CEA Week 1 Exam | NR 511 | Chamberlain University-Illinois | Questions with
100% Verified Answers | Latest Update
Question: The suggested International Normalized Ratio (INR) range in
a patient being treated for atrial fibrillation is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0
Answer:
2.0-3.0
Rationale Remember that for international normalized ratio, the patient is their own
normalization with an INR of 1.0 as the standard of untreated blood, so with an INR of 2.0,
think of the patient as twice as thin for their blood as their normal. Protime can also be used to
evaluate bleeding time for warfarin patients, but has in general been replaced many years ago
by the INR as the standard measurement, where PTT (partial thromboplastin time) or Anti-Xa
are more useful for evaluating bleeding times related to Heparin therapy.
Question: Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks Avoidance of cold Isometric exercise Ginkgo biloba
Answer:
Avoidance of cold
Rationale Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure
which causes the patient to have extremely pale/white vasoconstricted digits followed by a
over-dilated vasoplegic response causing purplish painful revascularization. Avoidance of cold
is the most effective non-pharmacologic way to mitigate this event from occurring.
Pharmacologic therapy would include the use of medications such as calcium channel
blockers.
,Question: At a follow up from a hospitalization, an adult patient
presents with ankle edema. Which of the following medications is the
most likely cause of the edema?
Metformin HCTZ Norvasc Nebivolol
Answer:
Norvasc
Rationale The most common side effects of calcium channel blockers include constipation and
lower extremity edema. The other options do not have any relationship specifically with
edema, in fact, hydrochlorothiazide specifically reduces edema via diuresis.
Question: An adult patient must maintain an International Normalized
Ratio (INR) between 2.0 and 3.0. The patient goes to a clinic for INR
determination, and the result is 1.4. Which of the following would likely
decrease the effects of warfarin (Coumadin)?
Red meat Grapefruit Red Wine Broccoli
Answer:
Broccoli
Rationale It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K
antagonist, and therefore it can be counteracted by a patient who is eating a dietary intake of
vitamin K. Leafy green vegetables such as broccoli and spinach are notorious for increasing
vitamin K levels, and therefore inhibiting the anticoagulation effect of warfarin. It's also
important to remember that with the direct oral anticoagulants category, vitamin K is not
affected, and therefore no dietary restrictions are required for this class of medications such as
apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above.
Also, with warfarin it is important to remember that the effects are based on the free drug, not
the protein bound drug level, so patients who have considerable protein stores will require
more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of
lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically
causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to
increase by thinning the blood and and red meat is not likely to have a considerable impact,
although it might have some impact if the protein stores are otherwise low prior to initiating
the red meat in the diet. Broccoli is the only option that has vitamin K and should be an
obvious choice for this question.
,Question: 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?
Congestive heart failure Pulmonary embolism Acute myocardial
infarction Chronic obstructive pulmonary disease
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.
Question: An older adult female presents for her annual examination.
She has been on antihypertensive medications for over 20 years, with
good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient's cardiac health risks, due her
to weight and her waist circumference. According to the AHA
guidelines, which of the following goals is expected for this patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week Physical activity
for 30 minutes daily, 7 days a week
Answer:
Physical activity for 30 minutes daily, for a minimum of 5 days a week
, Question: A 75-year-old patient has just been discharged to a nursing
facility following hospitalization for an exacerbation of chronic heart
failure. The patient's condition is classified as stage C, which involves
known structural heart disease with previous or present symptoms of
failure. If the patient is adherent to current clinical guidelines, the nurse
practitioner who is visiting can expect treatment to include which of the
following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg) Furosemide
(Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar)
Answer:
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully
improving ejection fraction in a patient with heart failure with reduced ejection fraction should
include carvedilol (Coreg) furosemide (Lasix) or another loop diuretic, and an ACE
inhibitor/ARB or ARB/ARNI such as sacubitril/valsartan (Entresto). Calcium channel blockers
are contraindicated and heart failure such as amlodipine (Norvasc).
Question: Your patient presents with bradycardia, severe nausea, and
substernal pain. STEMI was identified on the EKG. Which region of the
heart is most likely involved?
Lateral Wall Anterior Wall Inferior Wall Septal Wall
Answer:
Inferior Wall
Rationale The inferior wall, fed by the right coronary artery is commonly associated with these
symptoms. Remember right equals rate as it is the blood supply for the SA and AV nodes in
most patients. Dyspepsia is common in RCA territory injury due to vagal stimulation not
typical of other areas.
100% Verified Answers | Latest Update
Question: The suggested International Normalized Ratio (INR) range in
a patient being treated for atrial fibrillation is:
1.0-2.0
4.0-5.0
2.0-3.0
3.0-4.0
Answer:
2.0-3.0
Rationale Remember that for international normalized ratio, the patient is their own
normalization with an INR of 1.0 as the standard of untreated blood, so with an INR of 2.0,
think of the patient as twice as thin for their blood as their normal. Protime can also be used to
evaluate bleeding time for warfarin patients, but has in general been replaced many years ago
by the INR as the standard measurement, where PTT (partial thromboplastin time) or Anti-Xa
are more useful for evaluating bleeding times related to Heparin therapy.
Question: Nonpharmacologic therapy for Raynaud's disease include:
Use of hot soaks Avoidance of cold Isometric exercise Ginkgo biloba
Answer:
Avoidance of cold
Rationale Raynaud's disease is a peripheral vascular syndrome triggered by cold exposure
which causes the patient to have extremely pale/white vasoconstricted digits followed by a
over-dilated vasoplegic response causing purplish painful revascularization. Avoidance of cold
is the most effective non-pharmacologic way to mitigate this event from occurring.
Pharmacologic therapy would include the use of medications such as calcium channel
blockers.
,Question: At a follow up from a hospitalization, an adult patient
presents with ankle edema. Which of the following medications is the
most likely cause of the edema?
Metformin HCTZ Norvasc Nebivolol
Answer:
Norvasc
Rationale The most common side effects of calcium channel blockers include constipation and
lower extremity edema. The other options do not have any relationship specifically with
edema, in fact, hydrochlorothiazide specifically reduces edema via diuresis.
Question: An adult patient must maintain an International Normalized
Ratio (INR) between 2.0 and 3.0. The patient goes to a clinic for INR
determination, and the result is 1.4. Which of the following would likely
decrease the effects of warfarin (Coumadin)?
Red meat Grapefruit Red Wine Broccoli
Answer:
Broccoli
Rationale It's important to remember with warfarin (Coumadin) therapy that it is a vitamin K
antagonist, and therefore it can be counteracted by a patient who is eating a dietary intake of
vitamin K. Leafy green vegetables such as broccoli and spinach are notorious for increasing
vitamin K levels, and therefore inhibiting the anticoagulation effect of warfarin. It's also
important to remember that with the direct oral anticoagulants category, vitamin K is not
affected, and therefore no dietary restrictions are required for this class of medications such as
apixaban, rivaroxaban, and edoxaban, which is a distinct benefit over warfarin as noted above.
Also, with warfarin it is important to remember that the effects are based on the free drug, not
the protein bound drug level, so patients who have considerable protein stores will require
more warfarin than those who are emaciated or have low protein levels chronically.
With respect to this particular question, red wine and grapefruit do not have an effect of
lowering the INR, in fact, they will raise it by their unique mechanisms. Grapefruit specifically
causes warfarin levels to rise through the CYP 450 system, and red wine causes the INR to
increase by thinning the blood and and red meat is not likely to have a considerable impact,
although it might have some impact if the protein stores are otherwise low prior to initiating
the red meat in the diet. Broccoli is the only option that has vitamin K and should be an
obvious choice for this question.
,Question: 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?
Congestive heart failure Pulmonary embolism Acute myocardial
infarction Chronic obstructive pulmonary disease
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.
Question: An older adult female presents for her annual examination.
She has been on antihypertensive medications for over 20 years, with
good control. Laboratory values are within normal ranges. The nurse
practitioner is concerned about the patient's cardiac health risks, due her
to weight and her waist circumference. According to the AHA
guidelines, which of the following goals is expected for this patient?
Physical activity for 60 minutes daily, for a minimum of 6 days a week
Physical activity for 30 minutes daily, for a minimum of 5 days a week
Physical activity for 60 minutes daily, 7 days a week Physical activity
for 30 minutes daily, 7 days a week
Answer:
Physical activity for 30 minutes daily, for a minimum of 5 days a week
, Question: A 75-year-old patient has just been discharged to a nursing
facility following hospitalization for an exacerbation of chronic heart
failure. The patient's condition is classified as stage C, which involves
known structural heart disease with previous or present symptoms of
failure. If the patient is adherent to current clinical guidelines, the nurse
practitioner who is visiting can expect treatment to include which of the
following medications?
Hydrochlorothiazide (HCTZ), lisinopril (Zestril), amlodipine (Norvasc)
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg) Furosemide
(Lasix), prazosin (Minipress), propranolol (Inderal)
Hydrochlorothiazide (HCTZ), metoprolol (Lopressor), losartan (Cozaar)
Answer:
Furosemide (Lasix), lisinopril (Zestril), carvedilol (Coreg)
Rationale Goal directed therapy for reducing chronic symptoms of heart failure, and hopefully
improving ejection fraction in a patient with heart failure with reduced ejection fraction should
include carvedilol (Coreg) furosemide (Lasix) or another loop diuretic, and an ACE
inhibitor/ARB or ARB/ARNI such as sacubitril/valsartan (Entresto). Calcium channel blockers
are contraindicated and heart failure such as amlodipine (Norvasc).
Question: Your patient presents with bradycardia, severe nausea, and
substernal pain. STEMI was identified on the EKG. Which region of the
heart is most likely involved?
Lateral Wall Anterior Wall Inferior Wall Septal Wall
Answer:
Inferior Wall
Rationale The inferior wall, fed by the right coronary artery is commonly associated with these
symptoms. Remember right equals rate as it is the blood supply for the SA and AV nodes in
most patients. Dyspepsia is common in RCA territory injury due to vagal stimulation not
typical of other areas.
