately.

PBCs or PACs on an EKG. - correct answer Beta blockers are typically first-line therapy for this.
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You may or may not want to initiate these based upon your clinical practice. Labs may be
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needed to be checked, such as electrolytes, to determine if that is causing the etiology of the i i i i i i i i i i i i i i i i i




PBCs or PACs. Usually, most the time your lab tests are normal.
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SVT, or supraventricular tachycardia: - correct answer There are many different things that
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can cause SVTs, and this is a generic, broad term for tachycardic rhythm problems that have
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yet to be defined once they slow down. In SVT, most of the time the rhythm is going so fast that
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you're not really able to tell if it's an atrial arrhythmia or ventricular arrhythmia until we can get
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