1. Bob is being seen in the office, and you suspect an acute ischemic syndrome and an acute
myocardial infarction. Which would be the LAST step that you would consider?
A. Prompt admission to a monitored bed with cardiology consultation.
B. Administer aspirin immediately.
C. Obtain a 12-lead ECG within 10 minutes.
D. Obtain cardiac biomarkers.
E. Arrange for emergent cardiac catheterization.
Correct Answer: E. Arrange for emergent cardiac catheterization.
Rationale: Emergent cardiac catheterization is the definitive treatment for STEMI but is not
the immediate first step. The priority sequence is: 1) obtain 12-lead ECG within 10 minutes,
2) administer aspirin, 3) obtain cardiac biomarkers, 4) admit to monitored bed with
cardiology consultation. Cardiac catheterization is considered after initial stabilization and
ECG confirmation, not as the very first intervention.
2. Which of the following is a characteristic finding in right-sided heart failure?
A. Pulmonary edema.
B. Jugular venous distention.
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,C. Orthopnea.
D. Paroxysmal nocturnal dyspnea.
Correct Answer: B. Jugular venous distention.
Rationale: Right-sided heart failure results in systemic venous congestion. Signs include
jugular venous distention, peripheral edema, hepatomegaly, and ascites. Pulmonary edema,
orthopnea, and paroxysmal nocturnal dyspnea are characteristic of left-sided heart failure
due to pulmonary congestion.
3. A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which
instruction is correct?
A. Take one tablet daily in the morning.
B. Swallow the tablet with a full glass of water.
C. Take one tablet at the onset of chest pain and repeat every 5 minutes up to 3 doses.
D. Take one tablet 30 minutes before exercise to prevent angina.
Correct Answer: C. Take one tablet at the onset of chest pain and repeat every 5 minutes up
to 3 doses.
Rationale: Sublingual nitroglycerin should be taken at the first sign of angina. If pain
persists after 5 minutes, a second dose can be taken. If pain continues after a third dose at
5-minute intervals, the patient should seek emergency care. The tablet should be dissolved
under the tongue, not swallowed. Prophylactic use before exercise may be appropriate for
some patients but is not the standard acute instruction.
4. Sandra says she wants to know more about the Pooled Cohort Equation to determine her
10-year risk of ASCVD. You tell her that the variables include which of the following?
A. Total and HDL cholesterol levels.
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,B. Systolic BP.
C. Diabetes.
D. Current smoking status.
E. All of the above.
Correct Answer: E. All of the above.
Rationale: The Pooled Cohort Equation (PCE) estimates 10-year risk for atherosclerotic
cardiovascular disease (ASCVD) in adults aged 40-79. The variables include age, sex, race,
total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension,
diabetes, and current smoking status. All options listed (A-D) are components of the
equation.
5. Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue
over the past 6 months. She has been trying to lose weight, has been on a walking exercise
program for over a year, and had taken the fenfluramine-phentermine (Fen-Phen)
combination many years ago but stopped when its adverse effects were reported. Your
examination reveals a grade II/VI systolic murmur along the apex. What do you do?
A. Obtain pulmonary function tests.
B. Instruct the client about other exercise activities that may not produce her symptoms.
C. Refer the client to a cardiologist for an echocardiogram and cardiovascular work-up.
D. Start endocarditis prophylaxis.
Correct Answer: C. Refer the client to a cardiologist for an echocardiogram and
cardiovascular work-up.
Rationale: Martha's history of Fen-Phen use is significant because this combination was
associated with valvular heart disease, particularly mitral and aortic valve abnormalities.
Her symptoms (dyspnea, fatigue) and a systolic murmur at the apex raise concern for
mitral valve disease. An echocardiogram is essential to evaluate valve structure and
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, function. Endocarditis prophylaxis is not indicated without a definitive valve lesion that
meets current guidelines. PFTs and exercise counseling would delay necessary cardiac
evaluation.
6. Which statement about mitral valve prolapse (MVP) is true?
A. MVP occurs in about 10% of the population.
B. MVP is usually detected in older adults.
C. The incidence is equal in men and women younger than age 20.
D. The incidence is more common in women younger than age 20.
Correct Answer: D. The incidence is more common in women younger than age 20.
Rationale: Mitral valve prolapse is more common in young women, with a female-to-male
ratio of approximately 2:1 in the younger age groups. The prevalence is about 2-3% in the
general population, not 10%. It is typically detected in young to middle-aged adults, not
older adults. The gender disparity is most pronounced in younger individuals.
7. Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you
begin your examination, you know that it:
A. May present with only complaints of coldness or paresthesia of the extremity.
B. May present as the only disease.
C. Always occurs in the lower extremities.
D. Will result in an extremity that appears blue.
Correct Answer: A. May present with only complaints of coldness or paresthesia of the
extremity.
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myocardial infarction. Which would be the LAST step that you would consider?
A. Prompt admission to a monitored bed with cardiology consultation.
B. Administer aspirin immediately.
C. Obtain a 12-lead ECG within 10 minutes.
D. Obtain cardiac biomarkers.
E. Arrange for emergent cardiac catheterization.
Correct Answer: E. Arrange for emergent cardiac catheterization.
Rationale: Emergent cardiac catheterization is the definitive treatment for STEMI but is not
the immediate first step. The priority sequence is: 1) obtain 12-lead ECG within 10 minutes,
2) administer aspirin, 3) obtain cardiac biomarkers, 4) admit to monitored bed with
cardiology consultation. Cardiac catheterization is considered after initial stabilization and
ECG confirmation, not as the very first intervention.
2. Which of the following is a characteristic finding in right-sided heart failure?
A. Pulmonary edema.
B. Jugular venous distention.
SCHOLARSOURCE 1
,C. Orthopnea.
D. Paroxysmal nocturnal dyspnea.
Correct Answer: B. Jugular venous distention.
Rationale: Right-sided heart failure results in systemic venous congestion. Signs include
jugular venous distention, peripheral edema, hepatomegaly, and ascites. Pulmonary edema,
orthopnea, and paroxysmal nocturnal dyspnea are characteristic of left-sided heart failure
due to pulmonary congestion.
3. A patient with chronic stable angina is prescribed sublingual nitroglycerin. Which
instruction is correct?
A. Take one tablet daily in the morning.
B. Swallow the tablet with a full glass of water.
C. Take one tablet at the onset of chest pain and repeat every 5 minutes up to 3 doses.
D. Take one tablet 30 minutes before exercise to prevent angina.
Correct Answer: C. Take one tablet at the onset of chest pain and repeat every 5 minutes up
to 3 doses.
Rationale: Sublingual nitroglycerin should be taken at the first sign of angina. If pain
persists after 5 minutes, a second dose can be taken. If pain continues after a third dose at
5-minute intervals, the patient should seek emergency care. The tablet should be dissolved
under the tongue, not swallowed. Prophylactic use before exercise may be appropriate for
some patients but is not the standard acute instruction.
4. Sandra says she wants to know more about the Pooled Cohort Equation to determine her
10-year risk of ASCVD. You tell her that the variables include which of the following?
A. Total and HDL cholesterol levels.
SCHOLARSOURCE 2
,B. Systolic BP.
C. Diabetes.
D. Current smoking status.
E. All of the above.
Correct Answer: E. All of the above.
Rationale: The Pooled Cohort Equation (PCE) estimates 10-year risk for atherosclerotic
cardiovascular disease (ASCVD) in adults aged 40-79. The variables include age, sex, race,
total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension,
diabetes, and current smoking status. All options listed (A-D) are components of the
equation.
5. Martha, age 36, presents with a complaint of increasing shortness of breath and fatigue
over the past 6 months. She has been trying to lose weight, has been on a walking exercise
program for over a year, and had taken the fenfluramine-phentermine (Fen-Phen)
combination many years ago but stopped when its adverse effects were reported. Your
examination reveals a grade II/VI systolic murmur along the apex. What do you do?
A. Obtain pulmonary function tests.
B. Instruct the client about other exercise activities that may not produce her symptoms.
C. Refer the client to a cardiologist for an echocardiogram and cardiovascular work-up.
D. Start endocarditis prophylaxis.
Correct Answer: C. Refer the client to a cardiologist for an echocardiogram and
cardiovascular work-up.
Rationale: Martha's history of Fen-Phen use is significant because this combination was
associated with valvular heart disease, particularly mitral and aortic valve abnormalities.
Her symptoms (dyspnea, fatigue) and a systolic murmur at the apex raise concern for
mitral valve disease. An echocardiogram is essential to evaluate valve structure and
SCHOLARSOURCE 3
, function. Endocarditis prophylaxis is not indicated without a definitive valve lesion that
meets current guidelines. PFTs and exercise counseling would delay necessary cardiac
evaluation.
6. Which statement about mitral valve prolapse (MVP) is true?
A. MVP occurs in about 10% of the population.
B. MVP is usually detected in older adults.
C. The incidence is equal in men and women younger than age 20.
D. The incidence is more common in women younger than age 20.
Correct Answer: D. The incidence is more common in women younger than age 20.
Rationale: Mitral valve prolapse is more common in young women, with a female-to-male
ratio of approximately 2:1 in the younger age groups. The prevalence is about 2-3% in the
general population, not 10%. It is typically detected in young to middle-aged adults, not
older adults. The gender disparity is most pronounced in younger individuals.
7. Selma, age 76, has acute peripheral arterial occlusion of a lower extremity. Before you
begin your examination, you know that it:
A. May present with only complaints of coldness or paresthesia of the extremity.
B. May present as the only disease.
C. Always occurs in the lower extremities.
D. Will result in an extremity that appears blue.
Correct Answer: A. May present with only complaints of coldness or paresthesia of the
extremity.
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