A 31-year-old man comes into the office for an exam. He is 6' 5 " with a high-pitched voice,
and he has a moderate degree of mental impairment. It is discovered upon exam that his
body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for?
Klinefelter syndrome
Turner syndrome
Partial trisomy
Sex chromosome aneuploidy - ANSWER Klinefelter syndrome: a hereditary disease also
known as 47,XXY or XXY that manifests as the series of symptoms described.
A six-month-old female infant with failure to thrive comes in to the office with her parents. It
is noticed upon exam that the patient has facial deformities and is jaundiced. A complete
blood count (CBC) is ordered, which reveals anemia. When that patient's blood is examined
under a microscope, the red blood cells appear small and abnormally shaped. A mutational
analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha thalasse-
mia?
25%
100%
0%
50% - ANSWER 25% or 1/4 chance
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states
he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in
the patient's calf. A D-dimer test is ordered and comes back positive.
1
,Which additional test should be ordered to confirm a diagnosis in this patient?
A CT scan
A Doppler Ultrasound
The D-dimer test again
A clotting factors test - ANSWER A Doppler Ultrasound is the initial test of choice for pa-
tients who are not initially stratified according to clinical pretest probability (PTP) as being
low, moderate, or high risk for DVT.
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a re-
check 15 minutes later, his BP is 140/90. He states he suffers from "white coat hyperten-
sion." He states he has no history of high blood pressure and no family history of high blood
pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hyper-
tension?
Ordering the patient a cholesterol level test
Checking the patient's blood pressure in three months
Completing a biochemical blood profile
Completing an ambulatory blood pressure assessment - ANSWER Completing an ambula-
tory BP assessment.
Assessing blood pressure in a location of comfort like the home environment when no pro-
fessional is present will enable the ability to determine his blood pressure under routine cir-
cumstances.
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with re-
cumbent position. She states she has had a low-grade fever for two days. Upon exam, the
patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An
ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient?
2
,Stroke
Hypertension
Lupus
Asthma - ANSWER Lupus
Lupus is an autoimmune disorder that is often responsible for causing an inflammatory re-
sponse in the pericardial sac. Autoimmune disorders are known to cause chronic pericarditis.
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an
HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular dis-
ease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he
weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on?
Fenofibrate (Tricor) 145mg
Ezetimibe (Zetia) 10mg
Atorvastatin (Lipitor) 20mg
Ibuprofen (Motrin) 200mg - ANSWER Atorvastatin (Lipitor) 20mg
Atorvastatin is more effective in reducing total cholesterol having a greater impact on lower-
ing LDL cholesterol. The American College of Cardiology guidelines on blood cholesterol
management emphasize that the greater the reduction in the LDL-C on statin therapy, the
greater the subsequent risk reduction.
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction
(HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg
carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix)
daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is
1150.
Using the 2017 heart failure guidelines, which medication change should be recommended
for this patient?
3
, Add amlodipine (Norvasc)
Stop ARB and add lisinopril (Zestril)
Stop angiotensin receptor blockers (ARB) and add sacubitril/valsartan (Entresto)
Add nifedipine (Procardia) - ANSWER Stop angiotensin receptor blockers (ARB) and add
sacubitril/valsartan (Entresto)
The elevated BNP indicates significant heart failure. Guidelines recommend replacing an ARB
or ACE inhibitor with an ARNI such as Entresto, especially in those with HFrEF.
A 78-year-old man comes in with stable angina. He reports he has been having more angina
recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lip-
itor), aspirin, and Nitrostat PRN for chest pain. He has a history of COPD with bronchospasm.
His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient?
Diuretics
Beta blockers
Long-acting nitrates
Calcium channel blockers - ANSWER Beta Blockers
The use of nonselective beta blockers is contraindicated in the management of patients with
a history of COPD or asthma because they impact both beta 1 and beta 2 receptors and pre-
cipitate bronchospasms. Cardioselective beta blockers, while less likely to cause bron-
chospasms, may still add to the risk of respiratory compromise.
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes.
She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week
later, it is discovered she has not been taking the metformin. A second visit is scheduled.
During this visit, she states that she cannot take the medication as prescribed because it is
Ramadan, a month-long period of religious observances. Due to her religious beliefs, she
fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast
and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient?
4
and he has a moderate degree of mental impairment. It is discovered upon exam that his
body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for?
Klinefelter syndrome
Turner syndrome
Partial trisomy
Sex chromosome aneuploidy - ANSWER Klinefelter syndrome: a hereditary disease also
known as 47,XXY or XXY that manifests as the series of symptoms described.
A six-month-old female infant with failure to thrive comes in to the office with her parents. It
is noticed upon exam that the patient has facial deformities and is jaundiced. A complete
blood count (CBC) is ordered, which reveals anemia. When that patient's blood is examined
under a microscope, the red blood cells appear small and abnormally shaped. A mutational
analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha thalasse-
mia?
25%
100%
0%
50% - ANSWER 25% or 1/4 chance
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states
he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in
the patient's calf. A D-dimer test is ordered and comes back positive.
1
,Which additional test should be ordered to confirm a diagnosis in this patient?
A CT scan
A Doppler Ultrasound
The D-dimer test again
A clotting factors test - ANSWER A Doppler Ultrasound is the initial test of choice for pa-
tients who are not initially stratified according to clinical pretest probability (PTP) as being
low, moderate, or high risk for DVT.
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a re-
check 15 minutes later, his BP is 140/90. He states he suffers from "white coat hyperten-
sion." He states he has no history of high blood pressure and no family history of high blood
pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hyper-
tension?
Ordering the patient a cholesterol level test
Checking the patient's blood pressure in three months
Completing a biochemical blood profile
Completing an ambulatory blood pressure assessment - ANSWER Completing an ambula-
tory BP assessment.
Assessing blood pressure in a location of comfort like the home environment when no pro-
fessional is present will enable the ability to determine his blood pressure under routine cir-
cumstances.
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with re-
cumbent position. She states she has had a low-grade fever for two days. Upon exam, the
patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An
ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient?
2
,Stroke
Hypertension
Lupus
Asthma - ANSWER Lupus
Lupus is an autoimmune disorder that is often responsible for causing an inflammatory re-
sponse in the pericardial sac. Autoimmune disorders are known to cause chronic pericarditis.
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an
HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular dis-
ease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he
weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on?
Fenofibrate (Tricor) 145mg
Ezetimibe (Zetia) 10mg
Atorvastatin (Lipitor) 20mg
Ibuprofen (Motrin) 200mg - ANSWER Atorvastatin (Lipitor) 20mg
Atorvastatin is more effective in reducing total cholesterol having a greater impact on lower-
ing LDL cholesterol. The American College of Cardiology guidelines on blood cholesterol
management emphasize that the greater the reduction in the LDL-C on statin therapy, the
greater the subsequent risk reduction.
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction
(HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg
carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix)
daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is
1150.
Using the 2017 heart failure guidelines, which medication change should be recommended
for this patient?
3
, Add amlodipine (Norvasc)
Stop ARB and add lisinopril (Zestril)
Stop angiotensin receptor blockers (ARB) and add sacubitril/valsartan (Entresto)
Add nifedipine (Procardia) - ANSWER Stop angiotensin receptor blockers (ARB) and add
sacubitril/valsartan (Entresto)
The elevated BNP indicates significant heart failure. Guidelines recommend replacing an ARB
or ACE inhibitor with an ARNI such as Entresto, especially in those with HFrEF.
A 78-year-old man comes in with stable angina. He reports he has been having more angina
recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lip-
itor), aspirin, and Nitrostat PRN for chest pain. He has a history of COPD with bronchospasm.
His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient?
Diuretics
Beta blockers
Long-acting nitrates
Calcium channel blockers - ANSWER Beta Blockers
The use of nonselective beta blockers is contraindicated in the management of patients with
a history of COPD or asthma because they impact both beta 1 and beta 2 receptors and pre-
cipitate bronchospasms. Cardioselective beta blockers, while less likely to cause bron-
chospasms, may still add to the risk of respiratory compromise.
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes.
She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week
later, it is discovered she has not been taking the metformin. A second visit is scheduled.
During this visit, she states that she cannot take the medication as prescribed because it is
Ramadan, a month-long period of religious observances. Due to her religious beliefs, she
fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast
and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient?
4
