NR 667 PRACTICE EXAM WEEK 2
QUESTIONS & ELABORATED
COMPLETE SOLUTIONS PASSED
100%
Your 50 year-old male African American (AA) patient was found to have a blood
pressure of 160/96 upon arrival to your clinic. He does not have any other medical
conditions. For the following 24 hours of self-reported vital signs, it remained between
160-170 systolic and 90-100 diastolic without treatment. After finding all basic metabolic
panel (BMP) lab values to be within normal limits, your first choice of antihypertensive is
most likely which of the following agents?
carvedilol
metoprolol
amlodipine
lisinopril - Correct Answer ✔✔ amlodipine
A patient is being followed for type 2 diabetes mellitus and hypertension. He also has a
diagnosis of polycythemia vera and has regular phlebotomies for management. Which
of the following statements about this patient is correct?
The phlebotomies will improve his glycosylated hemoglobin levels
The phlebotomies will increase his blood pressure
He should increase dietary iron supplements
He should avoid dietary iron supplements - Correct Answer ✔✔ He should avoid dietary
iron supplements
As the nurse practitioner working in a primary care clinic, you have been notified from a
hospitalist that your long-term patient with a history of HFrEF (heart failure with reduced
ejection fraction) with an ejection fraction of 40% two years ago who is also not on
optimal medical therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior descending
artery. As the patient's medical home who will manage this patient after discharge,
which of the following would you expect to be a priority in the patient's care for their
heart failure after an acute MI?
Ordering a Holter monitor for 7 days post-discharge
Ordering a new transthoracic echocardiogram and Lifevest if EF is less than 35%
Ordering aspirin and clopidogrel for 3 months at discharge
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than
45% - Correct Answer ✔✔ Ordering a new transthoracic echocardiogram and Lifevest if
EF is less than 35%
,A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis?
Stroke
Transient ischemic attack (TIA)
Myocardial infarction (MI)
Seizure - Correct Answer ✔✔ Stroke
A 55 year-old female patient with no previous cardiac history and no family history of
hyperlipidemia with an acute myocardial infarction is treated successfully with a drug-
eluting stent during a recent hospitalization. As their long-term care provider, you
anticipate they were most likely to be also started on which of the following lipid-
lowering agents at discharge?
Ezetimibe prior to initiating statin therapy
PCSK9 inhibitor therapy
High intensity statin therapy
Moderate intensity statin therapy - Correct Answer ✔✔ High intensity statin therapy
Which of the following medications is not considered part of optimal medical therapy for
a 54 year-old male patient with a diagnosis of heart failure with reduced ejection fraction
(HFrEF) with an EF of 30%, known coronary artery disease, and normal renal function?
Aspirin
Carvedilol (Coreg)
Diltiazem (Cardizem)
Spironolactone (Aldactone) - Correct Answer ✔✔ Diltiazem (Cardizem)
An older adult with diabetes mellitus presents with leg cramps. She states that the
cramps were worst when walking to the supermarket. If she stops to rest, the pain
subsides. The nurse practitioner knows that this patient needs a workup for:
Popliteal aneurism
Deep vein thrombosis
Benign nocturnal leg cramps
Intermittent claudication - Correct Answer ✔✔ Intermittent claudication
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
Baseline reduction of blood pressure
Increase in libido
Potential increase in ejection fraction
Reduce in cardiac output - Correct Answer ✔✔ Potential increase in ejection fraction
An otherwise healthy patient reports episodes of palpitations lasting less than 5 minutes
and occurring 3-5 times daily. The patient describes a substernal flip-flop sensation with
a sudden rapid heart rate, ending with a forceful beat. Holter monitoring would most
likely document:
Premature ventricular contraction (extrasystole)
, Paroxysmal supraventricular tachycardia
Sinus tachycardia
Atrial flutter - Correct Answer ✔✔ Paroxysmal supraventricular tachycardia
Which of the following people groups represent the least risk of cardiac disease?
Native Hawaiians
American Indians
Caucasians
African Americans - Correct Answer ✔✔ Caucasians
An adult female presents with a chief complaint of fatigue and weight gain. She states
that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of
the following physical findings would support this diagnosis?
Dry skin, bradycardia, and hypoactive deep tendon reflexes
Tachycardia, exophthalmos, brittle hair
Diarrhea, tachycardia, and hypoactive deep tendon reflexes
Palpitation, bradycardia, and constipation - Correct Answer ✔✔ Dry skin, bradycardia,
and hypoactive deep tendon reflexes
An adult patient with type 2 diabetes mellitus returns at the nurse practitioner's request
to discuss medication management. Current medications include metformin
(Glucophage), 1000 mg twice daily, sitagliptin (Januvia), 10 mg daily, and insulin
detemir (Levemir), 60 U daily. Lab values are: A1c = 10.4% [normal = less than 7.0%],
fasting blood glucose = 180-190 mg/dL range [normal = less than 99 mg/dL]. Which of
the following regimens should the nurse practitioner recommend?
Basal insulin only, continuing oral medications
Switching to glargine (Lantus)
Basal and rapid-acting insulin
Rapid-acting insulin only, continuing oral medications - Correct Answer ✔✔ Basal and
rapid-acting insulin
Patients on levothyroxine should be monitored for signs of which one of the following:
Angina pectoris and dysrhythmias
Increased constipation and cramping
Focal deficits and hyperreflexia
Pedal edema and discomfort - Correct Answer ✔✔ Angina pectoris and dysrhythmias
A patient is having increased thirst and urination. You have ruled out diabetes mellitus.
After a compete history and physical you suspect diabetes insipidus. Your initial lab
tests should include?
Renal US and 24-hour urine for volume
Plasma sodium, 24-hour urine osmolality and volume
Plasma sodium and renal US
Recording Intake and output - Correct Answer ✔✔ Plasma sodium, 24-hour urine
osmolality and volume
QUESTIONS & ELABORATED
COMPLETE SOLUTIONS PASSED
100%
Your 50 year-old male African American (AA) patient was found to have a blood
pressure of 160/96 upon arrival to your clinic. He does not have any other medical
conditions. For the following 24 hours of self-reported vital signs, it remained between
160-170 systolic and 90-100 diastolic without treatment. After finding all basic metabolic
panel (BMP) lab values to be within normal limits, your first choice of antihypertensive is
most likely which of the following agents?
carvedilol
metoprolol
amlodipine
lisinopril - Correct Answer ✔✔ amlodipine
A patient is being followed for type 2 diabetes mellitus and hypertension. He also has a
diagnosis of polycythemia vera and has regular phlebotomies for management. Which
of the following statements about this patient is correct?
The phlebotomies will improve his glycosylated hemoglobin levels
The phlebotomies will increase his blood pressure
He should increase dietary iron supplements
He should avoid dietary iron supplements - Correct Answer ✔✔ He should avoid dietary
iron supplements
As the nurse practitioner working in a primary care clinic, you have been notified from a
hospitalist that your long-term patient with a history of HFrEF (heart failure with reduced
ejection fraction) with an ejection fraction of 40% two years ago who is also not on
optimal medical therapy has been diagnosed with a myocardial infarction this admission
and received emergent placement of a drug-eluting stent to the left anterior descending
artery. As the patient's medical home who will manage this patient after discharge,
which of the following would you expect to be a priority in the patient's care for their
heart failure after an acute MI?
Ordering a Holter monitor for 7 days post-discharge
Ordering a new transthoracic echocardiogram and Lifevest if EF is less than 35%
Ordering aspirin and clopidogrel for 3 months at discharge
Ordering a new transthoracic echocardiogram and order a Lifevest if EF is less than
45% - Correct Answer ✔✔ Ordering a new transthoracic echocardiogram and Lifevest if
EF is less than 35%
,A 70-year-old man with a history of atrial fibrillation presents with sudden-onset left-
sided weakness and slurred speech. What is the most likely diagnosis?
Stroke
Transient ischemic attack (TIA)
Myocardial infarction (MI)
Seizure - Correct Answer ✔✔ Stroke
A 55 year-old female patient with no previous cardiac history and no family history of
hyperlipidemia with an acute myocardial infarction is treated successfully with a drug-
eluting stent during a recent hospitalization. As their long-term care provider, you
anticipate they were most likely to be also started on which of the following lipid-
lowering agents at discharge?
Ezetimibe prior to initiating statin therapy
PCSK9 inhibitor therapy
High intensity statin therapy
Moderate intensity statin therapy - Correct Answer ✔✔ High intensity statin therapy
Which of the following medications is not considered part of optimal medical therapy for
a 54 year-old male patient with a diagnosis of heart failure with reduced ejection fraction
(HFrEF) with an EF of 30%, known coronary artery disease, and normal renal function?
Aspirin
Carvedilol (Coreg)
Diltiazem (Cardizem)
Spironolactone (Aldactone) - Correct Answer ✔✔ Diltiazem (Cardizem)
An older adult with diabetes mellitus presents with leg cramps. She states that the
cramps were worst when walking to the supermarket. If she stops to rest, the pain
subsides. The nurse practitioner knows that this patient needs a workup for:
Popliteal aneurism
Deep vein thrombosis
Benign nocturnal leg cramps
Intermittent claudication - Correct Answer ✔✔ Intermittent claudication
What is the key long-term benefit of using carvedilol for patients with coronary artery
disease and heart failure with reduced ejection fraction (HFrEF)?
Baseline reduction of blood pressure
Increase in libido
Potential increase in ejection fraction
Reduce in cardiac output - Correct Answer ✔✔ Potential increase in ejection fraction
An otherwise healthy patient reports episodes of palpitations lasting less than 5 minutes
and occurring 3-5 times daily. The patient describes a substernal flip-flop sensation with
a sudden rapid heart rate, ending with a forceful beat. Holter monitoring would most
likely document:
Premature ventricular contraction (extrasystole)
, Paroxysmal supraventricular tachycardia
Sinus tachycardia
Atrial flutter - Correct Answer ✔✔ Paroxysmal supraventricular tachycardia
Which of the following people groups represent the least risk of cardiac disease?
Native Hawaiians
American Indians
Caucasians
African Americans - Correct Answer ✔✔ Caucasians
An adult female presents with a chief complaint of fatigue and weight gain. She states
that she doesn't feel like herself. A diagnosis of hypothyroidism is suspected. Which of
the following physical findings would support this diagnosis?
Dry skin, bradycardia, and hypoactive deep tendon reflexes
Tachycardia, exophthalmos, brittle hair
Diarrhea, tachycardia, and hypoactive deep tendon reflexes
Palpitation, bradycardia, and constipation - Correct Answer ✔✔ Dry skin, bradycardia,
and hypoactive deep tendon reflexes
An adult patient with type 2 diabetes mellitus returns at the nurse practitioner's request
to discuss medication management. Current medications include metformin
(Glucophage), 1000 mg twice daily, sitagliptin (Januvia), 10 mg daily, and insulin
detemir (Levemir), 60 U daily. Lab values are: A1c = 10.4% [normal = less than 7.0%],
fasting blood glucose = 180-190 mg/dL range [normal = less than 99 mg/dL]. Which of
the following regimens should the nurse practitioner recommend?
Basal insulin only, continuing oral medications
Switching to glargine (Lantus)
Basal and rapid-acting insulin
Rapid-acting insulin only, continuing oral medications - Correct Answer ✔✔ Basal and
rapid-acting insulin
Patients on levothyroxine should be monitored for signs of which one of the following:
Angina pectoris and dysrhythmias
Increased constipation and cramping
Focal deficits and hyperreflexia
Pedal edema and discomfort - Correct Answer ✔✔ Angina pectoris and dysrhythmias
A patient is having increased thirst and urination. You have ruled out diabetes mellitus.
After a compete history and physical you suspect diabetes insipidus. Your initial lab
tests should include?
Renal US and 24-hour urine for volume
Plasma sodium, 24-hour urine osmolality and volume
Plasma sodium and renal US
Recording Intake and output - Correct Answer ✔✔ Plasma sodium, 24-hour urine
osmolality and volume
