NU553 Comprehensive Resource To Help You Ace Exams Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!!

NU553 Comprehensive Resource To Help You Ace Exams Includes Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS Guaranteed Pass First Attempt!! Current Update!! 1. Which hypertensive patient is most likely to have adverse blood pressure effects from excessive sodium consumption? a. 21-year-old Asian American male b. 35-year-old menstruating female c. 55-year-old post menopausal female d. 70-year-old African American male - Correct Answer: d. 70-year old African American male Rationale: Two groups of patients typically experience adverse blood pressure effects from consumption of sodium greater than 2,000 mg daily. Those patients considered to be most sodium sensitive are elderly patients and African American patients. 2. A patient with poorly controlled hypertension and history of myocardial infarction 6-years-ago presents today with mild shortness of breath. He takes quinapril, ASA, metoprolol, and a statin daily. What symptom in NOT indicative of a heart failure exacerbation? a. fatigue b. headache c. orthopnea d. cough - Correct Answer: b. headache Rationale: Fatigue is a common symptom in cardiac patients that can represent a worsening of many cardiac diseases such as coronary artery disease, heart failure, and valvular dysfunction. Orthopnea and cough, especially nocturnal, are classic symptoms of heart failure. 3. A patient with newly diagnosed heart failure has started fosinapril in the last few days. She has developed a cough. What clinical finding can help distinguish the etiology of the cough as heart failure? a. It is dry and non-productive. b. It is wet and worse with recumbence. c. It is purulent and tachycardia accompanies it. d. Shortness of breath always results after coughing. - Correct Answer: b. It is wet and worse with recumbence. Rationale: The cough associated with fosinapril (an ACE inhibitor), is dry, non productive and may be described as annoying. Its severity does not change with position or time of day. A cough associated with heart failure is wet, worse when lying down, and is usually described by patients as "worse at night". A cough that is purulent and when tachycardia accompanies it is often associated with fever and probably reflects an infectious process like pneumonia. 4. A patient with shortness of breath has suspected heart failure. What diagnostic test would best help determine this? a. Echocardiogram b. B type natriuretic peptide (BNP) c. EKG d. Chest x-ray - Correct Answer: b. B type natriuretic peptide (BNP) Rationale: BNP is a hormone involved in regulation of blood pressure and fluid volume. When the BNP level is 80 pg/mL or greater, the sensitivity and specificity is 98% and 92%, favoring a diagnosis of heart failure. Alternatively, BNP level less than 80 pg/mL strongly suggest that heart failure is not present (some U.S. institutions use 100 pg/mL). Other conditions may cause elevated BNP levels: thoracic and abdominal surgery, renal failure, and subarachnoid hemorrhage. Consequently, careful assessment of the patient is prudent. Echocardiograms mechanically evaluate the heart and establish an ejection fraction. If 35-40%, then CHF can usually be diagnosed. Ejection fractions do not always correlate with patient symptoms. EKG evaluates the electrical activity of the heart. Chest x-ray can indicate heart failure, but a BNP is a more sensitive measure. 5. Which class of medication id frequently used to improve long-term outcomes in patients with systolic dysfunction? a. Loop diuretics b. Calcium channel blockers c. ACE inhibitors d. Thiazide diuretics - Correct Answer: c. ACE inhibitors Rationale: ACE inhibitors are commonly used in patients with systolic dysfunction because they reduce morbidity and mortality, i.e. these medications alter prognosis. They also improve symptoms of fatigue, shortness of breath, and exercise intolerance. Loop and thiazide diuretics improve symptoms, but do not alter long-term prognosis with heart failure. Beta blockers should be used in conjunction with ACE inhibitors and diuretics, but not as solo agents. Beta blockers can potentially worsen heart failure, so their use in patients with heart failure should be monitored carefully. 6. Ramipril has been initiated at a low dose in a patient with heart failure. What is most important to monitor in about one week? a. Heart rate b. Blood pressure c. EKG d. Potassium level - Correct Answer: d. Potassium level Rationale: ACE inhibitors work in the kidney in the renin angiotensin aldosterone system and can impair renal excretion of potassium in patients with normal kidney function. In patients with impaired renal blood flow and/or function, the risk of hyperkalemia is increased. Common practice is to monitor potassium, BUN, and Cr at about one week after initiation of an ACE inhibitor and with each increase in dosage. 7. Which medication listed below could potentially exacerbate heart failure in a susceptible individual? a. Metoprolol b. Furosemide c. Metformin d. Acetaminophen - Correct Answer: a. Metoprolol Rationale: Metoprolol is a cardioselective beta blocker that decreases heart rate. A patient with heart failure wil compensate for heart failure by increasing heart rate to maintain cardiac output (CO). Metoprolol impairs the patient's ability to increase heart rate when needed to maintain cardiac output (CO=stroke volume x heart rate). Consequently, the use of beta blockers in patients with heart failure should be monitored carefully. Furosemide may actually improve shortness of breath in a patient with heart failure. Metformin and acetaminophen have no direct effect on cardiac output on a patient with heart failure. 8. A 75-year-old patient with longstanding hypertension takes a combination ACE inhibitor/thiazide diuretic and amlodipine daily. Today his diastolic blood pressure and heart rate are elevated. He has developed dyspnea on exertion and peripheral edema over the past several days. These symptoms demonstrate: a. primary renal dysfunction b. development of heart failure c. failure of HCTZ d. dietary indiscretions - Correct Answer: b. development of heart failure Rationale: The symptoms of increased heart rate in the presence of dyspnea on exertion and peripheral edema are symptoms of heart failure. Longstanding hypertension is a major risk factor for development of heart failure. Dietary indiscretion, like sodium/fluid excess may produce peripheral edema, but should not produce dyspnea and peripheral edema in the absence of heart failure. 9. A medication which may produce exercise intolerance in a patient with hypertension is a. hydrochlorothiazide b. amlodipine c. metoprolol d. fosinopril - Correct Answer: c. metoprolol Rationale: Metoprolol is a cardioselective beta blocker. It will produce bradycardia that is responsible for exercise intolerance. As a patient exercises, concomitant increase in heart rate allows for an increase in cardiac output. If the heart rate is not able to increase because of beta blocker influence, neither can the cardiac output. The patient will necessarily slow down his physical activity. Choices a and d have no direct effect on heart rate. Amlodipine is a calcium channel blocker that does not decrease heart rate. 12. A 40-year-old African American patient has a B/P readings of 175/100 and 170/102. What is the reasonable plan of care for this patient today? a. Start low dose thiazide diuretic b. Start an ACE inhibitor twice daily c. Initiate low dose HCTZ and candesartan d. Initiate amlodipine, beta blocker, or ACE inhibitor - Answer: c. Initiate low dose HCTZ and candesartan