NR 547 CEA
CONSISTS OF 300+ QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
Page 1
,1. The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA
view shows a left lower chest area of consolidation adjacent to the left border of the
heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view
shows this lesion absent of the window posterior to the cardiac silhouette. Which is the
most likely location of this area of focal consolidation?
A. Left upper lobe apex
B. Right middle lobe
C. Left upper lobe lingula
D. Left lower lobe
Correct Answer:
Left upper lobe lingula
Rationale:
Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette
is obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula.
2. The inability to fully relax the myocardium during relaxation is a trademark of which
of the following diagnoses?
Correct Answer:
Diastolic dysfunction
Rationale:
The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and
is common in patients with thickened hypertrophic myocardium.
3. An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is
still elevated. Which is the BEST medication to prescribe him?
Correct Answer:
Calcium channel blocker
Rationale:
African American patients per JNC8 Hypertension Guidelines should be managed with a
dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line
management therapy for hypertension not at goal with DASH and lifestyle modifications.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance?-
Page 2
, Correct Answer:
CT angiography of the chest
Rationale:
CT angiography is considered the standard of care for measuring vascular luminal
dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the
pulmonary artery). Although a plain film is able to catch large aneurysms at times, they are
not able to provide multi-axis reconstruction needed to accurately measure the size.
Transesophageal echo is not needed to accurately measure the aorta and requires the
patient to undergo sedation which is unnecessary.
5. Which of the following medications does not cause beta 1 stimulation?
Correct Answer:
phenylephrine
Rationale:
Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor
activity.
6. A 50-year-old woman with a history of hypertension presents with dyspnea on
exertion and orthopnea. On examination, she has jugular venous distention and
bilateral crackles on lung auscultation. What is the most likely diagnosis?
Correct Answer:
Congestive heart failure
Rationale:
Of the available options, the most accurate response is congestive heart failure as it is
signifying both a right ventricular back up with jugular venous extension and crackles on lung
assault, which are suggestive of left ventricular back up. it is possible the patient may have
an acute myocardial infarction that precipitated this, however, a patient has not described
that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a
state of fluid overload. The only appropriate response of these available is congestive heart
failure.
7. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with
an ejection fraction of 40% 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 medical
home who will manage this patient after discharge, which medication strategy would
you expect to be a priority in the patient's care?
Page 3
, Correct Answer:
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale:
The patient should have a protective mechanism such as an implantable automated
cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased
risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90
days for an AICD in this state, optimizing their medication regimen and repeating an echo in
2-3 months to re-evaluate for improvement in their EF is required by most insurance
companies. A baseline echo is needed at discharge to provide a baseline for improvement
vs their repeat echo in 2-3 months. Dual anti-platelet therapy is required for 12 months
minimum post-MI. A Holter monitor does not provide any conceivable benefit for this patient
as presented.
8. Which of the following people groups represent the least risk of cardiac disease?
Correct Answer:
Caucasians
Rationale:
Statistically African Americans, Native Hawaiians, and American Indians are at at increased
risk of cardiac disease due to higher rates of hypertension, diabetes, and obesity than
Caucasians.
9. A 65-year-old woman presents for a follow-up examination. She is a smoker, and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
Correct Answer:
a statin drug.
Rationale:
Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD
risk, but for a patient who is an active smoker with premature coronary disease history (less
than age 65 for women), has hypertension and is far from an LDL goal, this patient is most
certainly a candidate for statin therapy, which represents the most aggressive therapy option
of these four listed.
10. Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Page 4
CONSISTS OF 300+ QUESTIONS
Verified Questions & Answers With Rationales
(Differential Diagnosis Across the Lifespan Practicum)
Chamberlain
Page 1
,1. The patient is exhibiting a productive cough and a low-grade fever. Chest X-ray on PA
view shows a left lower chest area of consolidation adjacent to the left border of the
heart approximately 2 rib spaces above the costophrenic angle. The lateral x-ray view
shows this lesion absent of the window posterior to the cardiac silhouette. Which is the
most likely location of this area of focal consolidation?
A. Left upper lobe apex
B. Right middle lobe
C. Left upper lobe lingula
D. Left lower lobe
Correct Answer:
Left upper lobe lingula
Rationale:
Lingular consolidation is described in this question precisely. If the cardiac margin/silhouette
is obliterated by the mass, the lesion is either right middle lobe or left upper lobe lingula.
2. The inability to fully relax the myocardium during relaxation is a trademark of which
of the following diagnoses?
Correct Answer:
Diastolic dysfunction
Rationale:
The inability for the heart to relax is a trademark of the diagnosis of diastolic dysfunction and
is common in patients with thickened hypertrophic myocardium.
3. An otherwise healthy African American adult male has been diagnosed with
hypertension. He has been restricting his salt intake, eating a DASH (Dietary
Approaches to Stop Hypertension) diet, and exercising more, but his blood pressure is
still elevated. Which is the BEST medication to prescribe him?
Correct Answer:
Calcium channel blocker
Rationale:
African American patients per JNC8 Hypertension Guidelines should be managed with a
dihydropyridine calcium channel blocker such as amlodipine (Norvasc) as first line
management therapy for hypertension not at goal with DASH and lifestyle modifications.
4. Your patient has been diagnosed with a 4.5cm ascending aortic aneurysm. Which
medical imaging is considered standard of care for serial surveillance?-
Page 2
, Correct Answer:
CT angiography of the chest
Rationale:
CT angiography is considered the standard of care for measuring vascular luminal
dimensions with contrast. CT PE protocol is not timed properly for the aorta (it's timed for the
pulmonary artery). Although a plain film is able to catch large aneurysms at times, they are
not able to provide multi-axis reconstruction needed to accurately measure the size.
Transesophageal echo is not needed to accurately measure the aorta and requires the
patient to undergo sedation which is unnecessary.
5. Which of the following medications does not cause beta 1 stimulation?
Correct Answer:
phenylephrine
Rationale:
Phenylephrine only stimulates alpha 1 receptors. The remaining three all have beta receptor
activity.
6. A 50-year-old woman with a history of hypertension presents with dyspnea on
exertion and orthopnea. On examination, she has jugular venous distention and
bilateral crackles on lung auscultation. What is the most likely diagnosis?
Correct Answer:
Congestive heart failure
Rationale:
Of the available options, the most accurate response is congestive heart failure as it is
signifying both a right ventricular back up with jugular venous extension and crackles on lung
assault, which are suggestive of left ventricular back up. it is possible the patient may have
an acute myocardial infarction that precipitated this, however, a patient has not described
that, rather is only describing dyspnea on exertion and orthopnea, which both speak to a
state of fluid overload. The only appropriate response of these available is congestive heart
failure.
7. Your patient with a history of HFrEF (heart failure with reduced ejection fraction) with
an ejection fraction of 40% 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 medical
home who will manage this patient after discharge, which medication strategy would
you expect to be a priority in the patient's care?
Page 3
, Correct Answer:
Ordering a transthoracic echocardiogram and order a Lifevest if EF is less than 35%
Rationale:
The patient should have a protective mechanism such as an implantable automated
cardioverter defibrillator (AICD) or a Lifevest if the EF is less than 35% due to the increased
risk of sudden cardiac death with low EF states. Since most patients are not eligible for 90
days for an AICD in this state, optimizing their medication regimen and repeating an echo in
2-3 months to re-evaluate for improvement in their EF is required by most insurance
companies. A baseline echo is needed at discharge to provide a baseline for improvement
vs their repeat echo in 2-3 months. Dual anti-platelet therapy is required for 12 months
minimum post-MI. A Holter monitor does not provide any conceivable benefit for this patient
as presented.
8. Which of the following people groups represent the least risk of cardiac disease?
Correct Answer:
Caucasians
Rationale:
Statistically African Americans, Native Hawaiians, and American Indians are at at increased
risk of cardiac disease due to higher rates of hypertension, diabetes, and obesity than
Caucasians.
9. A 65-year-old woman presents for a follow-up examination. She is a smoker, and her
hypertension is now adequately controlled with medication. Her mother died at age 40
from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30,
and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
Correct Answer:
a statin drug.
Rationale:
Bile acid sequestrants and cholesterol absorption inhibitors may be useful in reducing ASVD
risk, but for a patient who is an active smoker with premature coronary disease history (less
than age 65 for women), has hypertension and is far from an LDL goal, this patient is most
certainly a candidate for statin therapy, which represents the most aggressive therapy option
of these four listed.
10. Which of the following end-organ sequelae is not directly caused by uncontrolled
hypertension?
Page 4
