APEA 3P EXAM PREP CARDIOVASCULAR THIS IS
A STUDY SET FOR THE APEA 3P EXAM THAT IS
REQUIRED TO BE TAKEN TO THE ‘P’ (COURSE OF
POST)QUESTIONS AND ANSWERS WITH
RATIONALES
University's MSN-FNP degree program).
, , , ,
,
Which,patient,could,be,expected,to,have,the,highest,systolic,blood,pressure?,
A,21-year-old,male,
A,50-year-
old,perimenopausal,female,A,35-year-
old,patient,with,Type,2,diabetes,A,75-year-
old,male,-,Answer,D.,
Nearly,25%,of,the,US,population,has,hypertension.,The,greatest,incidence,is,in,older,a
dults,because,of,changes,in,the,intima,of,vessels,as,aging,and,calcium,deposition,occu
r.,Males,of,any,age,are,more,likely,to,be,hypertensive,than,females,of,the,same,age.,Afr
ican,American,adults,have,the,highest,incidence,in,the,general,population.,Among,adol
escents,,African,Americans,and,Hispanics,have,the,highest,rates.,Hypertension,occurs
,in,5-10%,of,pregnancies.,
,
Mrs.,Brandy,is,having,contrast,dye,next,week,for,a,heart,catheterization.,What,drug,doe
s,NOT,need,to,be,stopped,prior,to,her,catheterization?,
Naproxen,
Furosemide,
Metformin,
Losartan,-,Answer,D.,
Naproxen,and,furosemide,should,be,stopped,for,24,hours,prior,to,the,catheterization.,M
etformin,should,be,stopped,48,hours,prior,to,the,catheterization.,Furosemide,is,stoppe
d,because,it,contributes,to,volume,depletion.,NSAIDs,like,naproxen,are,withheld,becau
se,of,the,impact,on,renal,prostaglandin,production.,Metformin,has,been,implicated,in,la
ctic,acidosis,when,combined,with,contrast,dye,in,an,impaired,kidney.,
,
In,older,adults,,the,three,most,common,ailments,are:,h
earing,loss,,vision,loss,,hypertension.,hearing,loss,,hy
,pertension,,arthritis.,,depression,,vision,loss,,hyperten
sion.,arthritis,,hearing,loss,,depression.,-,Answer,B.,
Hypertension,and,arthritis,are,the,two,most,common,ailments,in,older,adults.,Hearing,lo
ss,occurs,in,half,to,almost,2/3,of,older,adults.,The,most,common,form,is,known,as,presb
ycusis.,There,is,no,consensus,for,the,frequency,of,screening,for,hearing,loss,in,older,pa
tients,,but,minimally,,it,should,be,grossly,evaluated,at,each,visit,and,screened,more,tho
roughly,if,deficits,are,observed.,Blood,pressure,should,be,screened,annually,,but,it,is,u
sually,screened,at,each,visit.,Arthritis,is,not,routinely,screened.,
,
Mr.,Holbrook,,a,75-year-old,male,,is,a,former,smoker,with,a,30-pack-year,history.,He,
has,come,in,today,for,an,annual,exam.,He,walks,daily,for,25,minutes,,has,had ,
University's MSN-FNP degree program).
, , , ,
,
intentional,weight,loss,,and,has,a,near-
normal,BMI.,On,examination,,the,patient,is,noted,to,have,an,absence,of,hair,growth,on,
his,lower,legs.,Which,statement,is,true,regarding,this,patient?,
This,is,a,normal,consequence,of,aging.,
This,might,indicate,disease,in,the,lower,extremities.,
It,might,be,from,exercise,initiation.,
This,is,secondary,to,long-term,smoking.,-,Answer,B.,
An,absence,of,hair,growth,likely,indicates,peripheral,artery,disease,in,this,patient.,It,is,p
art,of,normal,changes,of,aging,that,hair,growth,will,diminish,,but,not,become,absent.,Hi
s,lower,extremity,pulses,should,be,assessed,,his,cardiac,risk,factors,should,be,assess
ed,(he,smoked,for,years),,and,he,should,be,questioned,about,leg,pain,when,he,walks.,
An,ankle-
brachial,index,could,be,measured.,If,<,0.9,,further,assessment,should,be,done.,A,norm
al,ankle-brachial,index,should,be,greater,than,0.9.,Less,than,0.4,is,considered,critical.,
,
The,usual,clinical,course,of,mitral,valve,prolapse:,is,benign.,,
results,in,sudden,cardiac,death.,results,in,chronic,heart,failu
re.,is,associated,with,multiple,episodes,of,emboli.,-
,Answer,A.,
The,usual,course,of,mitral,valve,prolapse,(MVP),is,benign,,and,most,patients,who,have,
MVP,are,asymptomatic.,A,murmur,may,be,present,and,is,best,auscultated,with,the,diap
hragm,of,the,stethoscope,over,the,cardiac,apex.,In,a,minority,of,patients,,symptoms,of,
heart,failure,or,sudden,death,may,occur.,When,heart,failure,results,,it,is,usually,a,result,
of,mitral,regurgitation.,Embolization,may,occur,,but,,this,is,not,common,or,usual,in,the,
majority,of,patients.,
,
An,ACE,inhibitor,is,specifically,indicated,in,patients,who,have:,h
ypertension,,diabetes,with,proteinuria,,and,heart,failure.,,diabet
,es,,hypertension,,hyperlipidemia.,asthma,,hypertension,,diabet
es.,renal,nephropathy,,heart,failure,,hyperlipidemia.,-
,Answer,A.,
ACE,inhibitors,have,numerous,indications.,Three,are,indicated,in,the,first,choice.,
ACE,inhibitors,are,also,indicated,in,patients,who,have,renal,insufficiency.,However,,AC
E,inhibitors,can,worsen,renal,insufficiency,,so,the,patients,must,be,monitored,closely,wi
th,lab,tests,for,BUN,,Cr,,and,potassium.,Diabetes,without,proteinuria,is,not,a,specific,in
dication,for,ACE,inhibitors,use,,though,they,are,used,by,some,healthcare,providers,in,t
his,way.,This,is,an,off-label,use.,
,
University's MSN-FNP degree program).
, , , ,
,
An,older,adult,who,has,hypertension,and,angina,takes,multiple,medications.,Which,one
,of,the,following,decreases,the,likelihood,of,his,having,angina?,
ACE,inhibitor,
Beta,blocker,,
Diuretic,
Angiotensin,receptor,blocker,-,Answer,B.,
The,beta,blocker,slows,down,heart,rate,,depresses,myocardial,contractility,,and,decrea
ses,sympathetic,stimulation.,These,decrease,myocardial,oxygen,demand,and,improve
,angina,symptoms.,It,is,an,excellent,drug,class,to,use,to,prevent,symptoms,of,angina,in,
patients,who,have,underlying,coronary,artery,disease.,Calcium,channel,blockers,are,a
nother,class,of,medications,that,could,be,used,to,improve,symptoms,of,angina.,
,
Orthostatic,hypotension,can,be,diagnosed,in,an,older,adult,if,the,systolic,blood,pr
essure,decreases:,more,than,20,points,anytime,after,rising.,more,than,20,points,
within,3,minutes,after,rising.,,more,than,20,points,within,1,minute,after,rising.,any,
degree,drop,if,the,patient,becomes,weak,or,dizzy.,-,Answer,B.,
Orthostatic,hypotension,,also,called,postural,hypotension,,is,diagnosed,in,older,adults,
when,the,systolic,blood,pressure,drops,20,mm,Hg,or,more,within,3,minutes,of,moving,t
o,a,more,upright,position.,Systolic,blood,pressure,can,be,expected,to,decrease,within,o
ne,minute,of,moving,to,an,upright,position.,Normally,,the,blood,pressure,returns,to,base
line,within,one,minute,of,a,position,change,and,orthostatic,hypotension,does,not,occur.,
It,is,always,abnormal,when,blood,pressure,decreases,beyond,one,minute,of,moving,to,
an,upright,position.,Orthostatic,hypotension,can,then,be,diagnosed.,Moving,to,an,uprig
ht,position,may,be,1),lying,to,sitting,or,2),sitting,to,standing.,Additionally,,if,the,systolic,bl
ood,pressure,does,not,meet,these,criteria,,but,the,diastolic,drops,by,10,mm,Hg,or,more,
with,a,position,change,,orthostatic,hypotension,can,be,diagnosed.,Patients,become,sy
mptomatic,when,this,occurs,and,often,report,lightheadedness,,weakness,,dizziness,,bl
urred,vision,,or,decreased,hearing.,
,
, Which,hypertensive,patient,is,most,likely,to,have,adverse,blood,pressure,effects,fr
om,excessive,sodium,consumption?,21-year-old,Asian,American,male,
35-year-old,menstruating,female,
55-year-old,post,menopausal,female,
70-year-old,African,American,male,-,Answer,D.,
University's MSN-FNP degree program).
, , , ,
,
Two,groups,of,patients,typically,experience,adverse,blood,pressure,effects,from,consu
mption,of,sodium,greater,than,2,000,mg,daily.,Those,patients,considered,to,be,most,so
dium-
sensitive,are,elderly,patients,and,African,American,patients.,Thus,,choice,d,is,the,best,
choice,listed.,
,
A,patient,who,takes,HCTZ,25,mg,daily,has,complaints,of,muscle,cramps.,He,pr
obably,has:,hypocalcemia.,hypomagnesemia.,hypokalemia.,,hypercalcemia.,-
,Answer,C.,
HCTZ,is,a,thiazide,diuretic,that,is,potassium-
wasting.,Patients,can,become,hypokalemic,and,experience,side,effects,of,this.,A,com
mon,one,is,muscle,cramps.,
,
A,25-year-
old,patient,has,aortic,stenosis,(AS).,The,etiology,of,his,AS,is,probably:,congenital.,,r
heumatic.,acquired,calcific.,unknown.,-,Answer,A.,
In,someone,younger,than,65,years,,the,most,likely,cause,is,congenital.,The,aortic,valve
,usually,consists,of,three,cusps,,but,some,people,are,born,with,a,bicuspid,aortic,valve.,
Rheumatic,heart,disease,is,the,second,most,common,cause,of,aortic,stenosis,in,this,ag
e,group,,but,the,incidence,has,decreased,drastically,in,the,last,many,decades,because,
of,the,use,of,antibiotics,to,treat,Streptococcal,infections.,In,more,than,90%,of,patients,ol
der,than,65,years,,acquired,calcifications,appear,on,a,normal,aortic,valve,and,produce,
aortic,stenosis.,
,
A,75-year-
old,patient,with,longstanding,hypertension,takes,an,ACE,inhibitor,and,a,thiazide,diureti
c,daily.,He,has,developed,dyspnea,on,exertion,and,peripheral,edema,over,the,past,se
veral,days.,This,probably,indicates:,worsening,hypertension.,development,of,heart,fail
ure,(HF).,,noncompliance,with,medication.,acute,myocardial,infarction.,-,Answer,B.,
The,symptoms,of,dyspnea,on,exertion,and,peripheral,edema,are,symptoms,of,HF.,Lon
g,standing,hypertension,is,a,risk,factor,for,HF.,Acute,myocardial,infarction,would,result,i
n,acute,symptoms,,not,development,of,symptoms,over,the,past,several,days.,Noncom
pliance,with,medication,and,fluid,or,sodium,excess,might,result,in,peripheral,edema,an
d,development,of,heart,failure.,
A STUDY SET FOR THE APEA 3P EXAM THAT IS
REQUIRED TO BE TAKEN TO THE ‘P’ (COURSE OF
POST)QUESTIONS AND ANSWERS WITH
RATIONALES
University's MSN-FNP degree program).
, , , ,
,
Which,patient,could,be,expected,to,have,the,highest,systolic,blood,pressure?,
A,21-year-old,male,
A,50-year-
old,perimenopausal,female,A,35-year-
old,patient,with,Type,2,diabetes,A,75-year-
old,male,-,Answer,D.,
Nearly,25%,of,the,US,population,has,hypertension.,The,greatest,incidence,is,in,older,a
dults,because,of,changes,in,the,intima,of,vessels,as,aging,and,calcium,deposition,occu
r.,Males,of,any,age,are,more,likely,to,be,hypertensive,than,females,of,the,same,age.,Afr
ican,American,adults,have,the,highest,incidence,in,the,general,population.,Among,adol
escents,,African,Americans,and,Hispanics,have,the,highest,rates.,Hypertension,occurs
,in,5-10%,of,pregnancies.,
,
Mrs.,Brandy,is,having,contrast,dye,next,week,for,a,heart,catheterization.,What,drug,doe
s,NOT,need,to,be,stopped,prior,to,her,catheterization?,
Naproxen,
Furosemide,
Metformin,
Losartan,-,Answer,D.,
Naproxen,and,furosemide,should,be,stopped,for,24,hours,prior,to,the,catheterization.,M
etformin,should,be,stopped,48,hours,prior,to,the,catheterization.,Furosemide,is,stoppe
d,because,it,contributes,to,volume,depletion.,NSAIDs,like,naproxen,are,withheld,becau
se,of,the,impact,on,renal,prostaglandin,production.,Metformin,has,been,implicated,in,la
ctic,acidosis,when,combined,with,contrast,dye,in,an,impaired,kidney.,
,
In,older,adults,,the,three,most,common,ailments,are:,h
earing,loss,,vision,loss,,hypertension.,hearing,loss,,hy
,pertension,,arthritis.,,depression,,vision,loss,,hyperten
sion.,arthritis,,hearing,loss,,depression.,-,Answer,B.,
Hypertension,and,arthritis,are,the,two,most,common,ailments,in,older,adults.,Hearing,lo
ss,occurs,in,half,to,almost,2/3,of,older,adults.,The,most,common,form,is,known,as,presb
ycusis.,There,is,no,consensus,for,the,frequency,of,screening,for,hearing,loss,in,older,pa
tients,,but,minimally,,it,should,be,grossly,evaluated,at,each,visit,and,screened,more,tho
roughly,if,deficits,are,observed.,Blood,pressure,should,be,screened,annually,,but,it,is,u
sually,screened,at,each,visit.,Arthritis,is,not,routinely,screened.,
,
Mr.,Holbrook,,a,75-year-old,male,,is,a,former,smoker,with,a,30-pack-year,history.,He,
has,come,in,today,for,an,annual,exam.,He,walks,daily,for,25,minutes,,has,had ,
University's MSN-FNP degree program).
, , , ,
,
intentional,weight,loss,,and,has,a,near-
normal,BMI.,On,examination,,the,patient,is,noted,to,have,an,absence,of,hair,growth,on,
his,lower,legs.,Which,statement,is,true,regarding,this,patient?,
This,is,a,normal,consequence,of,aging.,
This,might,indicate,disease,in,the,lower,extremities.,
It,might,be,from,exercise,initiation.,
This,is,secondary,to,long-term,smoking.,-,Answer,B.,
An,absence,of,hair,growth,likely,indicates,peripheral,artery,disease,in,this,patient.,It,is,p
art,of,normal,changes,of,aging,that,hair,growth,will,diminish,,but,not,become,absent.,Hi
s,lower,extremity,pulses,should,be,assessed,,his,cardiac,risk,factors,should,be,assess
ed,(he,smoked,for,years),,and,he,should,be,questioned,about,leg,pain,when,he,walks.,
An,ankle-
brachial,index,could,be,measured.,If,<,0.9,,further,assessment,should,be,done.,A,norm
al,ankle-brachial,index,should,be,greater,than,0.9.,Less,than,0.4,is,considered,critical.,
,
The,usual,clinical,course,of,mitral,valve,prolapse:,is,benign.,,
results,in,sudden,cardiac,death.,results,in,chronic,heart,failu
re.,is,associated,with,multiple,episodes,of,emboli.,-
,Answer,A.,
The,usual,course,of,mitral,valve,prolapse,(MVP),is,benign,,and,most,patients,who,have,
MVP,are,asymptomatic.,A,murmur,may,be,present,and,is,best,auscultated,with,the,diap
hragm,of,the,stethoscope,over,the,cardiac,apex.,In,a,minority,of,patients,,symptoms,of,
heart,failure,or,sudden,death,may,occur.,When,heart,failure,results,,it,is,usually,a,result,
of,mitral,regurgitation.,Embolization,may,occur,,but,,this,is,not,common,or,usual,in,the,
majority,of,patients.,
,
An,ACE,inhibitor,is,specifically,indicated,in,patients,who,have:,h
ypertension,,diabetes,with,proteinuria,,and,heart,failure.,,diabet
,es,,hypertension,,hyperlipidemia.,asthma,,hypertension,,diabet
es.,renal,nephropathy,,heart,failure,,hyperlipidemia.,-
,Answer,A.,
ACE,inhibitors,have,numerous,indications.,Three,are,indicated,in,the,first,choice.,
ACE,inhibitors,are,also,indicated,in,patients,who,have,renal,insufficiency.,However,,AC
E,inhibitors,can,worsen,renal,insufficiency,,so,the,patients,must,be,monitored,closely,wi
th,lab,tests,for,BUN,,Cr,,and,potassium.,Diabetes,without,proteinuria,is,not,a,specific,in
dication,for,ACE,inhibitors,use,,though,they,are,used,by,some,healthcare,providers,in,t
his,way.,This,is,an,off-label,use.,
,
University's MSN-FNP degree program).
, , , ,
,
An,older,adult,who,has,hypertension,and,angina,takes,multiple,medications.,Which,one
,of,the,following,decreases,the,likelihood,of,his,having,angina?,
ACE,inhibitor,
Beta,blocker,,
Diuretic,
Angiotensin,receptor,blocker,-,Answer,B.,
The,beta,blocker,slows,down,heart,rate,,depresses,myocardial,contractility,,and,decrea
ses,sympathetic,stimulation.,These,decrease,myocardial,oxygen,demand,and,improve
,angina,symptoms.,It,is,an,excellent,drug,class,to,use,to,prevent,symptoms,of,angina,in,
patients,who,have,underlying,coronary,artery,disease.,Calcium,channel,blockers,are,a
nother,class,of,medications,that,could,be,used,to,improve,symptoms,of,angina.,
,
Orthostatic,hypotension,can,be,diagnosed,in,an,older,adult,if,the,systolic,blood,pr
essure,decreases:,more,than,20,points,anytime,after,rising.,more,than,20,points,
within,3,minutes,after,rising.,,more,than,20,points,within,1,minute,after,rising.,any,
degree,drop,if,the,patient,becomes,weak,or,dizzy.,-,Answer,B.,
Orthostatic,hypotension,,also,called,postural,hypotension,,is,diagnosed,in,older,adults,
when,the,systolic,blood,pressure,drops,20,mm,Hg,or,more,within,3,minutes,of,moving,t
o,a,more,upright,position.,Systolic,blood,pressure,can,be,expected,to,decrease,within,o
ne,minute,of,moving,to,an,upright,position.,Normally,,the,blood,pressure,returns,to,base
line,within,one,minute,of,a,position,change,and,orthostatic,hypotension,does,not,occur.,
It,is,always,abnormal,when,blood,pressure,decreases,beyond,one,minute,of,moving,to,
an,upright,position.,Orthostatic,hypotension,can,then,be,diagnosed.,Moving,to,an,uprig
ht,position,may,be,1),lying,to,sitting,or,2),sitting,to,standing.,Additionally,,if,the,systolic,bl
ood,pressure,does,not,meet,these,criteria,,but,the,diastolic,drops,by,10,mm,Hg,or,more,
with,a,position,change,,orthostatic,hypotension,can,be,diagnosed.,Patients,become,sy
mptomatic,when,this,occurs,and,often,report,lightheadedness,,weakness,,dizziness,,bl
urred,vision,,or,decreased,hearing.,
,
, Which,hypertensive,patient,is,most,likely,to,have,adverse,blood,pressure,effects,fr
om,excessive,sodium,consumption?,21-year-old,Asian,American,male,
35-year-old,menstruating,female,
55-year-old,post,menopausal,female,
70-year-old,African,American,male,-,Answer,D.,
University's MSN-FNP degree program).
, , , ,
,
Two,groups,of,patients,typically,experience,adverse,blood,pressure,effects,from,consu
mption,of,sodium,greater,than,2,000,mg,daily.,Those,patients,considered,to,be,most,so
dium-
sensitive,are,elderly,patients,and,African,American,patients.,Thus,,choice,d,is,the,best,
choice,listed.,
,
A,patient,who,takes,HCTZ,25,mg,daily,has,complaints,of,muscle,cramps.,He,pr
obably,has:,hypocalcemia.,hypomagnesemia.,hypokalemia.,,hypercalcemia.,-
,Answer,C.,
HCTZ,is,a,thiazide,diuretic,that,is,potassium-
wasting.,Patients,can,become,hypokalemic,and,experience,side,effects,of,this.,A,com
mon,one,is,muscle,cramps.,
,
A,25-year-
old,patient,has,aortic,stenosis,(AS).,The,etiology,of,his,AS,is,probably:,congenital.,,r
heumatic.,acquired,calcific.,unknown.,-,Answer,A.,
In,someone,younger,than,65,years,,the,most,likely,cause,is,congenital.,The,aortic,valve
,usually,consists,of,three,cusps,,but,some,people,are,born,with,a,bicuspid,aortic,valve.,
Rheumatic,heart,disease,is,the,second,most,common,cause,of,aortic,stenosis,in,this,ag
e,group,,but,the,incidence,has,decreased,drastically,in,the,last,many,decades,because,
of,the,use,of,antibiotics,to,treat,Streptococcal,infections.,In,more,than,90%,of,patients,ol
der,than,65,years,,acquired,calcifications,appear,on,a,normal,aortic,valve,and,produce,
aortic,stenosis.,
,
A,75-year-
old,patient,with,longstanding,hypertension,takes,an,ACE,inhibitor,and,a,thiazide,diureti
c,daily.,He,has,developed,dyspnea,on,exertion,and,peripheral,edema,over,the,past,se
veral,days.,This,probably,indicates:,worsening,hypertension.,development,of,heart,fail
ure,(HF).,,noncompliance,with,medication.,acute,myocardial,infarction.,-,Answer,B.,
The,symptoms,of,dyspnea,on,exertion,and,peripheral,edema,are,symptoms,of,HF.,Lon
g,standing,hypertension,is,a,risk,factor,for,HF.,Acute,myocardial,infarction,would,result,i
n,acute,symptoms,,not,development,of,symptoms,over,the,past,several,days.,Noncom
pliance,with,medication,and,fluid,or,sodium,excess,might,result,in,peripheral,edema,an
d,development,of,heart,failure.,
