NSG 6440 PRACTICE TEST MAJORITY

Which of the following antihypertensive medications would you avoid prescribing for an elderly white female with the comorbid diagnosis of osteoporosis? a. Beta blockers b. Calcium channel blockers c. Ace inhibitors d. Diuretics - correct answer Calcium channel blockers Which of the following class of drugs is preferred treatment for a diabetic with stage II hypertension? a. Calcium channel blockers b. Alpha blockers c. Angiotensin converting enzyme inhibitor d. Loop diuretics - correct answer Angiotensin converting enzyme inhibitor You are caring for a 30-year-old white male in your office with a BP of 144/90. He has never had a diagnosis of hypertension. He doesn't check his blood pressure at home. He has a family history of hypertension. What are your recommendations? a. Start HCTZ 12.5mg daily, purchase a blood pressure cuff, and return to your office in 1 mth b. Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks. c. Order EKG, CMP, CBC, and lipid panel, and refer to cardiology. d. Order a cardiac stress test and lipid panel. - correct answer Instruct to purchase a BP cuff, record blood pressures, call if over 140's over 90's, low salt diet, return in 2 weeks You are treating a young adult female with HTN and migraine headaches. Which class of medications could you choose to treat both? Ace inhibitors Calcium channel blockers Beta blockers Angiotensin receptor blockers - correct answer Beta blockers A 42-year-old male presents with the following lipid profile. He is not on any medications for cholesterol or herbal supplements. Total: 210 LDL: 145 TG 162 HDL 52 What medication would you recommend? a. Low dose statin b. Low dose bile acid sequestrant c. Low dose fibrate d. Fish oil - correct answer Low dose statin You are caring for a 68-year-old male who has been taking atorvastain (Lipitor) for 8 weeks. He complains of fatigue, muscle aches, and dark-colored urine. Which of the following is the most appropriate treatment plan? a. Order a CBC and CMP. b. Order lipid level and serum creatine phosphokinase (CPK, creatine kinase) c. Order a 24 hr urine d. Recommend increasing his fluids and rest. - correct answer Order lipid level and serum creatine phosphokinase (CPK, creatine kinase). What would you advise this patient regarding taking his atrovastatin (Lipitor)? Continuing taking the medication until the labs are available Take atorvastatin every other day until labs are available Take half of the atorvastatin every other day until labs are available Stop taking the atorvastatin until the labs are available - correct answer Stop taking atorvastatin until the labs are available. A 58 year old male presents to your office with an episode of chest tightness in his substernal area that radiated to his back while he was jogging. It was relieved with rest. Which of the following does this best describe? Acute myocardial infarction Gastroesophageal reflux disease Angina pectoris Acute costochondritis - correct answer Angina pectoris What is the most common cause of left ventricular hypertrophy in the United States? Mitral valve prolapse Chronic atrial fibrillation Pulmonary hypertension Chronic hypertension - correct answer Chronic hypertension Which of the following heart sounds is associated with heart failure? Still's murmer and S4 S3 S1, S2, and S4 S1, S2, and S3 - correct answer S3 While performing a routine physical exam on a 60-year-old hypertensive male, you notice a bruit over the carotid area on the left side of the neck. There is no induration of the skin. This patient is at higher risk for: Stroke and coronary heart disease Temporal arteritis and brain aneurysms Abdominal aneurysm and congestive heart gailure Dizziness and headaches - correct answer Stroke and coronary heart disease A 72-year-old female presents to your office with gradual difficulty breathing, non-productive cough, bilateral swelling of her feet, and a 10 pound weight gain. Upon examination you hear crackles and rhonchi with an S3 heart sound. What is the most likely diagnosis? COPD Renal hypertension Congestive heart hailure Asthma - correct answer Congestive heart failure What is your treatment plan for this patient with difficulty breathing, cough, weight gain, edema, and S3 heart sounds? Rest and increase fluids Diuretics, digoxin, and anti-hypertensive medications Nebulized albuterol and prednisone Anti-coagulation and cardiology evaluation - correct answer Diuretics, digoxin, and anti-hypertensive medications You are treating a 49-year-old female who presents with fatigue and palpitations. You check her apical pulse and she is irregular and tachycardic. You obtain an EKG and it reveals afib with rapid ventricular response. What is your treatment plan? You order a 2D echo. You admit her to the hospital for new onset afib. You perform cardiac massage and have her relax. You order a cardiology consult. - correct answer You admit her to the hospital for new onset afib. Upon examination of a 17-year-old during a sports physical, you hear a split S2 during inspiration that disappears during expiration. The patient denies chest pain and dyspnea. What will you tell the mother and patient regarding your findings? You advise the patient to avoid strenuous physical activity until further investigation You recommend a referral to cardiology. Due to the patient being an athlete, you recommend a stress echo Educate the mother and patient that this is a benign finding - correct answer Educate the mother and patient that this is a benign finding. The first sign of an asthma exacerbation is: Cough Wheeze Dyspnea Chest tightness - correct answer Cough According to the NAEPP-3 Guidelines for the Treatment and Management of Asthma, what is the gold standard for daily treatment of mild-persistent asthma? Inhaled steroids Long-acting bronchodliators Short-acting bronchodilators Combination therapies - correct answer Inhaled steroids You are treating an adult asthma patient and reviewing her metered dose inhaler (MDI) technique. She demonstrates her MDI technique by shaking the inhaler, placing the inhaler in her mouth, pressing the canister, and inhaling quickly. What is your response? You praise the patient for demonstrating the correct MDI technique You educate the patient taht, first, she should exhale fully, then shake the inhale, and finally, as she presses the canister, inhale slowly and fully You instruct the patient to take a faster, even inspiratory effort You educate the patient that she should always use a spacer or holding chamber with all MDI's - correct answer You educate the patient that, first, she should exhale fully, then shake the inhaler, and finally, as she presses the canister, inhale slowly and fully. An adult patient with a history of chronic obstructive lung disease (COPD) presents to your office with 1 day of worsening shortness of breath, wheezing, and non-productive cough. You determine he has a COPD exacerbation. What is your treatment plan? Chest x-ray Levaquin 500 mg QD for 7 days, Prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID 7 - 10 day prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID Z-pak, 7 - 10 day prednisone spurt, Atrovent inhaler 2 puffs QID - correct answer 7-10 days prednisone spurt, Albuterol/Atrovent inhaler 2 puffs QID All of the following are useful in treating patients with COPD except: Antihistamines Anticholinergics Oral steroids Short-acting beta2-agonists - correct answer Antihistamines Which of the following is less likely to be found in a patient with emphysema dominant COPD? A cough that is productive with large amounts of sputum Prolonged expiration Exertional dyspnea Weight loss - correct answer A cough that is productive with large amounts of purulent sputum You are treating a patient in your office whom you suspect has chronic lung disease, but you are unsure if you should start treatment today. What do you consider ordering first? A pulmonary consult A chest x-ray An office spirometry A pulmonary function test - correct answer An office spirometry You are treating an elderly patient who tells you he has a history of allergies. His concern today is he is coughing more at night for the past 6 weeks and wheezing intermittently. He has no history of heart failure, smoking, or other lung disease. Your physical examination is unremarkable. What are your differential diagnosis(es) for cough? Select all that apply. Asthma Sinusitis Postnasal drip GERD - correct answer Asthma Sinusitis Postnasal drip GERD A chronic cough lasts longer than: a. 3 weeks. b. 1 month c. 6 months. d. 1 year. - correct answer a. 3 weeks. You are doing a cerumen extraction and touch the external meatus of your patient's ear. He winces and starts coughing. What is the name of this reflex? a. Baker phenomenon b. Arnold reflex c. Cough reflex d. Tragus reflex - correct answer b. Arnold reflex Julie has a postnasal drip along with her cough. You assess her for: a. Asthma. . b. Sinusitis. c. Allergic or vasomotor rhinitis. d. Influenza. - correct answer c. Allergic or vasomotor rhinitis. Your patient with hypertension comes in and insists that one of his new medications is causing